Infection Prevention and Control - PowerPoint Presentation

Slide1

Infection Prevention and Control

Q&A – APIC Greater NY

March 18, 2015

Natalie Fucito RN NYULMC Infection Prevention and Control Department263-5454 / 598-6767

Question 1

A

14-year old boy from rural Maryland was

seen

in

the emergency room with fever, fatigue, chills, headache and a large annular lesion on his left thigh which the patient described as burning and itching.

What

is the most probable vector of this child’s illness? Does this patient need isolation?

Answer 1

A. Tick

B. Mosquito

C. Flea

D. Louse

Answer 1 – continued…

A

Lyme

test comes back negative and the Dermatology consult suggests this is ringworm

.

Does

the patient need isolation now? How is ringworm transmitted?

What

precautions would you recommend to the worried staff nurses gathered around you in the hallway?

Question 2

A 73-year-old woman resides in an extended care facility (ECF). Yesterday, she enjoyed a lengthy visit with her 20 year old grandson. Her grandson calls

you, the

IP at his grandmother’s

ECF, today

because he was just informed that he was recently exposed to

N. meningitidis

from his college roommate who was

just hospitalized

for this illness. The grandson is asymptomatic. However, after careful evaluation by his physician today, he was strongly urged to start a prophylactic course of rifampin immediately. What should you do?

Answer 2

A. Nothing at this

point

B. Start a line listing of all the people with whom the boy came in contact during his visit with his grandmother

.

C

. Confirm the diagnosis and explore the boy’s “infectiousness

”

D. Start the grandmother on rifampin.

Answer 2 – continued…

Do you think the asymptomatic grandson needs prophylactic antibiotics?

Why

is C the right answer

?

Question 3

For 2015, your IP program

has selected

reduction of Ventilator-Associated Pneumonia (VAP) as your Quality Improvement project.

In

your

2014 annual evaluation,

you note that the rate has consistently been at or below the

NYS mean rate & NHSN

50

th

percentile for the past

year. In 2013, your VAP rate was

above the

NYS mean rate/NHSN

50

th

percentile.

You

recommend:

Answer 3

A. Assembling a team to analyze the problem and develop interventions to reduce the rate to 10% below the NHSN 50

th

percentile

because of the high mortality associated with

VAP.

B. Developing a team to study preventative measures for VAP that can be implemented before you begin your formal VAP Quality Improvement project.

C. Changing

the focus for the year to central line-related infections because that rate has been consistently above the NHSN 50

th

percentile and also has a high associated mortality.

D.

Changing the focus for the year to

Catheter-Associated Urinary Tract Infections (CAUTI) because

there is a new catheter

product available

with a guarantee that its use will

substantially reduce CAUTI rates.

Question 4

An 89 y-o female

is admitted to a med-

surg

unit on 3/6/15 after falling at

home. She is found to have a hip fracture

and will have ORIF on 3/9/15.

Her

urine output drops and a foley catheter is

placed on 3/8/15. She has ORIF on 3/9/15, and stays in PACU overnight to 3/10/15 due to lack of beds.

On 3/10/15, she finally gets a bed on different unit and becomes febrile

to 101.5

later that day.

Urine culture is taken on 3/11/15 and

the foley is removed. On

3/13/15,

the

culture shows

E

.

coli

>

100,000 cfu/ml.

Answer 4

According to

2015 NHSN definitions, is

this a CAUTI? If

so,

to which unit/area is it attributed

?

Original floor

OR

PACU

Second Unit, where fever occurred and culture was collected.

Answer 4 - continued

Did this patient need a foley in the first place?

Was this a preventable CAUTI?