7.2 Healthcare-Acquired & Infectious Diseases

AACN PCCN Progressive Care Certified Nurse, Adult

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1 Introduction, the Synergy Model & Exam Strategy

1.1 The PCCN Credential & the Progressive Care Nurse 1.2 Exam Blueprint, Format & Scoring 1.3 The AACN Synergy Model & How to Study

2 Cardiovascular Foundations — Hemodynamics, ACS & Catheterization

2.1 Hemodynamic Monitoring in Progressive Care 2.2 Acute Coronary Syndromes: Unstable Angina, NSTEMI & STEMI 2.3 Cardiac Catheterization, PCI & Structural Heart Procedures

3 Cardiovascular — Pump Failure, Rhythm, Vessels & Inflammation

3.1 Heart Failure & Cardiogenic Shock 3.2 Cardiomyopathies & Valvular Heart Disease 3.3 Dysrhythmia Interpretation & Electrical Therapies 3.4 Hypertensive Crisis, Vascular Disease & Aneurysms 3.5 Cardiac Inflammatory Disease, Tamponade & Post-Cardiac-Surgery Care

4 Respiratory — Gas Exchange, Failure & Ventilation

4.1 ABG/VBG Interpretation & Acid-Base Balance 4.2 Respiratory Failure & Oxygenation Support 4.3 Obstructive & Inflammatory Airway Disease 4.4 Acute Lung Injury, Embolism & Pleural Disorders 4.5 Thoracic Surgery & Airway Procedures

5 Endocrine, Renal & Electrolytes

5.1 Glycemic Emergencies: DKA, HHS & Glucose Control 5.2 Fluid-Regulation & Thyroid Disorders 5.3 AKI, CKD/ESRD & Electrolyte Imbalances

6 Neurology, Gastrointestinal, Hematology & Musculoskeletal

6.1 Stroke, TBI & Space-Occupying Lesions 6.2 Seizures, Encephalopathy & Altered Mental Status 6.3 GI Bleeding, Motility & Surgical Conditions 6.4 Hepatic, Pancreatic & Nutritional Disorders 6.5 Hematology, Immunology & Oncology 6.6 Musculoskeletal: Mobility, Falls & Compartment Syndrome

7 Multisystem — Sepsis, Infection, Wounds & End-of-Life

7.1 Sepsis, SIRS & Shock States 7.2 Healthcare-Acquired & Infectious Diseases 7.3 Wounds, Pressure Injuries & Rhabdomyolysis 7.4 Pain, Palliative Care & End-of-Life 7.5 Toxic Ingestion, Overdose & Withdrawal

8 Behavioral/Psychosocial & Professional Caring / Ethical Practice

8.1 Behavioral & Psychosocial Care 8.2 Advocacy, Moral Agency & Ethical Practice 8.3 Caring Practices & Response to Diversity 8.4 Facilitation of Learning & Patient/Family Education 8.5 Collaboration & Systems Thinking 8.6 Clinical Inquiry & Evidence-Based Practice

7.2 Healthcare-Acquired & Infectious Diseases

Key Takeaways Explain This Topic AI

CAUTI and CLABSI prevention both depend on daily review of device necessity and prompt removal; the CLABSI bundle additionally requires maximal sterile barrier precautions and chlorhexidine skin antisepsis at insertion.

The ventilator-associated pneumonia bundle centers on head-of-bed elevation to 30-45 degrees, daily sedation interruption with spontaneous breathing trials, and chlorhexidine oral care.

Surgical site infection prevention depends on correctly timed prophylactic antibiotics, maintained normothermia, and tight glycemic control around the time of surgery.

MRSA, VRE, CRE, and ESBL-producing organisms are multidrug-resistant organisms managed with contact precautions (gown and gloves).

Isolation category must match transmission route: contact precautions for MDROs and C. difficile, droplet precautions for influenza, and airborne precautions with an N95 and negative-pressure room for diseases like tuberculosis.

Last updated: July 2026

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 :

Bundle element Purpose
Head-of-bed elevation 30-45 degrees Reduces aspiration of oropharyngeal/gastric contents
Daily sedation interruption ("sedation vacation") Assesses readiness to wean, limits oversedation
Spontaneous breathing trials Assesses extubation readiness
Chlorhexidine oral care Reduces oropharyngeal bacterial burden
DVT and peptic ulcer prophylaxis Reduces complications of prolonged ventilation
Subglottic secretion drainage (when available) Removes pooled secretions above the cuff
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:

Precaution type PPE / setup Example pathogens
Contact Gown, gloves MRSA, VRE, CRE, ESBL, C. difficile
Droplet Surgical mask within 3-6 feet, private room or cohorting Influenza, pertussis, meningococcus
Airborne N95/PAPR respirator, negative-pressure room Tuberculosis, measles, varicella, disseminated zoster

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.