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Y1 TP2 Infection (topic 3 Onwards) > 5. Hospital Acquired Infections > Flashcards

5. Hospital Acquired Infections Flashcards

1
Q

3 terms for generality of hospital acquired infections

A
  • Hospital acquired infections (HAI)
  • Healthcare associated infections (HCAI)
  • Nosocomial infections
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2
Q

Hospital accquired infections - definition

A

—> Infections arising as a consequence of providing healthcare
• Must be an infection that you didn’t have before hospital admission
• Neither present nor incubating at time of admission (Onset is at least 48 hours after admission)

• Also includes infections in hospital visitors and healthcare workers = people in hospitals

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3
Q

Consequences of hai s

A 
Result in increase in: 
	• Length of hospitalization = longer stay in hospital, treatment
	• Morbidity 
	• Cost of care 
	• Mortality (some cases)
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4
Q

Highest prevalence of HAIs

A
  • generally in ICU (intensive care units)
    • People in ICU may be immunocompromised – therefore more vulnerable
    • Patients may be on ventilators, IV lines – exposed breakages of the skin
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5
Q

6 main types of HAIs

A
  • Respiratory tract infections (pneumonia/other respiratory infections) - 22.8%
    • Urinary tract infections - 17.2%
    • Surgical site infections (SSI) - 15.7%
    • Clinical sepsis - 10.5%
    • Gastrointestinal infections - 8.8%
    • Bloodstream infections - 7.3%
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6
Q

5 routes of infection transmission

A

Routes of entry of microbes:

  • Skin: 10%
  • Gastrointestinal (21%)
  • Respiratory (14%)
  • Urogenital (20%)
  • Person to person transmission (respiratory/faecal-oral)
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7
Q

Predisposing factors in patients - for HAIs

A
  • Extremes of age
    • Young people<6 – not immunocompromised
    • older people – low immune system
  • Obesity/malnourished
  • Diabetes
  • Cancer
    • Maybe due to drugs taken
  • Immunosuppression
    • e.g. HIV
  • Smoker
  • Surgical patient
  • Emergency admission
  • Prosthetic devices
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8
Q

Bacteria causing HAIs

A

• (Staphylococcus aureus including MRSA, Clostridium difficile, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa)

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9
Q

Viruses causing HAIs

A

• (Blood borne viruses hepatitis B, C, HIV, Norovirus, Rotavirus, SARSCoV-2)

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10
Q

Fungi causing HAIs

A

• (Candida albicans, Aspergillus species)

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11
Q

Parasites causing HAIs

A

• (Cryptosporidium spp - patient with cryptosporidiosis contaminated ice cubes through frequent use of the ice machines

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12
Q

Simple ventilator system

A
  • Big tube goes right into their lung

* If anything enters this system it can easily enter lung and establish infection

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13
Q

Ventilator associated pneumonia (VAP)

A

Pneumonia develops in 5-20% of mechanically ventilated patients

  • Mortality of ventilator associated infection is 10% = high
  • Associated complication- pulmonary ARDS (acute respiratory distress syndrome) , pneumothorax, pulmonary oedema.
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14
Q

Pathogenesis of Ventilator associated pneumonia (VAP)

A
  • Micro aspiration of oropharyngeal pathogens around the cuff
  • Micro aspiration of gastro-enteric regurgitated secretion
  • Bio film (sugar covering) within the endotracheal tube
  • Cross contamination via respiratory equipment
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15
Q

Ventilator associated pneumonia

  • Early causative pathogens
A

EARLY (<5 days) - less than 5 days on ventilator

• Streptococcus pneumoniae, Staphylococcus aureus, sensitive enteric Gram negative rods (GNR)

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16
Q

Ventilator associated pneumonia

  • late causative pathogens
A

LATE (>5days) - after 5 days on ventilator

• MRSA, Pseudomonas species, multi-drug resistant organisms

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17
Q

Ventilator associated pneumonia - bundle

A
  • Elevation of the head of the bed 30 degrees to prevent aspiration
  • Sedation holiday to check for continued ventilation needs
  • Weaning trials to indicate if the ventilator is still needed daily
    • = assess if they still need ventilator at regular intervals
  • Medication to prevent gastrointestinal bleeding (Stress-related mucosal disease is a typical complication of critically ill patients)
  • DVT Prophylaxis (Thromboembolism is a major complication in these patients)
  • Sub-glottal suctioning to prevent colonization and infection from pooling of secretions must be done every 4 hours
    • Prevent buildup of secretions that allow microorganisms to grow

• Oral care to prevent accumulation of oral bacteria every 4 hours

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18
Q

Catheter related blood stream infections

→ how can they occur

A
  • Introduction of skin pathogens at the time of insertion
  • Contamination of the catheter hub(s)
  • Contaminated infusate
  • Migration of skin pathogens into the cutaneous catheter tract
  • Hematogenous seeding from a distant infectious focus – spread microorganisms ?????
  • Most common pathogens: S. epidermidis, S. aureus, Candida albicans
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19
Q

Catheter related blood stream infections

  • prevention measures
A
  • Fill out central line insertion check list – before inserting catheter iv line etc
  • Hand Hygiene prior to insertion
  • Use standardized supply kit that is all inclusive for the insertion of central venous catheter
  • Use maximal barrier precautions (Full body drape, wearing of cap, mask, gown and gloves) = PPE
  • Clean Skin with Chlorhexidine and allow to air dry = remove microorganisms
  • Need for continuation of catheter is evaluated on a daily bases = evaluate IV lines look for signs of infection
  • Central line dressings are changed every 7 days
  • Positive pressure caps are used on all central line (IV line) posts and changed every 7 days
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20
Q

What are Surgical site infections (SSI)

A

• occur within 30 days postop, or within 1year if an implant is left (e.g. hip or knee), and infection appears to be related to the operation
○ As some microorganisms may be slow growing, or go to sleep at the site so no signs til later
• Most SSIs occur between 5-10 days post-operation

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21
Q

3 types of Surgical site infections (SSI)

A
  • Superficial incisional SSI: skin + subcutaneous tissue
  • Deep incisional SSI: deep soft tissue(fascia + muscle)
  • Organ/space SSI: organs, body cavities, sub-integumental spaces
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22
Q

Organisms causing SSIs

A

Enterobacterales (mainly present in bowel but can be disloged) -caused SSI are most prevalent in large bowel surgery, contributing 48.5% of superficial SSIs and 55.7% of deep or organ/space SSIs.

Infecting organisms in hip and knee surgery
• Methicillin Sensitive Staphylococcus aureus – Hip 32%, Knee 40.7% (MOST COMMON IN HIP AND KNEE)
• Methicillin Resistant Staphylococcus aureus – Hip 4%, Knee 3.1%
• Coagulase-negative Staphylococci – Hip 25.1%, Knee 23.9%

Infections can also be caused by a mixture of organisms

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23
Q

Prevention measures for Surgical site infections (SSI)

A

• Screened (patient and staff) prior to surgery for MRSA

• chlorhexidine washes/ shower
– pre operation to steralise them

  • Alcohol containing skin prep (2% chlorhexidine gluconate in 70% isopropyl alcohol solution)
  • Preoperative antibiotics

• Appropriate hair removal
– microorganisms at base of hair

• Euglycemia
– anyone with diabetes has it controlled

  • Optimise tissue oxygenation
  • Wound care
  • Best practice checklist
  • Surveillance for SSI
  • Educate providers, patient regarding SSI
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24
Q

CAUTI - Catheter Associated Urinary Tract Infection

A

• Urinary Catheter Associated Infections are defined as an infection occurring 48 hours after insertion of a urinary catheter, signs and symptoms of infection (fever, pain, frequency, urgency, increased white count, etc.) and a positive urine culture of ≥ 103 cfu/ml

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25
Q

CAUTI – causative organisms

A

• Multidrug resistant Enterobacteriaceae (MDRE)
– Escherichia coli
– Klebsiella, Proteus and Pseudomonas species

• Candida albicans

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26
Q

Prevention of CAUTI

A
  • Evaluation of catheter need prior to insertion
  • Hand Hygiene should be done immediately before and after any manipulation of the catheter site
  • Closed Catheter System
  • Catheter securement system
  • Urinary collection bag not to be higher than the bladder
  • Urinary collection bag not to rest on the floor – but should be at a lower level than the patietn
  • The catheter and collecting tube should be free of kinking
  • The collecting bag should be emptied regularly
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27
Q

Multiresistant organisms

Definition

A
  • MRO’s are bacteria that have become resistant to many of the antibiotics used to treat infections caused by them
    • In hospitals a lot of antibiotics used, easier for resistance to spread
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28
Q

3 multiresistant organisms

A

• Multidrug resistant organisms of concern are
– Methicillin Resistant Staphylococcus aureus (MRSA).- glycomyacin, titroplanin
– Vancomycin resistant Enterococci (VRE)
– Multidrug resistant Enterobacteriaceae (

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29
Q

Antimicrobial resistance

A

—> Antimicrobial resistance is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe.

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30
Q

Antibiotic resistance

A
  • The term antibiotic resistance is a subset of anti-microbial resistance, as it applies only to bacteria becoming resistant to antibiotics.
    • Only need one resistant bacteria for resistance to spread
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31
Q

Antimicrobial resistance - factors to consider

A
  • Duration of antibiotics
  • Use of broad spectrum antibiotics (also have side effects tho)
  • Hygiene
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32
Q

4 ways Antibiotic resistance can occur

A

Bacteria can cause

  1. Inactivation of antibiotic (eg. beta - lactamase)
  2. Alteration of target- or binding site
  3. Alteration of metabolic pathway
  4. Reduced drug accumulation
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33
Q

Methicillin Resistant Staphylococcus aureus (MRSA)

A

—-> Methicillin-resistant Staphylococcus aureus (MRSA) refers to a group of Gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus.
– mecA gene codes for PBP2a which has low affinity for beta lactam antibiotics
• Resistant to methacilin

34
Q

Methicillin Resistant Staphylococcus aureus (MRSA)

Prevention and management

A
  • Prevention: Screening/Handwashing/Isolation - isolate patients who have MRSA in chest causing coughing
  • Management: Antibiotics (Vancomycin), dependent on site of infection
35
Q

Norovirus

A
  • Norovirus is a non-enveloped, ss +ve strand RNA virus
  • Spread by fecal-oral route
  • Norovirus infection is characterized by nausea, vomiting, watery diarrhea, abdominal pain, and in some cases, loss of taste. A person usually develops symptoms of gastroenteritis 12 to 48 hours after being exposed to norovirus.
  • General lethargy, weakness, muscle aches, headaches, and low-grade fevers may occur.
  • Most who contract it make a full recovery within two to three days
36
Q

Rotavirus

A

Rotavirus is a non-enveloped ds RNA virus
• Rotavirus (RV) is considered as the most important viral agent of acute gastroenteritis worldwide in children less than 5 y.
• Vaccines available for prevention of Rotavirus infections
• 48 hours after the admission in hospital to 72 hours after hospital discharge

37
Q

Clostridium difficile (c.difficile)

A
  • Clostridium difficile Gram positive spore forming rods
    • c.difficile goes to spore form and goes to sleep, spores are very resistant

• Pathogenic strains produce 2 toxic polypeptides Toxin A and Toxin B (causing signs and symptoms)
– Toxin A is an endotoxin, stimulates inflammatory response and causes fluid secretion
– Toxin B is s cytotoxin which disrupts protein synthesis

  • Symptoms include watery diarrhea, fever, nausea, and abdominal pain. It makes up about 20% of cases of antibiotic-associated diarrhea.
    • Can cause more serious problems colitus ??
38
Q

Clostridium difficile (c.difficile)

2 toxins

A

– Toxin A is an endotoxin, stimulates inflammatory response and causes fluid secretion
– Toxin B is s cytotoxin which disrupts protein synthesis

39
Q

3 Clostridium difficile associated problems

A

Antibiotic associated diarrhoea:
Antibiotic associated colitis:
Antibiotic associated pseudomembranous colitis:

40
Q

Antibiotic associated diarrhoea:

A

• benign, self limited after use of antimicrobials, Clostridium difficile implicated in 10-25%

41
Q

Antibiotic associated colitis:

A

• worse diarrhoea , fever, abdominal pain, leukocytosis, Clostridium difficile implicated in 50-75%

42
Q

Antibiotic associated pseudomembranous colitis:

A

• typical pseudomembranes, high leukocytosis, profuse diarrhoea, abdominal pain + distension, can progress to toxic megacolon, sepsis and death(6-30%). Clostridium difficile implicated in 90-100%

43
Q

Clostridium difficile - risk factors

A

• Antibiotic use and Clostridium difficile infection
– (High risk: Cephalosporins, Clindamycin, Co-amoxiclav, Ciprofloxacin)
– Intermediate risk: Amoxicillin, Carbapenems,Erythromycin
– Low risk: Nitrofurantoin, Penicillin V, Trimethoprim, Vancomycin

44
Q

Clostridium difficile - management

A
  • Healthcare environment
  • Acid suppression medication (may help Clostridium difficile proliferate by altering gut flora)
  • Management: Isolation measure, treatment of dehydration and Vancomycin.
45
Q

Infection prevention

A

—> The discipline concerned with preventing nosocomial or healthcare-associated infections
• Can also include community acquired infections e.g. care homes
• Any place that looks after vulnerable people

• Focuses on evidence-based practices and procedures that can prevent or reduce the risk of transmission of microorganisms

46
Q

3 sources of infection

A

Patient
Healthcare workers
Contaminated environments

47
Q

Examples of spread of infection

A
  • Patient to patient
    • Patient to care worker
    • Care worker to patient
    • Patient contaminating environment (e.g. oral fecal route) contaminate water, air, surfaces, food
    • Patients can transmit infections to themselves e.g. self commensals carried by patient can infect patient when skin surface is broken or catheter
48
Q

4 routes of transmission

A
  • Blood and body fluids (pass person to person)
    • Fecal/oral route
    • Airborne
    • Contact
49
Q

Pathogens transmitted by Blood and body fluids (pass person to person)

A

○ Hep B and C and HIV

50
Q

Pathogens transmitted by Fecal/oral route

A

○ Rotavirus, salmonella, shigella, camplyobacter

51
Q

Pathogens transmitted by Airborne

A

○ Tb, chickenpox

52
Q

Pathogens transmitted by contact

A

○ Multi resistant gram negative, wound/line infections

53
Q

Basic reproduction number R0

A

the average number of cases one case generates over the course of its infectious period, in an otherwise uninfected, non-immune population

54
Q

Relationship between R0 and cases

A
  • If Ro >1 → increase in cases
  • If Ro =1 → stable number of cases
  • If Ro <1 → decrease in cases
55
Q

Factors determining transmissibility (causing infection)

A

Infectious dose – number of microorganisms required to cause infection

– Varies by:
• micro-organism = e.g. virulence factors
• immunity of potential host

56
Q

Preventing infections in healthcare

A
  • Distancing / separation (of beds in wards) / restriction of movement and of visitors
  • PPE: gloves, gowns, masks, eye-protection (where appropriate)
  • Hand hygiene
  • Cleaning, disinfection and sterilization
  • Waste management – dispose contaminated material properly
  • Staff health management: Exposure prophylaxis, health monitoring (Occupational Health)
  • Discharge of patients – ideally when free of infection and cured
  • Care of the deceased – if they died from infectious microorganism
57
Q

Goals of infection prevention

A

To prevent the spread of infections from
• patient-to-patient
• patients to health care providers
• health care providers to patients
• health care providers to health care providers and to visitors and others in the health care environment

58
Q

Desired outcomes of infection prevention

A
  • improved survival rates
  • reduced morbidity associated with infections
  • shorter length of hospital stay
  • a quicker return to good health
59
Q

4 Ps of infection prevention and control

A

Patient
Pathogen
Practice
Place

60
Q

Infection prevention- patients

A

General
Optimise patient’s condition
– Immunosuppressed patientscosiderations?
– Comorbidities (diabetes) - biggern chance of infection
– Nutrition is good to prevent infection
– Smoking - more liekly to get infection

Antimicrobial prophylaxis = minimize chance of infection after surgery
Skin preparation
Hand hygiene

Specific
MRSA screens – before surgery - eradicate MRSA with Mupirocin nasal ointment
Disinfectant body wash beofre operations, minimise commensals entry

61
Q

Infection prevention - pathogen

A

Reduce/eradicate pathogen using
– Antibacterials including disinfectants
– Decontamination
– Sterilisation of equipment

• Reduce/eradicate vector
– Eliminate vector breeding sites

62
Q

Infection prevention - practice

A

– Awareness = amongst all visitors, workers, patient
– Policies = clear guidance
– Training = of those involved in patient care
– Leadership (at all levels)
– Engagement at local and national level

63
Q

Infection prevention - place

A

Ensuring all premises delivering healthcare are infection control compliant

  • Building – consider not just medical wards (including kitchens, cafes, shops)
    • Wards
    • Consulting rooms
    • Communal areas
    • Toilets
    • Furnishing (including movable items)
    • Flooring
    • Air conditioning/heating system
64
Q

Examples of ppe

A

Gloves, aprons, long sleeved gowns, surgical masks, eye goggles, face visors and respirator masks

65
Q

Uses of PPE

A
  • create a barrier between healthcare workers and an infectious agent from the patient and to reduce the risk of transmitting micro-organisms from healthcare workers to patient(s) or vice versa
    • PPE may sometimes be used by the patient’s family / visitors, e.g. assisting patient with toileting, visiting patient who has a contagious infection, visiting vulnerable patients
  • Visitors must be fully inducted in the use of PPE and Hand Hygiene
66
Q

Choice of ppe

A

—> should be based on a risk assessment of potential exposure to blood / body fluids / infectious agents

67
Q

Care with blood and bodily fluids

A
  • Safe handling of blood, bodily fluids and spillages
  • Handling and labelling of specimens
  • Use of solidifying agents = when there is a spillage to prevent it leaking
  • Taking blood
68
Q

Decontamination of the environment

A
  • General environment
  • Ventilation (maintenance)
  • Air conditioning
69
Q

Safe management of sharps (infection can be transmitted with sharps)

A
  • All sharps must be disposed of into a designated BS 7320 approved sharps container.
  • All sharps must be removed prior to sending any trays/instruments to HSSU
  • Needles must NOT be resheathed
70
Q

Decontamination of equipment

A
  • All equipment used in the clinical environment should have the ability to be decontaminated or be single patient use. (ideally should be single use)
  • Infection Control should be consulted if the equipment being purchased cannot be decontaminated in line with infection control guidelines
71
Q

Key items of equipment/practices

A
  • Ventilators
  • Suction
  • Incubators
  • Humidifiers
72
Q

what to do in an innoculation accident

A

• First Aid
• Report to person in charge of the area
• Attend Occupational Health Department (OHD) or A&E out of hours
• Completion of incident report form.
Never ignore this accident

73
Q

Prevention of innoculation accidents

A
  • Safe handling
  • Disposal = of everything
  • Only competent practitioners should take blood and give injections to patients with known or suspected blood borne viruses
74
Q

Key times to wash hands

A
  • Before touching patient
    • Before any clean or aseptic treatment
    • After body fluid exposure
    • After touching patient
    • After touching patient surroundings
75
Q

Preventing patient to patient transmission of infection

A
  • Physical barriers - separate rooms
  • Isolation of infected patients
  • Protection of susceptible patients – sperate them from others
76
Q

Health care workers interventions

A

– must be Healthy
• Disease free
• Vaccinated

– ensure Good practice 
• Good clinical techniques (e.g. sterile non-touch) 
• Hand hygiene 
• PPE 
• Antimicrobial prescribing
77
Q

Environmental interventions

A

—> minimsie spread of infection from environment to patient

Built environment = build environment to ensure
– good Space/Layout
– clean Toilets
– Wash hand basins – wash dry touch door handles

• Furniture and furnishings = must be able to be cleaned and sterilized

78
Q

Environmental interventions cleaning

A
  • Disinfectants
  • Steam cleaning
  • Hydrogen peroxide vapour – to decontaminate
79
Q

Environmental interventions - operating theatres

A
  • Very sterile to prevent infections
    • Decontaminate
    • Positive or negative pressure in rooms
80
Q

Environmental interventions - medical devices

A
  • Single use equipment
    • Sterilization
    • Decontamination

Y1 TP2 Infection (topic 3 Onwards) (9 decks)

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