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[ ESA 3- Infection and Immunity > Healthcare Infections > Flashcards

Healthcare Infections Flashcards

1
Q

What are healthcare infections?

A

Infections arising as a consequence of providing health care, including community care

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2
Q

Who can healthcare infections present in?

A

Hospital patients
Hospital visitors
Hospital staff

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3
Q

What is it called when a hospital patient gets a healthcare infection?

A

Hospital acquired infection

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4
Q

What must be true of a hospital acquired infection?

A

The patient must neither be present nor incubating an infection at the time of admission

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5
Q

How is it ensured that the patient has not got an infection present or incubating at the time of admission when diagnosing hospital acquired infections?

A

Onset must be at least 48 hours after admission

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6
Q

Give an example of a group of people considered to be a hospital visitors

A

Contractors/builders

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7
Q

Give an example of a group of people who are considered to be hospital staff

A

Lab workers

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8
Q

What % of in-patients acquire an infection as a result of being in hospital?

A

8%

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9
Q

What is the problem with healthcare infections?

A

Can impact health, leading to increased deaths/poor outcome of treatment
Impacts the health care organisation

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10
Q

Why are healthcare infections particularly tragic?

A

The majority of these infections are preventable

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11
Q

What % of HCAI are UTIs?

A

20%

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12
Q

What % of HCAI is pneumonia?

A

14%

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13
Q

What % of HCAI are surgical wound infections?

A

14%

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14
Q

What % of HCAIs are of the skin and soft tissue?

A

10%

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15
Q

What % of HCAIs are of the primary bloodstream?

A

7%

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16
Q

What % of HCAI are gastro-intestinal?

A

21%

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17
Q

What contributes to the financial cost of HCAIs?

A 
Investigations
Treatment
Reputation loss
Funding loss
Patient's extended stay
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18
Q

Where are the areas for potential prevention of HCAIs?

A

Prevent pathogen from existing/meeting patient
Prevent colonisation leading to infection
Stop pathogen and infection from spreading

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19
Q

Give four examples of HCAI viruses

A

Blood borne viruses
Norovirus
Influenza
Chickenpox

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20
Q

Give 3 examples of blood borne viruses

A

Hepatitis B and C

HIV

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21
Q

How can blood borne viruses spread in a hospital environment?

A

Blood splashes or needle stick injuries in health workers

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22
Q

What does norovirus cause?

A

Projectile vomiting in patients and staff

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23
Q

When is chickenpox particularly bad?

A

Adults

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24
Q

Give 6 examples of HCAI bacterium

A 
Staph. Aureus
Clostridium diffile
E. coli 
Klebsiella pneumoniae
Pseudomonas aeruginosa
Mycobacterium tuberculosis
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25
Q

Give an example of a S. Aureus infection?

A

MRSA

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26
Q

How is S. Aureus often passed on?

A

By healthcare workers and unclean equipment

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27
Q

What is the problem with clostridium difficile in the hospital environment?

A

Forms spores that can survive for months in clinical environment

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28
Q

What is the problem with E. Coli and Klebsiella pneumoniae?

A

Wide drug resistance in developing

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29
Q

What is the problem with pseudomonas aeruginosa?

A

Inheriting resistance, particularly in UTIs

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30
Q

What is the problem with mycobacterium tuberculosis?

A

Often not picked up and contacts have to be traced

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31
Q

Give two examples of HCAI fungi

A

Candida albicans

Aspergillus species

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32
Q

How may an aspergillus infection be acquired in the hospital environment?

A

Spores can be released during building work

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33
Q

When is a aspergillus species HCAI important?

A

In immunodeficient patients

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34
Q

Give an example of a HCAI parasite

A

Malaria

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35
Q

What patient factors may lead to a HAI?

A 
Extremes of age
Obesity/malnutrition
Diabetes
Cancer
Immunosuppression 
Smoker
Surgical patient
Emergency admissions
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36
Q

What are the 4 Ps of infection prevention and control?

A

Patient
Pathogen
Practice
Place

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37
Q

What is considered when looking at the patient in infection prevention and control?

A

General and specific patient risk factors for infections

Interactions

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38
Q

Who may a patient interact with in the hospital environment?

A

Other patients
Healthcare workers
Visitors

39
Q

What is considered when looking at pathogen factors in infection prevention and control?

A

Virulence factors

Ecological interactions

40
Q

What ecological interactions should be considered when looking at infection prevention and control?

A

Other bacteria

Antibiotics/disinfectants

41
Q

What practices should be considered when looking at infection prevention and control?

A

General specific activities of healthcare workers
Policies and their implementation
Organisational structure and engagement
Regional and national political initiatives
Leadership at all levels from government to ward

42
Q

What are the general patient interventions aimed to prevent and control infections?

A

Optimise patient’s health
Antimicrobial prophylaxis
Skin preparation
Hand hygiene

43
Q

What can be done to optimise the patients health in infection prevention and control?

A

Reduce/stop smoking
Improve nutrition
Control diabetes

44
Q

What are some specific patient interventions aimed to control and prevent infection?

A

MRSA screening
Mupirocin nasal ointment
Hand hygiene

45
Q

How can patient to patient transmission be prevented in a healthcare setting?

A

Isolation of infected patients

Protection of susceptible patients

46
Q

What healthcare worker interventions can be made to prevent and control infections?

A

Keep workers disease free

Good practice

47
Q

How can HCW be kept disease free?

A

Vaccinations

48
Q

What is good practice of HCW when considering infection control and prevention?

A

Good clinical techniques
Hand hygiene
PPE
Effective antimicrobial prescribing

49
Q

What environmental interventions can be made when considering infection prevention and control?

A 
Built environment
Furniture/furnishings
Cleaning
Medical devices
Appropriate kitchen and ward food facilities 
Good food hygiene practice
Theatres
Positive/negative pressure rooms for immunocompromised patients
50
Q

What must be considered with the built environment with infection prevention and control?

A

Space/layout
Toilets
Wash basins

51
Q

How can a hospital environment be cleaned?

A

Disinfectants
Steam cleaning
Hydrogen peroxide vapour

52
Q

How can it be ensured that infection isn’t carried on medical devices?

A

Single use equipment
Sterilisation
Decontamination

53
Q

How should you I-five check patients?

A 
Identify
Isolate
Investigate
Inform
Initiate
54
Q

What does the identify stage of the I-five check of patients consist of?

A 
Abroad
Blood borne infections
Colonised
Diarrhoea/vomiting
Expectorating
Funny looking rash
55
Q

What are the global concerns relating to hospital acquired infection and drug resistance?

A

Costly
Preventable
Frequent
Deadly

56
Q

Where is clostridium difficile found as microbiota?

A

In the human GI tract

57
Q

In what % of humans is C. Diff found in the GI tract as microbiota?

A

~3%, higher in hospitalised patients

58
Q

Why can C. Diff in the microbiota become pathogenic?

A

Use of broad spectrum antibiotics

59
Q

Why does use of broad spectrum antibiotics allow C. Diff to become pathogenic?

A

It massively alters the GI microbiota, which;
Allows for endogenous C. Diff to proliferate
Allows for an exogenous infection to occur

60
Q

Why is an exogenous C. Diff infection more likely to occur in a hospital setting?

A

Due to the large number of patients releasing spores into the environment, which can colonise the GI tract

61
Q

What does the C. Diff pathogen release?

A

Toxins A & B

62
Q

What do C. Diff toxins A and B do?

A

Act on the gut to cause cytokine release

63
Q

What does the cytokine release induced by C. Diff cause?

A

Tissue damage and death

64
Q

How does C. Diff differ in neonates?

A

Neonates commonly carry large amounts of C. Diff in their gut, but lack the receptors for the toxins to take effect

65
Q

What are the symptoms of a C. Diff infection?

A 
Diarrhoea
Abdominal pin 
Malaise
Fever
Nausea
66
Q

What can inflammation caused by C. Diff lead to?

A

Bowel perforation and sepsis

67
Q

Why can inflammation caused by C. Diff cause bowl perforation and sepsis?

A

Due to cessation of peristalsis

68
Q

How is a diagnosis of C. Diff made?

A

From a stool sample, checking for antigen detection or toxin detection

69
Q

What is the treatment for C. Diff?

A

Oral metronidazole or vancomycin

Discontinuing current antibiotic regime

70
Q

What kind of pathogen is staphylococcus aureus?

A

A gram positive coccus

71
Q

Where is staphylococcus aureus found as part of the normal microbiota?

A

Carried on skin and mucous membranes of normal individuals

72
Q

What does S. Aureus require to cause infection?

A

Significant host compromisation

73
Q

What has happened regarding S. Aureus in recent decades?

A

Around 50% of hospital S. Aureus isolates have been found to be resistant to methicillin

74
Q

What is it called when S. Aureus is resistant to methicillin?

A

MRSA

75
Q

What is resistance due to in MRSA?

A

A chromosomal acquisition of the gene for a distinct penicillin binding protein that has a low affinity for ß-lactams

76
Q

What is MRSA linked with?

A

Longer hospital and ICU stays
Longer durations of mechanical ventilation
Higher mortality rates

77
Q

What is the problem with treating MRSA?

A

It is resistant to many microbials

78
Q

How is MRSA best treated?

A

Vancomycin

79
Q

What is the problem with vancomycin treatment of MRSA?

A

Resistance has been increassing

80
Q

What can S. Aureus infection cause?

A 
Localised skin infections
Deep infections
Acute endocarditis 
Septicaemia
Pneumonia
81
Q

What is the vaccination against S. Aureus?

A

There is none

82
Q

What is the best prevention of S. Aureus?

A

Barrier protection

Hand disinfection

83
Q

What kind of pathogens are noroviruses?

A

Positive-stranded, non-enveloped RNA viruses

84
Q

Where do noroviruses replicate?

A

In the GI tract

85
Q

Where are noroviruses shed?

A

In stool

86
Q

What is norovirus commonly known as?

A

The winter vomiting virus

87
Q

How does norovirus infection occur?

A

Via the fecal-oral route, following the ingestion of contaminated food or water, person-to-person contact, or contact with contaminated surfaces

88
Q

What is norovirus a major cause of?

A

Epidemic acute gastroenteritis at schools, prisons, and other closed environments

89
Q

Who does norovirus affect?

A

Adults and school-age children, but not infants

90
Q

How does norovirus clinically present?

A

Nausea
Vomiting
Diarrhoea

91
Q

How long do norovirus symptoms last?

A

24-48 hours

92
Q

How is norovirus diagnosed?

A

Antiviral antibodies can be detected by ELISA

93
Q

What is the specific antiviral treatment for norovirus?

A

There is none

94
Q

How can the incidence of norovirus infections be reduced?

A

Careful attention to handwashing and measures to prevent contamination of food and water supplies

[ ESA 3- Infection and Immunity (15 decks)

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