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.

“Infections prolong hospital stays, create long-term disability, increase resistance to antimicrobials, represent a massive additional financial burden for health systems, generate high costs for patients and their family, and cause unnecessary deaths”

World Health Organization

“Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance.”

MAYO CLINIC

Hyponatremia is a condition that occurs when the level of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that’s in and around your cells.

In hyponatremia, one or more factors — ranging from an underlying medical condition to drinking too much water during endurance sports causes the sodium in your body to become diluted. When this happens, your body’s water levels rise, and your cells begin to swell. This swelling can cause many health problems, from mild to life-threatening.

Hyponatremia treatment is aimed at resolving the underlying condition. Depending on the cause of hyponatremia, you may simply need to cut back on how much you drink. In other cases of hyponatremia, you may need intravenous fluids and medications.

Sodium we know what systems it effects from yesterday’s article on sodium in general of how it works in the human body.  If you don’t know and didn’t get a chance to read it yesterday stop this article going to yesterday’s to read over the general information of how sodium works and effects the human body.  This will help you understand the signs and symptoms easier.

Hyponatremia signs and symptoms may include:

• Nausea and vomiting
• Headache
• Confusion
• Loss of energy and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps
• Seizures
• All the way to a ComaA normal sodium level is between 135 and 145 milliequivalents per liter (mEq/L) of sodium. Hyponatremia occurs when the sodium in your blood falls below 135 mEq/L.
• Many possible conditions and lifestyle factors can lead to hyponatremia, including:
• Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance playing a particular role in acid and base balances inside our blood stream working with in particular potassium.

• Certain medications. Some medications, such as some water pills (diuretics), antidepressants and pain medications, can cause you to urinate or perspire more than normal.  Medications that increase your risk of hyponatremia include thiazide diuretics as well as some antidepressants and pain medications. In addition to the recreational drug Ecstasy has been linked to fatal cases of hyponatremia.
• Heart, kidney and liver problems. Congestive heart failure and certain diseases affecting the kidneys or liver can cause fluids to accumulate in your body, which dilutes the sodium in your body, lowering the overall level.
• Syndrome of inappropriate anti-diuretic hormone (SIADH). In this condition, high levels of the anti-diuretic hormone (ADH) are produced, causing your body to retain water instead of excreting it normally in your urine.
• Chronic, severe vomiting or diarrhea. This causes your body to lose fluids and electrolytes, such as sodium.
• Drinking too much water. Because you lose sodium through sweat, drinking too much water during endurance activities, such as marathons and triathlons, can dilute the sodium content of your blood. Drinking too much water at other times can also cause low sodium.
• Dehydration. Taking in too little fluid can also be a problem. If you get dehydrated, your body loses fluids and electrolytes.
• Hormonal changes. Adrenal gland insufficiency (Addison’s disease) affects your adrenal glands’ ability to produce hormones that help maintain your body’s balance of sodium, potassium and water. Low levels of thyroid hormone also can cause a low blood-sodium level.
• The recreational drug Ecstasy. This amphetamine increases the risk of severe and even fatal cases of hyponatremia. In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in coma and death.Seek emergency care for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness.
• Call your doctor if you know you are at risk of hyponatremia and are experiencing nausea, headache, cramping or weakness. Depending on the extent and duration of these signs and symptoms, your doctor may recommend seeking immediate medical care.
• Premenopausal women appear to be at the greatest risk of hyponatremia-related brain damage. This may be related to the effect of women’s sex hormones on the body’s ability to balance sodium levels.
• In chronic hyponatremia, sodium levels drop gradually over 48 hours or longer — and symptoms and complications are typically more moderate.
• Also for older adults they may have more contributing factors for hyponatremia, including age-related changes, taking certain medications and a greater likelihood of developing a chronic disease that alters the body’s sodium balance.

“If you suspect that someone has had a brain injury, the first step is to talk with the person, share your observations, and encourage the person to get help. The next step is for the person to share a medical, family and military history with the physician.”

Harvey E. Jacobs, Ph.D. and Flora Hammond, M.D

If you could split the brain right down the middle into two symmetrical, or equal parts, you would have a right and left hemisphere. Although equal in size, these two sides are not the same, and do not carry out the same functions.

Robert W. Sperry (awarded the Nobel Prize in 1981. While studying the effects of epilepsy)

“The brain stem controls the flow of messages between the brain and the rest of the body.”

MedicineNet.com (http://www.medicinenet.com/script/main/art.asp?articlekey=2517)

“The brain is a soft mass of supportive tissues and nerves connected to the spinal cord. Some of the nerves in the brain go right to the eyes, ears and other parts of the head. Other nerves connect the brain with other parts of the body through the spinal cord to control personality, senses and body functions from breathing to walking.”

Neurology and Neuro Surgery of John Hopkins Medicine http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/brain_tumor/about-brain-tumors/how-the-brain-works.html

“Catheter ablation for SVT utilizing radiofrequency ablation (electrocautery injury) was developed in the 1980’s and has since revolutionized the treatment of SVT.”

UNC Healthcare (Center for vascular and heart care)