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Nosocomial infections Flashcards

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1
Q

What is the prevalence of hospital acquired infections?

A

6.4% prevalence in hospital

Significant burden

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2
Q

What are common organisms responsible for HCAIs?

A

MRSA

MSSA

E. coli

C. difficile

Norovirus, Rotavirus, Sapovirus

VPE

Multi-resistant Gram Negatives

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3
Q

What does MRSA stand for?

A

Methicillin resistant S. aureus

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4
Q

What does MSSA stand for?

A

Methicillin sensitive S. aureus

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5
Q

Why are HCAIs so relevant?

A

Often in the news

Legal firms look for patients who developed HCAIs to seek compensation

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6
Q

Why are HCAIs important?

A

Estimated cost > £1 bn

Increased mortality and morbidity

Poor patient experiments

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7
Q

Why do HCAIs have such high costs?

A

Prolonged hospital stays

Further treatments and procedures

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8
Q

What are examples of HCAIs?

A

Urinary tract infections

Respiratory tract infections

Surgical site infections

Indwelling device infections

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9
Q

In which population are UTIs particularly prevalent?

A

Elder population

May be urinary catheter-associated

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10
Q

What is a way of diagnosing UTIs?

A

White blood cells or bacteria in urine sample

Grow bacteria in culture to see what antibiotic used

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11
Q

What are causes of respiratory infections?

A

May be caused by unusual organisms like Pseudomonas or other gram negative bacteria

May be associated with ventilation - bacteria like to stay in ventilators

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12
Q

What are examples of indwelling devices?

A

Venous and arterial catheters

Prosthetic joints

Cardiac pacemakers and prosthetic valves

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13
Q

What do infections of indwelling devices cause?

A

Local infections

Bacteraemia

Sepsis - venous catheter in major arteries or veins can cause wide spread infections

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14
Q

What are examples of multi-resistant gram negatives?

A

Extended spectrum B-lactamases

Carbapenemase producing Enterobacteriaceae

Multiresistant Pseudomonas spp, and Acinetobacter spp.

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15
Q

Where is MRSA found?

A

Present in 10-20% of population asymptomatically

Mostly in nose and perineum

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16
Q

What does MRSA cause?

A

Bacteraemia

SKin and soft tissue infections - indwelling devices

Endocarditis - infection of the heart valves

Osteomyelitis - infection of bones

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17
Q

Are MRSA rates rising or falling?

A

Falling

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18
Q

What new rule has been implemented regarding MRSA infections?

A

Trust requires all infections to be reported

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19
Q

How can hospitals lower the rates of MRSA infections?

A

Screen patients prior to admission/procedures

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20
Q

Which patients are at higher risk of containing MRSA colonies?

A

Patients that have been in health care setting before

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21
Q

What samples are used to test for MRSA?

A

From the nose or perineum

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22
Q

How are the samples screened to test for MRSA?

A

NAAR

Culture with chromogenic media

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23
Q

What is chromogenic media?

A

Only bacteria that are methicilin resistant can grow on these plates

Will show up pink

Quick and easy

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24
Q

What happens to the patients that are found to be carriers of MRSA?

A

Body washing with specific soaps or detergents

Antibiotics

Alternative antibiotics required to treat infections caused by MRSA

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25
Which viruses cause diahrrea and vomiting?
Norovirus Rotavirus Sapovirus
26
How many cases of Norovirus are there in the UK per year?
600 000 - 1 000 000 cases annually Normally self-limiting
27
What is a characteristic of Norovirus?
More common in winter
28
What is the significance of Norovirus?
Responsible for outbreaks and closures of hospital wards Enormous impact on trust Adds financial burden to the patients
29
How are Norovirus, Rotavirus, Sapovirus diagnosed?
Clinically by NAAT Specimen of stool sent to the lab
30
What is done to patients diagnosed with norovirus/ rotavirus/ sapovirus?
Controlled by isolation of infected patients and other strict infection control
31
What are examples of infection control?
Hand washing Barrier nursing - staff wearing gloves and disposable aprons Restriction of visitors
32
Where are C. difficile normally found?
Normal biota GI bacteria - associated with normal microflora
33
What causes C. difficile to increase in population?
Antibiotics Confers resistance to C. difficile Other bacteria that normally competes with the bacteria and keep them in low numbers are killed off
34
What are the symptoms of C. difficile?
Symptoms range from mild, self-limiting diarrhoea to life-threatening pseudomembranous colitis and toxic megacolon
35
What is pseudomembranous colitis?
Inflammation of the colon Occurs in some people who have taken antibiotics Almost always associated with an overgrowth of the bacteria
36
What is the treatment of C. difficile infection?
Depends on severity Removal of contributing agents Use of anti-C. difficile agents
37
What are examples anti-C. difficile agents?
Metronidaxole Vancomycin Fidaxomicin
38
How is C. difficile diagnosed?
Assessment of diarrhoea WBC Temperature Evidence of colitis Evidence of renal impairment
39
What is used to assess diarrhoea?
Bristol stool chart Record their stool habits
40
What is evidence of colitis?
Abdominal tenderness or abnormalities in the abdomen
41
How is stool tested for C. difficile?
Two stage algorithm Two of these 3 tests are used: - Glutamate dehydrogenase by ELISA - Toxin of C. difficile by ELISA - Detect the bacterium by NAAT - molecular method
42
What is ELISA?
Enzyme-linked immunosorbent assay
43
What is glutamate dehydrogenase?
Produced by organism in the stool sample Can't guarantee that C. difficile is creating the toxin
44
What is the positive test for glutamate dehydrogenase?
Yellow
45
What are the two main species of VRE seen clinically?
E. faecium E. faecalis
46
How do these bacteria obtain resistance?
Many mechanisms
47
Where are these organisms found?
In the GI tract
48
What type of organism are VREs?
Low pathogenicity organisms
49
What do VREs cause?
Opportunistic infections In patients who are immunocompromised
50
What are common types of infections caused by VREs?
Indwelling catheters Intra-abdominal infections post surgery or translocation from gut Endocarditis Joint infections
51
What precautions are taken in hospitals to prevent VREs from causing disease?
Patients are screened To know if they have the organism in the gut So they can be given different antibiotics if they develop the infection
52
What are ways to identify VREs?
Can see hazy growth around vancomycin in antibiotic sensitivity testing Grow using chromogenic media - purple indicates E. faecium/faecalis
53
What are ESBLs?
Externded spectrum beta-lactamases Enzymes expressed by Gram negative organisms Inactivate penicillin and cephalosporins
54
What are the main ESBLs which are of biggest concert?
Enterobacteriaceae
55
Where are Enterobacteriaceae found?
Carried in the GI tract as commensal
56
What do Enterobacteriaceae cause?
Infections in the same spectrum as other Enterobacteriaceae
57
What type of infections do Enterobacteriaceae cause?
Surgical meningitis UTI Intra-abdominal sepsis
58
What is a characteristic of ESBLs?
Resistant to large spectrum of - beta lactam antibiotics - 3rd generation cephaloporins
59
What is used to identify ESBLs?
Chromogenic media NAAT
60
What type of chromogenic media is used to identify ESBLs?
Media is selective Antibiotics used that only ESBLs will grow on Screen for broad set of resistant profiles
61
What antibiotics are used to treat ESBLs?
Carbapenems Fluoroquinolones Aminoglycosides Temocillin
62
What are CPEs?
Carbapenemase producing Enterobacteriaceae Multi-resistant gram negative organisms Resistant to carbapenem drug family
63
What type of infections do CPEs cause?
Urinary tract infections Abdominal sepsis
64
What type of antibiotics are used to treat CPEs?
Treated with other, less effective or toxic antibiotics Leave with few antibiotic options
65
What have public policy schemes done to prevent CPE infection?
Public health england have given guides to screen for, investigate and prevent transmission of these organisms
66
How are CPEs identified?
Culture or NAAT
67
What is an example of a culture form to identify CPE?
Modified Hodge test
68
Describe the modified Hodge test
Control strain that is placed in the agar is sensitive Test strain obtained from the patient is not resistant to the antibiotics when the zone inhibition is a round shape If the zone of inhibition has a clover-leaf shape = contains carbopenamase The resistant genes from the CPE have also been transferred to the E. coli found homogenously in the medium
69
What controls are taken once a patient has been identified with CPE?
Patients are screened Give antibiotics that act on the bacteria Isolate the infected people in rooms
70
What is done to prevent spread of nosocomial infections?
Each trust has a named individual responsible for Infection Prevention and Control Government targets are put for the number of MRSA, MSSA, E.coli and C, difficile cases Screening for key organisms Rotavirus vaccination Policies and guidelines for best practice
71
What happens if trusts breach the governmental targets of nosocomial infections?
Trusts are fined if they breach the targets
72
What are examples of policies and guidelines for best practice to prevent nosocomial infections?
Hand washing and environmental cleaning Isolation of patients with infections Antimicrobial stewardship
73
What is antimicrobial stewardship?
Use appropriate antibiotics Not receive antibiotics if they don't need them

PPS - infections (8 decks)

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