Healthcare Infections

Question 1

What are healthcare infections

Answer 1

Infections arising as a consequence of providing healthcare

Question 2

If a hospital acquired infection occurs , how many hours roughly would this arise ?

Answer 2

48 hours after admission

Question 3

Why are healthcare infections important ?

Answer 3

1) frequent - 8% of in patients will have an infection they didn’t come in with.
2) impact on health is quite bad : can kill , some take months / years to eradicate
3) impacts healthcare organisations - because it requires treatment which is expensive , sometimes surgery which is again time consuming and expensive. There is an opportunity cost to those on waiting list
4) All these complications are actually avoidable.

Question 4

What is the most common hospital acquired infection in 2006 ?

Answer 4

GI tract infections (21%)
UTI (20%).

Pneumonia / surgical wound infections (14%)

Question 5

What areas in the infection model can we intervene to prevent infection ?

Answer 5

1. Prevent infection from one patient to another from spreading
2. Prevent the patient actually acquiring the pathogen
   3) . Once patient has acquired pathogen , we can prevent this from becoming an infection

Question 6

What patients are more likely going to acquire hospital infections?

Answer 6

Extremes of age

Obesity / malnourished

Diabetes

Cancer

Immunosuppression

Smoker

Surgical patient

Emergency admission

Question 7

Examples of healthcare infections pathogens

Answer 7

Viruses - hep B C , HIV , norovirus, influenzas, chickenpox

Bacteria : staph aures incl MRSA , C. difficile , E.Coli, TB ( mycobacterium )

Fungi : Candida albicans , aspergillus species

Parasites : malaria

Question 8

What are the 4Ps of infection prevention and control ?

Answer 8

Patient ( general patient risk factors , interactions with other patients , healthcare workers , visitors )

Pathogen ( virulence factors , ecological interactions , antibiotics)

Practice ( organisational structure and engagement - how well we take care of the patient , good hand hygiene of doctors /nurses , how much money gets put into the ward or hospital, )

Place ( healthcare environment - where we carry out healthcare - eg space between beds which will help reduce droplet spread )

Question 9

List a few general patient interventions

Answer 9

1) optimise patients condition
2. Identify their Risk factors eg diabetes ; try and control their blood glucose during their. Surgery. Also smoking - tell patient to stop smoking for at least a week before surgery.
3. Provide antimicrobial prophylaxis before surgery : ( one dose) . Not a lot required. This prevents surgical site infections
4. Skin prep : disinfect the skin - body wash etc
5. Hand hygiene.

Question 10

List a few specific patient interventions

Answer 10

1. MRSAscreens for patients on admissions
2. All adult patients we give disinfectant body wash.
3. Mupirocin nasal ointment which helps to reduce MRSA

Question 11

How to handle patient to patient transmission ? An example of patient interventions

Answer 11

1. Isolation of infected patients

2. Protection of susceptible patients

Question 12

Give examples of healthcare worker interventions to try and prevent healthcare workers spreading infections to patient

Answer 12

1. Healthcare workers must be disease free by vaccinating them
2. Good practice : hand hygiene , good clinical techniques eg sterile non touch technique, personal protective equipment eg face masks. Good Antimicrobial prescribing

Question 13

Environmental interventions

Answer 13

1. Good built environment : for example wash hand basins. Spaces between beds to prevent infections spreading.
2. Furnishing : eg wash hand basins should be near patient bed so that healthcare workers can wash their hands soon after patient contact.
3. Cleaning : there are problems with keeping hospitals clean. Use bleach ( chlorine releasing agents). Ward emptied = hydrogen peroxide vapour to disinfect.
4. Medical devices : Single use equipment , sterilisation , decontamination of devices.
5. Good FOOD hygiene.

6.

Question 14

Have you I-fused your patients today ?

Answer 14

I- identify

A- have they been abroad ?

B- blood borne infections

C - colonised

D- diarrhoea / vomiting

E- expectorating ( coughing eg)

F- funny looking rash

Question 15

What happens if you have indentified your patients to have an infections using the I five

Answer 15

1. Isolate
2. Investigate
3. Inform someone

4, imitate