Healthcare-associated infections

Question 1

Objectives

Answer 1

 Understand the basic epidemiology
 Understand what is meant by the terms Standard infection control precautions (SICP) & Transmission based precautions (TBP)
 Hand Hygiene
 Know the importance of medical devices
to HCAI  COVID

Question 2

How do we stop HCAI?

Answer 2

 Measure the problem -Surveillance
 Understand the problem -epidemiology (where, when, who, how big, cost)
 Manage the problem -Education
-Knowledge
-Management tools for the problem ie audit, bundles
 Prevent the problem
-Interrupting transmission (Standard infection control precautions, Hand
hygiene, vascular access devices) -Prevention strategies
-Vaccines
-Behaviours

Question 3

What is the difference between HAI and HCAI

Answer 3

HAI = Hospital Acquired Infection or Healthcare Associated Infection
HCAI = Healthcare Associated Infection

Hospital Acquired Infection is one that was not present on admission but occurred >48hours after admission

Question 4

How can doctors take measures to prevent HCAI?

Answer 4

 Recognition of risk factors in patients 
 Behaviour & practice
 Hand hygiene
 Dress
 Personal protective equipment 
 Use isolation facilities correctly

Question 5

What are the three main modes of transmission?

Answer 5

 Contact transmission - can be direct or indirect
 Droplet transmission
 Airborne (aerosol) transmission
-ability to aerosolise depends on the pathogen
-medical procedures i.e. ventilation technique or specific medical procedures

Question 6

What are precautions for contact transmission?

Answer 6

 For patients infected/colonised with
organisms transmitted by direct or indirect
contact
-Syndromes: gastroenteritis, fever in patient returned from the tropics, patients with open wounds
-Specific organisms : C. difficile, MRSA, S. pyogenes, COVID-19
 Disposable gloves
 Disposal apron
 Single room if possible
 Disposable masks/eye protection if at risk of exposure to body fluid

Question 7

What are precautions for droplet transmission

Answer 7

 For organisms transmitted in droplets (>0.5 microns) These travel only short distances
-Syndromes: Respiratory illness, Meningism, fever with cough, fever with rash, vomiting
-Specific organisms: N. meningitis, mumps, rubella, COVID-19, influenza, RSV, all respiratory viruses
 Single room if possible
 Disposable apron and gloves
 Wear fluid resistant surgical mask
 Wear eye protection (goggles or visor)
 If patient undergoing aerosol generating procedures (AGP) wear FFP3 mask

Question 8

What are the precautions to prevent airborne transmission

Answer 8

 Particles <5microns. Can be widely dispersed
 FFP3 mask for all aerosol generating procedures (AGP)
-Syndrome: when undertaking a AGP -Specific organisms: TB, Chicken pox
 Single room
 Disposable apron or consider gown if manoeuvring the patient
 Disposable gloves
 High efficiency filter mask (FFP3 mask)
 Eye protection

Question 9

What should you consider in a ptx with resp symptoms

Answer 9

 Any adult patient with a respiratory illness, it could be COVID-19. What precautions do you take?
 Need to consider the possible pathogen and any procedure you are undertaking on a patient. Is it an AGP?

Question 10

What are the 2 before and 3 afters of hand decontamination?

Answer 10

Must decontaminate hands before:

• Touching ptx
• Clean/aseptic procedure

Must decontaminate hands after:

• body fluid exposure risk
• after touching a ptx
• after touching ptx surroundings

Question 11

Discuss hand decontamination

Answer 11

 Know the “2 before and 3 afters”
 Alcohol gel can be used if hands sociably clean
 MUST use soap and water after examination of a patient with diarrhoea and after removing gloves
 Know how the 7 steps to hand decontamination

Question 12

Discuss medical devices

Answer 12

 Invasive medical devices: Maybe long
term or short term. All break the skin or
mucous membrane barrier
-CVC, PVC, urinary catheters, dialysis lines…. etc
 Indwelling prosthetic devices: Usually
long term devices which are buried into
tissue under the skin
-Heart valves, joints, pacing units…etc

Question 13

What is the most common cause of hospital acquired S. aureus?

Answer 13

Vascular access devices (VAD)

 Most hospitals in the UK now have active management systems around PVCs & CVC
 PVCs most common source of hospital acquired S. aureus bacteraemias
 In Scotland the use of “bundles” used to manage PVC care

Question 14

What transmission based precautions should be used for what?

Answer 14

 Contact precautions for organisms spread by direct contact
 Droplet precautions for organisms spread by droplets (meningitis, many respiratory infections, Norovirus)
 Airborne precautions for organisms spread by aerosols (Flu, Measles, chicken pox, TB)