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BTS CPI: Healthcare-Associated Infection Prevention (CLABSI, CAUTI, VAP, SSI, MDRO/C. difficile)

BTS CPI · Work through your exam, one topic at a time.

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Healthcare-Associated Infection Prevention (CLABSI, CAUTI, VAP, SSI, MDRO/C. difficile)

HAI prevention questions test bundle elements, device necessity, and NHSN definitions. Expect CLABSI, CAUTI, VAP/VAE, SSI, and MDRO/C. difficile prevention, plus how to distinguish infection from colonization and contamination.

Core rules

  • CLABSI bundle: hand hygiene; maximal sterile barrier during insertion; chlorhexidine skin antisepsis; optimal site selection; daily review of line necessity; prompt removal. Maintenance includes scrubbing the hub and sterile dressing changes.
  • CAUTI bundle: avoid unnecessary catheters; use aseptic insertion; maintain closed drainage; keep bag below bladder; daily review of necessity; remove promptly. Do not irrigate or disconnect unnecessarily.
  • VAP/VAE bundle: elevate head of bed 30–45 degrees unless contraindicated; daily sedation interruption and readiness-to-extubate assessment; oral care; peptic ulcer and DVT prophylaxis when indicated; avoid unnecessary circuit changes.
  • SSI prevention: administer antimicrobial prophylaxis within 60 minutes before incision (within 120 minutes for vancomycin/fluoroquinolones); maintain normothermia and glucose control; remove hair with clippers, not razors; prepare skin with an appropriate antiseptic.
  • C. difficile: test only unformed stool in symptomatic patients; avoid testing formed stool or repeat testing within 7 days; contact precautions; soap and water; sporicidal cleaning; stop unnecessary antibiotics.
  • MDRO control: hand hygiene, contact precautions for colonized/infected patients, antimicrobial stewardship, environmental cleaning, and screening per policy.
  • Device days are the denominator; a device day is a day the device is present, regardless of insertion date.

Worked example

A patient has a central line in place for 10 days, fever, and a positive blood culture with coagulase-negative staphylococci. One of two bottles is positive; the patient has no other source. The case may be a CLABSI if the NHSN definition is met, but contamination must be excluded. The prevention response is not just antibiotics: review insertion and maintenance, audit hub scrubbing, and remove the line if no longer needed. Document the device days and apply the SIR.

Traps

Do not test formed stool for C. difficile. Do not attribute all bloodstream infections to the line. Do not skip daily necessity review. Do not count a device day only when the device was inserted that day.