8. Healthcare Infections

Question 1

What are healthcare infections?

Answer 1

• infections not present/ incubating at time of admission, that arise at least 48 hours after admission, as a consequence of providing healthcare e.g. hospitals
• includes infections in patients, visitors and healthcare workers

Question 2

Why are healthcare infections important?

Answer 2

• Frequent -prevalence = 8% of in-patients
• Impact on health
• Impact on healthcare organisations - costly
• Preventable

Question 3

What are some common examples of healthcare associated infections?

Answer 3

• surgical site infection
• central line bloodstream infection
• ventilator associated pneumonia
• catheter associated UTI

Question 4

How prevalent are healthcare associated infections?

Answer 4

Occur in 8% of patients

Question 5

How can healthcare associated infections be costly?

Answer 5

• patients stay in hospital longer
• expense of treatment e.g. specific antibiotics
• can delay treatment of other patients who will therefore have to stay as inpatients for longer

Question 6

In what stages of the infection model can infection be prevented/ intervened with?

Answer 6

1. Prevent the pathogen and patient from coming together
2. The patient and the pathogen have come together, the aim at this pint is to prevent an infection forming
3. At this point the patient has an infection, the aim now is to prevent it from being transmitted to others

Question 7

What are examples of healthcare associated infection viruses?

Answer 7

blood borne viruses (hepatitis B, C, HIV)
norovirus
influenza
chickenpox

Question 8

What are examples of healthcare associated infection bacteria?

Answer 8

Staph aureus including MRSA
Clostridium difficile
Escherichia coli, Klebsiella pneumoniae
Pseudomonas aeruginosa
Mycobacterium tuberculosis

Question 9

What are examples of healthcare associated infection fungi?

Answer 9

Candida albicans

Aspergillus species

Question 10

What are examples of healthcare associated infection parasites?

Answer 10

Malaria

Question 11

What is norovirus caused by?

Answer 11

Faecal oral transmission —> lack of hand washing hygiene

Question 12

What are examples of patient risk factors for healthcare associated infections?

Answer 12

• extremes of age
• obesity/ malnourishment
• diabetes
• cancer
• immunosuppression
• smokers
• surgical patients
• emergency admission

Question 13

What are the 4 Ps of infection prevention and control?

Answer 13

pathogen:
•Virulence factors
•Ecological interactions
-other bacteria
-antibiotics/disinfectants

Patient:
• General and specific
patient risk factors for infections
• Interactions with:
•other patients
•healthcare workers
•visitors

practise: 
•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
- variable features

Question 14

General interventions to reduce risk of patients own micro flora causing infection?

Answer 14

1. Optimise patients condition e.g stop patient from smoking, improve their nutrition and increase control of diabetes
2. Antimicrobial prophylaxis, give on e dose of antibiotics just before the surgeon makes the first incision.
   This is used to prevent surgery associated infections.
3. Skin preparation
   Thoroughly washing the skin of the patient before and after surgery and any interventions
4. Hand hygiene of any health care workers, physicians and the patients

Question 15

What are specific interventions used to prevent infection in a patient?

Answer 15

• MRSA screens
• mupirocin nasal ointment
• disinfectant body wash

Question 16

How can patient to patient transmission be halted?

Answer 16

• physical barriers - isolation of infected patients e.g. having a higher pressure in a lobby between patient room and corridor with the lobby having higher pressure so that air from the room does not enter the corridor
• protection of susceptible patients in positive pressure rooms - stops air going into room and air that goes through is filtered and sterile

Question 17

How can we prevent transmission of infection between patients and healthcare workers?

Answer 17

• ensure they are healthy and disease free
• vaccinated
• good practice: good clinical techniques such as sterile non-touch, hand hygiene, PPE (personal protective equipment) e.g. face masks, antimicrobial prescribing
• doctors entering room with susceptible patients gown up to avoid giving them bacteria

Question 18

How can the environment be made suitable to prevent healthcare associated infection?

Answer 18

Built environment:

• space/ layout
• more distance between patients
• toilets
• wash hand basins
• positive pressure rooms
• appropriate kitchen and ward food facilities
• isolation rooms (infectious patients, immunosuppresed patients
• theatres

Furniture and furnishings

Cleaning:

• disinfectants
• steam cleaning
• hydrogen peroxide vapour - for shut down wards after spread of infection
• bleach
• good food hygiene practice

Medical devices:

• single use equipment
• sterilisation
• decontamination

Environmental health officers:
- regular checks/ scores

Question 19

How can it be difficult to maintain these environmental interventions?

Answer 19

• costly e.g. single use equipment, positive pressure rooms

- deep decontamination depends on number of beds as hydrogen peroxide vapour is toxic so requires an empty ward

Question 20

Have you I-fived your patients today?

Answer 20

Identify
• Abroad
• Blood borne infections
• Colonised
• Diarrhoea/vomiting
• Expectorating
• Funny looking rash

Isolate
Investigate
Inform
Initiate