Section 3 IDS Flashcards
HEALTH CARE–ACquIRED ConDITIonS noT ELIgIBLE foR ADDITIonAL fEDERAL PAyMEnT
Foreign objects retained after surgery
Air embolism
Blood incompatibilities
Decubitus ulcers (stages III and IV)
Fractures/other injuries from falls or trauma
Catheter-associated urinary tract infections
Vascular catheter–associated infections
Manifestations of poor glycemic control
Surgical-site infection or mediastinitis following coronary artery bypass graft Surgical-site infection following certain orthopedic procedures
Surgical-site infection following bariatric surgery for obesity Surgical-site infection following cardiac electronic device implantation Venous thromboembolism (after hip or knee replacement)
Iatrogenic pneumothorax with venous catheterization
mode of transmission usually is either by an indirect spread of pathogens from one patient to another on the inadequately cleaned hands of hospital personnel
cross-infection
Mode of transmission by (e.g., aspiration of oropharyngeal flora into the lungs along an endo- tracheal tube).
autoinoculation
account for ~30–40% of nosocomial infections; up to 3% of bacteriuric patients develop bacteremia.
UTI
Most nosocomial UTIs are associated with preced- ing instrumentation or indwelling bladder catheters, which create a ___% risk of infection each day.
3–7%
Prevention of Urinary Tract Infections
- Place bladder catheters only when absolutely needed (e.g., to relieve obstruction), not solely for the provider’s convenience.
- Use aseptic technique for catheter insertion and urinary tract instrumentation.
- Minimize manipulation or opening of drainage systems.
Catheter maintenance bundle:
Cleanse patients daily with chlorhexidine.
Maintain clean, dry dressings.
Enforce hand hygiene among health care workers.
Prevention of Ventilator-Associated Events
Elevate head of bed to 30–45 degrees.
Decontaminate oropharynx regularly with chlorhexidine (controversial).
Give “sedation vacation” and assess readiness to extubate daily.
Use peptic ulcer disease prophylaxis.
Use deep-vein thrombosis prophylaxis (unless contraindicated).
Prevention of Surgical-Site Infections
Choose a surgeon wisely.
Administer prophylactic antibiotics within 1 h before surgery; discontinue within 24 h.
Limit any hair removal to the time of surgery; use clippers or do not remove hair at all.
Prepare surgical site with chlorhexidine-alcohol.
Maintain normal perioperative glucose levels (cardiac surgery patients)
Maintain perioperative normothermia (colorectal surgery patients)
is now the most common pathogen in nosocomial UTIs among patients on intensive care units (ICUs), treatment is often unsuccessful and is recommended only when there is upper-pole or bladder-wall invasion, obstruction, neutropenia, or immunosuppression
Candida
pneumonia has accounted for ~____ of nosocomial infections; ventilator-associated pneumonia (VAP) occurred in 1 to >4 patients per 1000 ventilator-day
10–15%
Most cases of bacterial nosocomial pneumonia are caused by
aspiration of endogenous or hospital-acquired oropha- ryngeal (and occasionally gastric) flora
~ of patients using mechanical ventilators develop VAEs.
5–10%
early-onset nosocomial pneumonia, which manifests within the first 4 days of hospitalization, is most often caused by community-acquired pathogens such as
Streptococcus pneu- moniae and Haemophilus species,
Late-onset pneumonias most commonly are due to
S. aureus, P. aeruginosa, Enterobacter species, Klebsiella pneumoniae, or Acinetobacter.
Infection is polymicrobial in as many as
20–40% of cases.
Wound infections occur in ~500,000 patients each year, account for ~of nosocomial infections,
15–20%
average wound infection has an incubation period of ___ longer than many postoperative stays.
5–7 days—
most common pathogens in postoperative wound infections are
S. aureus, coagulase-negative staphylococci, and enteric and anaerobic bacteria
In rapidly progressing postoperative infections manifesting within 24–48 h of a surgical procedure, the level of suspicion regarding____ should be high
group A streptococcal or clostridial infection
Intravascular device–related bacteremias cause ~____ of nosocomial infections;
__________ account for most of these bloodstream infections.
10–15%
central vascular catheters (CVCs)
is the most common cause of epidemic device-related bloodstream infection;
Intrinsic (during the manufacturing process) or extrinsic (on-site in a health care facility) contamination of infusate, although rare,
most common pathogens isolated from vascular device–associated bacteremias include
coagulase-negative staphylococci, S. aureus (with ≥50% of isolates in the United States resistant to methicillin), entero- cocci, nosocomial gram-negative bacilli, and Candida.
a target for future inter- ventions, help bacterial cells communicate during biofilm development
Quorum-sensing” proteins,
(the only vaccine-preventable childhood disease that is on the rise again in the United States
pertussis
differentiate an outbreak due to a single strain from a polyclonal outbreak (which requires an emphasis on antibiotic prudence
Molecular typing
, a drug that is consequently being “rediscovered,” or to no available agents.
colistin
an increasing prevalence of MRSA strains that exhibit upper-limit susceptibility to vancomycin.
MIC creep
Based on the Philippine Clinical Practice Guidelines on Community Acquired Pneumonia in Immunocompetent Adults 2016 Updates, what is the drug of choice for low risk pneumonia without comorbid illness?
Amoxicillin
