Which set of precaution measures are MOST appropriate for a patient being treated for Clostridioides (formerly Clostridium) difficile colitis?
Correct Answer: C
Alcohol-based hand rub does not kill C. (formerly Clostridium) difficile spores, which are more effectively removed by mechanical scrubbing with soap and water. It is recommended that contact precautions and soap-andwater hand washing be continued for at least 48 hours after diarrhea resolves.
You are placing a central venous catheter in a 44-year-old patient with unknown identity found down in the street. The patient is intubated and sedated. After multiple attempts to cannulate the vein, you accidentally stick your finger with the finder needle. You remove your glove and see that your finger is bleeding.
What should you do next?
Correct Answer: A
Soap and water should be used to wash the injured body part after a needlestick injury. The efficacy of chlorhexidine cleansing is not known. The patient on whom the procedure was being performed should be tested for HIV and hepatitis, but only after consent has been obtained from the patient. Because this patient is intubated and sedated, consent for testing cannot currently be obtained, and it is important to discuss postexposure prophylaxis against transmissible infections with your hospital’s needlestick team as soon as possible after a needlestick or mucosal exposure occurs.
A 32-year-old pregnant woman is admitted to your intensive care unit with severe respiratory distress and hypoxemia requiring supplementary oxygen delivered by high-flow nasal cannula. Computed tomography (CT) of the chest demonstrates bilateral perihilar ground-glass and nodular infiltrates. On physical examination, you notice a diffuse erythematous and vesicular rash, with crops of vesicles in different stages of development. The patient tells you the rash is extremely pruritic.
Which of the following infection control measures is MOST appropriate?
Correct Answer: B
Disseminated and severe varicella infection, including varicella pneumonia, is more likely to occur in pregnant and immune-compromised hosts. Primary infection is followed by viral replication in regional lymph nodes for 4 to 6 days, followed by secondary viremia and invasion of the skin tissue leading to rash approximately 2 to 3 weeks later. Varicella is highly transmissible, with secondary attack rates approaching 90% among household contacts in the prevaccine era. Varicella is spread both by contact with virus-filled vesicles and through aerosolized droplets or airborne viral particles, mandating strict infection control precautions. Because varicella is a fetal teratogen, it is recommended that pregnant women not be assigned to care for patients with active varicella infection.
Which of the following scenarios represents INAPPROPRIATE use of an indwelling urethral catheter?
Correct Answer: D
Up to half of all indwelling urethral catheters in hospitalized patients are placed for inappropriate indications. Patients who can void spontaneously or collect urine for testing do no need an invasive urethral catheter placed. Men with urinary incontinence without obstruction can have an external penile sheath (“Texas” or “condom” style) catheter placed. Intermittent urethral catheterization can be used for patients with urinary retention or obstruction and must be performed at regular intervals to prevent bladder overdistention.
After 4 days of being intubated and sedated on a ventilator, a 62- year-old man develops fever, an increased oxygen requirement, and new infiltrates on chest X-ray. Are these findings sufficient to diagnose the patient with a probable ventilator-associated pneumonia?
Ventilator-associated pneumonia is one of several ventilator-associated events (VAE). VAEs can be difficult to diagnose, as patients are often unable to report their symptoms. Diagnostic criteria for probable ventilator-associated pneumonia include new or progressive pulmonary infiltrates on chest X-ray or CT scan, plus one or more clinical signs of infection, including increased oxygen requirement, increased respiratory secretions, increased peripheral blood white blood cell count, and fever. Diagnosis of probable ventilator-associated pneumonia is confirmed when a potential pathogen is identified in a lower respiratory tract sample.
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