Health care associated infections

Question 1

describe the action to take if an outbreak occurs

Answer 1

depends on causative organism
isolation of patients
prophylactic antibiotic treatment for susceptible patients
staff harbouring organism relieved from duty and given antimicrobial agent to remove
disinfection of ward/envrionment/equpitment
closure of ward

Question 2

describe how you can prevent HCAI

Answer 2

hygiene
control of contamination  in hospital environments e.g air surfaces, fittings, furnitures
cleaning 
isolation
waste disposal
sterilisation disinfection
antibiotic therapy
surveillance.

Question 3

which are the most important ways to prevent HCAI

Answer 3

hygiene, survelance

Question 4

describe hand hygiene in england, wales and scotland

Answer 4

‘clean your hands’ campaign - england and wales
NHS scotland germs- wash your hands of them campaign started 2007/08 febuary

% compliance
2007 - 68%
2008 - 87%
2009- 93%

Question 5

describe whole gene fingerprinting

Answer 5

fluorescent amplified fragment
polymorphism FAFLP
analysis of P.s aeruginosa isolates from hospital patients

Question 6

describe rate of MRSA in england

Answer 6

decrease of 80.6% from 2007/08 to 13/14

BUT year to june 15 showed increase in MRSA from 1.34 to 1.55 per 100,000

Question 7

describe clostridium difficile

Answer 7

most important cause of hospital associated diarrhoea.
found in the guts of 3% of healthy adults
found in 66% of infants
rarely causes infection in healthy people
causes severe diarrhoea in susceptible patients and especially +65 group

trend= 75.9% decrease = 07/08 - 13/14 but 6.2% increase 14/15 to 27 cases per 100,000 population

Question 8

describe other important rates of infection

Answer 8

multi antibiotic resistance enterococci and acinetobacter
e.coli bacteria increase of 16.6% since 2012 now 67.5 reports per 100,000
norovirus in first 35 weeks of 2015 there were 539 hospital outbreaks with 509 ward closures

Question 9

describe MRSA strains

Answer 9

some more virulent than others

epidemic MRSA = EMRSA = spread very quickly difficult to eradicate
may need to close affected ward

ALSO community queried MRSA = ca-MRSA

Question 10

name predisposing factors for HCAI

Answer 10

malnutrition 
immunosuppression
age
severity of pre existing disease
operative procedure - length/complexity, technique, size of incision, level of activity in theatre
length of stay in hospital
catheterisation

Question 11

describe the INSIDE airborne route

Answer 11

inside - persons –
skin scales, wound dressings, bedding, droplet nuclei –»

staph aureus
strep pneumonia
respiratory viruses
mycotuberculosis

Question 12

describe airborne route AEROSOLS

Answer 12

aerosols–

nebulisers,
humidifiers
cooling towers
showers/sprinklers
cleaning equipment -->>

gram NEGATIVE rods
legionella

Question 13

describe airborne route OUTSIDE

Answer 13

outside –» dust –»

demolition, building work, soil, animal excreta –»

clos. perfringes,
clos. tetani
legionella
aspergillum (mould)

Question 14

describe persons contact route

Answer 14

persons –> hands/clothes –» staph aureus, gram negative rods

Question 15

describe food contact route

Answer 15

food –» hands, uncooked food, equipment –»

salmonella, other gram negative rods, clos.perfringes, staph aureus

Question 16

describe fluid contact route

Answer 16

fluid –»
parenteral/ topical antiseptics, disinfectants, detergents –»
gram negative rods
esp P.S. aeruginosa

Question 17

describe equipment contact route

Answer 17

equipment –»
endoscopes, catheters, bedpans/ urinals, disposatery equipment –»

gram Negative rods,
staph aureus

Question 18

describe MRSA

Answer 18

first appeared in Australia - early 1980
now all over world
carried on skin/ in nose
incidence reached peak in 2000
prevention campagnes lead to large reduction in incidence

Question 19

why has there been a big increase in HCAI since 1975?

Answer 19

more invasive procedures
overuse of antibiotics
e.g use of Vancomycin >200X use unnecessary in 2/3 cases
poor handwashing

Question 20

describe the costs of HCAI

Answer 20

patients acquiring an infection are 7X more likely to die in hospital
38% of elderly patients acquire infection die as a result
average additional cost per patient = 5000
estimated 5000 deaths per year in england and wales

Question 21

describe surveillance

Answer 21

outbreak of infections defined as “ two or more epidemiology related infections caused by organisms of the same type”

epidemiological investigations preformed by infection control nurses
studies consist of; gathering and correlating mass of data
preforming microbiological surveys
Data collected- - site, location, causative organism, patient details

microsamples, – from patients, nurses, medical staff, air/enviroment, equipment

need to identify causative organism
need to distinguish between different strains of bacteria
produce ‘epidemiological fingerprint’ now often use DNAANALYSIS

Question 22

briefly describe the history of nosocomial infections

Answer 22

1867 - Lister introduces antiseptic surgery
1935 - major cause of infection; streptococci, pnemoniococci, staph aureus

INTRODUCTION OF SULPHONAMIDE
1940- intro of penicillin
1940- mid 1960 - staph aureus dormant
mid 1960 - 1990 - gram Positive bacteria dominant
ecoli, enterbacter, klebsiella, ps aeruginosa

Question 23

describe hygiene

Answer 23

must have education of nursing, medical and ancillary staff in antiseptic and aseptic technique
regular hand washing
infection control nurses are responsible for educating staff