Heart disease is the leading cause of death in the United States for both men and women.

Robert F. Malacoff, M.D (is a Board-certified Cardiologist and Electrophysiologist who treats patients at Orange Regional Medical Group and Catskill Regional Medical Group and has been providing exceptional care for more than 35 years)

Many risk factors revolve around the nature of the traumatic event itself.

Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Women’s changing role in our military

A growing number of women are serving in the US military. In 2008, 11 of every 100 Veterans (or 11%) from the Afghanistan and Iraq military operations were women. These numbers are expected to keep rising. In fact, women are the fastest growing group of Veterans.

What stressors do women face in the military?

Here are some stressful things that women might have gone through while deployed:

-Combat Missions.                                                                                                                                                                               –Military -Sexual Trauma (MST). A number of women (and men) who have served in the military experience MST. MST includes any sexual activity where you are involved against your will, such as insulting sexual comments, unwanted sexual advances, or even sexual assault.

-Feeling Alone. In tough military missions, feeling that you are part of a group is important.

-Worrying About Family. It can be very hard for women with young children or elderly parents to be deployed for long periods of time. Service members are often given little notice. They may have to be away from home for a year or longer. Some women feel like they are “putting their lives on hold.”

Because of these stressors, many women who return from deployment have trouble moving back into civilian life. While in time most will adjust, a small number will go on to have more serious problems like PTSD.

How many women Veterans have PTSD?

Among women Veterans of the conflicts in Iraq and Afghanistan, almost 20 of every 100 (or 20%) have been diagnosed with PTSD. We also know the rates of PTSD in women Vietnam Veterans. An important study found that about 27 of every 100 female Vietnam Veterans (or 27%) suffered from PTSD sometime during their postwar lives. To compare, in men who served in Vietnam, about 31 of every 100 (or 31%) developed PTSD in their lifetime.

What helps? Research shows that high levels of social support after the war were important for those women Veterans.

What can you do to find help?

If you are having a hard time dealing with your wartime memories, there are a number of things that you can do to help yourself. There are also ways you can seek help from others.

• Do things to feel strong and safe in other parts of your life, like exercising, eating well, and volunteering.
• Talk to a friend who has been through the war or other hard times. A good friend who understands and cares is often the best medicine.
• Join a support group. It can help to be a part of a group. Some groups focus on war memories. Others focus on the here and now. Still others focus on learning ways to relax.
• Talk to a professional. It may be helpful to talk to someone who is trained and experienced in dealing with aging and PTSD. There are proven, effective treatments for PTSD. Your doctor can refer you to a therapist. You can also find information on PTSD treatment within VA at: VA PTSD Treatment Programs.
• Tell your family and friends about LOSS and PTSD. It can be very helpful to talk to others as you try to place your long-ago wartime experiences into perspective. It may also be helpful for others to know what may be the source of your anger, nerves, sleep, or memory problems. Then they can provide more support.

Don’t be afraid to ask for help. Most of all, try not to feel bad or embarrassed to ask for help. Asking for help when you need it is a sign of wisdom and strength.

Don’t let PTSD get in the way of your life, hurt your relationships, or cause problems at work or school.

PTSD treatment can help.

Learn what treatment is like to help you make choices about what’s best for you.

If you suspect that you or a loved one has post-traumatic stress disorder (PTSD), it’s important to seek help right away. The sooner PTSD is confronted, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past.

OTHER TYPES OF TREATMENT:

• Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replacing them with more balanced picture.
• Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems caused by PTSD symptoms.
• Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
• EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.
• When looking for a therapist for post-traumatic stress disorder (PTSD), seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can start by asking your doctor if he or she can provide a referral to therapists with experience treating trauma. You may also want to ask other trauma survivors for recommendations, or call a local mental health clinic, psychiatric hospital, or counseling center.

You have to remember the problem is not you, but the traumatic experience you went through whether it was a few weeks ago, a few years ago or 40 years ago. This  has left you in a black hole that you can’t get out of. You need to get that bad experience you went through that’s left in your brain  under control or with some form of closure. To do that you first need to recognize you need help and you are better off doing it with a group or a counselor. For you to help anyone else you have to help yourself.  If you don’t you can’t help anyone or escape from this black hole. Take the step that will help you move on and live a happier life.

“We owe this freedom of choice and action to those men and women in uniform who have served this nation and its interests in time of need. In particular, we are forever indebted to those who have given their lives that we might be free.”

Ronald Reagan (May 26, 1983)

“Health care-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a health care setting. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens.”

Office of disease prevention and health promotion (http://www.health.gov/hcq/prevent_hai.asp)

THE KEY is to not allowing a Health Acquired Infection-HAI to even occur; this is through PREVENTION!

To reach this key is to understand exactly what a HAI is and how they work in spreading.  If you didn’t get a chance to read Tues. Part 1, Wed. Part 2 and Thurs. Part 3 articles do that first to learn what HAIs actually are.  The public has to get focused.

Prevention with the most common HAI is UTIs, the CDC recommends healthcare workers to do the following:

• Insert urinary catheters only for the appropriate indications & minimize their use in those at high risk of UTIs, especially the elderly, women, & immunocompromised patients.
• Leave catheters in place only for as long as needed. Remove catheters on postoperative patients as soon as possible, preferably within 24 hours unless there are appropriate indications for continued use.
• Avoid use of urinary catheters in patients and nursing home residents for the management of incontinence. It is better to be do 2hr checks on the patient&do clean up immediately.
• Ensure that only properly trained persons insert and maintain catheters.
• Insert catheters using aseptic technique and sterile equipment. Use proper CDC hand hygiene and standard or appropriate isolation precautions (see discussion of these topics later in this course) when inserting or handling catheters. Perform hand hygiene immediately before and after insertion or any manipulation of the catheter site or device.
• Maintain a closed drainage system with unobstructed urine flow. Urinary catheter systems with preconnected, sealed catheter-tubing junctions are suggested for use.
• Do not clamp indwelling catheters prior to removal and do not change indwelling catheters or drainage bags at routine intervals. Catheters and drainage bags should be changed based on clinical indications, such as infection, obstruction, or when the closed system is compromised.
• Any visitors should wash hands before entering and upon leaving following with antiseptic cleaner, like Purell. If the pt is on any isolation a sheet taped to the door will show all instructions of what the visitor should do before entering the room and if not sure the visitor can always ask the RN or staff.

Prevention of an infection regarding female as a gender there is nothing you can do about that or the anatomy of the urethra. After having sex there is something you can do in attempting prevention of a UTI.   A women can clean the perineal/vaginal area right after the activity to decrease the chance of an infection from occurring through entering her urethra or even or vagina, with thorough drying. Remember water attracts bacteria.

Prevention is key to eliminating central line acquired bloodstream infections in healthcare facilities. The CDC recommends healthcare professionals follow these guidelines to reduce CLABSIs in the workplace:

• Staff shold choose proper central line insertion sites to minimize infections and mechanical complications. Avoid the femoral site in adult patients.
• Staff follow proper insertion practices, including complying with hand hygiene recommendations; using maximum sterile barrier precautions, performing adequate skin antisepsis with > 0.5% chlorhexidine with alcohol; and covering the site with sterile gauze or sterile, transparent, semipermeable dressings.
• Staff accessing the line, scrub the hub/port with an appropriate antiseptic (e.g., chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and access lines only with sterile devices.
• Replace dressings that are wet, soiled, or dislodged. When changing dressings, use aseptic technique, including clean and sterile gloves, as per facility policy.
• Staff perform daily audits to determine if a central line is still needed, and remove unnecessary central lines.
• Any visitors should wash hands before entering and upon leaving. If the pt is on any isolation a sheet taped to the door will show all instructions of what the visitor should do before entering the room and if not sure the visitor can always ask the RN or staff.

The key to prevention with surgery sites getting infected is the following:

Prior to Surgery

• Administer prophylactic antibiotics in accordance with evidence-based standards and guidelines 1 hour before surgery. This will help prevent an infection from occurring.
• Whenever possible, identify and treat remote infections before elective surgery, or postpone surgery until the infection has resolved.
• Prep skin using an appropriate antiseptic agent and proper technique. Do not remove hair at the operative site unless it will interfere with the operation. If hair must be removed, razors should not be used.
• For colorectal surgery patients, mechanically prepare the colon (enemas, cathartic agents).

During Surgery the following takes place:

• Keep operating room doors closed during surgery except as needed for passage of equipment, personnel, and the patient.
• Consider re-dosing antibiotics at the 3-hour interval in procedures lasting longer than 3 hours and adjust the antimicrobial prophylaxis dose for patients with a body mass index greater than 30.
• Consider using at least 50% fraction of inspired oxygen intra-operatively and immediately postoperatively in select procedures.

After Surgery

• Protect the primary closure incision with a sterile dressing for 24–48 hours postop.
• Maintain immediate postoperative normothermia.
• For cardiac surgeries, control blood glucose levels during the immediate postoperative period. Glucose level should be measured at 6:00 a.m. on postop day 1 and day 2 (procedure day is postop day 0). Postop glucose level should be maintained at < 200mg/dL.
• Discontinue antibiotics according to evidence-based standards and guidelines (within 24 hours after surgery end time, or 48 hours for cardiac surgeries).
• Any visitors should wash hands before entering and upon leaving. If the pt is on any isolation a sheet taped to the door will show all instructions of what the visitor should do before entering the room and if not sure the visitor can always ask the RN or staff.

• .Patients with MRSA, VRE, and C-DIFF HCIs are placed in single contact isolation rooms, or, if a single room is not available, cohort patients put the patients in the same room or in the same patient care area with the same HCI (Ex. Both patients with VRE in their urine). Treatment by healthcare workers for patients with MRSA, VRE, and C-DIFF infections is to use proper standard isolation techniques plus contact isolation techniques to prevent spreading of the HCI to anyone out of the room or to them-selves. Anyone visitor the patient with MRSA, VRE or C-DIFF would be educated on how to prevent spreading these HCIs out of the room with protecting themselves from getting the infection.
• Some bacteria does not need a living host to survive.  Microbes such as MRSA, vancomycin-resistant enterococci (VRE), and C. difficile can survive for long periods on environmental surfaces, such as bedrails and phones.  After being contaminated, these environmental surfaces become the source of infection.  A clean healthcare environment is essential for prevention of infection from these organisms.
• The other way in prevention of these HCIs are through cleaning and disinfection of the patient environment. This includes high touch surfaces, such as bedrails, carts, toilets, and doorknobs, as well as general housekeeping surfaces, such as floors, walls, and blinds. Proper disinfection and sterilization of medical and surgical instruments and devices are also vital in the prevention of HAIs.
• The Joint Commission includes infection prevention as one of its National Patient Safety Goals in hospitals, behavioral care facilities, and ambulatory care facilities, as well as home health care. Specifically, the Joint Commission emphasizes handwashing as key to infection prevention. Although hand hygiene and transmission precautions are routine in healthcare facilities, a review of evidence-based practice can remind healthcare professionals of the process of and rationale for these procedures.
• Handwashing is the single most effective way to prevent the transmission of infection.

The public must get involved with medical staff to stay on top of prevention with HAIs.  This is to allow HAIs to go on a continual reduction.  This will only occur if both staff of a health care facility get involved with the public.  Having everyone nationally in all communities take part will only happen if increased health awareness is provided, which in the end will help decrease infection.  This will indirectly put a reduction on our medical debt, which will take time.  Our medical technology has taken us so far in learning and treating infection compared to 100 years ago and even less; but we need the public to get more focused on how to prevent HAIs as well.  We can’t leave it up to the health care facilities staff to only take action to prevent HAIs.  The public needs to take part in this now.  Broadening the public’s knowledge will help prevent people from getting a HAI when admitted to the hospital or going to any type of medical facility for care.  It also will get the public more focused on HAIs allowing the family with the patient to take more action in prevention of HAIs (The key).  We the people in our society are responsible in reaching the goal for better health.  The medical staff, who is already carrying out infection control measures, with the public’s help through increased knowledge on HAIs will only increase the chance of continued reduction in infections, to possibly minimal infections one day, in all types of hospitals or health care facilities.  We all must get focused!

“More action is needed at every level of public health and health care to improve patient safety and eliminate infections that commonly threaten hospital patients.”

CDC (Center for disease control and prevention).

1-C-DIFF or C-difficile, know as Clostridium difficile infection (CDI), or Clostridium difficile–associated disease (CDAD), which is an infection of the intestines caused by the anaerobic, spore-forming, gram-positive bacillus C. difficile.  This microbe was first identified in 1935 when it was isolated from the stools of neonates. C. difficile produces heat-resistant spores that can remain viable on fomites in the environment for years, becoming a source of outbreaks in healthcare facilities. This bacillus also produces two types of toxins: Toxin A (an enterotoxin) and Toxin B (a cytotoxin). These toxins are responsible for the inflammatory responses of the colon, which results in loss of epithelial integrity and the production of watery diarrhea. C. difficile is the most common cause of antibiotic-associated diarrhea and pseudomembranous colitis and has proved extremely difficult to control due to new, more resistant strains.

The greatest risk factor for CDI is the use of antibiotics, such as cephlasporins, clindamycin, or the penicillins, because these antibiotics kill the normal flora of the colon, causing overgrowth of C. difficile. Risk is increased for those taking multiple antimicrobials and those who take antimicrobials for longer time periods. Other risk factors for CDI include advanced age. Although almost half of the infections occur in persons younger than 65, most CDI-related deaths occur in the elderly. People with HIV infection, compromised immune systems, and compromised physical status are also at increased risk for CDI. Hospital admission increases one’s chance of acquiring CDI, as does gastrointestinal surgery.

Transmission of CDI occurs by the fecal-oral route.

The time between exposure to C. difficile and infection is 2 to 3 days. Symptoms of CDI vary greatly, ranging from asymptomatic to mild (fever, malaise, and gastrointestinal symptoms, including abdominal pain and cramps, and mild to moderate foul-smelling diarrhea that is rarely bloody) to extremely severe toxic megacolon, septic shock, and even death. Complications of C. difficile include pseudomembranous colitis or fulminant colitis.

Diagnosis is based on clinical history (antibiotic use in the previous 2 months, diarrhea after 72 or more hours of hospitalization), and presence of C. difficile in the stool. Stool culture is the most sensitive test and is often used for diagnosis in the hospital setting. Colonoscopy revealing histopathology with pseudomembranous colitis is also diagnostic but not necessary in most cases.

Treatment for CDI begins with discontinuation of the antibiotic causing the infection. In many cases, this step is the only necessary treatment since normal flora can reestablish in the colon. If mild to moderate diarrhea persists, patients can be treated with either metronidazole or vancomycin. In cases of severe diarrhea, vancomycin is the drug of choice for treatment due to its history of rapid symptom resolution and overall fewer treatment failures. Although antibiotic treatment will clear the infection, it will not kill the bacterial spores. In 27% of cases, relapse occurs within 3 weeks of antibiotic termination. In extreme cases, colectomy with end ileostomy may be necessary. Treatment for asymptomatic cases is not recommended.

An innovative CDI treatment may be on the horizon. Researchers have shown that C. difficile infection arises as the result of the disruption of natural flora in the intestines, a condition known as dysbiosis. New research in the treatment of CDI involves isolating specific gut bacteria in the fecal matter of healthy individuals and incorporating it into the gut of a person with CDI to restore normal flora and cure the infection.

CDI can be catastrophic to patients and indeed to entire healthcare facilities if an outbreak occurs. To prevent CDI, follow these guidelines from the CDC:

• Immediately isolate patients  in a private room with confirmed C. difficile infection and use contact precautions for the duration of diarrhea.
• Educate healthcare personnel, patients, their families, and any visitors about C. difficile and help them maintain contact precautions.
• Follow proper handwashing techniques. Hand hygiene for C. difficile must include vigorous washing of hands with soap and water to mechanically remove spores. Alcohol-based hand rubs are not effective against C. difficile.
• Because C. difficile spores can survive on objects for long periods of time be sure to thoroughly clean and disinfect equipment and objects in the environment. Consider use of sodium hypochlorite (bleach)–containing agents or EPA-registered disinfectants with sporicidal claim for environmental cleaning.
• Any facility has a laboratory-based alert system for immediate notification of positive c-diff.

2- MRSA Methicillin-resistant Staphylococcus aureus (MRSA), also known as multidrug resistant S. aureus, includes any strain of S. aureus that has become resistant to the group of antibiotics known as beta-lactam antibiotics. Included in this group are the penicillins (methicillin, amoxicillin, oxacillin) and cephalosporins. Staphylococcus aureus includes gram-positive, nonmotile, non-spore-forming cocci that can be found alone, in pairs, or in grapelike clusters.

When penicillin was first introduced in the early 1940s, it was considered to be a wonder drug because it reduced the death rate from Staphylococcus infection from 70% to 25%. Unfortunately, by 1944, drug resistance was beginning to occur, so methicillin was synthesized, and, in 1959, it became the world’s first semisynthetic penicillin. Shortly thereafter in 1961, staphylococcal resistance to methicillin began as well, and the name “methicillin-resistant S. aureus” and the acronym MRSA were coined. Although methicillin was discontinued in 1993, the name and acronym have remained because of MRSA history.

MRSA is now the most common drug-resistant infection acquired in healthcare facilities. In addition to becoming more problematic as a top HAI in recent years, transmission of MRSA has also become more common in children, prison inmates, and sports participants. Community-associated MRSA (CA-MRSA) most often presents in the form of skin infections. Hospital-acquired MRSA (HA-MRSA) infections manifest in various forms, including bloodstream infections, surgical site infections, and pneumonia. Although approximately 25–30% of persons are colonized in the nasal passages with Staphylococcus, less than 2% are colonized with MRSA. MRSA are extremely resistant and can survive for weeks on environmental surfaces. Transfer of the pathogen can occur directly from patient contact with a contaminated surface or indirectly as healthcare workers touch contaminated surfaces with gloves or hands and then touch a patient.

Risk factors for healthcare-acquired MRSA infection include advanced age, young age, use of quinolone antibiotics, and extended stay in a healthcare facility. Those with diabetes, cancer, or a compromised immune system are also at increased risk of infection.

Symptoms of MRSA infection vary depending on the type and stage of infection and the susceptibility of the organism. Skin infections may appear as painful, red, swollen pustules or boils; as cellulitis; or as a spider bite or bump. They can be found in areas where visible skin trauma has occurred or in areas covered by hair. Patients may also have fever, headaches, hypotension, and joint pain. Complications of MRSA-related skin infections include endocarditis, necrotizing fasciitis, osteomyelitis, and sepsis.

Treatment for MRSA infections varies based on site of infection, stage of infection, and age of the individual. Treatment includes drainage of abscesses, surgical debridement, decolonization strategies, and antimicrobial therapy with antibiotics such as vancomycin, clindamycin, daptomycin, linezolid, rifampin, trimethoprim-sulfamethoxazole (TMP-SMX), quinupristin-dalfopristin, telavancin, and tetracyclines (limited use). MRSA is rapidly becoming resistant to rifampin; therefore, this drug should not be used alone in the treatment of MRSA infections. Consultation with an infectious disease specialist is recommended for treatment of severe MRSA infections.

3-VRE- Vancomycin-Resistant Enterococci Infection (VRE) or Enterococci (formerly known as Group D streptococci). VRE are non-spore-forming, gram-positive cocci that exist in either pairs or short chains. They are commonly found in the human intestine or the female genital tract. The most common organism associated with vancomycin-ressistant enterococci (VRE) infection in hospitals is Enterococcus faecium. Enterococcus faecalis is also a cause of human disease. VRE infections can occur in the urinary tract, in wounds associated with catheters, in the bloodstream, and in surgical sites. Enterococci are a common cause of endocarditis, intra-abdominal infections, and pelvic infections.

VRE was first reported in Europe in 1986, followed in 1989 by the first report in the United States. Since then it has spread rapidly. Between 1990 and 1997, the prevalence of VRE in hospital patients increased from less than 1% to 15%.

VRE, which is found predominantly in hospitalized or recently hospitalized patients, are difficult to eliminate because they are able to withstand extreme temperatures, can survive for long periods on environmental surfaces, and are resistant to vancomycin. Transmission of VRE occurs most commonly in the form of person-to-person contact by the hands of healthcare workers after contact with the blood, urine, or feces an infected individual. VRE is also spread from contact with environmental surfaces, or through contact with the open wound of an infected person.

People most at risk for infection with VRE include the elderly and those with diabetes, those with compromised immune systems, and those who are already colonized with the bacteria. Prolonged hospitalization, catheterization (urinary and intravenous), and long-term use of vancomycin or other antibiotics also increase a person’s risk of infection.

Symptoms of VRE infection vary depending on the site of infection and may include erythema, warmth, edema, fever, abdominal pain, pelvic pain, and organ pain. Definitive diagnosis is made by culture and susceptibility testing with specimens obtained from suspected sites of infection.

Children and geriatrics are two groups with the highest risk for infection. In addition to age but there are a number of other key risk factors that can contribute to the likelihood of getting a hospital infection. HAIs are one of the biggest public health issues facing society today. Every year, an estimated 1.7 million Americans get a healthcare associated infection, and 99,000 people die as a result of these infections.

Pennsylvania Dept. of Health

Factors and types of procedures that put a individual at risk for Health Acquired Infections (HAIs):

*Healthcare facilities, including hospitals, acute care facilities, and long-term care facilities, contain many organisms and methods of transfer of bacteria; however, certain infections occur more frequently than others in healthcare environment.

*The most common pathogens causing catheter associated urinary tract infections (CAUTIs) are E. coli, Candida spp., Enterococcus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter spp. Pathogens may gain access to the urinary system during insertion, manipulation, maintenance, or removal of a urinary catheter. Pathogens enter the urinary tract via the extra-luminal route, by moving along the outside of the catheter getting up in the urethra back up in the urinary bladder and something not sterile or even clean got up into a area that is causing risk of infection.

Studies show that by the 30th day of catheterization, which is also considered the demarcation between short- and long-term catheterization the daily risk, of bacteria in the urine approaches to 100%. In a acute hospital if a patient has a catheter applied for surgery it is out the next day or two and if not many facilities have MDs having to renew the order in the patient’s chart or its removed if the intial order stated the time it starts and the time the orders ends (usually in 48 hrs), again if it is a simple operation (ex. A pacemaker insertion with no post-op difficulties as opposed to a patient who has CABG-coronary artery bypass graft surgeRemember in most cases there’s several factors putting many people at higher risk for the UTIs, here are some examples:

*Certain women – One major reason for this is because the urethra in all women is shorter than in men, this cuts down on the distance for urine in the urinary bladder to reach the end of the urethra where the urine comes out. This allows bacteria to take a shorter route to enter a women in reaching her bladder going back up the urethra and putting her at higher risk of infection.      Also women more sexually active is at higher risk for UTIs also cause of the same reason again due to a shorter urethra.

`*AGE -the older adults and those with prolonged catheterization (infection begins when an organism successfully colonizes by entering the body, growing and multiplying). Medical conditions that increase the risk of a CAUTIs include diabetes, diarrhea, renal insufficiency, and a compromised immune system. Colonization of the catheter drainage bag can also increase a patient’s risk for a CAUTIs (the reason to get it out of the patient as soon as possible, if the patient is a candidate for removal). A patient for example that may not be a candidate and leaving it in for 2 weeks or more is a patient who is incontinent but let’s say is in the hospital with a open wound to the lower back or buttock or hip but if urine gets into the wound it will just infect it so to prevent urine incontinency from touching the wound the foley catheter is inserted as a diversion. When the wound heals it’s immediately discontinued and taken out of the patient, for example.

If a bacteria infection is presented (a UTI) than the patient should be started on a antibiotic that only kills bacterial infections. The patient should stay on the medication 7 to 14 days.

* Central Line-Associated Bloodstream Infections-Perhaps the most deadly HAI, central line–associated bloodstream infections (CLABSIs) are transmitted via a central venous catheter (CVC) directly to a patient’s bloodstream. A CVC is any intravascular catheter that terminates at or close to the heart or in one of the great vessels and is used for infusion of medications, nutrition, and blood; withdrawal of blood; hemodialysis access; and hemodynamic monitoring. CVCs may be placed in the large veins of the chest (through axillary or subclavian veins), the neck (through the internal jugular vein), or the groin (through the femoral vein). The infection cannot be related to any other infection the patient might have and must not have been present or incubating when the patient was admitted to the healthcare facility. Tens of thousands of CLABSIs occur in U.S. hospitals each year, with deadly results: Up to 25% of those diagnosed with a CLABSI will die from the infection. Unfortunately a significant number of these infections continue to occur in inpatient settings and in hemodialysis facilities, even though most CLABSIs, especially those occurring in ICUs, are preventable. The longer the patient has a central line, the more likely he or she is to acquire a bloodstream infection via the line. The type of material the catheter is made from also affects infection transmission. Infection risk is also increased in patients with concurrent infection and those treated in the ICU.

*Surgical Skin Infections (SSIs) – Anytime the skin barrier is broken, the risk for infection rises, so it is only logical that surgery will increase a patient’s risk for a HAI. Surgical site infections (SSIs) occur at the location where a surgery was previously performed. To be diagnosed as a SSI, the infection must occur within 30 days of surgery if no implant is left in place or within 1 year if the implant is in place and the infection appears to be related to the operative procedure.

*Ventilator-associated pneumonia (VAP) is an infection of the lungs that develops after a person has been on a ventilator for longer than 48 hours. The most common type of HAI contracted in the ICU, VAP occurs in as many as 28% of patients who have had mechanical ventilation. Infection occurs because the endotracheal or tracheostomy tube allows passage of microbes into the lungs. These organisms may originate from the patient’s aspirate, from the oropharynx and digestive tract, or from external sources, such as contaminated equipment and medications.

Although any microbe can be the causative agent, certain microbes are most often implicated due to increasing drug resistance. Pseudomonas aeruginosa is the most common multidrug-resistant organism responsible for VAP. Other microbes that cause VAP include Staphlococcus aureus, Klebsiella spp., Escherichia coli, Enterobacter spp., Actinobacter spp., MRSA, and Serratia marcescens. Pneumonia is considered early in onset if it occurs within the first 4 days after hospital admission. Multidrug resistant organisms are more likely to be the cause of late-onset pneumonia, defined as 5 or more days postadmission.

In addition to recent ventilation, other risk factors increase a patient’s chance of acquiring VAP, such as hospitalization or antibiotic use within the past 90 days, hospital stay greater than 5 days, hemodialysis within the past 30 days, and known circulation of multidrug-resistant organisms in the facility. Immunocompromised residents and those who reside in a nursing home or long-term care facility are also at greater risk for VAP.  Empiric treatment is vital in patients with suspected VAP and can be based on patient risk factors for multidrug-resistant organisms, known local prevalence of resistant organisms, severity of infection, and total number of days the patient was hospitalized before the onset of pneumonia. Unless diagnostic testing shows otherwise, initial empiric therapy should not be changed in the first 48 to 72 hours because clinical response to antibiotic therapy is not likely during this time frame. Patients should be treated with antibiotic therapy for at least 72 hours after a clinical response is attained.

To prevent VAP, the CDC recommends the following strategies:

Strategies to Prevent Aspiration

• Maintain patients in a semirecumbent position.
• Avoid gastric overdistention.
• Avoid unplanned extubation and reintubation.
• Use a cuffed endotracheal tube with inline or subglottic suctioning.
• Maintain an endotracheal cuff pressure of at least 20 cm water.

Strategies to Reduce Colonization of the Aerodigestive Tract

• When possible, use orotracheal intubation rather than nasotracheal intubation.
• Avoid histamine receptor 2 (H2)–blocking agents and proton pump inhibitors for patients who are not at high risk for developing a stress ulcer or stress gastritis.
• Perform regular oral care with an antiseptic solution.

Strategies to Minimize Contamination of Equipment

• Use sterile water to rinse reusable respiratory equipment.
• Remove condensate from ventilatory circuits, keeping the ventilatory circuit closed while you do so.
• Change the ventilatory circuit only when visibly soiled or malfunctioning.
• Store and disinfect respiratory therapy equipment properly.

In addition to these strategies, healthcare professionals should perform daily assessments of readiness to wean to minimize the duration of ventilation. Whenever possible, use noninvasive ventilation methods.                                                                                                                                         Tomorrow’s topic will cover actual common types of bacteria causing HCIs.  The public should know what infections are effecting health care facilities with knowing how to fight them with understanding how HCIs spread.  By increasing knowledge in the communities it will only decrease HCIs in those facilities.  The public should know which will increase our health.