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Sepsis

CMS Sepsis Core Measure

Appropriate Urine Culture Management

Introduction to Sepsis

*Please take the quiz below the video to receive credit.

Objectives

Define sepsis and its impact on the US population and hospitals
Understand the causes of sepsis and what increases a patients susceptibility to sepsis
Describe the first steps a provider should take following the recognition of sepsis
Understand when to appropriately send blood cultures when not part of a sepsis bundle

Articles

Severe sepsis and septic shock
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

Lecture

Quiz

Intro to Sepsis Quiz

Name*
First Last
1. Which statement is false regarding sepsis:*
- a. Patients diagnosed with sepsis spend 75% longer in the hospital than those individuals diagnosed with other conditions
- b. Sepsis is the most common cause of death in non-cardiac ICUs.
- c. Sepsis has been declared a medical emergency by the Center for Disease Control (CDC)
- d. Sepsis is caused by organisms with high levels of toxin production
- e. All the above are true
2. In 2013, the costs associated with septicemia equaled:*
- a. $2 billion
- b. $8 billion
- c. $17 billion
- d. > $20 billion
3. True or False: After general surgery, the incidence of sepsis is greater than the incidence of pulmonary embolism and myocardial infarction combined.*
- True
- False
4. Increased rates of sepsis have occurred due to all of the following except:*
- a. Increasing aging population.
- b. Increased use of chemotherapy.
- c. Increased number of individuals alive with organ transplants.
- d. Increased awareness
- e. Increased use of antibiotics
5. Among individuals who lived independently prior to severe sepsis, how many die by six months following sepsis.*
- a. One fourth
- b. One third
- c. One half
- d. Two thirds
6. What is not a part of the criteria to meet the current sepsis definition used by CMS?*
- a. Temperature greater than 38.3° C, or less than 36.0° C
- b. Heart rate greater than 90 beats per minute
- c. Systolic blood pressure less than 90mmHg or mean arterial pressure less than 65mmHg
- d. RR greater than 20 breaths per minute
7. Which is not a marker of organ dysfunction according to the definition of Severe Sepsis?*
- a. Decrease in SBP of 40 points
- b. UOP less than 0.5mL/kg/hr for 2 hours
- c. Lactate greater than 2mmol/L
- d. Platelets less than 100,000
- e. All are markers of organ dysfunction
8. All of the following must occur in under 3 hours following the recognition of sepsis except:*
- a. Medical practitioner assessment
- b. Measurement of a lactate level
- c. Central line placement
- d. Initiation of antibiotics
- e. Drawn blood cultures
9. True or False: According to current guidelines, at a minimum, cultures from blood, urine, and sputum must be sent once a patient meets criteria for sepsis despite having a suspected or known source.*
- True
- False
10. Given that sepsis is a time dependent condition that caries an increase in mortality with a delay in recognition and therapy, the CMS requires an initial assessment and labs to be performed within _____ hours and repeat assessment and labs (if needed) within _____ hours from the start of sepsis.*
- a. 1, 4
- b. 2, 4
- c. 1, 6
- d. 3, 6
- e. 4, 6

CMS Sepsis Core Measure

*Please take the quiz below the video to receive credit.

Objectives

Define Sepsis
Review pathophysiology of sepsis
Review National Impact of Sepsis
Explain CMS sepsis core measures and define strategies in place to meet current standards
Explain the use of MEWS/SRS as a tool for early sepsis recognition
Review UF Health’s Sepsis management protocol

Articles

Severe sepsis and septic shock
Sepsis Definitions: The Search for Gold and What CMS Got Wrong
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

Lecture

Quiz

Sepsis CMS Quiz

Name*
First Last
1. Sepsis with at least one organ dysfunction is the CMS defining criteria for which category of sepsis?*
- a. Sepsis
- b. Severe Sepsis
- c. Septic Shock
- d. SIRS
2. Sepsis is the 8th leading cause of death in the United States.*
- True
- False
3. Documentation of a suspected source of infection in addition to two or more SIRS criteria starts the sepsis time clock.*
- True
- False
4. How many minutes does a provider have to respond to the patient’s bedside when they are notified of a SWAT?*
- a. 30
- b. 20
- c. 10
- d. 15
5. Which antibiotic should be given first when initiating a sepsis protocol?*
- a. Vancomycin
- b. Ceftazidime
- c. Cefepime
- d. Flagyl
6. The Sepsis Protocol Checklist can be found on 4 east, 4 west, and the surgical critical care bridge page.*
- True
- False
7. Which note smart phrase must be utilized by the provider to document sepsis after they are notified of an elevated MEWS score by the RN?*
- a. .SWAT
- b. .sepsissurveillance
- c. .sepsisinitial
- d. .Sepsisfollowup
8. The early sepsis order set can be utilized in the Intensive Care Unit.*
- True
- False
9. In what time frame must a provider write the initial sepsis note?*
- a. 4 hours
- b. 30 minutes
- c. 3 hours
- d. 1 hour
10. When a provider has identified a patient having a suspected source of infection as well as SIRS criteria, the provider should initiate the sepsis protocol. What documentation must they then place in the chart according to the sepsis protocol?*
- a. Sepsis Order Set, Initial Note, Re-evaluation Note
- b. Sepsis surveillance, Initial note, Re-evaluation Note,
- c. Sepsis Order Set, MEWS, Initial Note, Re-evaluation Note, Sepsis Surveillance
- d. Sepsis Order Set, Initial Note, Sepsis Surveillance
11. Please attest that you have listened to this lecture in its entirety and that you understand the contents herein.*
- I agree
- I disagree

Appropriate Urine Culture Management

*Please take the quiz below the video to receive credit.

Objectives

Define and differentiate between catheter-associated urinary tract infection (CAUTI) and asymptomatic catheter-associated bacteriuria (CA-ASB).
Identify patient populations at high risk of asymptomatic bacteriuria.
List the types of diagnostic urine tests available and their advantages and disadvantages in determining if a patient has an infection or not.
Discuss the harmful effects of indiscriminate urine testing on patients, physicians and the hospital and introduce the concept of culturing stewardship.
Identify appropriate and inappropriate reasons for sending urine specimens for testing.

Articles

Guidelines for evaluation of new fever in critically ill adult patients: 2008 Update from the American College of Critical Care Medicine and the Infectious Diseases Society of America

Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

Lectures

Quiz

Urine Culture Management

Name*
First Last
1. True or False: Bacteriuria is defined as the presence of bacteria in an aseptically obtained urine specimen.*
- True
- False
2. Which of the following is not true?*
- a. Catheter associated urinary tract infections comprise approximately 25% of health care associated infections.
- b. Hospitals scoring in the lowest-performing quartile nationally face a 1% reduction in overall Medicare reimbursement the following year.
- c. CAUTI’s/UTI’s are under-diagnosed and inappropriately treated.
- d. Many cases of diagnosed UTI’s represent asymptomatic bacteriuria.
3. Which of the following is the definition of asymptomatic bacteriuria?*
- a. Presence of bacteria in urine specimen without any signs/symptoms of a urinary tract infection (with or without the presence of a catheter)
- b. Presence of ≥ 105 bacteria per ml of urine in a patient that has signs/symptoms suggestive of infection (with or without the presence of a catheter)
- c. Presence of bacteria in an aseptically obtained urine specimen.
- d. Presence of bacteria in a urine specimen with burning on urination.
4. Which of the following is the most at risk for developing asymptomatic bacteriuria?*
- a. Women
- b. Diabetics
- c. Elderly
- d. All of the above
5. What is the daily risk of developing bacteriuria in a catheterized patient?*
- a. 1-5%
- b. 3-10%
- c. 12-15%
- d. 25-30%
6. Which of the following is not a symptom that is suggestive of catheter associated urinary tract infections?*
- a. Fever
- b. Flank pain
- c. Acute hematuria
- d. Upper Abdominal cramping
7. True or False: Positive nitrites on a urinalysis are an indirect indicator of the presence of gram negative rods in the urine.*
- True
- False
8. Which of the following is not an indication for a urinalysis with culture and sensitivity in catheterized patients?*
- a. New onset hematuria
- b. Costovertebral tenderness
- c. Sediment present in urine
- d. New onset delirium with no other known cause
9. True or False: Catheterized patients should be thoroughly evaluated for other sources of the signs and symptoms before attributing them to the urinary tract and urine cultures should not be routinely sent.*
- True
- False
10. True or False: Change in urine quality, routine screening in asymptomatic patients, unit transfer, and documenting clearance of bacteriuria are indications for ordering a urine culture.*
- True
- False

CLABSI/CAUTI

*Please take the quiz below the video to receive credit.

Objectives

Describe criteria for classifying device related infections per the National Healthcare Safety Network (NHSN) criteria
Differentiate between clinical criteria and surveillance criteria for hospital acquired infections
Recognize the impact and costs associated with hospital acquired infections

Articles

Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI] and Other Urinary System Infections [USI]) Events

Preventing Harm from CLABSI

Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection)

CDC/NHSN Surveillance Definitions for Specific Types of Infections

Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

Lecture

Quiz

CLABSI/CAUTI

Name*
First Last
1. A 45-year-old male is transferred from the surgical ward to the ICU on June 1. On June 2 he develops a fever and again on June 3. Blood cultures are positive on June 4. Will this HAI be attributed to the ICU?*
- a. YES
- b. NO
2. The 7-day period during which all site-specific infection criteria must be met defines which of the following:*
- a. Infection Window Period
- b. Date of Event
- c. Repeat Infection Timeframe
- d. Attribution Period
3. Which of the following is not considered a central line?*
- a. Intra-aortic balloon pump
- b. Introducer
- c. Tunneled dialysis catheter
- d. Femoral Arterial Catheter
- e. A and D
- f. C and D
4. True or False: A culture taken from segments or tips of catheters are not used in the any part of the criteria for CLABSI*
- True
- False
5. Which of the following is true concerning criteria used for CLABSI?*
- a. S. aureus is always considered a pathogen
- b. Common commensal organisms are considered pathogens only if at least 2 blood cultures are positive
- c. Culture of segments or tips are not used in the any part of the criteria for CLABSI
- d. A central line must be present for >2 calendar days, where the date the device was placed is day 1
- e. All of the above are true
6. A 70-year-old female is admitted with an Ecoli UTI, 3 days later she develops septic shock and a central line is placed. She is found to have E. Coli bacteremia, which of the following is true?*
- a. This is a primary blood stream infection but not considered a CLABSI
- b. This is a primary blood stream infection and is considered a CLABSI
- c. This is not a primary blood stream infection and not considered a CLABSI
- d. This is not a primary blood stream infection but is considered a CLABSI
7. A 60-year-old female had a central line inserted on June 1. On June 3, the central line is removed. On June 4 she develops S. aureus bacteremia. No other source of infection is found*
- a. This meets criteria for a CLABSI
- b. This is a primary bloodstream infection but does not meet criteria for a CLABSI
- c. This is not a primary bloodstream infection and does not meet criteria for CLABSI
8. A 43-year-old male without a central line is transferred from the medical ward to MICU where a central line is inserted, the next day, bacteremia occurs*
- a. This is considered a bloodstream infection but not a CLABSI and is attributed to the medical ward
- b. This is considered a CLABSI and attributed to the medical ward
- c. This is considered a CLABSI and attributed to the ICU
9. A 52-year-old male with a central line is transferred from the medical ward to the CCU. After 4 days in the CCU and with the central line still in place, bacteremia occurs.*
- a. This is considered a BSI but not a CLABSI and is attributed to the medical ward
- b. This is considered a CLABSI and attributed to the medical ward
- c. This is considered a CLABSI and attributed to the CCU
10. True or False: ARDS is never a ventilator associated diagnosis.*
- True
- False

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