1: Nosocomial Infection Flashcards
What test is used to investigate for C.Difficile
Two-phase test:
- Toxin A and B
- Glutamate Dehydrogenase
What defines mild C.Difficle infection
- WCC <15
- 5-7 Bowel motions pd
What 4 factors indicate severe CDI
- WCC >15
- T >38.5
- Clinical or x-ray evidence colitis
- Increase serum creatinine by 50%
What 3 factors indicate life-threatening CDI
- Ileus
- Toxic megacolon
- Hypotension
According to the grey-book what is first line for C.Difficle
PO Vancomycin
If toxic megacolon or perforation is suspected was is done
Emergency Referral to surgery
If individual cannot tolerate oral medications, what is the alternative to PO vancomycin
IV metronidazole
When C.Diff has been confirmed on the two-phase test what is done
Switch to PO Fidaxomicin
What is the mnemonic to remember 4 signs of fulminant C. Difficile
SHIT
Shock
Hypotension
Ileus
Toxic megacolon
How is fulminant C.Difficle managed
IV metronidazole and oral or rectal vancomycin
Name 5 hospital acquired infections
- Surgical site infection
- Hospital-acquired pneumonia
- MRSA
- C.Diff
- UTI
What is a surgical site infection
Infection at wound made by surgery
What is the most common cause of SSI
S. Aureus
What are two other causes of SSI
S. Epidermis
Enterococcus
When is E.Coli a more common cause of SSI
Laparotomy
Give 5 patient factors that increase risk of SSI
- Old-age
- Immunocompromised
- Diabetic
- Smoker
- Malnourished
What are 5 operational factors increase risk of SSI
- Pre-operative shaving
- Poor wound closure
- Long operation
- Inadequate sterilisation
- Surgical drain insertion
When do surgical site infection usually manifest
3-7d following operation
How does SSI usually present
Erythema
Discharge
Localised Pain
Dehiscence
What should be performed in SSI
Wound swab
FBC, CRP
Culture
How should SSI be managed
- Open and pack wound - enable drainage. May require referral to tissue viability nurse
- Antibiotics
When can MRSA normally be found
Colonises nasal mucosa
What does infection with MRSA cause
Surgical-site infection
Cellulitis
How does staphylococcus aureus become resistant to methicillin
Modifies its penicillin binding protein - no longer binds methicillin
Who is screened for MRSA colonisation
All elective surgery cases (unless day surgery opthalm or TOP)
How is MRSA screened for
Nasal swab
In infection - wound swab
If MRSA is identified in the nose, what is given prior to surgery
Mupirocin (White soft paraffin) - 5d
what is given prior to surgery if MRSA is found in skin or hair
Chlorhexidine Glucoronate - 5d
how is MRSA infection treated
Vancomycin
how do St. George’s define hospital acquired infection
Onset of pneumonia more than 5d from admission to hospital
what is hospital acquired pneumonia usually caused by
Gram-negative
name two gram-negative bacteria
Pseudomonas auerginosa
Enterobacter
what investigations are ordered for pneumonia
Lactate
CXR
Urinary legionella and mycoplasma
how is non-severe HAP managed
Doxycycline
how is severe HAP managed
Benzylpenicillin and gentamicin
what is given if legionella confirmed
Levofloxacin
