Healthcare Associated Infection
- what is it? what makes it an HAI? Synonym? correct answers Include localized or systemic conditions resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s)
- no evidence that the infection was present or incubating at the time...
NURS 405 Exam 1 (100% Accurate Answers)
Healthcare Associated Infection
- what is it? what makes it an HAI? Synonym? correct answers Include localized or systemic conditions resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s)
- no evidence that the infection was present or incubating at the time of admission to the acute care setting. - After discharge from the hospital an infection could still be considered HAI based on certain factors (e.g. Time). - Synonyms: Hospital Acquired Infection, Nosocomial Infection
4 main types of HAIs correct answers Central line-associated bloodstream infections
Surgical site infections
Catheter-associated urinary tract infections
Ventilator-associated pneumonias
CLABSI
- what is a major risk factor for BSI? what effects rates of CLABSI? Outpatient populations? correct answers Rates of CLABSI appear to vary by type of catheter
Outpatient groups may be at risk
-Hemodialysis
-Malignancy: immunocompromised
-GI tract disorders: Use of TPN/sugars
-Pulmonary hypertension: medications have very short 1/2 life, catheter always open
most and least common mechanisms of CLABSI? correct answers Common mechanisms
-Pathogen migration along external surface (usually early, <7 days)
-Hub contamination with intraluminal colonization
Less common mechanisms
-Seeding from another source
-Contaminated infusates
modifiable RFs for CLABSI correct answers Insertion circumstances +
Skill of inserter -
Insertion site -
Skin antisepsis +
Catheter lumens -
Duration of catheter use +, influenced by RNs Barrier precautions +
CLABSI prevention and CL care correct answers Daily review of Catheter Necessity Catheter hub, cap, and tubing care
Care
Accessing the Line
Blood draws Catheter-site Care
Infection Control
Dressing
Activity
Evaluation
No routine replacement of CVCs
Surgical Site Infection
- pathogen sources (endogenous and exogenous)
- which of these can be controlled? correct answers Pathogen sources
Endogenous
- Patient flora (skin, mucous membranes, GI tract)
- Seeding from a distant source of infection
Exogenous
- Surgical personnel (soiled attire, breaks in aseptic technique, inadequate hand hygiene)
- Physical environment and ventilation
- Tools, equipment, materials brought to the operative field
- Only the exogenous things can be controlled.
Most common organisms that cause SSIs correct answers Staphylococcus aureus (30%)
Coagulase-negative staphylococci (13%)
Enterococcus (11%)
E. coli (9%)
Pseudomonas aeruginosa (5%)
Enterobactor (4%)
Klebsiella (3%)
Candida (2%)
challenges of SSIs correct answers Lack of standardized methods for detection
Antimicrobial prophylaxis may be causing resistant organisms
-Inappropriate choice of agent
-Improper timing (pre-incision)
-Inadequate doses
Skin or site prep ineffective
CAUTI
- frequency?common reasons for CAUTI? correct answers - most common type of HAI and increases LOS 2-4 days. Urinary catheter use in 15-25% of hospitalized patients and 5-10% of nursing home patients
Often placed for inappropriate reasons
Physicians were often unaware- did not monitor duration or discontinuation
Risk factors for symptomatic UTI correct answers Prolonged catheterization
Female sex
Older age (impaired immunity)
Impaired immunity Risk factors for bacteriuria (if Catheter, how infection occurs) correct answers Disconnection of drainage system (exposure)
Lower professional training of inserter (multiple attempts)
Placement of catheter outside of OR (not as clean)
Incontinence
Diabetes (immune system)
Meatal colonization (no way to bypass during insertion)
Renal dysfunction (cant flush out bacteria)
Ventilator-associated pneumonia/VAP
timeframe for developing? how common in ventilated patients? incidence rates for 1st 5 days, 6-
10 and 10+ correct answers - Develops 48 hours or longer after mechanical ventilation is initiated (may already have had an infection)
- Occurs in as many as 28% of patients
- Incidence increases with the duration of mechanical ventilation (3% per day for the 1st 5 days, 2% per day for days 6-10, 1% per day after 10 days)
Prevention using VAP bundle correct answers Elevation of the Head of the Bed at least 45 degrees (reduce secretions from rolling back)
Daily "Sedation Vacations" and Assessment of Readiness to Extubate (may not be perfect but gets them off asap)
Peptic Ulcer Disease Prophylaxis
Deep Venous Thrombosis Prophylaxis
5 moments for hand hygiene correct answers 1. before touching pt
2. before doing aseptic procedures
3. after body fluid exposure risk
4. after touching pt
5. after touching patient surroundings
standard precautions correct answers Every Patient Every Time! 1. Hand Hygiene: wash/gel upon entry & exit of patient room (before and after contact with patient OR their environment) 2. Glove for contact with body secretions, mucous membranes, or breaks in skin 3. Gown when exposure to body fluids likely 4. Mask for any aerosol-generating or respiratory procedure such as oral care/suctioning (including in-line suctioning)
enteric precautions correct answers c.diff, norovirus need to wash hands (diarrheal diseases)
nursing interventions for IV sites correct answers Evaluation
Evaluate for purulent drainage
Evaluate for chemical burn from Chloraprep (@ risk for infection)
Evaluate for adhesive sensitivity
Evaluate for suture site irritation
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