Apex- Misc: Infection

Question 1

What is hte most common source of bloodstream infection in hospitalized patients?

Answer 1

central venous catheters

Question 2

According to the CDC, what is the preferred method of skin prep before central line placement?

Answer 2

Chlorohexidine

Question 3

The Surgical Care Improvement Project (SCIP) provides 7 measures designated to do what?

how many of them are we responsible for?

Answer 3

reduce the incidence of perioperatie surgical site infection

3

1. prophylactic abx within 60 mins of incision (vanco 120)
2. cardiac pateints must achieve glycemic contro (<200mg/dL)
3. colororectal patients are normothermic upon arrival to PACU (>36 C)

Question 4

Prophylactic antibiotics should be administered within how many minutes of surgical incision

whats the exception

Answer 4

60 mins

vanco = 120 mins

Question 5

cardiac patients must achieve glycemiccontrol of less than what

Answer 5

200mg/dL

infection prevention (sCIP) protocol

Question 6

According to SCIP, which kind of surgical patients need to be normothermic upon arrival to PACU

Answer 6

colorectal (>36 degrees)

Question 7

Alochol based prep solutions must be allowed to dry for how long?

why?

Answer 7

2 mins

flammable

Question 8

SCIP Protocol:

The choice of antibotic is determined by what

Answer 8

the site of surgery

Question 9

SCIP protocol

Phophlyactic abx are discontinued within how many hours after surgery?

what about cardiac surgery patients?

Answer 9

24 hours

48 hrs

Question 10

What is the most common cause of occupational exposure to HIV?

Answer 10

a needle-stick injury with a hollow-bore needle

Question 11

Seroconversion rates after exposure to HIV-infected blood:

-Percutaneous injury (needle stick) =
-Mucous membrane exposure =

Answer 11

needle stick = 0.3%
mucous membrane = 0.09%

Question 12

Which procedure places health care workers at the HIGHEST risk of developing a positive TB skin test?

a. bronchosocopy
b. video-assisted thoracoscopic surgery
c. cataract removal
d. ORIF of a femur

Answer 12

A. bronchoscopy

endotracheal intubation is the second-highest risk procedure

Question 13

What happens if you have a positive TB skin test?

Answer 13

you get a CXR

Question 14

3 drugs to treat TB

2 risks with these drugs

Answer 14

1. Isoniazid (P450 inhibitor)
2. Rifampin (P450 inducer)
3. Pyridoxine

thrombocytopenia and renal failure

Question 15

elective surgery should be delayed for TB pts until what 3 things have occured?

Answer 15

1. they are on anti-TB chemo
2. have had 3 negative acid-fast bacillus tests
3. demonstrates improvement in symptoms

Question 16

Myobacterium tuberucolosis is a bacillus that thrives in what kind of enviornment

what does it mainly target?
what can it also infect? (5)

Answer 16

Aerobic enviornment

anterior apical lung segments

brain
spine
joints
gi tract
kidneys

Question 17

5 key symptoms of TB

Answer 17

*productive cough
*hemoptysis
*weight loss
*fever
*night sweats

anorexia and general malaize

Question 18

What does the Mantoux test tet for?

AKA?

Answer 18

TB

tuberculin skin test

Question 19

TB test should be read within what time frame

Positive TB test = site of induration > how many mm in a healthy pt vs immonocompromised pt (HIB)

Answer 19

48-72 hrs

> 10mm healthy
5mm immonocompromised

Question 20

CXR with apical infiltrates and nodules

Answer 20

TB

Question 21

T/F: a negative CXR rules out TB

Answer 21

True

Question 22

what does acid-fast bicillus test?

Answer 22

sputum for TB

Question 23

First line agent for TB

2 main side effecits

what can be done to reduce ffects

Answer 23

Isoniazid

peripheral neuropathy and hepatotoxicity

Pyridoxine can be added to reduce incidence of liver damage

Question 24

5 side effects of Rifampin

Answer 24

1. causes bodily secretions to turn orange/red
2. renal failure
3. thrombocytopenia
4. anemia
5. leukopenia

Question 25

TB patients- what is placed between the y-piece and pt’s airway
-what is placed in the expiratory limb of the circuit?

Answer 25

high efficiency particulate air filter (HEPA)- between y-piece and pt aiwrway
Bacterial filter in the expiratory limb