Healthcare associated infections Flashcards
(41 cards)
What is an infection?
deposition and multiplication of bacteria and other micro-organsisms in tissue or on surfaces of the body with an associated tissue reaction
When does colonisation occur?
if the response of the host is slight or absent
What are the different sources of infection?
endogenous = caused by hosts own resident organisms
exogenous = caused by organisms foreign to the host
What are the different modes of transmission of an infection?
airborne faecal -oral contact blood borne injection / inoculation sexual
What are some examples of host vulnerability?
extremes of ages immunocompromised drug therapy invasive devices pregnancy underlying disease nutritional state trauma
What are some local signs of infection?
erythema swelling pain oedema purulent discharge heat
What are systemic signs of infection?
sepsis
- fever or hypothermia
- rigor
- hypotension
- tachycardia
- raised WCC and CRP
- increased serum lactate
What are healthcare associated infections?
any infection acquires as a result of accessing healthcare
- could include acute hospital, rehabilitation facility, nursing or residential home
How common are healthcare associated infections?
at any one time 10% of patients will have them
risks vary according to the kind of setting e.g. ICU, type of patient
costs the NHS £1 billion
What are some different types of infections?
pneumonia urinary infection surgical site infection gastroenteritis bloodstream infection
Are HCAI preventable?
studies suggest 15% are preventable
predominantly exogenous
predominantly device associated
Why are HCAI a particular problem now?
vulnerable patients:
- extremes of life
- complex high tech treatments
use of antibiotics
- resistance means we are starting to run out
What does the health and social act of 2008 state?
all NHS trusts must register with care quality commission
- meet legal requirements, NHS trusts must ensure that patients, workers and others are protected agains the identifiable risks of acquiring an HCAI
CQC conduct unannounced inspections
What are the major current organisms of concern?
MRSA c diff MDR acinetobacter vancomycin resistant enterococci multiply resistance enterobacteriaceae pseudomonas aeruginosa from water sources mycobacterium tb
What is MRSA?
Meticillin resistant staphylococcus aureus
- common bacteria carriedby approx 30% pop
- resistant to flucloxacillin
- causes range of infections - some trivial, some serious
- often colonises without causing infection
What can MRSA cause?
skin infections chest infections endocarditis bone infection bacteraemia death
Why does MRSA cause an infection?
about 30% of people carry MRSA
Cross infection in community and hospitals
antibiotic misuse
patients not screened
What can be done to prevent MRSA infections occurring?
nasal swab
groin swab
wounds, urine, line sites, sputum
investigations of acquisitions to extract learning
targets set locally on number of blood stream infections
What is C. diff?
anaerobic gram +ve bacilli lives in the gut produces spores resists drying resists abx produces toxins toxins produce diarrhoea
What does C.diff cause?
watery diarrhoea abdominal pain pseudomembranous colitis dehydration bowel perforation death
Why is C. diff important?
human costs:
- morbidity and mortality
- 16/17 12840 cases
- costs healthcare an estimated £4500-9000
Why does C. diff occur?
antimicrobials prescribed for infection
colonisation due to cross infection
overgrowth of the bacteria in the gut
toxin causes bowel damage
What is the protocol for patients with C.diff?
1) stop abx if possible
2) start treatment
3) monitor fluids
4) specialist review
5) terminal clean when better
6) ensure discharge info given
What are the treatments for c.diff?
mainly focussed on drugs which kill c. diff
- metronidazole
- oral vancomycin
- fidaxomicin
