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MD3001 > Healthcare Associated Infections > Flashcards

Healthcare Associated Infections Flashcards

1
Q

How do we stop HCAIs ?

A

1) Measure the problem
- Surveillance

2) Understand the problem
- epidemiology (where, when, who, how big, cost)

3) Manage the problem
- Education
- Management tools for the problem (ie audit, bundles e.g. bundles to manage PVC care)

4) Prevent the problem
-Interrupting transmission (Standard infection control precautions, Hand
hygiene, vascular access devices)
-Prevention strategies

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2
Q

Distinguish between HAIs and HCAIs and community infections.

A

HAIs = Hospital Acquired Infection
HCAIs = Healthcare Associated Infection
Community infections = Community Acquired

Hospital Acquired Infection is one that was not present on admission but occurred >48hours after admission

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3
Q

How much do HAIs cost to the NHS in the UK ? In Scotland ?

A

~£1 billion extra cost in the UK (~£200m in Scotland) per annum

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4
Q

What proportion of HAIs are preventable ?

A

15-30%

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5
Q

How many extra deaths occur in Scotland as a result of HAIs ?

A

500 extra deaths a year in Scotland

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6
Q

True or False: HAIs occur in the community because of poor practice as much as in hospitals.

A

True

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7
Q

How many deaths in hospital in the UK are directly related to HAIs per annum ?

A

3000 deaths in hospital directly related to HAI p.a.

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8
Q

What is the proportion of patients in the hospital who have a HAI ?

A

1 in 22 patient in acute hospitals have an HAI

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9
Q

What are the four most common HAIs (rank them) ?

A

1) UTIs
2) Pneumonia
3) Blood stream infection
4) CVC/PVC related infection

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10
Q

What factors are resulting in HCAIs ?

A
  • Chronic disease
  • Invasive medical devices
  • Elderly population
  • Immunosuppression
  • More complex procedures
  • Increasing antibiotic resistance
  • Quality measures not developed in clinical medicine
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11
Q

To what extent are HCAIs included in measurements of QOL ?

A

-Hospital acquired infections are one indicator of performance

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12
Q

Explain the significance of the Francis Report wrt HCAIs.

A

The Francis Report is leading to a paradigm shift is clinical care.

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13
Q

How can doctors take measures to prevent HCAI?

A 
♦ Recognition of risk factors in patients 
♦ Behaviour & practice
♦ Hand hygiene
♦ Dress
♦ Personal protective equipment 
♦ Use isolation facilities correctly
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14
Q

Identify the components of the chain of infection.

A

1) Infectious Agent
2) Reservoir
3) Portal of Exit
4) Mode of Transmission
5) Portal of Entry
6) Susceptible Host

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15
Q

What are the main modes of transmission resulting in HCAIs ?

A

1) Direct or indirect contact via fomites or ingestion
2) Droplet transmission
3) Aerosol (airborne) transmission

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16
Q

Identify the main pathogens/conditions which lead to HCAIs via the mode of transmission of direct or indirect contact via fomites or ingestion.

A

Blood born viruses, diarrhoea/gastroenteritis, fever in patient returning from tropics

MRSA, C. difficile, Group A Streptococcus, N. gonorrhoea, S pyogenes

17
Q

Identify the main pathogens which lead to HCAIs via the mode of transmission of droplet transmission.

A

Meningism , fever with cough, fever with rash, vomiting, pneumonic plague, pertussis

N. meningitis, Norovirus, Diphtheria, Mumps, Rubella

18
Q

Identify the main pathogens which lead to HCAIs via the mode of transmission of aerosol (airborne) transmission.

A

Influenza (and influenza like illnesses), haemorrhagic fever, chicken pox

Tb, viral measles

19
Q

What are the main classes of precautions taken against HCAIs ?

A

1) Standard infection control precautions (global precautions that healthcare sector takes e.g. immunisation, cleaning, building design)
2) Standard precautions (part of SICP) (precautions doctors should take for every patient e.g. hand hygiene)
3) Transmission based precautions (part of standard precautions) (precautions to take for patients with certain organisms or patients with certain conditions)

20
Q

Identify types of transmission based precautions.

A

Contact Precautions
Droplets Precautions
Airborne Precautions

21
Q

Describe the main contact precautions.

A
  • Single room if possible
  • Gloves
  • Aprons
  • Disposable masks/eye protection if at risk of splashes
22
Q

Describe the main droplet precautions.

A
  • Single room if possible

- Wear surgical mask when within touching distance (1 metre) of patient or cough inducing procedure

23
Q

Describe the main airborne precautions.

A
  • Single room
  • Gloves
  • Apron
  • High efficiency filter mask (Wear FFP3 mask for all aerosol generating procedures)
24
Q

Distinguish between droplet and airborne transmissions.

A

Droplet Transmission: Organisms transmitted in droplets (>0.5 microns) These travel only short distances.

Airborne Precautions: Particles <5microns. Can be widely dispersed

25
Q

What are the moments in which hands MUST be washed ? What are the moments in which alcohol based rubs may be used instead ?

A

1) Before touching a patient
2) Before clean/aseptic procedure
3) After touching a patient
4) After body fluid exposure risk
5) After touching patient surroundings

Alcohol gel can be used if hands sociably clean, but then after about 4 consecutive uses of alcohol gel need to wash hands to remove the build up of dried gel.
(Must always wash hand after examining a patient with diarrhoea and after removing gloves)

26
Q

Is it necessary to wash hands after removing gloves ?

A

Yes

27
Q

Identify the main steps of hand hygiene.

A

Step 1 - Wet your hands and apply enough soap (coin size).
Step 2 - Rub your palms together.
Step 3 - Rub the back of each hand.
Step 4 - Rub both your hands while interlocking your fingers.
Step 5 - Rub the back of your fingers.
Step 5 - Rub the tips of your fingers.
Step 6 - Rub your thumbs and the ends of your wrists.

28
Q

Identify, describe, and give examples of the the main classes of medical devices for the purposes of HCAIs.

A

Invasive medical devices: Maybe long
term or short term. All break the skin or
mucous membrane barrier
-e.g. CVC, PVC, urinary catheters, dialysis lines

Indwelling prosthetic devices: Usually
long term devices which are buried into
tissue under the skin
-e.g. Heart valves, joints, pacing units

29
Q

Identify the main antibiotic resistant organisms.

A

Gram positive :
MRSA (Meticillin Resistant)
VRE (Vancomycin Resistant Enterococcus)

Gram negative:

  • Extended Spectrum Beta-Lactamase producing Enterobacteriaceae (ESBL producer)
  • Carbapenem Resistant Enterobacteriaceae (CRE)
  • Carbapenemase Producing Pseudomonas
30
Q

Describe the trend of HCAIs of Staph Aureus (both MSSA and MRSA), C. Difficile, and E. Coli over the last few years in Fife.

A

MSSA: Relatively constant
MRSA: Decrease
C. Difficile: Decrease
E. Coli: Increase

31
Q

Is the majority of E. Coli infections community based, or HCAIs, or HAIs ?

A

Community acquired

32
Q

What is the most common source of E. Coli bacteraemia ?

A

Lower urinary tract infection

33
Q

What is the most common source of hospital acquired S. aureus bacteraemias ?

A

PVCs

MD3001 (75 decks)

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