27-10-22 - Healthcare-Associated Infections Flashcards
Learning outcomes
- Understand the basic epidemiology
- Understand what is meant by the term “transmission-based precautions”
- Know the importance of hand hygiene
- Know the importance of medical devices to HCAIs
What is a HAI?
What is a HCAI?
What is a CAI?
- Hospital acquired infection (HAI) - not present on admission, but present more than 48 hours after
- Healthcare associated infections (HCAI) – infections acquired by hospital or other healthcare setting.
- Community acquired infections (CAI) - Infections contracted outside of a healthcare setting or an infection present on admission
What are HCAI costs in Scotland?
How much does it increase length of stay (LOS)?
How many deaths does HAI cause a year in the UK?
What % of HCAI Is preventable?
- HCAI cost in Scotland is ~£76.5m or 1.1% of the NHS budget in Scotland
- HCAI results in average increase in LOS (length of stay) of 7.8 days
- 3000 deaths in hospital directly related to HAI In the UK
- 15-30% of HCAI are preventable
What are 4 common HAI types?
- 4 common HAI types:
1) Urinary tract infection
2) Blood stream infection
3) Lower respiratory tract infection
4) Gastrointestinal infection
What are 7 reasons why HCAI is an issue?
- 7 reasons why HCAI is an issue:
1) Chronic disease
2) Invasive medical devices
3) Elderly population
4) Immunosuppression
5) More complex procedures
6) Antibiotic use
7) Failure by HCW to see it as a problem
What is the Francis report leading to?
What are 2 ways we measure quality of care?
- The Francis Report is leading to a paradigm shift in clinical care
- How we can measure quality of care:
1) Health Improvement Scotland (HIS)
2) Rates of HAI
What are 6 ways doctors can take measures to prevent HCAI?
- 6 ways doctors can take measures to prevent HCAI:
1) Recognition of risk factors in patients
2) Behaviour & practice
3) Hand hygiene
4) Dress
5) Personal protective equipment
6) Use isolation facilities correctly
What are the 6 links of the chain of infection?
- 6 links of the chains of infection
1) Infectious agent
* The disease-causing organism e.g bacteria, virus etc
2) Reservoir
* Where the infectious agent usually lives and multiplies e.g humans, animals, insects, environment
3) Portal of exit
* The means by which the infectious agent leaves e.g saliva, nose, throat, vomit, faeces, blood
4) Mode of transmission
* How the infection moves to the susceptible host
* Airborne spread
* Sexual intercourse
* Skin to skin contact
* Vectors
* Direct transmission via droplet spread (coughing and sneezing)
5) Portal of entry
* The place the infectious agent enters the new host
* Mucous membrane of respiratory tract
* Broken skin
* Open wound
* Urinary tract
* Placenta
6) Susceptible host
* The person who is at risk of infection
* High risk groups
* Elderly
* Very young
* Chronic disease
* Immunosuppressed
What are SICPs?
What are standard precautions?
What are TBPs?
- Standard Infection Control Precautions (SICP) – Measures necessary to reduce the spread of microorganism from both known and unknown sources of infection e.g ventilation, bed spacing, vaccination
- Standard precautions – Precautions we take for any patient e.g hand washing
- Transmission Based Precautions (TBPs) – A set of measures used when a patient Is either suspected or known to be infected with a specific infection e.g diarrhoea – we don’t know if it is caused by an infectious agent, or has an inflammatory cause
What are the 3 main modes of transmission?
What does the ability to aerolise depend on?
What medical procedures needed to be used for airborne transmission?
- 3 main modes of transmission:
1) Contact transmission - can be direct or indirect
2) Droplet transmission
* When we breath out, droplets travel a short distance before falling on surfaces
3) Airborne (aerosol) transmission
* Droplets that are less than 5 microns, which can travel a much longer distance than larger droplets
* Droplets this small can also enter alveoli and cause infection there
* Ability to aerosolise depends on the pathogen
* Medical procedures i.e. ventilation technique or specific medical procedures need to be used
When are contact precautions used?
What 3 syndromes require contact precautions?
What 4 specific organisms require contact precautions?
What 4 things does contact precautions involve?
- Contact precautions are used for patients infected/colonised with organisms transmitted by direct or indirect contact
- 3 syndromes that require contact precautions:
1) Gastroenteritis
2) Fever in patient returned from the tropics
3) Patients with open wounds - 4 specific organisms require contact precautions:
1) Clostridium difficile
2) MRSA (methicillin resistant staphylococcus aureus)
3) Streptococcus pyogenes
4) COVID-19 - 4 things contact precaution involves:
1) Disposable gloves
2) Disposal apron
3) Single room if possible
4) Disposable masks/eye protection if at risk of exposure to body fluid
When are droplet precautions used?
What 5 syndromes require precautions be used for?
What 7 specific organisms require droplet precautions?
What 5 things does droplet precaution involve?
- Droplet precautions are for organisms transmitted in droplets (>0.5 microns)
- These travel only short distances
- What 5 syndromes that require droplet precautions:
1) Respiratory illness
2) Meningism
3) Fever with cough
4) Fever with rash
5) Vomiting - 7 specific organisms that require droplet precautions:
1) Neisseria meningitis
2) Mumps
3) Rubella
4) COVID-19
5) Influenza
6) RSV (Respiratory Syncytial Virus)
7) All respiratory viruses - 5 things droplet precaution involves:
1) Single room if possible
2) Disposable apron and gloves
3) Wear fluid resistant surgical mask
4) Wear eye protection (goggles or visor)
5) If patient undergoing aerosol generating procedures (AGP) wear FFP3 mask - medical procedures that can result in the release of aerosols from the respiratory tract e.g bronchoscopy
When are airborne precautions used?
What 1 syndrome requires airborne precautions?
What 3 specific organisms require airborne precautions?
What 5 things does airborne precaution involve?
- Airborne precautions are for particles that are <5 microns
- They can be widely dispersed
- FFP3 mask for all aerosol generating procedures (AGP) - medical procedures that can result in the release of aerosols from the respiratory tract e.g bronchoscopy
- 3 specific organisms that require airborne precautions:
1) TB
2) Chicken pox
3) Measles - 5 things airborne precaution involves:
1) Single room
2) Disposable apron or consider gown if manoeuvring the patient
3) Disposable gloves
4) High efficiency filter mask (FFP3 mask)
5) Eye protection
What are the 2 before and 3 afters of hand decontamination?
When can alcohol gel be used?
When does soap and water need to be used?
What are the 6 steps to hand decontamination?
- 2 befores of hand decontamination:
1) Before touching a patient
2) Before clean/aseptic procedure - 3 afters of hand decontamination:
1) After body fluid exposure risk
2) After touching patient
3) After touching patient surroundings - Alcohol gel can be used between patients if hands sociably clean
- After about 4 consecutive uses of alcohol gel, we need to wash hands to remove build-up of dried gel
- Must use soap and water after examination of a patient with diarrhoea and after removing gloves
- 6 steps to hand decontamination:
1) Bare below the elbows plus removal of watches and rings with stones
2) Wet hands and then apply soap to all surfaces of the hands
3) Rinse hands
4) Dry hands on paper towels
5) Turn off tap with elbows or paper towel
6) Dispose of towel without contaminating hands
How long can invasive medical devices be used for?
What do they all do?
What are 4 examples of invasive medical devices?
How long are indwelling prosthetic devices used for?
What are 3 examples of indwelling prosthetic devices?
What is the most common source of Staph Aureus HAI?
- Invasive medical devices may be long term or short term
- All break the skin or mucous membrane barrier
- 4 examples of invasive medical devices:
1) CVC
2) PVC
3) Urinary catheters
4) Dialysis lines - Indwelling prosthetic devices are usually long-term devices which are buried into tissue under the skin
- 3 examples of indwelling prosthetic devices:
1) Heart valves
2) Joints
3) Pacing units - The most common source of Staph Aureus HAI is vascular access devices (VAD), specifically PVCs
- Most hospitals in the UYK now have active management systems for PVCs and CVCs
- The use of ‘bundles’ are used to managed PVC care in Scotland
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