Section 3 IDS

Question 1

HEALTH CARE–ACquIRED ConDITIonS noT ELIgIBLE foR ADDITIonAL fEDERAL PAyMEnT

Answer 1

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

Question 2

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

Answer 2

cross-infection

Question 3

Mode of transmission by (e.g., aspiration of oropharyngeal flora into the lungs along an endo- tracheal tube).

Answer 3

autoinoculation

Question 4

account for ~30–40% of nosocomial infections; up to 3% of bacteriuric patients develop bacteremia.

Answer 4

UTI

Question 5

Most nosocomial UTIs are associated with preced- ing instrumentation or indwelling bladder catheters, which create a ___% risk of infection each day.

Answer 5

3–7%

Question 6

Prevention of Urinary Tract Infections

Answer 6

1. Place bladder catheters only when absolutely needed (e.g., to relieve obstruction), not solely for the provider’s convenience.
2. Use aseptic technique for catheter insertion and urinary tract instrumentation.
3. Minimize manipulation or opening of drainage systems.

Question 7

Catheter maintenance bundle:

Answer 7

Cleanse patients daily with chlorhexidine.
Maintain clean, dry dressings.
Enforce hand hygiene among health care workers.

Question 8

Prevention of Ventilator-Associated Events

Answer 8

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).

Question 9

Prevention of Surgical-Site Infections

Answer 9

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)

Question 10

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

Answer 10

Candida

Question 11

pneumonia has accounted for ~____ of nosocomial infections; ventilator-associated pneumonia (VAP) occurred in 1 to >4 patients per 1000 ventilator-day

Answer 11

10–15%

Question 12

Most cases of bacterial nosocomial pneumonia are caused by

Answer 12

aspiration of endogenous or hospital-acquired oropha- ryngeal (and occasionally gastric) flora

Question 13

~ of patients using mechanical ventilators develop VAEs.

Answer 13

5–10%

Question 14

early-onset nosocomial pneumonia, which manifests within the first 4 days of hospitalization, is most often caused by community-acquired pathogens such as

Answer 14

Streptococcus pneu- moniae and Haemophilus species,

Question 15

Late-onset pneumonias most commonly are due to

Answer 15

S. aureus, P. aeruginosa, Enterobacter species, Klebsiella pneumoniae, or Acinetobacter.

Question 16

Infection is polymicrobial in as many as

Answer 16

20–40% of cases.

Question 17

Wound infections occur in ~500,000 patients each year, account for ~of nosocomial infections,

Answer 17

15–20%

Question 18

average wound infection has an incubation period of ___ longer than many postoperative stays.

Answer 18

5–7 days—

Question 19

most common pathogens in postoperative wound infections are

Answer 19

S. aureus, coagulase-negative staphylococci, and enteric and anaerobic bacteria

Question 20

In rapidly progressing postoperative infections manifesting within 24–48 h of a surgical procedure, the level of suspicion regarding____ should be high

Answer 20

group A streptococcal or clostridial infection

Question 21

Intravascular device–related bacteremias cause ~____ of nosocomial infections;

__________ account for most of these bloodstream infections.

Answer 21

10–15%

central vascular catheters (CVCs)

Question 22

is the most common cause of epidemic device-related bloodstream infection;

Answer 22

Intrinsic (during the manufacturing process) or extrinsic (on-site in a health care facility) contamination of infusate, although rare,

Question 23

most common pathogens isolated from vascular device–associated bacteremias include

Answer 23

coagulase-negative staphylococci, S. aureus (with ≥50% of isolates in the United States resistant to methicillin), entero- cocci, nosocomial gram-negative bacilli, and Candida.

Question 24

a target for future inter- ventions, help bacterial cells communicate during biofilm development

Answer 24

Quorum-sensing” proteins,

Question 25

(the only vaccine-preventable childhood disease that is on the rise again in the United States

Answer 25

pertussis

Question 26

differentiate an outbreak due to a single strain from a polyclonal outbreak (which requires an emphasis on antibiotic prudence

Answer 26

Molecular typing

Question 27

, a drug that is consequently being “rediscovered,” or to no available agents.

Answer 27

colistin

Question 28

an increasing prevalence of MRSA strains that exhibit upper-limit susceptibility to vancomycin.

Answer 28

MIC creep

Question 29

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?

Answer 29

Amoxicillin