The nurse evaluates the chart of a 65-year-old client with no apparent risk factors and concludes that which immunizations are current? Select all that apply

Iatrogenic infections, also known as healthcare-associated infections (HAIs), are infections acquired during the course of receiving healthcare treatment. These infections can result from invasive procedures, improper hand hygiene, or contamination from the healthcare environment.

Rationale for correct answer:

A. Teaching correct handwashing to assigned patients: Hand hygiene is the most effective method to prevent the spread of infection. Educating patients on proper handwashing technique helps reduce transmission of pathogens.

B. Using correct procedures in starting and caring for an intravenous infusion: Proper aseptic technique when inserting and maintaining IV lines reduces the risk of bloodstream infections, a common type of HAI.

C. Providing perineal care to a patient with an indwelling urinary catheter: Perineal care prevents bacterial colonization around the catheter site and reduces the risk of catheter-associated urinary tract infections (CAUTIs), a common iatrogenic infection.

Rationale for incorrect answer:

D. Isolating a patient on antibiotics who has been having loose stool for 24 hours: While loose stool could suggest a Clostridioides difficile (C. diff) infection, isolation might not be warranted until there's confirmation-either through a positive lab result or continued symptoms with clinical suspicion. Premature isolation without evidence may not align with resource allocation or institutional policy.

E. Decreasing a patient’s environmental stimuli to decrease nausea: While comfort measures are important, reducing environmental stimuli for nausea does not contribute to the prevention of infections and is unrelated to infection control practices.

Take home points:

Preventing iatrogenic infections requires vigilance in patient care practices, including:

• proper catheter care
• IV-line maintenance
• patient education on hand hygiene among others

Immunization in older adults is a key preventive strategy to reduce morbidity and mortality from vaccine-preventable diseases. For adults 65 years and older without specific risk factors, ensuring up-to-date status on influenza, tetanus, and zoster vaccines is crucial.

Rationale for correct answer:

B. Receives a flu shot every year: Annual influenza vaccination is strongly recommended for all individuals aged 6 months and older, and especially for adults over 65, due to higher risk of severe complications.

C. Has not received the hepatitis B vaccine: Hepatitis B vaccination is not routinely indicated for adults unless they are in a high-risk group (e.g., healthcare workers, IV drug users, diabetics under 60). This client has no risk factors, so it's not required.

D. Has not received the hepatitis A vaccine: Hepatitis A vaccine is given to those at increased risk (e.g., travelers to endemic areas, people with chronic liver disease, drug users). It's not a routine vaccine for healthy older adults with no risk.

Rationale for incorrect answers:

A. Last tetanus booster was at age 50: Tetanus boosters (Td or Tdap) are recommended every 10 years. Since the client received the last booster at age 50, another is due by age 60.

E. Has not received the herpes zoster vaccine: The Shingrix vaccine (2 doses, 2–6 months apart) is recommended for all adults aged 50 and above, regardless of prior shingles history. The absence of this vaccine means the client is not current.

Take home points:

Adults aged 65 and above should receive:

• the annual flu vaccine
• stay up-to-date on tetanus boosters (every 10 years)
• receive the shingles vaccine even if they’ve had shingles before.