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UF Health University of Florida
Department of Anesthesiology College of Medicine
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Clinical Overview

Sepsis

CMS Sepsis Core Measure
Appropriate Urine Culture Management
CLABSI/CAUTI

Introduction to Sepsis

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

Objectives

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

Articles

Lecture

Quiz

Name(Required)
1. Which statement is false regarding sepsis:(Required)
2. In 2013, the costs associated with septicemia equaled:(Required)
3. True or False: After general surgery, the incidence of sepsis is greater than the incidence of pulmonary embolism and myocardial infarction combined.(Required)
4. Increased rates of sepsis have occurred due to all of the following except:(Required)
5. Among individuals who lived independently prior to severe sepsis, how many die by six months following sepsis.(Required)
6. What is not a part of the criteria to meet the current sepsis definition used by CMS?(Required)
7. Which is not a marker of organ dysfunction according to the definition of Severe Sepsis?(Required)
8. All of the following must occur in under 3 hours following the recognition of sepsis except:(Required)
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.(Required)
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.(Required)

CMS Sepsis Core Measure

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

Objectives

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

Articles

Lecture

Quiz

Name(Required)
1. Sepsis with at least one organ dysfunction is the CMS defining criteria for which category of sepsis?(Required)
2. Sepsis is the 8th leading cause of death in the United States.(Required)
3. Documentation of a suspected source of infection in addition to two or more SIRS criteria starts the sepsis time clock.(Required)
4. How many minutes does a provider have to respond to the patient’s bedside when they are notified of a SWAT?(Required)
5. Which antibiotic should be given first when initiating a sepsis protocol?(Required)
6. The Sepsis Protocol Checklist can be found on 4 east, 4 west, and the surgical critical care bridge page.(Required)
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?(Required)
8. The early sepsis order set can be utilized in the Intensive Care Unit.(Required)
9. In what time frame must a provider write the initial sepsis note?(Required)
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?(Required)
11. Please attest that you have listened to this lecture in its entirety and that you understand the contents herein.(Required)

Appropriate Urine Culture Management

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

Objectives

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

Articles

Lectures

Quiz

Name(Required)
1. True or False: Bacteriuria is defined as the presence of bacteria in an aseptically obtained urine specimen.(Required)
2. Which of the following is not true?(Required)
3. Which of the following is the definition of asymptomatic bacteriuria?(Required)
4. Which of the following is the most at risk for developing asymptomatic bacteriuria?(Required)
5. What is the daily risk of developing bacteriuria in a catheterized patient?(Required)
6. Which of the following is not a symptom that is suggestive of catheter associated urinary tract infections?(Required)
7. True or False: Positive nitrites on a urinalysis are an indirect indicator of the presence of gram negative rods in the urine.(Required)
8. Which of the following is not an indication for a urinalysis with culture and sensitivity in catheterized patients?(Required)
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.(Required)
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.(Required)

CLABSI/CAUTI

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

Objectives

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

Articles

Lecture

Quiz

Name(Required)
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?(Required)
2. The 7-day period during which all site-specific infection criteria must be met defines which of the following:(Required)
3. Which of the following is not considered a central line?(Required)
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(Required)
5. Which of the following is true concerning criteria used for CLABSI?(Required)
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?(Required)
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(Required)
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(Required)
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.(Required)
10. True or False: ARDS is never a ventilator associated diagnosis.(Required)