Glossary of Hematologic and Vascular infections
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- What are 2 characteristics of Bacteremia?
-Secondary to infection elsewhere.
- What are 2 characteristics of Septicemia?
- -Bloodstream infection
-Usually systemic spread of GNB.
- What are the 2 types of Endocarditis?
What is the difference?
- Subacute: less severe, caused by valve damage.
Acute: more severe, caused by primary infection.
- What are the top two causes of bloodstream infections?
- 1. Coag neg staphs
(check on this though)
- How do Iv catheters cause BSIs?
- -By causing biofilms
-NF on skin enters puncture site.
- How are catheter-induced BSIs processed?
- 1. Cut off 2" of IV/catheter
2. Roll across BA w/ sterile forceps
- How is a catheter roll interpreted?
- If 15 or more colonies grew, indicates infection.
- What timeframe should blood be collected in for:
- Septic - doesn't matter.
Bacteremia - 30-45 min before fever spike.
- What variables should be controlled during blood collection?
- 1. Skin antisepsis/venipuncture
2. Blood volume required
3. Number of draws/timing
4. NEVER draw from IV.
- How many draws are optimal?
- 3 - 99% recovery
2 - 90%
1 - 80%
- How soon before one arm can have another sample drawn?
- 45 minutes
- What is the best wipe to use for cleaning the draw site?
- Tincture of iodine
- Describe the skin antisepsis prep:
- 1. Use alcohol wipe/iodine tinct
2. wipe 30-60 seconds
3. Wait 30 sec before puncture
- What are the requirements re: blood volume for drawing?
- Blood:diluent should be 1:10
- How many mls per draw is optimal?
- At least 20 mL
- What should be done, whatever culture media is used for blood?
- Vent at least one bottle for aerobic bugs.
- What additive is used for blood cultures? What is its purpose?
- SPS - anti coagulant to prevent clot from trapping bugs.
- What bug resists SPS?
- How long should blood cultures be incubated? At what temp?
- Keep 5-7 days
- What are 4 Non-automated methods for blood cultures?
- 1. Manually observe the bottles
- How does the Isolator work?
- -It spins the blood to concentrate bugs, then you inoculate the plate.
-Adds lysing reagent to free bugs from host cells.
- How does the septi-chek work?
- It has solid media in neck of tube, over broth. You invert everyday.
- How does the Signal system work?
- It detects CO2 released as bacteria grow. Forces gas into upper chamber above media.
- What are the automated blood culture systems NOT for?
- Identification; only detection.
- What are the 4 principles of automated systems?
- 1. Fluorescence detection
2. Laser detection
3. Colorimetric CO2 detection
4. Headspace pressure change detection
- -What's the principle of the Fluorescence detection?
-What's an example?
- -Matrix at bottom of tube lets H+ ions release, changes fluorescence.
-Detector is against matrix.
- -What's an example of the fluorescence detection?
- Bactec 9000
- What is a laser detection system?
- Bactec LX
- How does the laser detection work?
- Growth of bacteria causes CO2 diffusion; Fluorescence changes; Laser passes through bottle neck and detects change.
- How does the Colorimetric CO2 detection work?
- Acidic CO2 causes a pH change in the environment, An indicator in matrix changes color.
- What is an example of colorimetric detection?
- What's another name for headspace pressue change detection? What does it work for?
-Works for ANY gas, not only CO2
-Decreases when bug USES O2
-Increases when bug produces gas.
- How are positive blood cultures PROCESSED?
- -Stain with 1)GRAM 2)ACRIDINE Orange
-Contact DOctor IMmediately!!!
-Culture to BA/Chocolate, if GNB do Lemb/MAC
- What is the ACCEPTABLE CONTAMINATION RATE for blood cultures?
- Less than 3%
- What are some causes of blood culture contamination?
- -Poorly trained phlebotomist
-Not drawing directly into tubes
-Poor skin prep
-Touched the site of puncture
-Drawing from the IV TUBE! :(
Bad contamination tracking
- What are 4 indicators of bacterial contamination?
- 1. Only one bottle/3 is positive
2. Patient's WBC cnt is normal
3. 2/more organisms grow
4. Growth is slow to emerge.
- How should a possibly contaminated transfusion blood bag be worked up?
- 1. Process as a blood culture
2. Inoculate 2 bottles
-25'C for psychrophiles
-37'C for mesophiles
3. Save bag/tube till done.
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