Nosocomial Infections Flashcards
What is the classical definition of nosocomial?
Hospital acquired infections
What is the current definition of nosocomial?
HAI: Healthcare associated infections
From the patient’s body
Endogenous
Sources external to the patient like personnel, equipment, visitors, and hospital environment?
Exogenous
What does the CDC define an HAI as?
A localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s)
Who is credited with instituting the first standards of infection control by suggesting that physicians wash their hands before delivering babies which resulted in decreased infection and mortality?
Ignaz Semmelweis (1847)
What were women dying from during childbirth?
Strep pyogenes (Childbed fever/Puerperal fever) -Went from autopsies directly to L&D
Who used carbolic acid to chemically sterilize surgical equipment and bandages?
Joseph Lister
According to the CDC, in the US annually:
- # Nosocomial Infections
- Leads to # deaths
- # deaths per day
- Cost
- 1.7 million
- 99,000 deaths
- 270
- 30 billion dollars (approximately)
What are the 13 categories of HAI developed by the CDC?
- Urinary tract infection
- Surgical site infection
- Bloodstream infection
- Pneumonia
- Bone and joint infection
- Central nervous system infection
- Cardiovascular system infection
- Eye, ear, nose, throat or mouth infection
- Gastrointestinal system infection
- Lower resp. tract infection other than pneumonia
- Reproductive tract infection
- Skin and soft tissue infection
- Systemic infection
What is the most common HAI at 32%?
UTI
What are UTIs associated with and what is the recommendation?
- Use of a catheter
- Shorten duration of use
What 3 HAI cause the most serious illness and death?
- Surgical site infections (SSI) - 22%
- Pneumonia - 15%
- Bloodstream infections (bacteremia) - 14%
The highest infections rates are in what patients?
Intensive Care Unit
What are some common bugs causing nosocomial infections?
- E. Coli
- S. Aureus
- Streptococcus
- Pseudomonas
- Klebsiella
- Enterobacter
- Candida
- S. Epidermidis
- Bacteroides
- Serratia
What are the 3 most common gram + microbes seen in nosocomial infections?
- S. Aureus
- Coagulase - Staph (CoNS/S. Epidermidis)
- Enterococci sp.
What are the 4 most common gram - microbes seen in nosocomial infections?
- E. Coli
- Pseudomonas aeruginosa
- Enterobacter
- Klebsiella
- Gram + Anaerobe
- Spore Former
- Toxin Producer
Clostridium Difficile
What % of the population are asymptomatic carriers of C. Difficile?
3%
Nosocomial infections caused by Clostridium Difficile are increasing in (2)?
- Incidence
2. Severity
What patients are at most risk from a Clostridium Difficile infection?
- Hospitalized patients on antibiotics
2. Older than 65
What has to happen for C. Difficile to grow uncontrollably?
Antibiotics have to kill off normal flora
What can C. Difficile result in?
Diarrhea and Pseudomembranous colitis
What is the estimated annual cost of C. Difficile?
3.2 billion dollars
What 2 things are essential in the care of any patient with CDI?
- Good hygiene with soap and water
2. Contact isolation
True or False: Hand sanitizers are sporicidal for C. Difficile
FALSE… wash your nasty hands with soap and water
What fungus is a major nosocomial pathogen?
Candida Albicans
Other candida species are becoming and increasing problem
What are the 3 factors involved in nosocomial infections?
- Antimicrobial use in hospitals and long term care facilities
- Failure of basic infection control
- Patients are immunocompromised
Why are nosocomial infections particularly difficult to treat?
Increasing antimicrobial resistance
-Microbes in health care settings are constantly coming into contact with disinfectants, antiseptics, and antimicrobials
What are 3 examples of agents causing nosocomial infections that have developed resistance?
- Vancomycin Resistant Enterococcus (VRE)
- Methicillin Resistant Staphylococcus Aureus (MRSA)
- Multi-drug Resistant Pseudomonas Aeruginosa
What are recommendations to improve infection control?
- Better surveillance and reporting
- Improving design of invasive devices (like infection resistant catheters)
- Antibiotic control programs
- Requiring vaccinations of all health care workers
- Implementing hand hygiene program (developed by CDC)
What is the most common mode of transmission of pathogens?
Via Hands
Infections acquired in healthcare and spread of antimicrobial resistance
What is performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis?
Hand Hygiene
What is washing hands with plain soap and water?
Handwashing
What is washing hands with water and soap or other detergents containing an antiseptic agent?
Antiseptic handwash
What is rubbing hands with an alcohol-containing preparation?
Alcohol-base handrub
What is handwashing or using and alcohol-based handrub before operations by surgical personnel?
Surgical hand hygiene/Antisepsis
When should you alcohol-rub or wash?
Before and after every contact
What 2 categories of patients are vulnerable to infection?
- Immunocompromised
2. Immunosuppressed
What can compromise the initial defense barriers providing potential pathogens an entryway in patients who are immunocompromised or immunosuppressed
Placing a urinary catheter or an IV catheter
Who compiles monthly reports of nosocomial infections from over 3,000 participating US hospitals into 4 categories including patient safety, healthcare personnel safety, biovigilance, and research and development?
The National Healthcare Safety Network (NHSN) established in 2005
(Maintained by CDC)
What was the National Healthcare Safety Network previously known as?
The National Nosocomial Infection Surveillance System (NNIS)
Does PA have mandatory HAI reporting using NHSN?
Yes
Who publishes guidelines for the prevention of healthcare associated infections?
The CDC
What are 3 examples of health care associated
“conditions that could reasonably have been prevented” that Medicare no longer pays for as of October 1, 2008?
- Bedsores and pressure ulcers
- Vascular catheter associated infections
- Catheter associated UTIs
*The cost of treating the above preventable conditions cannot be passed onto the patient
Within what act was $50 million authorized to support states in the prevention and reduction of healthcare associated infections (HAI) through
- Surveillance and prevention of HAIs
- Encourage collaboration
- Train the workforce in HAI prevention
- Measure outcomes
The American Recovery and Reinvestment Act of 2009, which was signed into law on February 17, 2009
