PHC 6517 Assignment #4 ANSWER KEY

PHC 6517 Answer Key for Assignment #4:

Patient Care Practices
Instructions: To see which questions you may have missed on the set of guidelines you selected
to complete on the Assignment #4, go directly to that guideline. You are also
encouraged to review the questions and answers for the other sets of guidelines, as this
knowledge is important for Infection Control practice. Please email me or post to the Discussion
Board if you have any questions/comments.

I. Prevention of Nosocomial Pneumonia (2003)

1. TRUE or FALSE. It is a Category II recommendation that states “Do not routinely sterilize or
disinfect the internal machinery of mechanical ventilators”. This is TRUE. (See III.A 2.
“Prevention of Transmission of Microorganisms”).

2. Patients with what type of device/equipment are at highest risk of nosocomial pneumonia?
Patients receiving mechanically assisted ventilation (3rd sentence of section I. A.).

3. What is the most important route of exposure for both nosocomial and community-acquired
pneumonia? Aspiration is believed to be the most important mechanism for infection for
both nosocomial and community-acquired pneumonia. (Section IV, first paragraph).

4. List 5 groups of risk factors for nosocomially-acquired bacterial pneumonias. There are many
correct answers to this question. The purpose of this exercise was to become familiar with
the guideline and its main concepts. First paragraph of I.A., first paragraph of V., all pages
in section V are correct. A good summary for this answer is as follows: 1) Factors that
enhance colonization of the oropharynx and/or stomach by microorganisms, Host factors
(such as extremes of age, malnutrition, and severe underlying condition, including
immunosuppression), 2) Conditions favoring aspiration or reflux from the gastrointestinal
tract, 3) Conditions requiring prolonged use of mechanical ventilatory support with
potential exposure to contaminated respiratory equipment and/or contact with
contaminated or colonized hands of HCWs, and factors that impede adequate pulmonary
toilet.

5. Give a one-sentence recommendation regarding pneumococcal vaccination. Patients at high

risk for complications of pneumococcal infections should be vaccinated with pneumococcal
polysaccharide vaccine. (In section, “Prevention of Healthcare-associated Bacterial
Pneumonia,” section IV.A.1).

6. What are two risk factors for both acquiring Legionnaires Disease and dying of the disease?
Underlying disease (end-stage renal, cancer) and advanced age (in “Healthcare-associated
Legionnaire’s Disease,” section I Epidemiology, fifth paragraph, line 1).

7. What is the primary risk factor for invasive aspergillosis? Severe and prolonged
granulocytopenia, both disease- and therapy-induced (in “Healthcare-associated

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Aspergillosis,” section IV Risk Factors, 2nd sentence).

8. List 4 types of viruses that have accounted for 70% of nosocomial pneumonias caused by
viruses. Adenovirus, influenza, parainfluenza, and respiratory syncytial virus (RSV) (in
“Healthcare-associated Viral Pneumonia, introductory section, last sentence of 2nd
paragraph).

9. When are gloves NOT useful in preventing transmission of RSV in the hospital? If gloves are
not changed after contact with an infected patient or with contaminated fomites and if
hands are not washed adequately after glove removal, then they will not be effective in
preventing transmission of RSV in the hospital (This is an application question).

10. State the primary focus of efforts to prevent and control nosocomial influenza. The
vaccination of high-risk patients and healthcare workers before the influenza season begins
(in “Healthcare-associated influenza” section, first sentence of IV. B.).
II. Prevention of Intravascular Catheter-Related Infections (2011)

1. What is the difference between CRBSI and CLABSI?

CRBSI vs. CLABSI
Clinical definition Simpler definition
Used for diagnosing and treating patients Used for surveillance
Requires lab testing to confirm catheter as Primary BSI in a patient that had a central
source of BSI line within the last 48 hours and is not
related to another site

CLABSI rates are used to estimate the incidence of CRBSI, but may actually be an
overestimate (Background, p. 21).

2. What are the four recognized routes for contamination of catheters?

a. Migration of skin organisms at the insertion site into the cutaneous catheter tract
and along the surface of the catheter with colonization of the catheter tip.
b. Direct contamination of the catheter or catheter hub by hands or contaminated
fluids or devices.
c. Catheters might become seeded from another source of infection (less common).
d. Infusion of contaminated fluids (infusate contamination, less common) (Pathogenesis,
p. 23-24).

3. Which type of catheter accounts for the majority of CRBSI? Non-tunneled central venous
catheters (p. 22, Table 1).

4. What are the four most commonly reported pathogens causing CLABSIs?
a. Coagulase-negative Staphylococci
b. Staphylococcus aureus
c. Enterococci

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d. Candida spp.
(Epidemiology and Microbiology in Adult and Pediatric Patients, p. 23)

5. What are three important determinants of pathogenesis of CRBSI?

a. That material of which the device is made.
b. The host factors of consisting of protein adhesions that form a sheath around the
catheter.
c. The intrinsic virulence factors of the infection organism
(Pathogenesis, p. 24)

6. Describe what is known about the likelihood of 3 sites to get infected: femoral, jugular, or
subclavian. No randomized trial satisfactorily has compared infection rates for catheters
placed in jugular, subclavian and femoral sites. Catheters inserted into an internal jugular
vein have been associated with higher risk of infection than those inserted into subclavian
or femoral (Selections of Catheters and Sites, Background, p. 28).

7. Which two materials have been associated with lower risks of catheter infections? Teflon or
polyurethane (Type of Catheter Material, p. 29)

8. What is the difference in the gloving requirement for starting a peripheral catheter vs. inserting
a central catheter? Sterile gloves are not necessary when starting a peripheral catheter. A
new pair of disposable nonsterile gloves and a “no touch” technique can be used. Sterile
gloves must be worn for insertion of central catheters (Hand Hygiene and Aseptic
Technique, Background, p. 30).

9. Clinical studies involving high-risk patients, including hemodialysis patients, and the use of
10% povidone iodine have found what effect? Positive effect: a significant decrease in
colonization, exit site infection, or bloodstream infection (Antibiotic/Antiseptic Ointments,
Background, p. 40).

10. What are the benefits of midline catheters in terms of rates of phlebitis and rates of infection?
They have lower rates of phlebitis than short peripheral catheters and lower rates of
infection than CVCs (Replacement of Peripheral and Midline Catheters, Background, p.
45).

III. Prevention of Surgical Site Infections (2017) (Be sure to use both readings to answer the
questions)

1. List the 2 Category IA recommendations regarding parenteral antimicrobial prophylaxis.

1B. Administer the appropriate parenteral prophylactic antimicrobial agents before skin incision in
all cesarean section procedures.
1E. In clean and clean-contaminated procedures, do not administer additional prophylactic
antimicrobial agent doses after the surgical incision is closed in the operating room, even in the
presence of a drain. (SSI 2017 guidelines, Page E3, under “Parenteral Antimicrobial Prophylaxis”)

2. List the 1 Category IA recommendation regarding glycemic control. 3A.1. Implement

perioperative glycemic control and use blood glucose target levels less than 200 mg/dL in patients with
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and without diabetes. (SSI 2017 guidelines, Page E4, under “Glycemic Control”)

3. This question has 2 parts. Fill in the blanks: Approximately __% of SSI become evident after
discharge and costs can exceed ___ $ per infection when the SSI involves a prosthetic joint
implant. “Approximately 50% of SSI become evident after discharge and costs can exceed
$90,000 per infection when the SSI involves a prosthetic joint implant. (SSI 2017 guidelines,
Page E3, under “Core Section”)

4. List the 1 Category IA recommendation regarding oxygenation. For patients with normal
pulmonary function undergoing general anesthesia with endotracheal intubation, administer
increased FIO2 during surgery and after extubation in the immediate postoperative period. To
optimize tissue oxygen delivery, maintain perioperative normothermia and adequate volume
replacement. (SSI 2017 guidelines, Page E4, under “Oxygenation”)

5. How many of the 4 recommendations (20A.-20D.) regarding biofilm are classified as “No
recommendation/unresolved issue”? All of the 4 recommendations for biofilm are classified as
“No recommendation/unresolved issue”. (SSI 2017 guidelines, Pages E5-E6, under “Biofilm”)

6. With what agent should intraoperative skin preparation be performed unless contraindicated?
Unless contraindicated, intraoperative skin preparation should be performed with an
alcohol-based antiseptic agent. Category IA. (SSI 2017 guidelines, Page E4, under “Antiseptic
Prophylaxis”)

7. List the 1 Category IA recommendation regarding postoperative antimicrobial prophylaxis

duration with drain use. In prosthetic joint arthroplasty, recommendation 1E applies: in clean and
clean-contaminated procedures, do not administer additional antimicrobial prophylaxis doses after
the surgical incision is closed in the operating room, even in the presence of a drain. (SSI 2017
guidelines, Page E5, under “Postoperative Antimicrobial Prophylaxis Duration with Drain
use”)

8. What 6 parameters are to be maintained for operating room ventilation? The 6 parameters are:
1) the number of air exchanges, 2) airflow patterns, 3) temperature, 4) humidity, 5) location
of vents and 6) use of filters. (See SSI Reading #2 [supplement] page 41)

9. Should sterile gloves be donned (put on) before or after donning a sterile gown? Sterile gloves
should be donned after donning a sterile gown. (See SSI Reading #2 [supplement] page 41)

10. TRUE or FALSE. At the July 2014 Healthcare Infection Practices Advisory Committee
(HICPAC) meeting, HICPAC reviewed and recommended to the Centers for Disease Control and
Prevention (CDC) that many of the 1999 strong recommendations should be re-emphasized as
accepted practice for preventing surgical site infections. This statement is TRUE. (See SSI
Reading #2 [supplement] page 41)

Use this worksheet to study for Exam 2.

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