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Infection > Healthcare Acquired Infections > Flashcards

Healthcare Acquired Infections Flashcards

1
Q

What is a HAI? [2]

A

-infections that were not present or in the pre-symptomatic phase at time of admission -which arise at least 48h after admission or within 48h of discharge

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2
Q

Possible outcomes of a HAI? [4]

A
  • extended length of stay, pain, discomfort, permanent disability, death
  • increased costs
  • Litigation
  • loss of public confidence and decreased staff morale
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3
Q

What are most common sites of HAI? What in the healthcare context can cause these? [6]

A

>UTI: catheterisation

> Surgical site infection

>Respiratory tract infection: intubation

>Blood stream infections: central venous catheters

>GI infection

>Skin and soft tissue infection

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4
Q

Are people colonised by Staph Aureus? % and what strain

A

Yes. Approx. 30% are colonised. Most are colonised with Meticillin Sensitive Staph Aureus (MSSA)

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5
Q

Colonised Staph Aureus can also cause infection how? [4]

A

>Break in skin eg surgical site infection

>Vascular device (eg PVC, CVC)

>Catheter associated UTI

>Ventilator associated pneumonia

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6
Q

What are microbial factors tipping balance towards infection? [5]

A

Increased

>resistance

>virulence

>transmissability

>Inc survival ability

>ability to evade host defences

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7
Q

What are host factors tipping balance towards infection? [7]

A

>devices eg CVC, catheter, ventilation

>antibiotics

>break in skin surface

>foreign body

>immunosuppression

>age extremes >overcrowding

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8
Q

What are the means of transmission? [4] Give an example of an organism which you can be infected by for each transmission mode

A

>Direct: staph aureus

>Respiratory: Neisseria meningitidis, mycobacterium tuberculosis

>Faecal-oral: C Diff

>Penetrating injury: Group A streptococcus, blood borne viruses

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9
Q

How can you ‘break the chain’ of infection? (Microbe source, transmission, host) [6]

A
  • risk awareness
  • standard infection prevention and control precautions
  • hand hygiene
  • appropiate PPE
  • vaccination
  • post exposure prophylaxis
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10
Q

What is: >cleaning >disinfection >sterilisation?

A

Cleaning - physical removal of organic material and decrease in microbial load

Disinfection - large reduction in microbe numbers - spores may remain

Sterilisation - removal/destruction of ALL microbes and spores

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11
Q

Name 3 instruments that come with low risk of HAI and how do we reduce this risk?

A

From intact skin contact:

  • Stethoscope -cots
  • mattresses

Reduce risk by washing frequently

  • detergent and water; drying
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12
Q

Name 3 instruments that come with medium risk of HAI and how do we reduce the risk? [2]

A
  • bedpans
  • vaginal specula
  • endoscopes

Reduce risk by pasteurisation, boiling (heat), alcohol, chlorhexidine, bleach (chemical means)

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13
Q

Name instruments that come with high risk of HAI and how do we reduce the risk? [4]

A

-surgical instruments

Reduce risk by autoclave, hot air oven, gas, ionizing radiation

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14
Q

Discuss features of cleaning equipment [3]

A
  • use detergent of water
  • drying is important part of process
  • cleaning essential prior to disinfection and sterilisation
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15
Q

What are methods of disinfection? 2 ways

A

Heat

>Pasteurisation (eg bedpans, linen, dishwashers)

>Boiling (eg vaginal specula, ear syringes)

Chemical

>eg alcohol, hydrogen peroxide

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16
Q

What are methods of sterilisation? [4]

A

>steam under pressure

>hot air oven

>gas (ethylene dioxide)

>ionising radiation

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17
Q

What different surveillance types exist for disinfection of equipment?

A
  • Local
  • National
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18
Q

Define an outbreak?

A

2 or more cases of an infection linked in time and place

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19
Q

How do you go about identifying outbreaks?-have to act on suspicion Typing is necessary to determine if strain is present. Name 5 typing methods

A

-typing methods (necessary to determine if same strain present):

>antibiogram

>phage typing

>pyocin typing

>serotyping

>molecular typing

20
Q

What are control measures for outbreaks? [6]

A

>Single room isolation

>Case cohorting

>Clinical ward closure

>Re-inforcement of IPC measures

>Staff exclusion

>Staff colonisation

21
Q

C. Diff infection clinical features? [4]

A
  • diarrhoea
  • faeces have characteristic colour
  • abdominal pain, pyrexia, raised WCC
  • pseudomembranous colitis
22
Q

Describe pathophysiology of C.diff [3]

A

Enterotoxin (A) and cytotoxin (B) which is inflammatory Toxin negative strains of C. Diff do not cause disease!

23
Q

What does C. diff infection arise from? What complication can arise if untreated and pseudomembranous colitis is present?

A

Imbalance in gut flora, either endogenous or exogenous source. Underdiagnosed in community Cx: toxic megacolon

24
Q

How is C. Diff infection diagnosed? What are investigations to order? [3]

A

Positive toxin test AND diarrhoeal symptoms

  • FBC: leucocytosis
  • Sigmoidoscopy: tissue culture
  • Stool: culture and ELISA or PCR to detect C. diff toxins
25
Q

Why is C. Diff infection still occurring?

A
  • cant prevent all cases
  • antibiotics can predispose to CDI
  • new strains?
  • environmental contamination may be issue
  • Inc number of vulnerable patients close together
26
Q

Treatment of C. diff infection [7]

A
  • stop precipitating antibiotics
  • if symptomatic, give:

>oral metronidazole

>oral vancomycin if severe

>oral fidaxomycin if 2nd episode

  • dont treat if symptom free, can cause CDI (C diff infection)
  • Stool transplants
27
Q

What are the 4C’s we should avoid to reduce CDI? [4] Other methods of prevention [3]

A
  • cephalosporin -co-amoxiclav -clarithromycin -ciprofloxacin
    1. Follow Antimicrobial Management Team and local antibiotic policy
    2. Isolate symptomatic patients
    3. Wash hands between patients
28
Q

What does MRSA stand for?

A

Methicillin resistant staphylococcus aureus

29
Q

MRSA Ix - describe how you would screen What to do if there’s active infection? [2]

A
  1. Screening of carriers by nasal swab
  2. Active infection: swab the affected site and take blood culture
30
Q

MRSA Mx of asymptomatic carriers [2] Mx of active infection [3]

A
  1. Asymptomatic carriers:
    - MUPIROCIN 2% in white soft paraffin 4x daily for 5 days
    - CHLORHEXIDINE GLUCONATE applied all over body with particular attention to axilla, groin and perineum once daily for 5d
  2. Active infection: VANCOMYCIN, TEICOPLANIN or LINEZLOID
31
Q

Grampian C.diff severity markers [6]

A
  • Temperature > 38.5
  • Consider severe co-morbidities and immunodeficiency
  • Suspicion of pseudomembranous colitis, toxic megacolon, ileus
  • Evidence of severe colitis on CT scan/x-ray
  • WBC >15x10^9 cells/L
  • Acute rising creatinine >1.5x baseline
32
Q

What is Giotra’s triad and what is its connection to C.diff?

A

Increasing abdominal pain, abdo pain, distension Leukocytosis >18000 Haemodynamic instability Risk factor

33
Q

What is ESBL?

A

Extended Spectrum Beta Lactamases

Ax: E. coli producing extended spectrum beta lactamases, usually causing UTIs

34
Q

How does ESBL present?

Ix Mx

Mx: second line

A

Presentation: UTI Ix: Urine MC&S

Mx:

Nitrofurantoin + patient isolation

  • Fosfomycin
35
Q

SSI

Causative organisms [4]

Investigations Mx

A

Ax:

    • staph aureus (also coagulase -ve staph (e.g. staph epidermidis)
    • strep
    • pseudomonas, E. coli
    • Enterobacter, fungi, anaerobes)

Ix: pus or infective tissue cultures (aim for deep structures as opposed to superficial swabs)

Mx: ab according to C&S

36
Q

SSI Procedural Risk factors [4]

A
  • shaving wound using razor (disposable clip preferred)
  • non-iodine impregnated incise drape
  • tissue hypoxia
  • delayed administration of prophylactic abx in tourniquet surgery
  • use of diathermy for skin conditions
37
Q

Prevention of SSI

Pre-op [3]

Intra-op [2]

Post-op

A

• Pre-op:

  • no routine body hair removal (if rqd use electrical clipper with single use head)
  • abx prophylaxis if placement of prosthetic valve
  • clean contaminated or contaminated surgery (aim to give single dose of IV abx on anaesthesia or earlier if tourniquet to be used)

• Intra-op:

  • prep skin within alcoholic chlorhexidine
  • cover surgical site with dressing

• Post-op: tissue viability advice for surgical wounds healing by secondary infection

38
Q

Cellulitis Define Ax [2] Features [3]

A
  • Inflammation of skin and subcutaneous tissues
  • Typically due to Streptococcus pyogenes or Staphylcoccus aureus

Features:

  • commonly occurs on the shins
  • erythema, pain, swelling
  • there may be some associated systemic upset such as fever
39
Q

Cellulitis Eron classification [4]

A
40
Q

Cellulitis Criteria for admission [6]

A
  • Has Eron Class III or Class IV cellulitis.
  • Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
  • Is very young (under 1 year of age) or frail.
  • Is immunocompromized.
  • Has significant lymphoedema.
  • Has facial cellulitis (unless very mild) or periorbital cellulitis.
41
Q

Cellulitis mx for: - Mild-moderate - Other options? [3] - Pregnancy - Severe [2]

A

Mild-moderate: Flucloxacillin

Option: clarithromycin, erythromycin (pregnancy) , doxycycline

Severe: co-amoxiclav, cefuroxime

42
Q

Osteomyelitis

Define

Ax

Ix

A

Osteomyelitis describes an infection of the bone.

Staph. aureus is the most common cause Ix: MRI

43
Q

When can a trial of ab prophylaxis be considered? [2]

How long a review should be arranged?

What antibiotic would be first line?

A
  • Hospital admission for 2 separate eps of cellulitis/erysipelas
  • In previous 12m
  • Review antibiotic prophylaxis for recurrent cellulitis or erysipelas at least every 6 months
  • Phenoxymethylpenicillin
44
Q

What is OPAT? [3]

A

Outpatient parenteral antimicrobial therapy (OPAT)

  • administration of parenteral antimicrobial therapy without intervening hospitalization.
  • Less visits to hospital, reduced HAIs
45
Q

Eligibility criteria for OPAT

A

Infection (20 decks)

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