Infection Exemplars

Healthcare Associated Infections (HAI)

Infection that a patient acquires while receiving care in a health care setting

Iatrogenic Infection

Type of HAI resulting from a diagnostic or therapeutic procedure

HAI S&S

Fevers, chills, productive cough, SOP, palpitations, plyuria, hypo or hypoerthermia, tachypnea, tachycardia, hypotension

Catheter Associated Urinary Tract Infection

Occurs in an individual whose urinary bladder is catheterized or has been within the past 48 hours. Most common HAI, typically UTIs caused by E. coli

CAUTI Manifestations

Pain or burning in genitalia, lower back pain, malaise, nausea, vomiting, foul smelling uring, exudate, hematuria

CAUTI Diagnostics

Urinalysis and urine culture. CBC may show elevated WBCs

Urine culture is definitive diagnosis

C. Diff

Gram positive bacteria seen mostly in older people who have been hospitalized or taking antibiotics. Causes foul smelling diarrhea. Can be found in water, air, feces, soil. Typically results from disruption of healthy bacteria in the colonC

C. Diff Risk Factors

Antibiotic use is leading risk factor, number one cause is clindamycin or cephalosporin. Other causes can be age, chemo, PPIs, renal and liver disease, and malnutrition

C. Diff Manifestations

Water diarrhea with mucous or blood, anorexia, nausea, vomiting, lower abdominal pain and cramping, distention, hypovolemia. Sever infection can cause perforated bowel, shock, and death

C Diff Diagnostics

3 or more loose stools in 24 hours with no other etiology they should be checked with a stool sample or stool culture

C Diff Medical Management

Discontinue antibiotics, isolate patient, rehydrate, treat with oral vancomycin or fidaxomicin. Or use a fecal transplant

Healthcare Associated Pneumonia (HAP)

Pneumonia that occurs 48 hours or more after hospital admission that was not present originally

Ventilator Associated Pneumonia (VAP)

Subset of HAP, pneumonia that occurs more than 48 to 72 hours after intubation

HAP and VAP Common Pathogens

Gram neg. bacilli and gram positive cocci

HAP and VAP S&S

Fever, sputum, crackles, wheezing, tachypnea, use of accessory muscles, orthopnea

HAP and VAP Diagnostics

Increased WBC, cultures, hypoxemia, Lactate, Chest x ray, Bronchoscopy

Central Line Associated Blood Stream Infection (CLABSI)

Laboratory confirmed blood stream infection not related to an infection at another site that develops within 48 hours of central line placement

Central Lines (AKA CVC, Central Venous Catheter)

Intravenous Catheter whose internal tip lies in the large central vein

Non Tunnelled CVC

For short term use only

Tunnelled CVC

For long term use, placed with a tract under the skin with a cuff

Peripherally Inserted Central Catheters (PICC)

Long term out patient use, inserted into peripheral vein, tip ends in the great veins

Midlines

Considered a peripheral, not a central line. Tip ends at or below the axillary vein, not the superior vena cava, looks very similar to PICC

CLABSI Etiology

Mostly gram positive. Bacteria on skin surface migrate along external surface of catheter into the intravascular space

CLABSI Manifestations

Fevers and chills most common, Sepsis, AMS (altered mental status), Hypotension, lethargy, fatigue, pain, erythema, exudate, edema at site

CLABSI Diagnostics

Blood cultures to show elevated WBC, Lactate increased sign of sepsis

CLABSI Medical Management

Use of broad spectrum antibiotics until cultures return and remove line