7.2 Healthcare-Acquired & Infectious Diseases

7.2 Healthcare-Acquired & Infectious Diseases

Catheter-Associated Urinary Tract Infection (CAUTI)

CAUTI is one of the most common healthcare-associated infections (HAIs) and is directly tied to indwelling urinary catheter use — risk rises the longer a catheter remains in place. The CAUTI prevention bundle emphasizes:

• Avoiding unnecessary catheterization — use only for clearly indicated reasons (accurate output monitoring in unstable patients, urinary retention, certain wound-healing situations), not for nursing convenience or incontinence management alone
• Aseptic insertion technique
• Maintaining a closed, unobstructed drainage system below the level of the bladder
• Securing the catheter to prevent movement and urethral trauma
• Daily review of continued necessity, with prompt removal as soon as the indication resolves

The single highest-leverage intervention across nearly every HAI bundle is the same: ask every day whether the device is still needed, and remove it the moment it isn't.

Central Line-Associated Bloodstream Infection (CLABSI)

The CLABSI (central line) bundle shares the "daily necessity review, prompt removal" principle with CAUTI prevention but adds insertion-specific elements unique to central venous access:

• Hand hygiene before insertion and any line manipulation
• Maximal sterile barrier precautions during insertion — cap, mask, sterile gown, sterile gloves, and a large full-body sterile drape (this comprehensive barrier requirement is what distinguishes the CLABSI bundle from the more limited precautions used for a urinary catheter)
• Chlorhexidine skin antisepsis at the insertion site
• Optimal catheter site selection — subclavian or internal jugular sites are generally preferred over femoral in adults due to lower infection risk
• Daily review of line necessity with removal as soon as it is no longer required

Surgical Site Infection (SSI) and Ventilator-Associated Pneumonia (VAP)

SSI prevention centers on the perioperative window: prophylactic antibiotics given within 60 minutes before incision (within 120 minutes for vancomycin or fluoroquinolones, which require a longer infusion), maintained normothermia, tight glycemic control, and hair removal with clippers rather than razors when hair removal is necessary at all (razors nick skin and increase infection risk).

Hospital-acquired pneumonia (HAP) and its ventilator-specific form, ventilator-associated pneumonia (VAP), are prevented with the ventilator bundle:

Multidrug-Resistant Organisms (MDROs) and Isolation Precautions

Progressive care units routinely manage patients colonized or infected with MDROs, all requiring contact precautions (gown and gloves for anyone entering the room):

• MRSA — methicillin-resistant Staphylococcus aureus
• VRE — vancomycin-resistant Enterococcus
• CRE — carbapenem-resistant Enterobacteriaceae, classified by the CDC as an urgent antibiotic-resistance threat
• ESBL-producing organisms — extended-spectrum beta-lactamase-producing Gram-negative bacteria resistant to most penicillins and cephalosporins

Matching the isolation category to the pathogen's actual transmission route is a core competency:

Influenza is transmitted primarily by droplet spread and managed with droplet precautions plus standard precautions; during surge or pandemic conditions, units also implement pandemic management strategies — surge capacity planning, PPE conservation and reuse protocols where sanctioned, patient cohorting, and expanded telehealth triage — to protect staff and preserve capacity while continuing to deliver progressive-level critical care.

For the exam, remember the pattern: HAI prevention bundles are about reducing the chance of infection developing in the first place (device necessity, sterile technique, positioning, oral care), while isolation precautions are about preventing transmission of an infection a patient already has to other patients and staff. Confusing these two purposes — for example, treating maximal barrier precautions as an isolation category rather than an insertion-bundle element — is a common test-taking error.

Surveillance, Decolonization & Unit-Level Practices

Many progressive care units add daily chlorhexidine gluconate (CHG) bathing for at-risk patients as an adjunct HAI-prevention measure, since CHG bathing reduces overall skin bacterial burden and has been associated with lower CLABSI and MRSA transmission rates in high-acquisition units. Facilities track HAI rates through National Healthcare Safety Network (NHSN) surveillance definitions, which standardize what counts as a CAUTI, CLABSI, SSI, or VAE (ventilator-associated event) for benchmarking and public reporting; the progressive care nurse's bedside bundle compliance directly drives these unit-level metrics.

Newly admitted patients with a history of MDRO colonization, a recent hospitalization, or transfer from a long-term care facility are frequently screened on admission with nasal or rectal swabs so that contact precautions can be initiated promptly rather than after a delayed culture result. Some organisms warrant additional environmental cleaning considerations — C. difficile spores, for example, are not reliably killed by alcohol-based hand sanitizer, so soap-and-water hand hygiene and sporicidal (bleach-based) disinfectants are required in addition to standard contact precautions whenever C. difficile infection is suspected or confirmed.