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Fall24 PoA II > HAI & Abx pt1 (Ex2) > Flashcards

HAI & Abx pt1 (Ex2) Flashcards

(44 cards)

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1
Q

What are significant sources of hospital-acquired infections? (6)

A
  • CVL sepsis
  • UTI 13%
  • SSI 22%
  • HAP 22%
  • VAP
  • C-diff 12%
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2
Q

What contaminated areas increase susceptibility to HAI’s?

A
  • Inguinal
  • Perineal
  • Axilla
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3
Q

What bacteria are your skin flora?

A

Coag neg staphylococci

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4
Q

What labs can be useful for evaluation of HAI’s? (6)

A
  • Lactate
  • PT
  • Bun/Cr
  • WBCs
  • ⇅Blood glucose
  • Cultures

evidence of organ dysfunction

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5
Q

Surgical site infections typically occur within ___ days of surgery.

A

30 days

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6
Q

What are the categories for surgical site infection? (3)

A
  • Superficial = skin & SQ
  • Deep = fascia & muscle
  • Organ/Space
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7
Q

What are the three most common types of bacteria associated with surgical site infections?

A
  • Staphylococcus
  • Streptococcus
  • Pseudomonas
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8
Q

How would a wound that is not inflamed or contaminated and does not involve internal organs be categorized?

A

Clean

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9
Q

How would a wound that has no outward signs of infection but does involve internal organs be categorized?

A

Clean-Contaminated

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10
Q

How would a wound that involves internal organ infection along with spillage of contents into surrounding tissue be categorized?

A

Contaminated

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11
Q

What is an example of contaminated SSI?

A

Ruptured appendix

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12
Q

How is a Dirty SSI defined?

A

Known infection at the surgical site at the time of the surgery.

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13
Q

What are risks factors for SSI? (5)

A
  • > 2hr surgery
  • Comorbidities (smoker, DM, cancer, obese, etc)
  • Elderly
  • Emergency surgery
  • Abdominal surgery
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14
Q

Potentially ___% of SSI’s are preventable.

A

50%

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15
Q

What is a category 1A recommendation?

A

1A = Strongly recommended; moderate to high quality of evidence

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16
Q

What is a category 1B recommendation?

A

1B = Strongly recommended; low quality evidence

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17
Q

What is a category 1C recommendation?

A

1C = Strong recommendation based on state/federal regulation

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18
Q

What is a category II recommendation?

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A

Weak recommendation

19
Q

What exclusions were there to the Guideline for Prevention of SSI’s? (5)

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A
  • SSI not a reported outcome
  • All patients w/ “dirty procedures”
  • No dental or oral health procedures
  • Procedures that did not have primary closure
  • Study included wound protectors post-incision
20
Q

What are the recommendations for parenteral antibiotics? (2)

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A

1B - Administer only when indicated
1B - Time so that agent is active on tissue incision

21
Q

What are the recommendations for non-parenteral antibiotics?

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A

1B - no antibiotic ointment on incision

Dry incisions are better.

22
Q

What recommendations are there for antibiotic irrigation and prosthetic soaking in antibiotic solution?

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A

No recommendations on prosthetic soaking in abx solution or abx irrigation

23
Q

What are the 1A recommendation levels for glycemic control?

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A
  • Perioperative control of glucose
  • Target glucose < 200 mg/dL
24
Q

What is the recommendation level for A1C targets?

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A

No recommendation for A1C target

Just acute control of BG.

25
Maintaining perioperative normothermia is a ___ recommendation.
1A
26
What is the 1A recommendation for oxygenation in GETA patients?
↑ FiO₂ intraop and after extubation w/ GETA patients w/ normal pulmonary function. *Recommendation is losing credibility as a way to prevent SSI's*.
27
What are the 1A, 1B, and II recommendations for antiseptic prophylaxis?
1A - Intraoperative skin prep w/ alcohol-based antiseptic. 1B - Shower or bathe w/ soap/antiseptic the night before surgery. II - Consider intraoperative Iodine irrigation.
28
What is the recommendation for blood transfusion?
1B - Do not withhold necessary blood transfusions as a means to prevent SSI.
29
Should systemic corticosteroids be utilized in a patient with joint arthroplasty?
Uncertain. Infection is most common indication for TKA revision however.
30
What does MIC stand for?
Minimum Inhibitory Concentration -adequate bactericidal concentration in serum and tissues when incision made
31
What are the 6 general principles of preoperative antibiotic prophylaxis?
1. Should be active against *common* SSI pathogens 2. Proven efficacy by clinical trials 3. MIC must be achieved 4. Shortest possible effective course 5. New ABX reserved for resistant infections 6. If possible, use oldest/cheapest ABX
32
ABX should be initiated within ____ hour of incision.
1 hour (30 min even better)
33
_________ and _________ can be initiated within 2 hours of incision.
Vancomycin and Fluoroquinolones (like Cipro)
34
Can antibiotics be held for cultures?
yes
35
ABX must be completely infused prior to use of a __________. Why?
Tourniquet -To make sure concentration gets to that tissue.
36
Re-dosing parameters of antibiotics consists of what conditions? (4)
- 2 ABX half-lives - Excessive blood loss - Cardiac bypass - Prolonged procedures (usually 2-4 hours in OR)
37
What drug classes are β-lactam based?
- Penicillins - Cephalosporins - Carbapenems
38
What are the 5 major common surgical antibiotics?
- β-lactams - Vancomycin - Aminoglycosides (gentamycin) - Fluoroquinolones (cipro) - Metronidazole (flagyl)
39
How do Penicillin β-lactam antibiotics work?
Inhibition of bacterial cell wall synthesis
40
Resistance to Penicillin β-lactam antibiotics is based on what?
β-lactamase enzyme on outer surface of cytoplasmic membrane
41
Penicillin β-lactams are the drug of choice for what pathogens?
Gram + Bacterium (Cocci) - Streptococci - Meningococci - Pneumococci
42
β-lactams are good for which HAI's?
skin, catheter, and upper respiratory infections
43
What four examples of penicillin based antibiotics were given?
- Penicillin G - Methicillin - Nafcillin - Amoxicillin .
44
What are three common adverse reactions to penicillin β-lactams?
- Hypersensitivity (includes anaphylaxis 0.05%) - GI upset - Vaginal Candidiasis

Fall24 PoA II (34 decks)

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