Healthcare Infections Flashcards
1
Q
What are healthcare infections?
A
Infections arising as a consequence of providing health care, including community care
2
Q
Who can healthcare infections present in?
A
Hospital patients
Hospital visitors
Hospital staff
3
Q
What is it called when a hospital patient gets a healthcare infection?
A
Hospital acquired infection
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
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
6
Q
Give an example of a group of people considered to be a hospital visitors
A
Contractors/builders
7
Q
Give an example of a group of people who are considered to be hospital staff
A
Lab workers
8
Q
What % of in-patients acquire an infection as a result of being in hospital?
A
8%
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
10
Q
Why are healthcare infections particularly tragic?
A
The majority of these infections are preventable
11
Q
What % of HCAI are UTIs?
A
20%
12
Q
What % of HCAI is pneumonia?
A
14%
13
Q
What % of HCAI are surgical wound infections?
A
14%
14
Q
What % of HCAIs are of the skin and soft tissue?
A
10%
15
Q
What % of HCAIs are of the primary bloodstream?
A
7%
16
Q
What % of HCAI are gastro-intestinal?
A
21%
17
Q
What contributes to the financial cost of HCAIs?
A
Investigations Treatment Reputation loss Funding loss Patient's extended stay
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
19
Q
Give four examples of HCAI viruses
A
Blood borne viruses
Norovirus
Influenza
Chickenpox
20
Q
Give 3 examples of blood borne viruses
A
Hepatitis B and C
HIV
21
Q
How can blood borne viruses spread in a hospital environment?
A
Blood splashes or needle stick injuries in health workers
22
Q
What does norovirus cause?
A
Projectile vomiting in patients and staff
23
Q
When is chickenpox particularly bad?
A
Adults
24
Q
Give 6 examples of HCAI bacterium
A
Staph. Aureus Clostridium diffile E. coli Klebsiella pneumoniae Pseudomonas aeruginosa Mycobacterium tuberculosis
25
Give an example of a S. Aureus infection?
MRSA
26
How is S. Aureus often passed on?
By healthcare workers and unclean equipment
27
What is the problem with clostridium difficile in the hospital environment?
Forms spores that can survive for months in clinical environment
28
What is the problem with E. Coli and Klebsiella pneumoniae?
Wide drug resistance in developing
29
What is the problem with pseudomonas aeruginosa?
Inheriting resistance, particularly in UTIs
30
What is the problem with mycobacterium tuberculosis?
Often not picked up and contacts have to be traced
31
Give two examples of HCAI fungi
Candida albicans
| Aspergillus species
32
How may an aspergillus infection be acquired in the hospital environment?
Spores can be released during building work
33
When is a aspergillus species HCAI important?
In immunodeficient patients
34
Give an example of a HCAI parasite
Malaria
35
What patient factors may lead to a HAI?
```
Extremes of age
Obesity/malnutrition
Diabetes
Cancer
Immunosuppression
Smoker
Surgical patient
Emergency admissions
```
36
What are the 4 Ps of infection prevention and control?
Patient
Pathogen
Practice
Place
37
What is considered when looking at the patient in infection prevention and control?
General and specific patient risk factors for infections
| Interactions
38
Who may a patient interact with in the hospital environment?
Other patients
Healthcare workers
Visitors
39
What is considered when looking at pathogen factors in infection prevention and control?
Virulence factors
| Ecological interactions
40
What ecological interactions should be considered when looking at infection prevention and control?
Other bacteria
| Antibiotics/disinfectants
41
What practices should be considered when looking at infection prevention and control?
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
What are the general patient interventions aimed to prevent and control infections?
Optimise patient's health
Antimicrobial prophylaxis
Skin preparation
Hand hygiene
43
What can be done to optimise the patients health in infection prevention and control?
Reduce/stop smoking
Improve nutrition
Control diabetes
44
What are some specific patient interventions aimed to control and prevent infection?
MRSA screening
Mupirocin nasal ointment
Hand hygiene
45
How can patient to patient transmission be prevented in a healthcare setting?
Isolation of infected patients
| Protection of susceptible patients
46
What healthcare worker interventions can be made to prevent and control infections?
Keep workers disease free
| Good practice
47
How can HCW be kept disease free?
Vaccinations
48
What is good practice of HCW when considering infection control and prevention?
Good clinical techniques
Hand hygiene
PPE
Effective antimicrobial prescribing
49
What environmental interventions can be made when considering infection prevention and control?
```
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
What must be considered with the built environment with infection prevention and control?
Space/layout
Toilets
Wash basins
51
How can a hospital environment be cleaned?
Disinfectants
Steam cleaning
Hydrogen peroxide vapour
52
How can it be ensured that infection isn't carried on medical devices?
Single use equipment
Sterilisation
Decontamination
53
How should you I-five check patients?
```
Identify
Isolate
Investigate
Inform
Initiate
```
54
What does the identify stage of the I-five check of patients consist of?
```
Abroad
Blood borne infections
Colonised
Diarrhoea/vomiting
Expectorating
Funny looking rash
```
55
What are the global concerns relating to hospital acquired infection and drug resistance?
Costly
Preventable
Frequent
Deadly
56
Where is clostridium difficile found as microbiota?
In the human GI tract
57
In what % of humans is C. Diff found in the GI tract as microbiota?
~3%, higher in hospitalised patients
58
Why can C. Diff in the microbiota become pathogenic?
Use of broad spectrum antibiotics
59
Why does use of broad spectrum antibiotics allow C. Diff to become pathogenic?
It massively alters the GI microbiota, which;
Allows for endogenous C. Diff to proliferate
Allows for an exogenous infection to occur
60
Why is an exogenous C. Diff infection more likely to occur in a hospital setting?
Due to the large number of patients releasing spores into the environment, which can colonise the GI tract
61
What does the C. Diff pathogen release?
Toxins A & B
62
What do C. Diff toxins A and B do?
Act on the gut to cause cytokine release
63
What does the cytokine release induced by C. Diff cause?
Tissue damage and death
64
How does C. Diff differ in neonates?
Neonates commonly carry large amounts of C. Diff in their gut, but lack the receptors for the toxins to take effect
65
What are the symptoms of a C. Diff infection?
```
Diarrhoea
Abdominal pin
Malaise
Fever
Nausea
```
66
What can inflammation caused by C. Diff lead to?
Bowel perforation and sepsis
67
Why can inflammation caused by C. Diff cause bowl perforation and sepsis?
Due to cessation of peristalsis
68
How is a diagnosis of C. Diff made?
From a stool sample, checking for antigen detection or toxin detection
69
What is the treatment for C. Diff?
Oral metronidazole or vancomycin
| Discontinuing current antibiotic regime
70
What kind of pathogen is staphylococcus aureus?
A gram positive coccus
71
Where is staphylococcus aureus found as part of the normal microbiota?
Carried on skin and mucous membranes of normal individuals
72
What does S. Aureus require to cause infection?
Significant host compromisation
73
What has happened regarding S. Aureus in recent decades?
Around 50% of hospital S. Aureus isolates have been found to be resistant to methicillin
74
What is it called when S. Aureus is resistant to methicillin?
MRSA
75
What is resistance due to in MRSA?
A chromosomal acquisition of the gene for a distinct penicillin binding protein that has a low affinity for ß-lactams
76
What is MRSA linked with?
Longer hospital and ICU stays
Longer durations of mechanical ventilation
Higher mortality rates
77
What is the problem with treating MRSA?
It is resistant to many microbials
78
How is MRSA best treated?
Vancomycin
79
What is the problem with vancomycin treatment of MRSA?
Resistance has been increassing
80
What can S. Aureus infection cause?
```
Localised skin infections
Deep infections
Acute endocarditis
Septicaemia
Pneumonia
```
81
What is the vaccination against S. Aureus?
There is none
82
What is the best prevention of S. Aureus?
Barrier protection
| Hand disinfection
83
What kind of pathogens are noroviruses?
Positive-stranded, non-enveloped RNA viruses
84
Where do noroviruses replicate?
In the GI tract
85
Where are noroviruses shed?
In stool
86
What is norovirus commonly known as?
The winter vomiting virus
87
How does norovirus infection occur?
Via the fecal-oral route, following the ingestion of contaminated food or water, person-to-person contact, or contact with contaminated surfaces
88
What is norovirus a major cause of?
Epidemic acute gastroenteritis at schools, prisons, and other closed environments
89
Who does norovirus affect?
Adults and school-age children, but not infants
90
How does norovirus clinically present?
Nausea
Vomiting
Diarrhoea
91
How long do norovirus symptoms last?
24-48 hours
92
How is norovirus diagnosed?
Antiviral antibodies can be detected by ELISA
93
What is the specific antiviral treatment for norovirus?
There is none
94
How can the incidence of norovirus infections be reduced?
Careful attention to handwashing and measures to prevent contamination of food and water supplies
