Healthcare-Associated Infections (HAIs) Quiz
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Questions and Answers

What percentage of hospital admissions in the U.S. were associated with HAIs in 2015?

  • 5%
  • 1%
  • 10%
  • 3% (correct)

    • Which of the following is an example of an endogenous source of HAIs?

  • Escherichia coli from contaminated instruments
  • Skin flora after surgery (correct)
  • MRSA from healthcare providers
  • C.difficile from the environment

    • Which organism is NOT commonly associated with HAIs in U.S. hospitals?

  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Acinetobacter baumannii (correct)
  • Clostridioides difficile

    • Which type of infection is classified as a healthcare-associated infection (HAI)?

    <p>MRSA blood stream infection</p> Signup and view all the answers

    What role does the NHSN serve in the context of HAIs?

    <p>Surveillance and reporting system</p> Signup and view all the answers

    What is a characteristic of Multi-Drug Resistant Organisms (MDRO)?

    <p>Are selected for through antibiotic exposure</p> Signup and view all the answers

    Which procedure is mandated for reporting certain HAIs to the CDC?

    <p>Central Line Associated Bloodstream Infections</p> Signup and view all the answers

    What constitutes a healthcare-associated infection (HAI)?

    <p>Infection acquired while receiving healthcare services</p> Signup and view all the answers

    What does the term 'endemic' refer to in the context of healthcare-associated infections (HAIs)?

    <p>The predicted number of cases within a specific group</p> Signup and view all the answers

    Which of the following infections is categorized as having airborne transmission?

    <p>Measles</p> Signup and view all the answers

    What is one key factor in preventing healthcare-associated infections (HAIs)?

    <p>Strict adherence to hand hygiene practices</p> Signup and view all the answers

    Which pathogen is resistant to carbapenems and is classified as a significant antibiotic resistance threat?

    <p>Acinetobacter baumannii</p> Signup and view all the answers

    In which scenario would the use of gloves be required according to standard body substance precautions?

    <p>When performing venipuncture</p> Signup and view all the answers

    What constitutes the 'Iceberg Effect' in infection management?

    <p>The visible signs of infection are only a small part of the total cases</p> Signup and view all the answers

    What type of respiratory protection is typically needed in an airborne transmission scenario?

    <p>N95 respirator</p> Signup and view all the answers

    Which of the following is NOT considered a route of transmission for MRSA?

    <p>Vector-borne transmission</p> Signup and view all the answers

    What intervention was reinforced in October 2005 as part of the response to increasing CDI rates?

    <p>Infection control practices</p> Signup and view all the answers

    Which chemical agent was introduced for environmental cleaning starting in October 2005?

    <p>Chlorine releasing agent</p> Signup and view all the answers

    What was observed in September 2006 during the random chart reviews of CDI patients?

    <p>Inconsistent clinical symptoms</p> Signup and view all the answers

    What was the significant finding related to roommates and controls during the investigations in April 2007?

    <p>No increased risk for CDI cases vs. controls with selected antibiotics</p> Signup and view all the answers

    What action did the laboratory take regarding specimens collected in transport media in May 2007?

    <p>They initiated a policy to reject such specimens</p> Signup and view all the answers

    What issue was investigated in April 2007 regarding the laboratory's false positive tests?

    <p>Poor recovery of C difficile from positive cases</p> Signup and view all the answers

    What type of isolates were typed by REA in June 2007?

    <p>CDI isolates collected over 17 months</p> Signup and view all the answers

    What was the potential cause of the pseudoepidemic mentioned in the content?

    <p>False positive lab tests</p> Signup and view all the answers

    What is a characteristic of the typical duration of outbreaks?

    <p>Lasting from weeks to 48 months</p> Signup and view all the answers

    Which step is not part of the Outbreak Investigation Steps?

    <p>Develop a treatment plan</p> Signup and view all the answers

    What can epidemic curves provide clues about?

    <p>Mode of transmission</p> Signup and view all the answers

    In descriptive epidemiology, which of the following is essential to specify?

    <p>Time of the outbreak</p> Signup and view all the answers

    Which of the following represents a potential mode of transmission for CRAB?

    <p>Direct contact with contaminated surfaces</p> Signup and view all the answers

    What is one of the first steps in investigating an outbreak?

    <p>Confirm outbreak</p> Signup and view all the answers

    What type of study is used to identify risks associated with an outbreak?

    <p>Case control study</p> Signup and view all the answers

    Which of the following is typically included in a case definition for an outbreak?

    <p>Location of infection</p> Signup and view all the answers

    What is a characteristic of special cause variation in control charts?

    <p>One value outside control limits</p> Signup and view all the answers

    Which of the following is NOT a goal of an outbreak investigation?

    <p>Confirm the case definition</p> Signup and view all the answers

    What is a pseudoepidemic?

    <p>A real cluster of false infections</p> Signup and view all the answers

    Which step comes first in the outbreak investigation process?

    <p>Confirm outbreak</p> Signup and view all the answers

    What does the control limit in a control chart primarily indicate?

    <p>Acceptable range of variability</p> Signup and view all the answers

    Which method is NOT associated with verifying the diagnosis in an outbreak investigation?

    <p>Case definition confirmation</p> Signup and view all the answers

    What is the purpose of developing and testing a hypothesis in outbreak investigations?

    <p>To identify potential sources and preventions</p> Signup and view all the answers

    What could lead to errors during the collection and handling of specimens in outbreak investigations?

    <p>Inexperienced personnel</p> Signup and view all the answers

    Which of the following is an implicit assumption during outbreak investigation?

    <p>Consistency in diagnostic methods</p> Signup and view all the answers

    What strategy is NOT part of the goals of outbreak investigations?

    <p>Conduct ongoing disease surveillance</p> Signup and view all the answers

    What does the rise in unique patients tested indicate during the outbreak investigation?

    <p>An increasing prevalence of the disease.</p> Signup and view all the answers

    What is a common complication associated with Carbapenem Resistant Acinetobacter baumannii in ICU patients?

    <p>Pneumonia</p> Signup and view all the answers

    What feature makes Acinetobacter baumannii typically non-virulent under normal circumstances?

    <p>Non-fermenter characteristics.</p> Signup and view all the answers

    Which scenario indicates the need for further investigation of an outbreak?

    <p>Three patients detected with CRAB.</p> Signup and view all the answers

    Why might CRAB be particularly concerning in an ICU setting?

    <p>Patients may have compromised immune systems.</p> Signup and view all the answers

    What does the statement about specimens in Cary-Blair Media indicate?

    <p>Specimens collected in that medium are not accepted anymore.</p> Signup and view all the answers

    What could be a potential result of a confirmed outbreak of CRAB?

    <p>Urgent communication to other facilities about potential risk.</p> Signup and view all the answers

    How does the presence of CRAB outbreaks in the U.S. impact clinical practice?

    <p>It necessitates stricter antibiotic prescription policies.</p> Signup and view all the answers

    What primary action should hospitals take after identifying multiple cases of CRAB?

    <p>Implement infection control measures.</p> Signup and view all the answers

    Study Notes

    Hospital Epidemiology and the Laboratory

    • Healthcare-associated infections (HAIs) occur in about 3% of hospital admissions in the US (2015).

    • Hospitals are required to report some HAIs to the CDC/NHSN.

    • Examples of HAIs include:

      • Central line-associated bloodstream infections (CLABSI)
      • Catheter-associated urinary tract infections (CAUTI)
      • Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
      • Surgical site infections (SSI) of colon and hysterectomies
      • Clostridioides difficile infection (CDI)

    • Healthcare-associated infections (HAIs) are defined as infections acquired while receiving healthcare in a hospital or long-term care facility.

    • Colonization is when organisms are on a body surface (e.g., skin, nose) without causing disease.

    • Infection is when organisms invade body tissues causing disease with clinical signs and symptoms.

    • The CDC's National Healthcare Safety Network (NHSN) system is used to monitor HAIs in the US.

    • The criteria used by the NHSN for surveillance of HAIs are not the same as clinical diagnosis.

    • The data collected by NHSN is used for compliance with state and federal mandates, benchmarking, and driving progress to eliminate HAIs.

    • Common organisms causing HAIs include:

      • Clostridium difficile
      • Staphylococcus aureus
      • Escherichia coli
      • Candida species
      • Enterococcus species
      • Enterobacter species
      • Pseudomonas aeruginosa
      • Klebsiella species
      • Streptococcus species
      • Coagulase-negative staphylococcus

    • Multi-drug resistant organisms (MDROs) are selected for by antibiotic exposure.

    • MDROs can be "shared" via cross-transmission.

    • Carbapenem-resistant Acinetobacter baumannii (CRAB) and Carbapenem-resistant enterobacterales (CRE) are urgent public health threats in US healthcare facilities.

    • Also, Candida auris and Clostridioides difficile are threats as well.

    Outbreak Investigations

    • An outbreak is more cases of a disease than expected in a given area or specific group of people over time.
    • HAI rates within a healthcare setting can be considered endemic, epidemic (outbreak) or predicted.
    • Endemic refers to the predicted number of cases.
    • An epidemic (outbreak) is a significant increase from the endemic rate or an unusual infection.
      • Most nosocomial infections are preventable.
    • Analyzing variation with control charts plots data over time to compare aggregate pre and post.
    • Special cause variation identifies a value outside control limits or eight consecutive values on one side of the mean.

    Goals of an Outbreak Investigation

    • Identify the etiologic agent, reservoir, and mode of transmission.
    • Eliminate the reservoir.
    • Prevent transmission.
    • Prevent future outbreaks.

    Outbreak Investigation Steps

    • Verify diagnosis.
    • Confirm outbreak.
    • Research the disease.
    • Establish case definition.
    • Conduct descriptive epidemiology.
    • Develop a hypothesis.
    • Test and refine the hypothesis.
    • Implement control and prevention measures.
    • Communicate findings.

    Implicit Assumptions in Outbreak Diagnoses

    • Case definitions and diagnostic methods remain unchanged.
    • Issues may arise with new tests (e.g., PCR) or alternative case-finding methods, like active surveillance.

    Pseudoepidemics

    • Pseudoepidemics can be false clusters of real infections or real clusters of false infections.
    • A study found pseudoepidemics in 11% of 181 CDC nosocomial epidemic investigations from 1956-75 that were due to errors in specimen collection, handling, or processing (55%), surveillance artifacts (30%), or errors in clinical diagnosis (15%).

    Additional Topics

    • Transmission:
      • Direct and indirect contact (examples like MRSA, VRE, CRE, CRAB, C. diff, C. auris, Norovirus, and RSV)
      • Droplets and splashes (examples like Neisseria meningitidis, Pertussis, Group A Strep, H. influenza, and Influenza)
      • Airborne (examples like Tuberculosis, Chicken Pox, Measles, and limited airborne SARS-CoV-2)
    • Laboratory and Administrative CDI Rates:
      • Increased rates, especially when a virulent strain develops.
      • Interventions to control outbreaks include education and dissemination of CDI rates, improved cleaning practices, and policy changes.
    • Molecular typing of initial cases, used to better understand the cause and spread
    • Epicurve as a graph of cases over time, providing clues about transmission modes, either person-to-person or common source
    • Multiple hypotheses for outbreak causes
    • Case control studies used to test hypotheses and identify risk factors.

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    Hospital Epidemiology And The Laboratory - PDF

    Description

    Test your knowledge on healthcare-associated infections (HAIs) and their impact on hospital admissions in the U.S. This quiz will cover various aspects, including definitions, classifications, and prevention strategies related to HAIs. Challenge your understanding of pathogens, epidemiology, and reporting requirements.

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