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Diseases > Healthcare Acquired Infections, Diseases, Yr 3, Wk 1 > Flashcards

Healthcare Acquired Infections, Diseases, Yr 3, Wk 1 Flashcards

1
Q

What does HAI mean?

A
  • Healthcare Associated Infection
  • they are infections that were not present or in the pre-symptomatic phase at the time of admission to hospital
  • which arise > or equal to 48 hrs after admission or within 48 hrs of discharge
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2
Q

List some possible outcomes of HAI:

A
  • Extended length of stay, pain, discomfort, permanent disability, death
  • Increased cost: 33% decrease in HAI in Scotland would lead to savings of £55 million
  • Litigation (taking legal action)
  • Loss of public confidence and decreased staff morale
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3
Q

Whats the a) most common cause of a HAI

b)What are the most common sites of HAI?

A

a) Proportion of HAIs are due to different infections
b) -UTI (22.6% of all HAI)- mainly related to catheterisation
- Surgical Site Infection (18.6%)
- Respiratory Tract Infection (17.5%)- intubation accounted for about 1/4 of these
- Bloodstream Infections (10.8%)- many central venous catheter (CVC) related
- Gastrointestinal infection (6.8% versus 15.4%)
- Skin and soft tissue infection (4.0%)

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4
Q

Give context to Bacteria versus Humans:

A
  • Approx 10 to the power of 14 bacteria in adult human
  • Approx 10 bacterial cells to every human cell
  • Human beings carry >1Kg of bacteria in their gut alone
  • 500 different species of bacteria have been isolated from human stool
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5
Q

List some of Nature’s defence mechanisms (1st line of defence):

A

1st line of defence:

  • Intact skin
  • ‘Normal’ bacteria flora e.g. skin, GIT
  • Body secretions e.g. tears containing antibodies/ enzymes, coughing
  • Gastric Acid
  • Flushing e.g. urination
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6
Q

List the body’s 2nd line of defence:

A

Immune system

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7
Q

Everyone and everything harbours microbes that may pose a risk…..Patients in hospital are……(finish this sentence)

A

…….Patients in hospital are more vulnerable to microbial colonisation AND infection

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8
Q

What is the fundamental question in clinical microbiology?

A

Colonisation versus Infection

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9
Q

Who discovered Staphylococcus aureus, (aka SA)?

A

Alexander Ogston

credited with introducing carbolic antiseptic spray to Aberdeen

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10
Q

What percentage of the population are colonised with SA in their nose (this includes patients, staff and relatives)?

A

30%

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11
Q

What type of SA are most people colonised with?

A

Most are colonised with the METICILLIN SENSITIVE Staphylococcus aureus (MSSA)

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12
Q

The same strain of Staphylococcus aureus can that is COLONISING can also cause INFECTION through:

A
  • Break in skin e.g. surgical site infection
  • Vascular device e.g. PVC, CVC
  • Catheter associated urinary tract infection (CAUTI)
  • Ventilator associated pneumonia (VAP)
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13
Q

Generally, what is the most common cause of a HAI?

A

Disturbance in bacterial-host equilibrium leads to most HAI

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14
Q

What are some factors related to MICROBIAL which tip the balance towards infection?

A

INCREASED:
-Resistance

  • Virulence
  • Transmissibility
  • Increased survival ability
  • Increased ability to evade host defences
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15
Q

What are some factors related to HOST which tip the balance towards infection?

A
  • Devices: PVC, CVC, Urinary catheter, Ventilation
  • Antibiotics
  • Break in the skin surface
  • Foreign body
  • Immunosuppression
  • Gastric Acid suppression
  • Age extremes
  • Overcrowding
  • Increased opportunity for transmission e.g. Interventions, Hands !!
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16
Q

Number of bacteria required to cause infection if
a) No SILK SUTURE?

b) SILK SUTURE present?

A

(Silk suture is a surgical suture used to hold skin together)

a) 6.5 million bacteria
b) 100 bacteria

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17
Q

List some means of transmission microbes:

A
  • Direct contact: e.g. SA, coliforms
  • Respiratory/Droplet: e.g. neisseria meningitidis, Mycobacteria tuberculosis
  • Faecal-Oral: e.g. Clostridium difficile, Salmonella sp.
  • Penetrating injury: e.g. Group A streptococcus, Bloodborne viruses
18
Q

List some ways of breaking the chain of infection:

A
  • Risk awareness
  • Standard Infection Prevention and Control Precautions (SICPs)
  • Hand hygiene
  • Appropriate PPE
  • Vaccination
  • Post exposure Prophylaxis
  • Environment
19
Q

Give the meaning of Cleaning:

A

Physical removal of organic material and decrease in microbial load

20
Q

Give the meaning of Disinfection:

A

Large reduction in microbe numbers- spore may remain

21
Q

Give the meaning of Sterilisation:

A

Removal/ Destruction of ALL microbes and spores

22
Q

Cleaning, Disinfection, Sterilisation:

List some;

a) Low risk categories and how they should be treated:
b) Medium risk categories and how they should be treated:
c) High risk categories and how they should be treated:

A

a) Low risk: Intact skin contact e.g. stethoscopes, cots, Mattresses: Cleaning compatible with manufacturer’s instructions
b) Medium risk: Mucous membrane contact e.g. bedpans, vaginal specula, Endoscopes: Disinfection or sterilisation as appropriate
c) High risk e.g. surgical instruments: Sterilisation

23
Q

Describe CLEANING and how it should be carried out:

A
  • Manufacturer’s instructions
  • Detergent and water
  • DRYING IS AN IMPORTANT PART OF THE PROCESS!
  • Cleaning essential PRIOR to disinfection and Sterilisation if these are required
24
Q

Give 2 methods of Disinfection and describe them:

A

Heat:

  • Pasteurisation (e.g. bedpans, linen, dishwashers)
  • Boiling (vaginal specula, ear syringes)

Chemical:

  • Chemicals vary in their organism activity range
  • Needs to be equipment compatible
  • Examples: Alcohol chlorhexidine, hypochlorites, hydrogen peroxide

(This is disinfection, NOT sterilisation)

25
Q

List some Methods of Sterilisation:

A
  • Steam under pressure (autoclave)
  • Hot Air Oven
  • Gas (ethylene dioxide)

Ionising Radiation

26
Q

List the 2 types of surveillance:

A

Local surveillance:-
Laboratory Based
-Ward/ Clinical Area Based

National Surveillance

27
Q

Give some advantages of Local surveillance (Lab based):

A

Laboratory detects an organism and notifies IPCT and clinicians:

Advantages:
-Know what organism is and specific recommendations can be made

28
Q

Give some disadvantages of Local surveillance (Lab based):

A

Disadvantages:
-Depends on samples being sent

  • Time taken to detect organism
  • Tests not 100% accurate
29
Q

List some advantages of Local Surveillance (Clinical Area Based):

A

Clinical area staff notify Infection Prevention and Control Team (IPCT)

Advantages:
-Detect potential problem sooner

-Can ensure correct samples sent

30
Q

List some disadvantages of Local Surveillance (Clinical Area Based):

A

Disadvantages:
-Causative microbe not known

-IPC measures need to be more general

31
Q

Describe OUTBREAKS- Definition and Identification:

A

-An outbreak of an infection is defined as 2 or more cases of infection linked in time and place

N.B.:
-1st purpose of IPCT is to PREVENT individual infections AND outbreaks!!

-Purpose of surveillance is to DETECT and IDENTIFY a possible outbreak at the earliest opportunity

32
Q

How do you act in an outbreak and describe ‘typing’ :

A
  • Have to act in suspicion
  • Typing necessary to determine if the same strain present i.e. an outbreak

Typing methods:

  • Antiobiogram (antibiotic sensitivity pattern)
  • Phase typing (e.g. SA)
  • Pyocin typing (Pseudomonas)
  • Serotyping (Salmonella, Pseudomonas)
  • Molecular typing (DNA typing)

(Exam question: Give 2 typing methods)

33
Q

In an OUTBREAK, list some Control Measures:

A
  • Single room isolation
  • Cohorting of cases (group of people with shared characteristic)
  • Clinical Area/ Ward Closure
  • Re-inforcement of IPC measures
  • Staff exclusion (e.g. colonised staff in case of MRSA; non-immune staff in case of VZV, measles etc.)
  • Staff decolonisation or other measures
34
Q

Give some Clinical Characteristics of C difficile infection:

A
  • Diarrhoea
  • Faeces have a characteristic odour
  • May have abdominal pain, pyrexia, raised white cell count
  • Pseudomembranous colitis (PMC)
35
Q

What is C difficile?

A
  • Part of the normal gut flora in approx 2% of adults
  • Carriage rate increases with age
  • Approx 30% of the elderly are colonised
  • Can survive in environment- importance of cleaning
  • 2 toxins produced- Toxin negative strains DO NOT cause disease
36
Q

Give more information about C. Difficile:

A
  • IMBALANCE in gut flora
  • Endogenous or exogenous source
  • Variable in severity
  • Elderly most susceptible
  • N.B. UNDER DIAGNOSED IN THE COMMUNITY
37
Q

List some laboratory tests that can be used in C. Difficile:
N.B. Clinical Interpretation is required!

A
  • Positive Toxin Test DOES NOT ALWAYS MEAN DISEASE!

- Diarrhoeal symptoms NEED TO BE PRESENT for diagnosis of CDI!

38
Q

Why is CDI still occurring?

A
  • Not possible to prevent all cases
  • All antibiotics can predispose to CDI although some are more predisposing than others
  • New strains?
  • Less handwashing because more handgelling?
  • Environmental contamination may still be an issue?
  • Increased no. of vulnerable patients close together?
  • Increased throughput of patients?
  • Other drugs having an effect e.g. PPIs?
39
Q

Why have there been a reduction in incidence and explain this:

A

New Antibiotic Guidelines (ARI 2009) developed to:

  • Treat infection but also to
  • reduce incidence of C diff!!!

-Available in ARI on INTRANET

40
Q

What is the the treatment used in C. Difficile infection?

A

-STOP THE ANTIBIOTICS PREDISPOSING TO C difficile IF POSSIBLE!

IF SYMPTOMATIC, treatment:
-Oral metronidazole

  • Oral vancomycin if severe or failure to improve on metronidazole
  • Oral fidaxomicin if 2nd episode (Scottish Medicines Consortium (SMC) Guidance 2012)
  • N.B. DO NOT TREAT THE SYMPTOM FREE!
  • Any antibiotic can cause CDI including Metronidazole and Vancomyin

Diseases (9 decks)

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