Unit 1 Exam - week 1 Flashcards
(70 cards)
1
Q
Healthcare-Associated Infections
aka Nosocomial (hospital specific)
definition and examples of what they are not
A
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)
2
Q
Exogenous infection
A
from environment or personnel
UIT’s are most common
3
Q
Endogenous Infection
A
from immunosuppressed patient
C. diff, MRSA
4
Q
Rate of HAI’s
A
1 in 20 patients
5
Q
Who covers cost of HAI
A
Insurance
6
Q
How to determine if it is an HAI
A
if infection presents on or after 3rd hospital day
7
Q
Common HAI’s
CAUTI
A
Catheter-associated Urinary
Tract Infection
8
Q
Common HAI’s
SSI
A
surgical site infection
9
Q
Common HAI’s
VAP
A
Ventilator-associated pneumonia
10
Q
Common HAI’s
CLABSI
A
Central Line-associated
Bloodstream Infection
11
Q
Common HAI’s
C. diff
A
Clostridium difficile disease
12
Q
Common HAI MDRO’s
examples (5)
M V P E T “my vicious pet”
A
- 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)
13
Q
MRSA
A
methicillin resistant staphylococcus aureus
14
Q
What is the purpose of the NPSGs
National patient safety goals
A
- 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
15
Q
Who reviews the NPSGs?
A
The Joint Commission (jay co)
they audit hospitals to ensure compliance
16
Q
What are the 6 links in the chain of infection?
IRPTPS “I rapped party songs”
A
- 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
17
Q
what is an infectious agent?
A
- 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)
18
Q
Normal Flora
A
- 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
19
Q
what is a reservoir?
living and non-iving
A
- 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
20
Q
what is a portal of exit?
A
- the most frequent portal of exit is through bodily fluids
- coughs, sneezes, vomit, diarrhea
- wounds, bites, abrasions
- tubes, IV lines
21
Q
what is a direct contact mode of transmission?
A
- involves physical contact: kissing, sexual intercourse
- contact with wound drainage
- can involve scratching and biting
22
Q
what is are indirect contact modes of transmission?
A
Fomites
droplet transmission
airborne transmission
vector
23
Q
what is a fomite
A
a contaminated object that transfers a pathogen
24
Q
what is droplet transmission
mode of transmission, direct and indirect contact
A
- 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
25
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**
26
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
27
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
28
what is a susceptible host?
| definition and examples
- **Person with inadequate defense**
- examples of susceptibility: **age, compromised immune system, immune deficiency conditions**
29
Four determining factors of susceptibility
| VSND "V Sand"
1. **V**irulence of pathogen
2. Organism’s ability to **s**urvive in the host’s environment
3. **N**umber of organisms
4. Host’s **d**efense
30
Incubation stage
* From time of infection until manifestation of symptoms
* **can infect others**
31
5 stages of infection
| IPIDC "I pretend in da club"
1. incubation
2. prodromal
3. Illness
4. Decline
5. Convalescence
32
Prodromal Phase
* Appearance of **vague symptoms**
* not all diseases have this stage
33
Illness Stage
Signs and symptoms present
34
Decline Stage
Number of pathogens decline
35
Convalescence Stage
* Tissue repair
* return to health
36
Primary Infection
The first infection that occurs in a patient
ex: the flu
37
Secondary Infection
* one that follows a primary infection **especially in immunocompromised patients**
ex: Following the flu, patients are susceptible to pneumonia.
38
Local Infection
Occurs in a **limited region in the body**
(e.g., urinary tract infection)
39
systemic infection
* Spread via **blood or lymph**
* **Affects many regions** (e.g., septicemia)
40
Acute Infection
Rapid onset of short duration
(e.g., common cold)
41
Chronic Infection
Slow development, long duration
(e.g., osteomyelitis)
42
Latent Infection
Infection present with no discernible
symptoms (e.g., HIV/AIDS)
43
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**
44
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
45
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
46
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**
47
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
48
implementation of standard precautions
| 7 points
## Footnote
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
49
CDC’s two-tier system of isolation precautions
**1. protective isolation**
**2. transmission based isolation**
50
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**
51
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
52
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**
53
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
54
what is used for contact precatutions
| PPE equipment
- gloves and gown always
- face PPE if indicated
55
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**
56
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**.
57
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
58
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
59
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
60
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**
61
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**
62
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
63
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**
64
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.
65
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
66
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
67
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**
68
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**
69
MDRO's
| multi drug resistant organisms
## Footnote
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**.
70
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**
