Hospital Acquired Infections & Antibiotic Basics - EXAM 2 Flashcards
1
Q
What are 6 possible sources of HAI?
A
- central line associated sepsis
- urinary catheter associated
- SSI
- HAP
- VAP
- Cdiff
2
Q
What are 8 risk factors for developing HAI?
A
- immunocompromised
- infection control practices
- prevalence of community pathogens
- older age
- longer hospital stays
- critical care unit stays
- multiple chronic illnesses
- mech. vent support
3
Q
What are 3 possible transmission sources?
A
- direct contact w/ healthcare worker
- contaminated environment
- extraluminal migration
4
Q
What are symptoms that suggest a pre-existing infection?
A
- fever, chills, night sweats
- AMS
- productive cough, SOB
- rebound tenderness
- suprapubic pain
- dysuria
- CVA tenderness
5
Q
V/S changes suggestive of infection
A
- HoTN, tachy
- tachypnea, low sats
6
Q
What lab values suggest organ dysfunction?
A
- increased lactic acid
- increased PT
- increased BUN/creat
- elevated WBC
- hypo/hyperglcyemia
- cultures
7
Q
When do SSIs typically occur?
A
- within 30 days
8
Q
Types of SSI
Superficial incisional:
A
- isolated to area of incision
- erythema
- easiest to treat
9
Q
Types of SSI
Deep incisional:
A
- beneath the incision area
- area in muscle & tissue surrounding muscle
- pus/elevated WBCs
10
Q
Types of SSI
Organ or space:
A
- area other than skin/muscle
- includes organs or space b/w organs
- difficult to treat - more powerful Abx & longer course
11
Q
Signs of SSI
A
- erythema
- pain
- warmth
- delayed healing
- fever
- drainage of pus
- swelling
12
Q
What are the 3 most common bacteria that lead to SSI?
A
- Staphylococcus
- Streptococcus
- Pseudomonas
13
Q
Risk of SSI
What is a clean wound?
A
- not inflamed/contaminated
- does not involve organ
14
Q
Risk of SSI
What is a clean-contaminated wound
A
- no evidence of infection
- does involve an internal organ
15
Q
Risk of SSI
What is a contaminated wound?
A
- involves internal organ w/ spillage of contents
- ex: ruptured gallbladder/bowel
16
Q
Risk of SSI
What is a dirty wound?
A
- a wound w/ a known infection prior to surgery
- ex: MVA, trauma, stabbing
17
Q
Risk of SSI
What effect does surgery length have on risk?
A
- > 2 hrs = more risk
18
Q
Risk of SSI
What comorbidities can lead to increased risk?
A
- cancer, smoking, DM, overweight, immunocompromised
19
Q
Risk of SSI
Why are elderly @ increased risk?
A
- malnourished
- multi-organ issues
20
Q
Grading Categories for Prevention of SSI
Grade 1A:
A
- strongly recommend
- mod-high quality evidence
- ex: IV Abx
21
Q
Grading Categories for Prevention of SSI
Grade 1B:
A
- strongly recommend
- low quality of evidence
22
Q
Grading Categories for Prevention of SSI
Grade 1C:
A
- strong recommendation required by state/federal regulation
23
Q
Grading Categories for Prevention of SSI
Grade II:
A
- weak recommendation
24
Q
Guideline for prevention of SSI
Parenteral Abx
IB:
A
- admin when indicated (SCIP - pre-op IV)
- timed so Abx is established in tissue upon incision (usually w/i 30min)
25
# Guideline for the Prevention of SSI
**non-parenteral Abx**
IB recommendation:
* should not apply Abx ointment to incisions
* *provider discretion*
26
# Guidelines for the Prevention of SSI
**Glycemic control**
1A recommendation:
* intra-op and post-op BG < 200mg/dL
27
# Guidelines for the Prevention of SSI
**Normothermia**
1A recommendation:
* maintain normothermia peri-op helps reduce SSI
28
# Guidelines for the Prevention of SSI
**Antiseptic prophylaxis**
1A:
1B:
II:
* 1A: use of alcohol-based antiseptic intraop
* 1B: shower/bathe w/ soap or antiseptic pm before
* II: iodine irrigation in deep tissues intra-op
29
# Guidelines for the Prevention of SSI
**Blood Transfusion**
1B:
* don't hold necessary transfusion from a surgical pt to try to prevent infection
30
# Guidelines for the Prevention of SSI
**Immunosuppresives: Decadron**
joint arthroplasty -
**provider preference**
* may lead to infection
31
What is the main goal of **antibiotic prophylaxis?**
* adequate bactericidal concentration in serum and tissues by incision
* **w/i 30min (ancef 15min)**
32
# Abx prophylaxis
What is MIC?
Minimum inhibitory concentration
*what needs to be in the tissues prior to incision & maintained throughout surgery*
33
# Abx prophylaxis
What are the 5 general principles of Abx prophylaxis?
1. should work against common surgical wound pathogens (strep, staph)
2. proven efficacy in clinical trials
3. must achieve MIC in serum & tissues
4. shortest possible course effective
5. newer Abx reserved for resistant infections
34
# Abx prophylaxis
When should Abx be administered?
* within at least 1hr of incision - **30min better**
* completely infused before tourniquet goes up
* may hold for cultures
35
# Abx Prophylaxis
What Abx can be given w/i 2 hrs of incision?
* Vancomycin
* Fluoroquinolones
* Clindamycin - not used as much b/c colitis & GI bleed
36
# Abx Prophylaxis
What do we do if the surgeon refuses Abx or they are on scheduled Abx?
* document
* Scheduled should be given in time frame - or they will need prophylaxis
37
# Abx prophylaxis
When should Abx be re-dosed?
1. 2 half-lives
2. excess bleeding
3. after cardiopulmonary bypass
4. drug dependent (2-4hrs)
