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95 Cards in this Set
- Front
- Back
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contamination
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presence of microorganisms without multiplication
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colonization
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presence of microorganisms with multiplication but NO invasion of tissues
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infection
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microorganisms present, multiplying, and invading tissue
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risk of infection
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dose of bacterial contamination * virulence / resistance of host
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characteristics of viruses
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1. smallest microorganisms
2. require living tissue for growth and reproduction 3. not killed by antibiotics |
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characteristics of fungi (yeasts)
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1. reproduce by spores
2. present in air, soli, water 3. not killed by antibiotics 4. cause infection in the immunosuppressed |
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protozoa
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- single celled
- parasitic |
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contributing factors for infection
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- age
- immune response - underlying conditions and illnesses - interventions and treatments |
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transmission of infection
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1. airborne
2. droplet - mucous membranes 3. contact 4. vehicle - in food or water 5. vector |
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preventing spread of infection
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1. hand hygiene
2. medical asepsis 3. standard precautions 4. isolation 5. barrier practices |
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Airborne Precautions
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- neg. pressure isolation room
- respiratory protection - limit transport of patient from room to room |
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Airborne Diseases
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- TB: active, untreated pulmonary or layngeal
- measles - varicella-zoster |
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Droplet Precautions
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- single room
-wear mask w/in 3 feet of patinet -use mask on patient during transport |
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Droplet Diseases
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- meningococcal meningitis
- influenza, pertussis, diptheria - rubella, mumps |
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Contact Precautions
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- single room or cohort
- gown and gloves for contact with patient or support equipment - dedicated equipment |
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contact diseases
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- antimicrobial-resistant organisms
- lice - scabies - C. difficile - varicella-zoster -impetigo - RSV |
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Neutropenic precautions
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- single room
- handwashing - limit traffic into the room - no fresh fruits or vegetables |
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Neutropenic person
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- person at-risk for acquiring infection
- absolute granulocyte count < 1000 |
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Healthcare - Associated Infection
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- aka Nosocomial infection
- not present or incubating on admission |
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stats for healthcare-associated infection
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- 5% of all hospital admissions
- ~2 million patients per year - $4.5 billion associated costs - 1/3 may be preventable |
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Urinary Tract Infections
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- 10^5 or greater organisms on culture
- > 10 WBCs per high power field on urinalysis |
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UTI associated with indwelling urinary catheters
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- chronic indwelling urinary catheters - colonization of urine
- residents in LTC facilities frequently colonized and asymptomatic - leading nosocomial infection in acute and long term care |
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Pneumonia
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- 2nd most common nosocomial infection in the US (15%)
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Pneumoina - Long term care
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- Bacterial pneumonia usually secondary to aspiration
- may also occur following viral URI and influenza |
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organisms that cause pneumonia
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- streptococcus pneumoniae
- klebsiella pneumoniae - staphylococcus aureus |
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types of skin and soft tissue infection
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- surgical wound infections
- chronic wound: pressure ulcers, stasis ulcers - soft tissue infections - topcial skin infections |
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Incisional Surgical Site Infection
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-within 30 days of surgery and involves skin, subq tissue, or muscle above fascia and any of the following:
- purulent drainage, postive culture from fluid from would, surgeon opens wound, doctor diagnosis of infection |
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Intrinsic factors for wound infection
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- age - extremes
- nutritional status - serum albumin <3.5g/dl - diabetes - glucose > 200mg/dl in immediate post-op period - smoking - nicotine delays healing - obestiy >20% ideal body weight |
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barriers to wound healing
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Host factors:
- age - underlying disease - malnutrition Altered immune response: - disease / conditions - drugs / tratemtns - bypass natural defenses |
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Non-surgical skin and soft tissue infections (ex)
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- chronic wounds --> pressure ulcers and static ulcers
- cellulitis - fungal skin infection |
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C. difficile diarrhea
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- profuse, watery
- associated with prior antibiotic use - higher incidence in patients receiving tube feeding - environmental contamination - cross-infection potential |
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Def - Mulit-drug-resistant organism
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- organism that has developed mechanism to protect it from being killed by the use of anitmicrobial agents
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significance of multi-drug-resistant organisms
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- increased potential for sepsis and death in patients with MDRO
- increased length of hospitilization - increase cost - patiens with MDRO are reservoirs for trnasmission of MDRO to others |
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MRSA
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Methicillin-resistant Staphylococcus aureus
- also resistant to Nafcillin, oxacillin - not just hospital bug |
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Treatment for MRSA (methicillin-resistant staph aureus)
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Vancomycin
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control measures for MRSA
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- single room or cohort if colonized or infected
-contact precautions - if outbreak suspcted, take additional precautions |
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GISA or VISA
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- glycopeptide intermediate resitance staph aureus or vanomycin intermediate resistance staph aureus
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problem with GISA or VISA
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No treatment
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control measures for GISA
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- rapid identification of staph with th ereduced sensitivity to glycopeptide agents
- isolation - 1:1 care for patient or cohort - baseline cultures of HCW, roommates, and others with direct contact with pateint |
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more control measures for GISA
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- avoid patient transfer between facilities
- notify local and state DOH and CDC |
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VRE
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Vancomycin-resistant enerococci
- E. faecium predominantly |
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VRE characteristics
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- survives on environmental surfaces
- transient carriage on HCW hands - NO rectal colonization of healthy HCWs - VRE coloniation frequent, but infx uncommon - concern that will shart resistance factor with S aureus |
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VRE and C. difficile
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- electronic thermometes and transmission of C. difficile
- tx. of C. difficile my predispose to dev. of VRE - patients at risk for C. difficile may be reservoirs for VRE |
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control measures for VRE
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- prudent vancomycin use
- education - rapid identification of VRE - isolation -dedicated noncritical items - env. cleaning and disinfection |
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control for VRE in LTC
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- consider room with person not at high riske for VRE disease
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VRE patients in LTC - when to allow them to ambulate and participate in activities?
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1. moist body substances are contained
2. resident washes hands prior to leaving the room |
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types ofPediculosis
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1. head - most common
2. body 3. pubic |
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Nits
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eggs of lice
- do not wash or blow away -most often found at nape of neck, behind ears, crown |
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treatment of head lice
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1. insecticidal shampoo (not use Lindane)
2. fine tooth comb - removes nits 3. nit check for 10 days |
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Scabies - what caused by
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caused by the mite - Sarcoptes scabiei --> burrows under skin
- spread skin to skin contact |
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symptoms of scabies
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- severe itching - esp at night
- rash - back "tracks" - symptoms not releived by moisturizing or other interventions |
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usual loctaions of scabies
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wrist, finger webs, elbows, skin fold, pelvic girdle, butt, behind knees, sides of feet
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Tx of scabies
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- contact precautions
- insecticide lotion - apply in shower - change linens and clothes |
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Infection with varicella-zoster virus
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- chickenpox
- attaches to nerve endings and becomes dormant |
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local zoster vx. disseminated zoster
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local - nerve endings in one dermatome, unilateral distribution, standard precautions
disseminated - full body involved, airborne and contact precautions |
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Herpes Zoster
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reactivation of varicella-zoster virus when immune response compromised.
- shingles |
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#2 leading cause of death due to infectious disease in the world
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Tuberculosis
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etiologic agent and transmission of TB
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- Mycobacterium tuberculosis
- droplet expelled and inhaled |
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T/F: YOu can be infected with TB without disease
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true
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TB infection with NO disease
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- cannot spread
- + skin test - neg x-ray - no symptoms |
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sites of active TB
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- lungs
- larynx - lymph nodes - brain - kidneys - bone |
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why has there been a recent return in TB?
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- decreased funding and attention
- lack of compliance with infx control measures - poor ventialation and air in older facilities - HIV epidemic - Inc immigaration from high-prevalence countries - inc inmates and homeless |
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impact on reappearnce of TB
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- increased morbidity and mortality
- resistant strains - $$ - new quidelines for prevention and control |
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populations with high prevalence of TB infection
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- residents LTC facilites
- HIV + - Inmates - ppl who inject drugs - ppl with occupational exposure |
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S&S of TB
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- long duration
- fatigue - malaise - weight loss - fever - night sweats - cough / blood (pulmonary) |
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Mantoux Tuberculin Skin Test
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- for TB
- inject PPD into skin - Examined 48-72 hours - measured for induration NOT redness |
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other diagnostic tests for TB
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- x-ray
- AFB smear -AFB culture |
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infx control for TB
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- airborne isolation
- precaution for cough-inducing procedures - effective anti-TB tx |
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which Hepatitis viruses are caused by viruses?
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Hep A, B, C, D, E
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Hep A mode of trnsmission, incubation period
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-fecal-oral
-15-50 days - avg 28 days |
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Hep A - diagnosis, outcome,
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- anti-HAVIgM
- outcome: mild, self-limiting |
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which strands of hepatitis can use a vaccine
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Hep A
Hep B Hep D |
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Which strands of Hepatitis have prevention with hygiene?
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Hep A
Hep E |
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Hepatitis transmitted by blood and body fluids
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Hep B
Hep C Hep D |
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Hepatitis transmitted by fecal-oral route
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Hep A
Hep E |
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Diagnosis of Hep B
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HBsAg
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Diagnosis of Hep C
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anti-CHV
HCV-PCR and elevated LTFs |
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super infection with HBV
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Hep D
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20% mortalilty in pregnant women
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Hep E
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stages of HIV
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- acute retroviral syndrome
- asymptomatic - early symptomatic - late symptomatic - advanced |
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epidemiology of HIV in the US
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- 800,000 - 900,000 with HIV in US
- 40,000 new cases per year - 70% infx in men |
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transmission of HIV
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- sexual contact
- blood to blood - perinatally |
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body fluids for HIV transmission
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- blood - highest amt virus
- semen - high amt virus - vaginal secretion - lower - breast milk - low |
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components of OSHA bloodborne pathogen rule
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- written exposure control plan
- enginerring controls - safe work practices - hep B vaccine - education and post-exposure follow-up |
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percutaneous exposure
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any new break in the skin caused by contaminated needle or other sharp object
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mucous membrane exposure
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any splash of blood or body fluds to the eyes, eras, nose, mouth, etc.
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non-intact skin
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any contact of blood or body fluid with an existing break in the skin
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bloodborne pathogens
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- Hep B
- Hep C - Hep D - HIV |
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risk of HIV infx after exposure
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0.2-0.3%
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why the risk of HIV varies with an exposure
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- amount of blood involved
- amount of virus in blood - if postexposure treatment taken |
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risk of infection with hep B after exposure to HBV infected blood?
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- 6-12% risk
- varies with amount blood, amount virus, and whether HCW had antibody to HBV |
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factors that contribute to development of infection
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- immune response
- underlying conditions / illness - occupational exposure - unsafe work practices - missing or poor engineering controls |
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infection control for healthcare worker
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- hand hygiene
- safe practices - be kind to immune system - up to date immunizations |
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post-exposure follow up for blood and body fluid exposure
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- wash / flush with water or saline
- report to supervisor - medical evaluation and follow-up |
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post-exposure follow up for communicable disease
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- report to supervisor
- review your immune status - medical evaluation if susceptible |
