Healthcare Infections

Question 1

What are healthcare infections?

Answer 1

• Infections arising as a consequence of
providing healthcare
• In hospital patients:
– Neither present nor incubating at time of
admission
– For practical purposes, this means onset is at least 48 hours after admission
• Also includes infections in hospital visitors and healthcare workers

Question 2

Why are healthcare infections important?

Answer 2

• Frequent - prevalence = 8% of in-patients
• Impact on health
• Impact on healthcare organisations
• Preventable
On average very patient stays 1 day extra due to infection - draining on healthcare resources 30-50% are preventable

Question 3

Name some types of HCAI

Answer 3

UTI - 20%
GI e.g. diarrhoea - 21%
Pneumonia - 14%
Surgical wound infections - 14%
Skin and soft tissue - 10%
Primary bloodstream - 7%
Other - 14%

Question 4

How can risk of hcai be reduced?

Answer 4

Patient with an infection is a risk to other patients - need to prevent secondary passing on
can do that by
getting rid of pathogen
preventing pathogen patient interaction
prevent person with infection becoming a risk to peother ppl

Question 5

Give examples of healthcare infection pathogens

Answer 5

Viruses:
Blood borne e.g. hep b/c, HIV
Norovirus
Influenza
Chickenpox

Bacteria:
Staph aureus eg MRSA
C diff
E. Coli, klebsiella pneumoniae 
Pseudomonas aeruginosa 
Mycobacterium tuberculosis 

Fungi:
Candida albicans
Aspergillosis species

Parasites: malaria

Question 6

Which parents are at risk of healthcare infections?.

Answer 6

extremes of age 
obesity/malnourished 
diabetes 
cancer 
immunosuppression 
smoker 
surgical patient - surgery wounds break down in both fat and thin patients (thin - sutures pull through skin. Fat - wound comes apart)
emergency admission - higher rate of complication

Question 7

What are the 4 Ps of infection prevention and control?

Answer 7

Patient, pathogen, practice, place

Question 8

Explain the ‘patient” element of the 4Ps

Answer 8

• General and specific patient risk factors for infections
• Interactions with:
• other patients
• healthcare workers
• visitors

Question 9

Explain thr “pathogen” element of the 4 Ps

Answer 9

•Virulence factors
•Ecological interactions
-other bacteria
- antibiotics/disinfectants

Question 10

Explain the “practice” element of the 4 ps?

Answer 10

• General and 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 the ward

Question 11

Explain the “place” element of the 4 ps

Answer 11

•Healthcare environment

- fixed features - variable features

Question 12

What are general interventions for a patient

Answer 12

• General
– Optimise patient’s condition
     • Smoking, nutrition, diabetes etc 
– Antimicrobial prophylaxis 
– Skin preparation 
– Hand hygiene

Question 13

Give example of specific interventions for a patient

Answer 13

• Specific
– MRSA screens
– Mupirocin nasal
nutrition, diabetes
– Antimicrobial
ointment – Disinfectant body wash

Question 14

What are methods of halting patient to patient transmission?

Answer 14

– Physical barriers
• Isolation of infected patients - e.g. seperate room with a gowning lobby with higher air pressure
• Protection of susceptible patients - inter to get rid of bacteria in the air

Question 15

What are health care worker interventions?

Answer 15

• Healthcare workers
– Healthy
• Disease free 
• Vaccinated
– Good practice
• Good clinical techniques
(e.g. sterile non-touch) 
• Hand hygiene 
• PPE 
• Antimicrobial prescribing

Question 16

What are environmental interventions?

Answer 16

• Built environment
– Space/Layout
– Toilets
– Wash hand basins

• Furniture and furnishings

• Built environment
– Space/Layout
– Toilets - individual toilet for infected patients e.g. with c dif
– Wash hand basins

• Furniture and furnishings
• Cleaning
  • Disinfectants
  • Steam cleaning
  • Hydrogen peroxide vapour

• Medical devices
– Single use equipment
– Sterilisation
– Decontamination- eg endoscopes washed with chemicals(but these are then rinsed as they are toxic but the water may recontaminate)

• Theatres • Positive/Negative pressure
rooms • Immunosuppressed
patients

Question 17

What are the 5 is?

Answer 17

•  Identify
– Abroad
– Blood borne infections
– Colonised
– Diarrhoea/vomiting
– Expectorating
– Funny looking rash
• Isolate • Investigate • Inform • Initiate