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VET 413: Infectious Disease/Immunology > Nosocomial Infections > Flashcards

Nosocomial Infections Flashcards

1
Q

nosocomial infection

A

infection acquired inside the hospital environment

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2
Q

healthcare associated infection (HAI)

A

an infection acquired as a result of healthcare interventions

can be acquired within or outside of the hospital environment

ex. treating with immunosuppressants –> secondary infection

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3
Q

what are the most common HAIs

A
  • UTIs
  • aspiration pneumonia
  • infectious diarrhea
  • surgical site infections
  • URT infections
  • dermatophytes (ringworm)
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4
Q

what organisms are most common in HAI

A

viruses, bacteria (primary or opportunistic), fungi

commensal organisms most common

often causes biofilm formation

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5
Q

what are the main risk factors for HAIs

A
  1. weakened immune system
  2. implants and invasive devices
  3. anesthesia and sedation
  4. surgery
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6
Q

what are the two ways that an immune system can be weakened

A
  1. diseases that disrupt barrier function or target immune system components
  2. medications (immunosuppressants)
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7
Q

what species are implant associated infections most common in

A

dogs

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8
Q

what devices are most commonly associated with implant infections

A
  • IV catheters
  • urinary catheters
  • bone plates
  • surgical implants
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9
Q

IV catheter infection

A

causes LOCAL infection but can spread and cause septicemia
- local cellulitis
- abscess formation
- septic thrombophlebitis

organisms can form biofilm on catheter –> hematogenous dissemination

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10
Q

risk factors for IVC infection

A
  • administration of blood products or parenteral nutrition through IVC
  • duration of placement (>3 days)
  • # of attempts to place
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11
Q

urinary catheter infections

A

ascending catheter colonization leading to bacteriuria and biofilm formation

can cause subclinical or clinical bacteriuria
- does NOT commonly cause bacteremia

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12
Q

risk factors for urinary catheter infection

A
  • duration of catheterization
  • immunosuppression
  • antimicrobial usage (wipes out normal flora)
  • non-sterile placement
  • open vs closed catheters
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13
Q

do you culture/treat subclinical bacteriuria

A

no

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14
Q

do you culture/treat clinical bacteriuria

A

yes - remove catheter and culture urine collected by cystocentesis

do NOT collect from bag or catheter tip

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15
Q

diagnosing IV or urinary catheter infections

A

IVC: blood culture
UC: urine culture

monitor patients for new fever development and local inflammation

do NOT culture catheter tips or urine from UC bag - too many bacteria will grow

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16
Q

how to prevent IVC infections

A
  • standard precaution: hand washing, gloves
  • shave and prep
  • monitor site and fever
  • replace every 72 HOURS
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17
Q

how to prevent urinary catheter infections

A
  • minimize use and duration
  • use sterile technique while placing
  • maintain closed system
  • keep bag in dependent position (below patient)
  • e-collar
  • UC care q8-12
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18
Q

should you administer prophylactic antimicrobials when placing a U catheter

A

NO - can increase chance of developing UTI by wiping out normal flora

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19
Q

is anesthesia/sedation related infections more common in dogs or cats

A

dogs - at risk for aspiration pneumonia associated with anesthesia/sedation

20
Q

nosocomial penumonia

A

hospital acquired or ventilator acquired pneumonia that occurs in a patient hospitalized for at least 48 hours +/- on a ventilator

often occurs after sedation, anesthesia, intubation, vomiting, or impaired swallowing

21
Q

what are risk factors in dogs for HAP

A

laryngeal paralysis
brachycephalic breeds

22
Q

clinical signs of HAP

A

new fever
cough
tachypnea
leukocytosis
leukopenia

23
Q

how to diagnose HAP

A

3 view thoracic radiographs
- lung consolidation normally only visualized on one side

can do airway lavage

24
Q

HAP prevention

A
  • fasting before sedation/anesthesia
  • careful ET tube placement
  • avoid excessive sedation
  • suction
  • upright positioning
25
Q

what are the main causes of surgery associated infections

A

surgical incisions OR surgical implants

26
Q

what is the most common pathogen associated with surgical infections

A

staphylococcus (MRSP)

signs an be delayed months to years

27
Q

surgical risk factors for surgery infections

A
  • tissue trauma during incision
  • long surgical time
  • improper prep
  • failure to use infection control protocol
  • improper sterilization of instruments
28
Q

animal risk factors for surgical infections

A
  • pre-existing skin conditions (pyoderma)
  • decreased proteins
  • immunocompromised
29
Q

how to diagnose surgical infection

A

blood culture

30
Q

how to treat surgical infections

A
  • removal of surgical implant
  • antimicrobials
31
Q

what are the 8 HAI risk mitigation strategies

A
  1. establish hospital infection control program
  2. proper surgical prep
  3. improve general animal handling
  4. obey contact precautions
  5. patient monitoring
  6. proper urinary catheter placement
  7. improve antibiotic use
  8. proper hand hygiene
32
Q

infection control protocols

A

decreasing risk of HAI by establishing SOPs for animals from arrival to departure from hospital
- general handling precautions
- isolation and contact procedures
- antimicrobial use guidelines
- proper cleaning procedures

established and maintained by infection control committees and antimicrobial stewardship programs

33
Q

sterilization

A

complete elimination of ALL microbes using pressurized steam, dry heat, etc

autoclave is gold standard

34
Q

germicides

A

elimination of MANY microbes on inanimate and animate surfaces

includes disinfectants and antiseptics

35
Q

disinfectants

A

germicide use on inanimate objects

  • glutaraldehyde & OPA: specialized equipment w/ long contact time
  • accelerated H2O2: 5 min contact time
  • trifectants: works on non-enveloped viruses
  • bleach: effective for parvovirus
  • QUATs: low level disinfectants; many bacteria are resistant
36
Q

antiseptics

A

germicide used on animate objects (skin)

  • alcohol: works on enveloped viruses and bacteria w/ rapid activity
  • betadine: requires frequent reapplication
  • chlorhexidine: persistent activity on skin; preferred antiseptic for surgery and catheter placement
37
Q

what is germicide activity affected by

A

contact time
presence of organic material (ex. feces)

38
Q

safe animal handling procedures

A
  • removing patients w/ contagious disease away from general population
  • use proper cage disinfection
  • limit outside items being brought into hospital
  • minimize unnecessary contact
39
Q

effect of antibiotic use on developing HAI

A

some may increase risk of infection by clearing the natural microbiome

40
Q

patient monitoring

A
  • temperature, respiratory signs
  • IVC care
  • positioning
  • mentation
  • incision sites
41
Q

urinary catheter guidelines

A
  • use sterile technique
  • use only CLOSED systems
  • keep collection bag below patient (dependent position)
  • catheter care q8-12
  • NO prophylactic antibiotics
42
Q

surgical prep guidelines

A
  • clip hair
  • clean with chlorhex scrub then solution
  • use sterile drapes
  • proper OR attire
  • cleaning protocols
  • sterile surgical instruments
  • ALWAYS use prophylactic antibiotics
43
Q

surgical antibiotic usage

A

IV cefazolin

pre-op: 30 min before
peri-op: every 90-120 minutes to maintain concentration above MIC throughout surgery
post-op: discontinue

44
Q

when should contact precautions be used

A
  • patients with known transmissible infections (esp. MDR)
  • patients that are at high risk of contracting HAI
45
Q

proper hand washing technique

A

15 second scrub time with either:
- soap and water
- alcohol

VET 413: Infectious Disease/Immunology (38 decks)

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