1: Nosocomial Infection

Question 1

What test is used to investigate for C.Difficile

Answer 1

Two-phase test:

1. Toxin A and B
2. Glutamate Dehydrogenase

Question 2

What defines mild C.Difficle infection

Answer 2

• WCC <15

- 5-7 Bowel motions pd

Question 3

What 4 factors indicate severe CDI

Answer 3

• WCC >15
• T >38.5
• Clinical or x-ray evidence colitis
• Increase serum creatinine by 50%

Question 4

What 3 factors indicate life-threatening CDI

Answer 4

• Ileus
• Toxic megacolon
• Hypotension

Question 5

According to the grey-book what is first line for C.Difficle

Answer 5

PO Vancomycin

Question 6

If toxic megacolon or perforation is suspected was is done

Answer 6

Emergency Referral to surgery

Question 7

If individual cannot tolerate oral medications, what is the alternative to PO vancomycin

Answer 7

IV metronidazole

Question 8

When C.Diff has been confirmed on the two-phase test what is done

Answer 8

Switch to PO Fidaxomicin

Question 9

What is the mnemonic to remember 4 signs of fulminant C. Difficile

Answer 9

SHIT

Shock
Hypotension
Ileus
Toxic megacolon

Question 10

How is fulminant C.Difficle managed

Answer 10

IV metronidazole and oral or rectal vancomycin

Question 11

Name 5 hospital acquired infections

Answer 11

• Surgical site infection
• Hospital-acquired pneumonia
• MRSA
• C.Diff
• UTI

Question 12

What is a surgical site infection

Answer 12

Infection at wound made by surgery

Question 13

What is the most common cause of SSI

Answer 13

S. Aureus

Question 14

What are two other causes of SSI

Answer 14

S. Epidermis

Enterococcus

Question 15

When is E.Coli a more common cause of SSI

Answer 15

Laparotomy

Question 16

Give 5 patient factors that increase risk of SSI

Answer 16

• Old-age
• Immunocompromised
• Diabetic
• Smoker
• Malnourished

Question 17

What are 5 operational factors increase risk of SSI

Answer 17

• Pre-operative shaving
• Poor wound closure
• Long operation
• Inadequate sterilisation
• Surgical drain insertion

Question 18

When do surgical site infection usually manifest

Answer 18

3-7d following operation

Question 19

How does SSI usually present

Answer 19

Erythema
Discharge
Localised Pain
Dehiscence

Question 20

What should be performed in SSI

Answer 20

Wound swab
FBC, CRP
Culture

Question 21

How should SSI be managed

Answer 21

• Open and pack wound - enable drainage. May require referral to tissue viability nurse
• Antibiotics

Question 22

When can MRSA normally be found

Answer 22

Colonises nasal mucosa

Question 23

What does infection with MRSA cause

Answer 23

Surgical-site infection

Cellulitis

Question 24

How does staphylococcus aureus become resistant to methicillin

Answer 24

Modifies its penicillin binding protein - no longer binds methicillin

Question 25

Who is screened for MRSA colonisation

Answer 25

All elective surgery cases (unless day surgery opthalm or TOP)

Question 26

How is MRSA screened for

Answer 26

Nasal swab

In infection - wound swab

Question 27

If MRSA is identified in the nose, what is given prior to surgery

Answer 27

Mupirocin (White soft paraffin) - 5d

Question 28

what is given prior to surgery if MRSA is found in skin or hair

Answer 28

Chlorhexidine Glucoronate - 5d

Question 29

how is MRSA infection treated

Answer 29

Vancomycin

Question 30

how do St. George’s define hospital acquired infection

Answer 30

Onset of pneumonia more than 5d from admission to hospital

Question 31

what is hospital acquired pneumonia usually caused by

Answer 31

Gram-negative

Question 32

name two gram-negative bacteria

Answer 32

Pseudomonas auerginosa

Enterobacter

Question 33

what investigations are ordered for pneumonia

Answer 33

Lactate
CXR
Urinary legionella and mycoplasma

Question 34

how is non-severe HAP managed

Answer 34

Doxycycline

Question 35

how is severe HAP managed

Answer 35

Benzylpenicillin and gentamicin

Question 36

what is given if legionella confirmed

Answer 36

Levofloxacin