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Infection > Healthcare Associated Infections > Flashcards

Healthcare Associated Infections Flashcards

1
Q

What are healthcare associated infections (HAI)?

A

Infections which were not present, or were in the pre symptomatic phase at the time of admission to hospital, but which arise 48 hours or more after admission or within 48 hours of discharge

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2
Q

What percentage of patients in Scotland develop HAI?

A

4.9%

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3
Q

Possible outcomes of HAI

A

Extended length of stay, pain, discomfort, permanent disability, death
Financial implications
Loss of public confidence and decreased staff morale
Litigation

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4
Q

Common HAIs

A 
UTI 
Surgical site infection 
Pneumonia 
Blood stream infection
Eye/ear/nose/throat/mouth infection 
GI infection 
Skin and soft tissue 
Systemic 
LRTI 
CVC/PVC related 
Neonatal 
CNS 
Bone/joint 
Reproductive tract 
CVS
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5
Q

How many bacteria are there in the adult human body?

A

10^14
10 bacterial cells to every human cell
1kg bacteria in the human gut alone
500 different species of bacteria have been isolated from human stool

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6
Q

First line of defence against infection

A 
Intact skin 
Normal bacterial flora 
Body secretions 
Coughing 
Gastric acid 
Flushing
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7
Q

Why do ventilation and catheterisation increase the risk of HAI?

A

They bypass the body’s natural protective mechanisms (coughing and urination)

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8
Q

Second line defence against infection

A

Immune system

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9
Q

Why are patients in hospital more vulnerable to microbial colonisation and infection?

A

People and inanimate objects all harbour microbes that may pose a risk to others, other patients are more likely to carry more microbes

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10
Q

What percentage of the population are colonised with staph aureus?

A

Approximately 30%, most with methicillin sensitive staph aureus (MSSA)

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11
Q

How can the same strain of staph aureus that colonises the population cause infection?

A

Break in skin
Vascular device
Catheter associated UTI
Ventilator associated pneumonia

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12
Q

What causes most HAI?

A

Disturbance in the bacterial-host equilibrium

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13
Q

What is colonisation?

A

When bacteria are in or on the body but do not cause illness

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14
Q

What is infection?

A

Where bacteria are in or on the body and cause illness, resulting in signs and symptoms

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15
Q

Microbial factors leading to increased risk of infection

A 
Resistance 
Virulence 
Transmissibility 
Increased survival ability 
Ability to evade host defences
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16
Q

Host factors leading to increased risk of infection

A 
Devices e.g. PVC, CVC, urinary catheter, ventilation 
Antibiotics 
Break in skin surface
Foreign bodies 
Immunosuppression 
Gastric acid suppression 
Age extremes 
Proximity to others 
Increased opportunity for infection e.g. poor hand washing 
Overcrowding
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17
Q

Modes of transmission of microbes

A

Direct contact
Respiratory/droplet
Faecal-oral
Penetrating injury

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18
Q

Chain of infection

A

Source of microbe
Transmission vector
Host

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19
Q

Ways to break the chain of infection

A 
Risk awareness 
Standard IPC precautions 
Hand hygiene 
Personal protective equipment 
Vaccination 
Post exposure prophylaxis 
Environment
20
Q

What is cleaning?

A

Physical removal of organic material and microbial load reduction

21
Q

When can cleaning be used?

A

For low risk e.g. intact skin contact - stethoscopes, cots, mattresses

22
Q

When is cleaning essential?

A

Prior to disinfection/sterilisation

23
Q

What is disinfection?

A

Large reduction in microbial numbers, spores may remain

24
Q

When can disinfection be used?

A

For medium risk e.g. mucous membrane contact - bedpans, endoscopes

25
Q

Method of cleaning

A

Detergent and water

Drying

26
Q

Method of disinfection

A

Heat - pasteurisation, boiling

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

27
Q

What is sterilisation?

A

Removal/destruction of all microbes and spores

28
Q

When can sterilisation be used?

A

High risk e.g. penetration through the skin/sterile body cavities - surgical instruments

29
Q

Methods of sterilisation

A

Steam under pressure - autoclave
Hot air oven
Gas
Ionising radiation

30
Q

Infection prevention and control surveillance methods

A

Local surveillance

National surveillance

31
Q

Features of local surveillance - lab based

A

Lab detects microbe and notifies IPCT and clinicians
Identify microbe and recommendations can be specific
Depends on samples being sent, takes time to grow and identify microbe

32
Q

Features of ward/clinical area based surveillance

A

Ward/clinical staff notify IPCT or microbiology
Detects potential problem sooner and can ensure correct samples are sent
Potential causative microbe is not always clear initially, IPC measures more general

33
Q

Mandatory surveillance reporting for Scotland

A 
MRSA bacteraemia 
MSSA bacteraemia 
C. diff
E. coli bacteraemia 
Surgical sites
34
Q

What is an outbreak?

A

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

35
Q

What is the purpose of the IPCT?

A

To prevent individual infections and outbreaks

36
Q

What is the purpose of surveillance?

A

To detect and identify a possible outbreak at the earliest opportunity

37
Q

Typing methods, to determine strain responsible

A 
Antibiogram 
Phage typing 
Pyocin typing 
Serotyping 
Molecular typing
38
Q

Control measures for outbreaks

A 
Reinforcements of IPC measures 
Single room in isolation 
Cohorting of cases
Ward/clinical area closure 
Staff/patient decolonisation 
Staff exclusion
39
Q

Features of C. diff infection

A

Diarrhoea
Abdominal pain, pyrexia, raised WCC
Pseudomembranous colitis

40
Q

In what percentage of adults is C. diff part of the normal gut flora?

A

Around 2%

41
Q

Pattern of carriage rate of C. diff with age

A

C. diff carriage rate increases with age

42
Q

What percentage of the elderly are colonised with C. diff?

A

Around 30%

43
Q

When does C. diff infection occur?

A

When there is an imbalance in the gut flora due to an endogenous or exogenous source
Variable in severity
Elderly more at risk

44
Q

What must be present for a diagnosis of C. diff infection to be made?

A

Diarrhoeal symptoms - positive toxin test does not always indicate disease

45
Q

Possible reasons for increasing incidence

A 
More antibiotics 
More of a particular type of antibiotic
New strains 
Less hand washing due to more hand-gelling 
Increasing environmental contamination 
Increased number of vulnerable patients close together 
Increased throughput of patients 
Other drugs having effect
46
Q

Treatment of C. diff

A

Stop predisposing antibiotic is possible
Oral metronidazole if symptomatic
Oral vancomycin if severe or failure of metronidazole
Oral fidaxomicin

Infection (14 decks)

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