HAIs - Bug Invasion Central
Hospital-Acquired Infections (HAIs) are infections acquired during hospital stay, not present at admission. Major types:
| HAI Type | Key Pathogens | Core Prevention |
|---|---|---|
| CAUTI | E. coli, Klebsiella | Aseptic insertion, remove ASAP (risk ↑ >2 days), closed drainage. |
| CLABSI | Staph spp. (incl. MRSA), Candida | Hand hygiene, CHG skin prep, sterile barriers, daily line necessity review. |
| VAP | P. aeruginosa, S. aureus | VAP Bundle (Head up 30-45°, daily sedation breaks, oral CHG, PUD/DVT prophylaxis). 📌 HUSH for VAP (Head Up, Sedation Holidays) |
| SSI | S. aureus, Enterococci | Pre-op Abx, aseptic technique, glycemic control. |
| C. diff | Clostridioides difficile | Abx stewardship, contact precautions, soap & water hand hygiene. |
⭐ Strict adherence to hand hygiene is the single most effective measure in preventing the spread of hospital-acquired infections.
VTE Prophylaxis - Clot Blockers
- Virchow’s Triad: 📌 SHE - Stasis, Hypercoagulability, Endothelial injury.
- Risk Factors: Surgery (esp. major ortho/abdominal/pelvic), immobility, active cancer, prior VTE, obesity, estrogen, thrombophilia.
- Risk Assessment Tools: Padua (medical), Caprini (surgical). High risk: Padua ≥4, Caprini >5.
- Prophylaxis:
- Pharmacological: LMWH (e.g., Enoxaparin 40mg SC OD), UFH (e.g., 5000 IU SC BD/TDS).
- Mechanical: Intermittent Pneumatic Compression (IPC), Graduated Compression Stockings (GCS).
- Indications: High-risk medical/surgical patients.
- Contraindications (Pharm.): Active bleed, platelets <50,000/µL, high bleed risk surgery.
⭐ In renal impairment (CrCl <30 mL/min), UFH preferred over LMWH (renal clearance).
Pressure Ulcers & Falls - Mobility Mishaps
Pressure Ulcers (PUs)
- Risk: Braden Scale (Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction & Shear). At-risk: Braden Scale ≤18.
- Stages:
- I: Non-blanchable erythema, intact skin.
- II: Partial-thickness loss, dermis exposed.
- III: Full-thickness skin loss, fat.
- IV: Full-thickness tissue loss, muscle/bone.
- Unstageable: Obscured full-thickness loss.
- DTPI: Deep red/purple, non-blanchable discoloration.
- Prevention: Reposition q2h, meticulous skin care, adequate nutrition.
Falls
- Risk Factors: Intrinsic (e.g., age, gait, meds); Extrinsic (e.g., environment, hazards).
- Assessment: Morse Fall Scale.
- Prevention: Multifactorial (medication review, env. mod, alarms, PT/OT).
⭐ Regular patient repositioning (e.g., every 2 hours for bed-bound patients) is a cornerstone of pressure ulcer prevention.
Delirium & ADEs - Mind & Med Mix-ups
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High‑Yield Points - ⚡ Biggest Takeaways
- HAP >48h post-admission; VAP >48-72h post-intubation, prevent with head elevation.
- CAUTI: most common nosocomial infection; prevent by aseptic insertion, prompt removal.
- CLABSI prevention: strict sterile technique, chlorhexidine, daily line review.
- VTE (DVT/PE) prophylaxis (LMWH) vital for immobilized/post-op patients.
- Pressure ulcers: prevent with repositioning, skin care, nutritional support.
- C. difficile: antibiotic-associated; contact precautions, soap/water hand hygiene crucial.
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