Unit 1 Exam - week 1 Flashcards
Healthcare-Associated Infections
aka Nosocomial (hospital specific)
definition and examples of what they are not
Resulting from healthcare delivery while receiving treatment for another
condition
Following are not HAIs:
* Infection present on admission
* Transplacental infection (i.e. herpes)
* Reactivation of latent infection (i.e. shingles)
Exogenous infection
from environment or personnel
UIT’s are most common
Endogenous Infection
from immunosuppressed patient
C. diff, MRSA
Rate of HAI’s
1 in 20 patients
Who covers cost of HAI
Insurance
How to determine if it is an HAI
if infection presents on or after 3rd hospital day
Common HAI’s
CAUTI
Catheter-associated Urinary
Tract Infection
Common HAI’s
SSI
surgical site infection
Common HAI’s
VAP
Ventilator-associated pneumonia
Common HAI’s
CLABSI
Central Line-associated
Bloodstream Infection
Common HAI’s
C. diff
Clostridium difficile disease
Common HAI MDRO’s
examples (5)
M V P E T “my vicious pet”
- MRSA (Methicillin-resistant Staphylococcus aureus)
- VRE (Vancomycin-resistant Enterococci)
- PRSP (penicillin-resistant S. pneumoniae)
- ESBLs (extended spectrum beta-lactamase)
- (MDR) TB (Multidrug-resistant TB disease)
MRSA
methicillin resistant staphylococcus aureus
What is the purpose of the NPSGs
National patient safety goals
- Initiatives include strategies for healthcare providers to prevent infection in inpatient and community-based settings
- goals focus on improving hand cleaning and using proven guidelines to prevent infections that are difficult to treat
- reduce HAIs
Who reviews the NPSGs?
The Joint Commission (jay co)
they audit hospitals to ensure compliance
What are the 6 links in the chain of infection?
IRPTPS “I rapped party songs”
- infectious agent
- reservoir
- portal of exit
- transmission
- Portal of entry
- susceptible host
*all six links Must be present for the infection to be transmitted from one individual to another
what is an infectious agent?
- Pathogens microorganisms that are capable of causing disease
-
Normal flora that become pathogenic
(ex: E. coli is native to the gut, but becomes pathogenic if it enters the body elsewhere)
Normal Flora
- Normal flora limit the growth of harmful bacteria by competing with them for available nutrients
- normal flora may become pathogenic when a patient is especially vulnerable to disease or if they enter regions of the Body they do not normally inhabit ex: E. coli
what is a reservoir?
living and non-iving
- A reservoir is a source of infection
- a place where pathogens survive and multiply
Living organisms
- most pathogens flourish in a warm moist dark environment
- the human body is the most common reservoir for pathogens
nonliving reservoirs
- include soil, water, food, and environmental surfaces
what is a portal of exit?
- the most frequent portal of exit is through bodily fluids
- coughs, sneezes, vomit, diarrhea
- wounds, bites, abrasions
- tubes, IV lines
what is a direct contact mode of transmission?
- involves physical contact: kissing, sexual intercourse
- contact with wound drainage
- can involve scratching and biting
what is are indirect contact modes of transmission?
Fomites
droplet transmission
airborne transmission
vector
what is a fomite
a contaminated object that transfers a pathogen
what is droplet transmission
mode of transmission, direct and indirect contact
- pathogens that do not remain infectious over long distances
-water droplets are expelled as an infected person exhales, sneezes, or talks
- or during suctioning and Oral Care
- Droplets can be inhaled or enter the eye of a susceptible person
- direct contact portal of entry: respiratory or mucous membrane contact
- indirect contact like touching a bedside table that was contaminated with droplets and then rubbing your eyes
- discontinue droplet precautions according to pathogens specific recommendations
what is airborne transmission?
- when microorganisms float considerable distance on air currents to infect large numbers of people
- stirred up by: air conditioning, sweeping, changing beds
what is a portal of entry?
- normal body openings such as the eye, nostrils, mouth, urethra, vagina, and anus
- abnormal openings such as wounds, surgical sites, IV or drainage tube sites
- Vectors create portals of Entry when they bite through the skin
what is a vector?
- an organism that carries a pathogen to a susceptible host
- mosquitoes are common Vector for diseases as well as ticks fleas mites and some animals
what is a susceptible host?
definition and examples
- Person with inadequate defense
- examples of susceptibility: age, compromised immune system, immune deficiency conditions
Four determining factors of susceptibility
VSND “V Sand”
- Virulence of pathogen
- Organism’s ability to survive in the host’s environment
- Number of organisms
- Host’s defense
Incubation stage
- From time of infection until manifestation of symptoms
- can infect others
5 stages of infection
IPIDC “I pretend in da club”
- incubation
- prodromal
- Illness
- Decline
- Convalescence
Prodromal Phase
- Appearance of vague symptoms
- not all diseases have this stage
Illness Stage
Signs and symptoms present
Decline Stage
Number of pathogens decline
Convalescence Stage
- Tissue repair
- return to health
Primary Infection
The first infection that occurs in a patient
ex: the flu
Secondary Infection
- one that follows a primary infection especially in immunocompromised patients
ex: Following the flu, patients are susceptible to pneumonia.
Local Infection
Occurs in a limited region in the body
(e.g., urinary tract infection)
systemic infection
- Spread via blood or lymph
- Affects many regions (e.g., septicemia)
Acute Infection
Rapid onset of short duration
(e.g., common cold)
Chronic Infection
Slow development, long duration
(e.g., osteomyelitis)
Latent Infection
Infection present with no discernible
symptoms (e.g., HIV/AIDS)
A patient with AIDS develops oral hairy
leukoplakia, an infection caused by the
Epstein-Barr virus. The leukoplakia is
considered a…
secondary infection
AIDs is primary infection that makes the pt immunocompromised
How to educate re: antibiotics
5 points
- don’t take for viruses
- do not self initiate
- avoid taking if infection is probably low
- take full course as ordered
- notify provider if not responding
standard precautions indication and purpose
tier, rationale, purpose
Indication
- - The first tier of protection
- - assume that every patient is potentially colonized or infected with an organism that could be passed on to others
- - based on a risk assessment and make use of common sense practices and PPE use
Purpose
- - prevent pathogen transfer between HCW and pt’s
- - Prevent contact with
– body fluids/secretions/excretions (sweat
excluded)
– non-intact skin, mucous membranes
transmission based precautions indication
tier, when
- the second tier of protection for patients with known or suspected infection
- used with standard precautions
- Use transmission based precautions when the roots of transmission are not completely interrupted using standard precautions alone
how does indirect contact transmission occur?
- Indirect contact transmission occurs when there is no direct human-to-human contact
- Contact occurs from a reservoir to contaminated surfaces or objects, or to vectors such as mosquitoes, flies, mites, fleas, ticks, rodents or dogs
implementation of standard precautions
7 points
actions, equipment, education
- hand hygiene
- Gloves as indicated
- PPE as indicated
- Manage sharps, linen, equipment
- Private room if patient likely to contaminate
environment - Cleaning/disinfection procedures
- coughing etiquette for patients
CDC’s two-tier system of isolation precautions
1. protective isolation
2. transmission based isolation
protective isolation
who, HCW, equipment
- Prevent infection in immune-compromised patient, high susceptibility to infection
- “reverse isolation” protecting them from us
- HCW’s caring for patients in protective isolation should not also be providing care for other patients with active infections
- meticulous hand hygeine
- be sure that equipment has been disinfected before it’s taken into the room
- take Linens and dishes directly to the protective isolation room and hand them to someone wearing the required protective clothing
protective isolation
room and visitors
- Private room
- Meticulous hand hygiene
- Visitors restricted
- No plants/flowers/standing water
- Avoid fresh fruit, raw milk products, raw honey,
processed meats, mold foods (e.g., blue cheese) - reduce mold possibility
transmission based isolation
procedures mitigating the spread
- disinfect the equipment on removal from the room
- when removing Linens or non-disposable items from a room with contact, droplet, or Airborne isolation, place them in special isolation bags
indication for contact precautions
how spread, examples
- for organisms spread by direct contact with the patient or their environment
- this is the most common form of transmission
- Use when the patient’s environment can lead to spread of the pathogen
ex:
* MDRO
* C. diif, scabies…
* Excessive drainage, incontinence
what is used for contact precatutions
PPE equipment
- gloves and gown always
- face PPE if indicated
Contact precautions
equipment/supplies mgmt, procedures
- Use dedicated or disposable equipment.
- otheriwse, clean and disinfect reusable equipment before use on another person.
- Keep contact precaution supplies just outside the patient’s room on a cart
- double bag all linen and trash and clearly mark as contaminated
- ensure that the patient room is clean and disinfected at least daily
PPE contact precautions rules
step-by-step
Before Entering
- hand hygeine
- Don gloves and gown
Before Exiting
- Doff gloves and gown
Hand hygeine upon exit
- Do not wear the same gown and gloves for the care of more than one person.
contact precaution immplementation
room, spread mitigation, visitors
- Private room or cohort (2+ pt’s with same disease)
- Transport patient for essential purposes only
- change gown/linens before moving
- ensure that infected areas of the body are contained and covered
- visitors gown/glove per facility policy
PPE Rules for Droplet Precations
step-by-step
Before entering
- Hand hygeine
- Face PPE: Make sure their eyes, nose and mouth are fully covered
- surgical mask within 3’ of the pt
Before Exit
- Remove face protection
Hand hygeine upon exit
- change PPE and perform hand hygiene between contact with patients in the same room, regardless of whether one or both patients are on droplet precautions
Droplet Precautions PPE
Supplies and circumstances
eye/nose/mouth covering only
hand hygeine
- more PPE in peds b/c they do not manage their droplets as well.
- keep supplies just outside the patient’s room on a cart
Patients on droplet precautions
education, room, procedures
- instruct patients to cough or sneeze in an elbow or cover nose and mouth with tissue
- private room preferred.
- if no private room is available ensure that the patients are physically separated by more than 3 ft and keep the Privacy curtain closed
- limit transport outside the room to medically necessary purposes if transport is necessary the patient should wear a mask
Patients with airborne precautions
room and transport procedures
- place the patient in an Airborne infection isolation room AIIR with negative pressure that discharges and exchanges the air outside or through a high efficiency particulate air filtration system HEPA
- neg press hold pathogens in, high press outside room is sucked in when door opens.
- if such a room is not available transfer the patient to a facility where one is available
- keep the room door closed
- limit tansporting the patient outside the room to medically necessary purposes
- if transport is necessary cover any infectious skin lesions and have the patient wear a mask notify the receiving department to take airborne precautions
indication for airborne precautions
indication, examples, HCW’s
- for pathogens that are very small and remain infectious over long distances when suspended in the air and are easily transmitted through air currents
ex: pulmonary tuberculosis, smallpox, active varicella, rubeola
- if the hospitalized patient has or is suspected of having rubeola, varicella, measles, chickenpox, disseminated zoster, or smallpox, only immunized caregivers should provide care
PPE for Airborne Precautions
supplies/environment
- private AIIR room
-
N95 respirator mask fit testing required
students don’t do airborne precautions - keep Airborne isolation supplies just outside the patient’s room on a cart
PPE For Airborne Precautions
step-by-step
Before Entering
- hang hygeine
- Put on a fit-tested N-95 or higher level respirator
After Exiting
* close door
* remove respirator
* hand hygeine
- Door to room must remain closed.
Donning PPE Sequence
1. GOWN
* Fully cover torso from neck to knees, arms
to end of wrists, and wrap around the back
* Fasten in back of neck and waist
2. MASK OR RESPIRATOR
* Secure ties or elastic bands at middle
of head and neck
* Fit flexible band to nose bridge
* Fit snug to face and below chin
* Fit-check respirator
3. GOGGLES OR FACE SHIELD
* Place over face and eyes and adjust to fit
4. GLOVES
* Extend to cover wrist of isolation gown
Safe Practices to prevent contamination
4 points
- Keep hands away from face
- Limit surfaces touched
- Change gloves when torn or heavily contaminated
- Perform hand hygiene
Doff PPE Sequence
1. GOWN AND GLOVES
* Gown front and sleeves and the outside of gloves are contaminated!
-
Grasp the gown in the front and pull away from your body so that the ties break, touching outside of gown only with gloved
hands - While removing the gown, fold or roll the gown inside-out into a bundle
- As you are removing the gown, peel off your gloves at the same time, only touching the inside of the gloves and gown with your bare hands. Place the gown and gloves into a waste container
2. GOGGLES OR FACE SHIELD
* Outside of goggles or face shield are contaminated!
- Remove goggles or face shield from the back by lifting head band and without touching the front of the goggles or face shield
- If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container
3. MASK OR RESPIRATOR
* Front of mask/respirator is contaminated — DO NOT TOUCH!
- Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front
- Discard in a waste container
4. HAND HYGEINE IMMEDIATELY AFTER REMOVING ALL PPE
PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS BECOME CONTAMINATED
How to mitigate adverse psychological impact of isolation
6 points plus strategy
- Spend time in room: don’t linger in doorway
- Sit with patient
- Educate & answer questions
- Encourage objects of comfort
- Encourage activities: don’t have to lie in bed all day
- Observe for mood changes ex: depression
* cluster care: bring all supplies in at one time
MDRO’s
multi drug resistant organisms
significance, spread, definition
- Antibiotic resistance is one of the most significant challenges in treating patients with severe infectious diseases
- MDRO’s are microbes that have mutated to develop resistance to one or more classes of antimicrobial drugs associated with serious illness increased hospitalization and higher death rates
- transmission is one person to another via the hands of HCW’s/visitors, bed linens, bed rails, medical equipment, personal items, and other contaminated inanimate objects.
Recognizing and Preventing Epidemics
- Quickly recognize unusual disease patterns
- am I seeing an unexpected number of infectious diseases
- seeing similar cases that are not responding to Medical treatment?
- are HCW’s who come into contact with infectious patients becoming ill?
- after identifying a suspicious pattern you should notify the institutions interventionist or safety officer as soon as possible
- in the event of an epidemic the essential principles of hand hygiene and standard precautions will be the core of your infection prevention and control measures
