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41 Cards in this Set
- Front
- Back
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nosocomial infxs
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-infx arising >72 hrs after hospital admission
-prolongs hospital stay on avg by 5-10 days -UTI most common type! -PNA (15%) -Surgical wound infx (22%) -bloodstream infx (14%) |
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sources of hospital infxs
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1. endogenous source: 80%
-may occur by translocation of resident micro flora secondary to a breach in host defense 2. Exogenous source: -may result from transmission from patient to patient or from healthcare worker to patient -may occur after exposure of a susceptible patient to a contaminated environmental source |
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Risk factors
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1. neonates/elderly pts
2. severity of underlying disease 3. prolonged duration of hospitalization 4. inappropriate use of abx 5. invasive devices and procedures 6. failure of healthcare workers to wash their hands |
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Fever: hospitalized pts
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1. PNA
2. catheter related infx 3. surgical wound infx 4. UTI 5. drugs 6. pulmonary emboli 7. infected pressure sore |
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signs of infx in hospitalized pts
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1. fever
2. change in mental status 3. tachypnea 4. hypotension 5. oligouria 6. leukocytosis |
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new fever basic w/u
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1. CBC with diff
2. CXR 3. blood and urine cx 4. xray of abdomen if needed 5. gram stain and cx: sputum/urine 6. stool for C.diff toxin 7. stool or body fluid analysis if needed |
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nosocomial PNA
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-nonsocomial PNA that occurs >48 hrs after hospital admission but not incubating at the time of admission
-6-20 fold inc for pts receiving mechanical ventilation -2nd most common nosocomial infx -highest mortality and morbidity -prolongs avg duration of hospital stay on avg of 7-9 days |
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risk factors for nosocomial PNA- Enodgenous
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1. >70
2. cardiopul dz 3. depressed level of consciousness 4. DM 5. severity of underlying dz 6. alcoholism 7. malnutrition 8. presence of comorbid illness |
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risk factors for nosocomial PNA- exogenous
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1. infx control related
2. abd or thoracic surgery 3. immobility 4. conditions favoring aspiration 5. use of abx |
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risk factors for nosocomial PNA- intervention related
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1. Those procedures and therapies that undermine normal host defenses or allow the host to be exposed to large inocula of bacteria
2. sedation/narcotics: aspiration 3. steroids/cytotoxic agents: blunt nml response to infx 4. use of H2 blockers or antacid for stress ulcers |
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risk factors for nosocomial PNA- the use of ventilatory support
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1. the greatest risk factor for development of nosocomial PNA
2. Compromises the natural barrier between the oropharynx and the trachea impairing natural defenses such as coughing and mucocilliary action 3. endotracheal tube can become coated with bacteria |
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nosocomial PNA- patho
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-oropharyngeal and gastric colonization
-oropharynx can become colonized by many species of gram-neg organisms within 48 hrs of hospitalization -aspiration: occurs during sleep, and is increased by altered consciousness, decreased gag reflex |
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PNA ssx
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1. new cough
2. fever 3. leukocytosis 4. sputum production 5. new infiltrate on CXR |
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PNA causes
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-60% caused by gram neg bacilli
1. Enterobacteriacea 2. Psudomonas 3. Late onset: enteric gram neg bacilli 4. staph aureua |
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CDC def of nosocomial PNA
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-infection no present or incubating on admission
-def: New lung infiltrate, consolidation, cavitations or pleural effusion on CXR and one of the following: 1. change occurs in character of sputum 2. etc. slide 24 2. |
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nosocomial PNA prevention
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1. wash hands
2. Routinely assess patients for changes in lung sounds, sputum color or production, and redness or drainage around stoma sites 3. provide freq suctioning and resp therapy 4. proper mechanical ventilation 5. weaning pt from ventilators ASAP 6. avoid excess sedation 7. avoid use of broad-spectrum or high dose abx therapy 8. assess patency of NG tube 9. elevated head of bed >30 degrees |
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Bacteremia
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-primary bloodstream infx
-caused by intravascular devices -these devices bypass skin defenses -most common point of entry for infx related to IVD is the insertion site! |
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factors related to risk of IV cath related infx
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1. failure to wash hands
2. duration of catheterization (>72hrs) 3. lower extremity (groin) >upper extremity 4. cut down >percutaneous insertion 5. emergency >elective insertion 6. break down in skin integrity 7. triple lumen >single lumen 8. contamination of lumen from frequent disconnection |
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line-related bactermia: predominant pathogens
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1. S aureus
2. S. epidermidis 3. enterococcus |
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nosocomial etiologies in bloodstream infxs
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Nosocomial etiologies in bloodstream infections:
Coagulase-negative staphylococci - 40% Enterococci - 11.2% Fungi - 9.65% Staphylococcus aureus - 9.3% Enterobacter species - 6.2% Pseudomonads - 4.9% |
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if pt has fever and signs of infx at insertion site..
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1. blood cx
2. remove vascular access line 3. submit catheter tip for quantitative cx -In general, when a line is removed because of possible infection, the site should be changed |
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bactermia dx
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-cultures from two separate venipuncture sites must be obtained
-when obtaining bl cxs: 1. use proper antisepsis 2. cx blood, not the skin or catheter hub 3. use proper methods or obtain and process all cultures |
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bactermia prevention
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1. standardize insertion tech and care for all peripheral, central venous and arterial catheters
2. select catheters with as few lumens as possible for the pt needs 3. avoid use of femoral catheters in pts with fecal or urinary incontinence 4. use aseptic technique to insert catheters 5. Stabilize cannula and tubing, and maintain a sterile occlusive dressing at the site of insertion 6. label insertion sites with date and time of insertion -slide 43 |
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UTI
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-most common nosocomial infx
-Catheterization and instrumentation of the urinary tract are implicated as precipitating factors in approximately 80% of the cases -Rate of infection in a patient with an indwelling catheter doubles from 50% at two weeks to 100% if the catheter remains in place for more than 4 weeks |
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risk factors for nosocomial UTI
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1. female
2. prolonged urinary catheterization 3. lack of systemic abx therapy 4. breach of appropriate catheter care |
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nosocomial UTI patho
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-In women: periurethral colonization of fecal flora and tracking of organisms up the catheter to bladder
- In men: by contrast, periurethral colonization often cannot be demonstrated and most infections seem to arise from intraluminal spread of organisms into the bladder |
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nosocomial etiologies in UTI
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1. gram neg enterics- 50%
2. fungi - 25% 3. enterococci - 10% |
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catheter-assoc UTI
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-E. coli -
Klebsiella, Proteus - Enterococcus (VRE) - Enterobacter - Serratia - Candida - MRSA |
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symptomatic UTI
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-fever
-urgency -frequency -dysuria -suprapubic tenderness AND -urince cx with >10^5 colonies/ml with no more than 2 species of organisms -OR 2 of the presecding sx AND any of the following: 1. + leukocyte esterase and/or nitrate 2. pyruia 3. + gram stain 4. Two urine cultures with repeated isolation of organism with >100 colonies/ml in nonvoided specimens |
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asymptomatic bacteruia
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-an indwelling catheter is present within 7 days before urine is cultured AND pt has not sx AND a pt has a urine cx >10^5 colonies/ml with no more than 2 species
-OR -2 urine cultures with >10^5 colonies/ml of the same organism in a pt who has no indwelling catheter in the previous 7 days and had no sx |
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UTI prevention
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1. use alternatives to indwelling catheters
2. anticipate pts catheter needs 3. use sterile technique to insert 4. maintain a closed catheter system 5. change draining bags that are leaking, smell 6. Keep tubing and drainage bag below level of the bladder to prevent backflow of urine 7. secure cath, prevent stasis of urine 8. routinely acces for fecal incontinence, thorough cleaning 9. straight cath better than indwelling -REMOVE cath ASAP |
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surgical wound classification
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-slide 56-58
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ssx of surgical skin infx
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1. pain or tenderness
2. localized swelling 3. erythema or warm to touch 4. purulent drainage |
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superficial incisional SSI
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-infx occurs within 30 days after operation, involves only skin or subcutaneous tissue and at least one of the following
1.Purulent drainage, with or without lab confirmation from the superficial incision 2. Organism isolated from aseptically obtained culture of fluid or tissue 3. One of the signs and symptoms of infection and superficial incision is opened by surgeon |
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deep incisional SSI
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-infx occurs within 30 days after the operation if no implant is left in place and the infx appears to be related to the operation; infx involves deep soft tissues AND at least 1 of the following:
1.Purulent drainage from the deep incision 2.A deep incision spontaneously dehisces or is deliberately opened when patient has fever or localized pain or tenderness 3.An abscess is found |
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organ/space SSI
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-infx occurs within 30 days after the operation if no implant is left in place or within 1 year if implant is in place and the infx appears to be related to the operation and infection involves any part of the anatomy, other than the incision AND one of the following:
1.Purulent drainage from a drain placed through a stab wound into the organ/space 2.Organisms isolated from organ/space fluid or tissue culture 3.An abscess involving the organ/space |
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Patient characteristics that may influence the risk of SSI
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1. age
2. nutritional status 3. DM 4. obesity 5. coexistent infxs at a remote body site 5. colonization with microorganisms 6. altered immune response 7. length of preoperative stay |
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Operation characteristics that may influence the risk of SSI
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1. Duration of surgical scrub
2. Skin antisepsis 3. Preoperative shaving 4. Duration of operation 5. Antimicrobial prophylaxis 6. Operating room ventilation 7. Inadequate sterilization of instruments 8. Foreign material in the surgical site 9. Surgical drains 10. Surgical technique (i.e. poor hemostasis, failure to obliterate dead space, tissue trauma) |
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Nosocomial etiologies in surgical-site infections
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S aureus - 20%
Pseudomonads - 16% Coagulase-negative staphylococci - 15% Enterococci, fungi, Enterobacter species, and Escherichia coli - Less than 10% each |
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surgical skin infx- always assess for
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1. erythema
2. drainage 3. dehiscence of sutures 4. warmth and induration 5. fluctance |
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C.Diff
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-anaerobic spore forming bacillus
-C.diff associated illness: pseudomembranous colitis, toxic mega colon, sepsis, and death -fecal oral transmission -antimicrobial exposure major risk for the dz -clindamycin, PNCs, cephalosporins |
