Session 5 Flashcards
(23 cards)
What are healthcare infections?
•Infections arising as a consequence of providing healthcare
•In hospital patients:
Neither present nor incubating at time of admission
For practical purposes, this means onset is at least 48 hours after admission
•Also includes infections in hospital visitors and healthcare workers
Also called nosocomial infections (hospital acquired).
Why are healthcare infections important?
- Frequent -prevalence = 8% of in-patients
- Impact on health
- Impact on healthcare organisations (cost, longer in hospital so other patients cant come in.)
- Preventable
In what areas of the infection model can we try to prevent hospital acquired infections?
Stop the pathogen attaching to the patient.
Prevent further colonisation of the pathogen in the patient.
Once the infection has been recognised, preventing it from infecting another patient.
Give some examples of healthcare infections.
Viruses
blood borne viruses (hepatitis B, C, HIV) norovirus influenza chickenpox
Bacteria Staph aureus including MRSA Clostridium difficile Escherichia coli, Klebsiella pneumoniae Pseudomonas aeruginosa Mycobacterium tuberculosis
Fungi
Candida albicans Aspergillus species
Parasites
Malaria
What makes a patient more susceptible to healthcare acquired infection?
Extremes of age Obesity/malnourished Diabetes cancer Immunosuppression Smoker Surgical patient Emergency admission
What are the 4 Ps of infection prevention and control?
Patient - General and specific patient risk factors for infections • Interactions with: •other patients •healthcare workers •visitors
Pathogen - •Virulence factors •Ecological interactions -other bacteria -antibiotics/disinfectants
Practice -
•General and specific activities of healthcare workers
•Policies and their implementation
•Organisational structure and engagement
•Regional and national political initiatives
•Leadership at all levels from government to the ward
Place -
•Healthcare environment
-fixed features - side rooms where patients can be isolated.
-variable features - closer beds means more spread.
What type of patient interventions can reduce healthcare acquired infections?
General •Optimise patient’s condition •Smoking, nutrition, diabetes •Antimicrobial prophylaxis •Skin preparation •Hand hygiene
Specific •MRSA screens •Mupirocin nasal ointment •Disinfectant body wash • Halting patient to patient transmission - Physical barriers • Isolation of infected patients • Protection of susceptible patients
What type of healthcare worker interventions can we use to reduce healthcare acquired infections?
• Healthcare workers:
- Healthy
• Disease free
• Vaccinated - Good practice
• Good clinical techniques (e.g. sterile non-touch)
• Hand hygiene
• PPE
• Antimicrobial prescribing - limits C. diff
What type of environmental interventions can we use to reduce healthcare acquired infections?
• Built environment - Space/Layout - Toilets - separate for patients with diarrhoea. - Wash hand basins • Furniture and furnishings •Cleaning - Disinfectants - Steam cleaning - Hydrogen peroxide vapour • Medical devices - Single use equipment - Sterilisation - Decontamination • Appropriate kitchen and ward food facilities • Good food hygiene practice • Theatres • Positive/Negative pressure rooms • Immunosuppressed patients
How do we identify people who present an infection control risk?
“I five patients “
Identify: •Abroad •Blood borne infections •Colonised •Diarrhoea/vomiting •Expectorating •Funny looking rash Isolate the patient Investigate the condition Inform healthcare staff Initiate treatment
Are antibiotics new?
Antibiotics are ancient –originating 2 billion to 40 million years ago
• Resistance is only slightly younger
How do we combat MRSA?
Not only methicillin resistant but resistant to all beta-lactams so some cephalosporins can be used instead.
Is resistance reversible?
All exposure of bacteria to antimicrobials leads to antimicrobial resistance and that resistance is effectively irreversible so we just try to wipe out that resistant bacteria. New antimicrobial development is stalled due to it not being profitable.
What are the consequences of antibacterial resistance?
- Treatment failure
- Prophylaxis failure
- Economic costs
What are the different definitions of antimicrobial resistance?
MDR (multi-drug resistant) - Non-susceptibility to at least one agent in three or more antimicrobial categories
XDR (extensively drug resistant - Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories
PDR (pan-drug resistant) - Non-susceptibility to all agents in all antimicrobial categories
What is the evidence that antibacterial use leads to resistance?
- Laboratory evidence –Provides biological plausibility
- Ecological studies –Relates levels of antibacterial use in a population with levels of resistance
- Individual level data –Relates prior antibacterial use in an individual with the subsequent presence of bacterial resistance (detected by culture or molecular means)
What is antimicrobial stewardship?
Coordinated interventions designed to:
• Promote appropriate use of antimicrobials
• Optimise clinical outcomes
• Minimize toxicity and other adverse events
• Reduce the costs of health care for infections
• Limit the selection for antimicrobial resistant strains.
What are the elements of an antimicrobial stewardship programme?
- Multidisciplinary team and relationships to other quality/safety teams
- Surveillance
- Process measures - Antibacterial use: quantity, antibacterial classes, appropriateness, over time in the same institution and benchmarking this against other institutions. (diagnosis and treatment).
- Outcome measures - how successful is the treatment, side effects and levels of resistance
• Interventions - Persuasive: Education Consensus Opinion leaders Reminders Audit Feedback
- Restrictive: Restricted susceptibility reporting
Formulary restriction
Prior authorisation
Automatic stop orders - Structural: Computerised records
Rapid lab tests
Expert systems
Quality monitoring
Who would be in the multi-disciplinary team for antimicrobial stewardship?
- Medical Microbiologist/Infectious diseases physician
- Antimicrobial pharmacist
- Infection control nurse
- Hospital epidemiologist
- Information system specialist
What are the requirements for successful stewardship?
- Long term confirmed and appropriate resources
- Hospital leadership support and delegated authority to challenge/change inappropriate antimicrobial therapy
- Integration into organisational patient safety and quality of care structure and processes
What is better, restrictive or persuasive methods?
Restrictive is better in short term although all work out to be relatively equal long term
What are the possible consequences of stewardship?
Increased readmission
Reduced risk of mortality
Not proven if stewardship reduces resistance.
Why could antibiotic resistance be bad for the bacteria?
Mutation which gives resistance to antibiotic could e detrimental to the bacteria itself so if the antibiotic is no longer present, keeping the mutation could actually be a hindrance.
