Chapter 03 Infection Prevention and Control in the Perioperative Setting


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Chapter 03  Infection Prevention and Control in the Perioperative Setting



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1. Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patient’s own endogenous sources. The most typical causative microorganism cultured from SSIs is:

  1. Staphylococcus epidermidis.
  2. Streptococcus pyogenes.
  3. Staphylococcus aureus.
  4. Enterococcus.

The organisms most commonly found in postoperative SSIs include staphylococcal, enterococcal, pseudomonal, and streptococcal species. S. aureus is the most frequently identified organism.

REF: Page 48

2. A swab of a fluid collection from an edematous, red, and separating postoperative wound is sent to the microbiology lab for culture, sensitivity, and Gram stain. The surgeon expects that the result will show a gram-positive coccus. This Gram stain designation is based on the:

  1. ability to cause plasma to coagulate and form a microscopic clot.
  2. physical and chemical properties of the cell wall.
  3. formation of aerobic clustered spheres.
  4. appearance of a thicker and brownish colored cell wall.

Gram stain is a procedure for staining bacteria; it is the first step in classifying and differentiating bacteria into two large groups (gram-positive and gram-negative) based on the chemical and physical properties of their cell walls. A gram-positive microorganism has a thicker cell wall than a gram-negative microorganism.

REF: Pages 48-49

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 3-2

3. The hospital epidemiologist was alerted when several cultures had recently revealed suspicious similarities. He was concerned about two unrelated patients with similar abscesses in similar body regions. Susan Grant, a 72-year-old diabetic patient taking immunosuppressive medications for chronic Crohn’s disease, had an incision and drainage of a perianal fistula. Shawn Ames, a healthy 22-year-old college student and motocross racer, had an incision and drainage plus excision of a pilonidal cyst. Both patients cultured out a new subtype of S. aureus. Susan’s specimen results showed a significant colony growth of S. aureus plus differential growth of coagulase-negative S. epidermidis, while Shawn’s specimen was a high colony growth coagulase-positive, similar subtype of S. aureus. The epidemiologist charged his department to be alert for this S. aureus subtype and cross-check for trends. He was most concerned about one of these patients in particular and pulled up the medical record for review. Which patient may be at higher risk with the more virulent strain and why?

  1. Susan because she is immunocompromised and elderly and has Crohn’s disease
  2. Shawn because he has pilonidal sinus tracts from sacral pressure caused by racing
  3. Susan because she has a mixed microorganism culture that is coagulase negative
  4. Shawn because he has a high microbial load that is coagulase positive

Coagulase-positive staphylococci are more virulent or pathogenic than coagulase-negative staphylococci. S. aureus is hemolytic, parasitic, pathogenic, and coagulase positive. S. epidermidis is parasitic, less pathogenic, and coagulase negative. Virulence is the potency of a pathogen measured in the numbers required to kill the host.

REF: Pages 48-49

4. While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Antibiotic use is prolific in the perioperative setting. Select the antibiotic application has evidence to support it as a best practice and not, potentially, a misuse of antibiotics.

  1. Antibiotics given IV within 1 hour of the incision for every procedure with an

    incision or entered body system

  2. Vancomycin paste applied to cut edges of the sternum in cardiac surgery
  3. Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions

    at risk for osteomyelitis

  4. Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing


Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 3-3

Drug resistance from treatment-related causes is often the result of misuse (e.g., incorrect use, overuse, or underuse) of antibiotics. It is believed that 50% of all antibiotic use in the United States can be characterized by misuse in one form or another, and efforts to reduce surgical site infections include appropriate prophylactic antibiotic use in surgical patients. It is estimated that half of all antibiotic prescriptions written are not warranted. During antibiotic therapy, the patient may have retained a few resistant organisms. By natural selection, as the susceptible organisms are killed, the resistant organisms multiply and become predominant. Failure to perform sensitivity testing along with inappropriate dosing can contribute to resistance. Although some surgical complications are unavoidable, surgical care can be improved through decisions and subsequent care focusing on evidence-based practice recommendations. Research shows that delivering antibiotics to a patient within 1 hour of beginning surgery can dramatically decrease SSI rates, yet this practice is not followed in all situations.

REF: Pages 55, 58

5. The Centers for Disease Control and Prevention (CDC) has identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption.

  1. Anthrax, tuberculosis, C. difficile, tularemia
  2. Smallpox, plague, botulism, tularemia
  3. Smallpox, monkeypox, avian influenza, anthrax
  4. Anthrax, H1N1 influenza, botulism, smallpox

The potential for bioterrorism is a reality in today’s world. The CDC has identified agents that may pose a risk to national security because of their (1) easy dissemination or transmission from person to person, (2) potential to cause high mortality and have a major public health impact, (3) potential to cause public panic and social disruption, and (4) necessity for special action for public health preparedness.

REF: Pages 64-66

6. Willard Braun was admitted to the ICU 3 weeks ago for heart failure and intractable atrial fibrillation. He has had diarrhea for 4 days that has cultured C. difficile. The transmission-based precautions sign on the door to his room alerts the staff to employ:

  1. Contact Precautions with eye protection.
  2. both Standard Precautions and Contact Precautions.
  3. body substance isolation.
  4. droplet Precautions with standard isolation technique.

In addition to Standard Precautions, Contact Precautions should be used for patients known or suspected to be infected or colonized with epidemiologically important organisms that can be transmitted by (1) direct contact, as occurs when the caregiver touches the patient’s skin, or (2) indirect contact, as occurs when the caregiver touches patient care equipment or environmental surfaces in the patient’s room.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 3-4

REF: Page 64

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