Healthcare Associated Infections and Antimicrobial Stewardship Flashcards
What is a healthcare associated infection?
Occuring >48 hours after hospital admission
Patients in community also receive healthcare
Multi-resistant organisms in community in patients with risk factors
What bacteria aren’t covered by piperacillin?
MRSA
ESBL
What bacteria that aren’t covered by piperacillin, but are by vancomycin?
MRSA
If Gram positive cocci are seen in blood cultures, what guides empirical treatment until sensitivities come back?
Continue to cover MRSA
What are the requirements for the transmission of pathogens?
Source
Mode of transmission
Susceptible host
What are the possible sources of a nosocomial infection?
Animate - Healthcare worker - Patient - Visitor Inanimate - Fomite - Environment
What are the modes of transmissions of nosocomial infections?
Contact transmission - Direct = person-to-person - Indirect = via contaminated intermediate object/person Droplet - >5 um - Generated by coughing and sneezing - Drop to ground by 1 m Airborne - <5 um - Stay suspended in air - Dispersed widely by air currents - May be inhaled by susceptible hosts over long distances
What are the risk factors for infection?
Old and young age Diabetes Immune compromise Other medical conditions Intensive care Breech of 1st line defences - IV lines - Urinary catheters - Endotracheal tube - Drain tube - Procedures - Antimicrobial therapy
What is MRSA?
Methicillin-resistant Staphylococcus aureus
Resistant to all penicillins and most cephalosporins
Where can MRSA colonise on the body?
Nose Throat Groin Axilla GI tract
What is the primary mode of spread of MRSA?
Contaminated hands of healthcare workers
How is VRE colonisation tested for?
Rectal swabs
What is bacterial colonisation?
Growth somewhere in body without causing any clinical illness
Predisposes to developing infection
Can be transmitted to other patients
Do you need to treat colonisation?
No
Why are VRE and multi-resistant Gram negative bacilli important?
Limited in choice of antibiotics
Have to treat in hospital - no oral options
What is VRE?
Vancomycin resistant enterococcus
What is the primary mode of spread of VRE?
Contaminated hands of healthcare workers
Environment also important
Where is the primary colonisation site of VRE?
GI tract
What are the precautions for VRE?
Contact precautions
Single rooms
Environmental cleaning
What is the importance of carbapenemase producing Enterobacteriaceae (CPE)?
Genes often on plasmids
- Easily transmissible
- May also carry other resistance genes
High mortality rates
How is CPE transmitted?
Patient-to-patient
Why do you need to ask if patients have been in an overseas healthcare facility overnight in the past year, regarding CPE?
Associated with medical tourism and travel
What do you need to do if a patient has been in an overseas healthcare facility overnight in the past year?
Screening for CPE
Contact precautions
What bacteria are included in Enterobacteriaceae?
E coli Klebsiella Enterobacter Proteus Citrobacter Serratia
What are the first, second, and third line treatments for Clostridium difficile?
1st = oral metronidazole 2nd = oral vancomycin 3rd = oral vancomycin + IV metronidazole
What is a C difficile infection associated with?
Antibiotic use
Bad hand hygiene
What does a C difficile infection cause?
Diarrhoea
Pseudomembranous colitis
Toxic megacolon
What are some major hospital associated pathogens?
Bacterial - MRSA - VRE - Multi-resistant Gram negative bacilli - C difficile - TB Viral - Respiratory viruses - Norovirus - Varicella - Measles - Viral haemorrhagic fever Fungi - Aspergillus - Candida
What does norovirus cause?
Gastroenteritis outbreaks
Does alcohol kill norovirus?
No, need to use soap and water
How is norovirus spread?
Contaminated food/water
Touching contaminated surfaces
Droplets from vomitus
What is an outbreak?
Arises from point source
Increased numbers beyond expected
Subtyping shows same type
How do you prevent healthcare associated infections?
Prevent development of antibiotic resistance
Prevention of transmission
Prevention of infection in individual patient
What does inappropriate antibiotic use do?
Drives selection of resistant bacteria
Disrupts normal antimicrobial flora
Increases risk of colonisation with resistant bacteria
Risk of transmission to others
What is antimicrobial stewardship?
Systematic approach to using antibiotics prudently
- Reduce inappropriate antimicrobial use
- Improve patient outcomes
- Reduce adverse consequences
Aims to change antimicrobial prescribing behaviour
When don’t you used alcohol based products for hand hygiene?
Hands visibly soiled
Patient has
- Norovirus
- C difficile
