Nosocomial infections

Question 1

What’s our top 5 ddx for nosocomial UTI?

Answer 1

1. E. coli
2. Enterococcus
3. Pseudomonas
4. Klebsiella pneumoniae
5. Candida albicans

Question 2

___________is normal with someone with a catheter; do not treat this, esp if there is no pyuria.

Answer 2

Bacteriuria

Question 3

Whats our top 5 ddx for nosocomial lower respiratory tract infections?

Answer 3

1. S. aureus
2. Pseudomonas aeruginosa
3. Enterobacter
4. Klebsiella pneumoniae
5. H. influenzae

Question 4

Whats our top 5 ddx for nosocmial blood stream infections?

Answer 4

1. Coagulase (-) staph
2. S. aureus
3. Enterococcus
4. Klebsiella pneumoniae
5. E. coli

Question 5

The most common organism causing nosocomial urinary tract infections:

1. Staphylococcus saprophyticus
2. Escherichia coli
3. Candida albicans
4. Streptococcus pyogenes

Answer 5

2. Escherichia coli

Question 6

Nosocomial pneumonias are most likely related to:

1. Septic pulmonary emboli from an indwelling venous catheter.
2. Following influenza illness
3. Mechanical ventilation
4. Use of nasal oxygen by cannula

Answer 6

3. Mechanical ventilation

Question 7

Which of the following types of vascular catheters is associated with the highest risk of nosocomial bloodstream infection?

1. Quinton hemodialysis catheter
2. Peripheral intravenous catheter
3. Radial arterial catheter
4. Tunneled central venous catheter

Answer 7

1. Quinton hemodialysis catheter

Question 8

Gloves should be worn by healthcare workers in which situations:

1. When examining all patients.
2. In lieu of handwashing to save time between patient encounters.
3. When examining patients with cancer.
4. When examining patients with Clostridium difficile colitis.
5. All of the above.

Answer 8

4. When examining patients with Clostridium difficile colitis.

Question 9

You have removed the central IV catheter from a febrile patient in the intensive care unit. A semi-quantitative culture of the catheter tip is performed. What is the minimum cutoff for a significant number of colonies on the plate?

1. > 10³
2. > 10⁵
3. > 15
4. Any

Answer 9

3. > 15

Question 10

The worst offenders in terms of handwashing practices are:

1. Respiratory therapists
2. Registered nurses
3. Physicians
4. Phlebotomists
5. Licensed practical nurses

Answer 10

3. Physicians

Question 11

You suspect that there is an outbreak of bloodstream infections in the medical intensive care unit due to Stenotrophomonas maltophilia because of a sharp spike in the number of cases. The most appropriate way to investigate the cause is:

1. Culture the hands of all intensive care unit personnel.
2. Culture the sinks and counters in the intensive care unit.
3. Culture all intravenous infusates.
4. Perform a case control study.

Answer 11

4. Perform a case control study.

Question 12

Which of the following contribute to the occurrence of nosocomial lower respiratory tract infections?

1. Mechanical ventilation
2. Abdominal surgery
3. Use of proton pump inhibitors
4. Suctioning of respiratory secretions
5. All of the above

Answer 12

5. All of the above

(abd surgery b/c hurts to cough. teach pt to clutch pillow & cough)

Question 13

Which of the following organisms is least likely to cause a nosocomial lower respiratory tract infection?

1. Pseudomonas aeruginosa
2. Methicillin-resistant Staphylococcus aureus
3. Candida albicans
4. Klebsiella pneumoniae

Answer 13

3. Candida albicans

Question 14

Which is(are) the appropriate procedure(s) when examining a patient with documented Clostridium difficile infection?

1. Donning a gown.
2. Wearing a mask.
3. Wearing disposable gloves and washing hands with soap & water afterwards.
4. Wearing disposable gloves and washing hands with an alcohol handwashing product afterwards.
5. 1 & 3

Answer 14

5. 1 & 3

Question 15

A patient was resuscitated in the ER and had placement of a subclavian IV catheter during the code. He then went to the MICU & retained the catheter for 8 days. On day 7 he developed a fever; blood cultures grew MRSA. The family wants to know how he became infected. You tell them:

1. He was likely brewing the infection before he came to the hospital.
2. Everybody gets this if they are in the MICU long enough.
3. The catheter was the likely source. An unfortunate oversight was made and he should have had his catheter replaced when he arrived in the MICU.
4. It is his fault for using IV drugs.

Answer 15

3. The catheter was the likely source. An unfortunate oversight was made and he should have had his catheter replaced when he arrived in the MICU.

Question 16

When you insert a central venous line in the Surgical Intensive Care Unit, you should:

1. Clean the skin with chlorhexidine.
2. Wear a mask
3. Wear a gown
4. Use the femoral vein preferentially.
5. 1, 2, & 3

Answer 16

5. 1, 2, & 3