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Infection > HAI > Flashcards

HAI Flashcards

1
Q

Define HAI

A

An infection that was not present/in its pre-symptomatic phase during time of admission and which has arisen 48h+ after admission/within 48h of discharge

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2
Q

Define colonisation

A

Microbes in body not causing disease

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3
Q

Give an example of a colonising microbe

A

MSSA around the nose

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4
Q

Define infection

A

Microbes in the body causing disease

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5
Q

Give an example of an infection

A

Same MSSA can cause UTIs, surgical site infections, ventilator assoc. pneumonia etc.

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6
Q

Define cleaning

A

Physical removal of organic material and reduction in microbial load

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7
Q

For which situations do we just clean?

A

Low risk, e.g. in tact skin surface, stethoscopes, beds, cots etc.

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8
Q

How do we clean?

A

Water, detergent, dry properly

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9
Q

Define disinfection

A

Massively reducing the microbial load (but spores remain)

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10
Q

In which situations do we disinfect?

A

Medium risk situations, e.g. mucous membranes - vaginal speculums, bed pans, endoscopes

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11
Q

What are the two methods of disinfecting?

A

Heat - pasteurisation (bedpans, linen etc.) & boiling (speculums, ear syringes)

Chemical - e.g. alcohol, chlorhexidine, hypochlorites, hydrogen peroxide

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12
Q

Define sterilisation

A

Removal/destruction of all microbes and spores

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13
Q

When would we sterilise?

A

High risk situations, e.g. surgical equipment

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14
Q

What are the methods of sterilisation?

A

Steam under pressure, e.g. autoclave
Hot air oven
Gas, e.g. ethylene dioxide
Ionisation radiation

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15
Q

What must you do prior to sterilisation and disinfection?

A

Cleaning

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16
Q

Define outbreak of infection

A

2+ cases of an infection linked in time and place

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17
Q

How many patients does HAI affect?

A

5%

18
Q

What are the possible outcomes of HAI?

A

Extended length of stay, discomfort, pain, death, disability
Increased cost
Litigation
Reduced staff morale/public confidence

19
Q

What are the most common HAIs? (in order)

A 
UTIs (mostly catheter assoc.)
Surgical site infection 
RTI (esp related to intubation)
Bloodstream infections
GI infections
Skin and soft tissue infections
20
Q

Most HAI is the result of a disturbance in _______

A

Bacterial-host equilibrium

21
Q

What microbial factors make infection more likely?

A

Increased resistance, virulence, transmissibility, survival ability, ability to evade defences

22
Q

What host factors make infection more likely?

A

Devices (PVC, CVC, catheters, ventilators), break in skin, antibiotics, FB, immunosuppression, gastric acid suppression, age extremes, overcrowding, increased opportunity for infection (e.g. interventions/hands)

23
Q

What is the chain of infection?

A

Source of microbe
Transmission
Host

24
Q

What are the different forms of transmission?

A

Direct contact, e.g. staph aureus and coliforms
Respiratory droplet, e.g. Neisseria meningitidis, mycobacterium tuberculosis
Faecal-oral, e.g. c. diff, salmonella sp.
Penetrating injury, e.g. group A strep, bloodborne viruses

25
Q

How do you break the chain of infection?

A 
Risk awareness
SIPCs
Hand hygiene campaigns 
Antibiotics steward ship 
Universal MRSA screening
Appropriate MRSA screening
PPE
Vaccination and PEP
Environment
26
Q

Define antibiotic stewardship

A

Co-ordinated programme that promotes appropriate use of antibiotics and improves patients outcomes whilst decreasing microbial resistance

27
Q

What are the two kinds of surveillance of HAI?

A

Local and national

28
Q

What is the purpose of surveillance of HAI?

A

To detect and identify a possible outbreak at earliest opportunity

29
Q

What must you do in suspected outbreaks?

A

Typing to determine if it is the same strain

Control measures

30
Q

What methods of typing can you use?

A

Antibiogram - antibiotic sensitivity pattern
Phage typing - bacteriophages used to identify different strains
Pyocin typing - based on pycoin production (pseudomonas)
Serotyping (salmonella, pseuodomonas) - based on antigens
Molecular typing - DNA

31
Q

What are the control measures implemented in outbreaks of HAI?

A

Single room isolation
Cohorting
Reinforcement of IPC measures
Staff exclusion/decolonisation

32
Q

What is the classical presentation of c. diff?

A

Really smelly diarrhoea, abdominal pain, pyrexia, raised WCC

33
Q

What kind of colitis do you get in c. diff infection?

A

Pseudomembranous colitis

34
Q

How does c. diff survive in the environment?

A

It is spore forming

35
Q

C. diff produces two toxins - what is the significance of this?

A

Toxin negative strains do not produce disease

Even toxin +ve ones can also not be symptomatic

36
Q

What is the pathophysiology behind c. diff infection?

A

Infection results from imbalance in gut flora (protective commensals reduced allowing c. diff to flourish)

37
Q

In which group of people is c. diff most common?

A

Elderly

38
Q

What drugs predispose to c. diff?

A

Antibiotics

39
Q

What is involved in the management of c. diff?

A

Stop antibiotics

Give oral metronidazole, oral vancomycin if severe/2nd line, oral fidaxomicin if 2nd episode

40
Q

Reducing use of which 4 drugs has reduced the incidence of c. diff?

A

4 Cs

Clindamycin, ceftriaxone, co-amoxiclav, ciprofloxacin

Infection (22 decks)

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