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CSI 1a > 3. Javier Ratchett: Hospital Acquired Infection > Flashcards

3. Javier Ratchett: Hospital Acquired Infection Flashcards

1
Q

What is a HAI?

A

-Infections patients get white receiving treatment for medical/surgical conditions
-Many HAIs are preventable

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2
Q

What usually causes HAIs?

A

Invasive devices such as catheters/ventilators used in medical procedures

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3
Q

Where do HAIs typically occur?

A
  1. Acute care hospitals
  2. Ambulatory surgical centres
  3. Dialysis facilities
  4. Outpatient care
  5. Long-term care facilities
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4
Q

What is a central line-associated bloodstream infection (CLABSI)?

A
  • serious HAI that occurs when pathogens enter the blood stream through the central line
  • results in 1000s of deaths
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5
Q

What is Methicillin-resistant Staphylococcus aureus (MRSA)?

A

-Type of bacteria resistant to many antibiotics
-Causes life-threatening bloodstream infections, pneumonia and surgical site infections

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6
Q

What are 2 sources of HAI?

A
  1. CLABSI
  2. MRSA
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7
Q

What are the 5 common types of HAIs?

A
  1. Catheter-associated urinary tract infections
  2. Surgical site infections
  3. Bloodstream infections
  4. Ventilator-associated pneumonia
  5. Clostridium difficile
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8
Q

Why are HAIs important ?

A

-source of complications across the continuum of care
-can be transmitted between different health care facilities

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9
Q

What are the 4 risk factors of HAIs?

A
  1. Medical procedures and antibiotic use
  2. Organisational factors
  3. Patient characteristics
  4. Behaviour of healthcare providers and interactions with healthcare system
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10
Q

How can we reduce the occurrence of HAIs?

A
  1. Proper education and training of healthcare workers to increase compliance
  2. Infection control
  3. Hand hygiene
  4. Attention to safety culture
  5. Antibiotic stewardship
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11
Q

What are a few examples of ‘best practices’?

A
  1. Careful insertion, maintenance, prompt removal of catheters
  2. Careful use of antibiotics
  3. Decolonisation of patients - evidence based method to reduce transmission of MRSA in hospitals
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12
Q

Why do HAIs tend to occur in outpatient settings?

A

Limited capacity for oversight and infection control compared to hospital-based settings

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13
Q

What is the chain of infection?

A

Sequence of events that show how infectious diseases spread

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14
Q

Outline the Chain of Infection.

A
  1. Agent leaves its reservoir/ host
  2. Through portal of exit
  3. Mode of transmission
  4. Enters through portal of entry
  5. Into susceptible host
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15
Q

What is the reservoir of an infectious agent?

A

Habitat in which the agent normally lives, grows and multiplies
-inc: humans, animals and environment

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16
Q

What are asymptomatic/passive healthy carriers?

A

Those who never experience symptoms despite being infected

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17
Q

Who are incubatory carriers?

A

Those who can transmit the agent during the incubation period before clinical illness begins

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18
Q

Who are convalescent carriers?

A

Those who have recovered from their illness but remain capable of transmitting to others

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19
Q

Who are chronic carriers?

A

Those who continue to harbour a pathogen for months/years after initial infection
-e.g/Hep B

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20
Q

What is zoonosis?

A

Infection disease that is transmissible from vertebrate animals to humans

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21
Q

What are examples of environmental reservoirs?

A

-plants/soil/water
-usually fungal agents

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22
Q

What is the portal of exit?

A

-path by which a pathogen leaves its host
-usually corresponds to site where pathogen is localised
-some blood borne agents can exit by crossing the placenta from mother to foetus (syphilis)
-exit through cuts/needles in skin (Hep B)
-blood sucking arthropods (malaria)

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23
Q

What are the two classifications of modes of transmission?

A
  1. Direct: direct contact; droplet spread
  2. Indirect: airborne; vehicle borne; vector borne
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24
Q

What is direct transmission?

A

Infectious agent is transferred from a reservoir to a susceptible host by direct contact or droplet spread

25
Q

What is direct contact?

A

-skin-to-skin contact
-kissing/sex
-contact with infected soil

26
Q

What is droplet spread?

A

-spray with large, short-range aerosols
-sneezing/coughing/talking
-e.g/meningitis

27
Q

What is indirect transmission?

A

Transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects or vectors

28
Q

What is airborne transmission?

A

-infectious agents carried by DUST or DROPLET NUCEI suspended in air
-DUST = settled on surfaces - resuspended by air currents
-DROPLET NUCEI = suspended in air for long periods of time
E.g/measles

29
Q

What is vehicleborne?

A

-food
-water
-biological products (blood)
-fomites (handkerchiefs/bedding/scalpels

30
Q

What are vectors?

A

-mosquitoes/fleas/ticks carries infectious agent through MECHANICAL means
-BIOLOGICAL transmission = agent undergoes maturation in intermediate host before transmission to humans (e.g/malaria)

31
Q

What is the portal of entry?

A

Manner in which a pathogen enters a susceptible host
Must provide access to tissues for pathogen to multiply in

32
Q

What portal of entry do pathogens that case gastroenteritis follow?

A

Fecal-oral route

33
Q

Describe the fecal-oral portal of entry route.

A

Exit host in feces —> carried on unwashed hands —> contaminate vehicle (food) —> enter new host through mouth

34
Q

Give examples of 4 portals of entry.

A
  1. Fecal-Oral
  2. Skin (hookworm)
  3. Mucous membranes (syphilis)
  4. Blood (Hep B)
35
Q

What factors contribute to the susceptibility of a host?

A
  1. Genetic/constitutional factors
  2. Specific immunity
  3. Nonspecific factors
36
Q

How can genetic factors affect susceptibility of a host?

A

May increase/decrease susceptibility

37
Q

How can specific immunity affect susceptibility of a host?

A

-protective antibodies that are directed against a specific agent
- develops in response to an infection/transplacental transfer from mother to foetus/injection of antitoxin or immune globulin

38
Q

How can non-specific factors affect susceptibility of a host?

A

Decrease: skin, mucous membranes, gastric acidity, cilia in respiratory tract, cough reflex
Increase: malnutrition, alcoholism, disease

39
Q

Where are interventions directed at?

A
  1. Controlling/eliminating agent at source of transmission
  2. Protecting portals of entry
  3. Increasing host’s defences
40
Q

How can we intervene at the source of transmission?

A
  1. Treating sick patient with antibiotics to eliminate infection
  2. Treating asymptomatic patient - reduce transmission
  3. Soil decontaminated to prevent escape of agent
41
Q

How can we intervene at the mode of transmission?

A

Direct: isolation of infected person/ advising to avoid contact
Vehicleborne: elimination/ decontamination
Fecal-oral: rearranging environment to reduce contamination/ behaviour change - hand washing
Airborne: modifying ventilation, air pressure/ filtering air
Vectorborne: controlling population - insecticides

42
Q

How can we intervene at the portal of entry?

A
  1. Bed nets - sleeping people from mosquitoes
  2. Mask and gloves - protect from blood/secretions/droplets
  3. Insect repellent - prevent bites
43
Q

How can we intervene to increase host’s defences?

A
  1. Vaccinations - a.b stimulation
  2. Prophylactic use of drugs
44
Q

How can we intervene to prevent a pathogen from encountering a susceptible host?

A

Herd immunity - high proportion vaccinated then less likely for the vulnerable to become infected

45
Q

What is the name given to defence strategies against antibiotics?

A

Resistance mechanisms

46
Q

What is the the resistance mechanism ‘restrict access of the antibiotic’?

A

Pathogens restrict access by charging the entryways/limiting number of entryways

47
Q

What is the resistance mechanism: ‘eliminating antibiotic’?

A

Getting rid of antibiotics by using pumps in their cell wall before they enter the cell

48
Q

What is the resistance mechanism: ‘change/destroy antibiotic’?

A

Using enzymes to break down the drug

49
Q

What is the resistance mechanism: ‘changing the target’

A

Pathogens change the antibiotic’s target so it can no longer bind and do its job

50
Q

What is the resistance mechanism: ‘bypass the effects of the antibiotic’?

A

Pathogens develop new cells processes that avoid antibiotic’s target

51
Q

How does antibiotic resistance move directly from pathogen to pathogen?

A

Mobile genetic elements

52
Q

What are the different mobile genetic elements?

A
  1. Plasmids
  2. Transposons
  3. Phages
53
Q

What are plasmids?

A

Circles of DNA that can move between cells

54
Q

What are transposons?

A

Small pieces of DNA —> go into cell —> change overall DNA
Can move to chromosomes and plasmids and back

55
Q

What are phages?

A

Viruses that attack germs and can carry DNA from pathogen to pathogen

56
Q

What is transduction?

A

Resistance genes transferred from one pathogen to another via PHAGES

57
Q

What is conjugation?

A

Resistance genes can be transferred between pathogens when they DIRECTLY CONNECT

58
Q

What is transformation?

A

Resistance genes RELEASED FROM NEARBY PATHOGENS that can be picked up directly by other pathogens

59
Q

What should be considered in an antimicrobial stewardship programme?

A
  1. Monitoring/evaluating PRESCRIBING - how it relates to RESISTANCE PATTERNS
  2. Providing regular FEEDBACK to prescribers: using correct codes/ patient safety incidents
  3. Providing EDUCATION and TRAINING
  4. INTEGRATING AUDIT

CSI 1a (2 decks)

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