Hospital Acquired Infections Flashcards
What are HAI?
Healthcare Associated Infections
Not present on admission
How much do HAI cost?
Lots
£1 bn/ year
300,000 HAI pa
Are HAI preventable?
About 15-30% - up to 33% are
How common are HAI in the UK?
About 8%
How common are HAI in the globally?
3.5- 10.5% of hospitalised patients in industrialised countries
May be greater than 25% of hospitalised patients in developing world nations
Which HAI is the most common?
• Most common syndrome of HAI = hospital-acquired PNEUMONIA o 2nd = surgical site infections o 3rd = urinary tract infections o 4th = blood stream infections o 5th = gastrointestinal infections
What % of HAI are MRSA and C Diff?
15%
What is MRSA associated with?
Catheters/ urinary catheters
Surgical site infections
What is C Diff associated with?
Antibiotic associated Diarrhoea
What is E. coli associated with?
Urinary catheter UTI - only treat Sepsis
Ventilator associated pneumonia
What is MSSA associated with?
Central Catheters (blood) Surgical site infection
What is R Gram negs associated with?
Catheter/ urinary catheter
Surgical site
What is Yeasts/ Candida associated with?
Catheter/ urinary catheter
What type of infection is C Difficile?
Gram positive spore forming Anaerobe
What is the hospital microbiome project?
o This tried to figure out where the organisms in the hospital came from
o 1st day (before occupied) - bugs go from the environment onto the patient
o 2+ days - bugs go from the patient outwards
• Surveillance will be useful for reducing infection risk
Why is E. coli bacteraemia increasing?
There is an increase in cases during the summer which may be due to factors such as dehydration in elderly patients
It’s possible that the drive to reduce antibiotic use in the community has led to increased rates of invasive disease (bacteraemia)
How do we reduce E. coli?
> Reduce number of bugs
Reduce number of resistant bugs
Prioritisation of side rooms
Reducing transmission of bugs
How we reduce transmission of bugs?
o Educating staff
o Cleaning the environment and equipment
o Reduce the use of broad-spectrum or unnecessary antibiotics
o Better surfaces to prevent adherence of bacteria
What are the main contributors to surgical site infections?
Host defence
Wound environment
Pathogens
Why are HAI’s increasing?
- We do more invasive procedures
- Prosthetic and implantable devices
- Obesity
- Diabetes
- Extremes of age
- Immunosuppression
- Emerging organisms and resistance
How do we manage hospital environments?
- Environmental hygiene and cleaning
- Control of environmental sources (e.g. water)
- Building works (aspergillus)
- Negative pressure isolation - protect others from an infectious patient with airborne infection
- Positive pressure isolation - protection of transplant patients from organisms outside the room
How does MRSA bacteraemia affect hospital inpatient stay?
Morbidity 2.5 x longer admission Bed occupancy Repeat surgery Prolonged Abx Use of isolation rooms (MRSA, CDiff) Medical complications Death (7.1 x more likely to die)
Why is Carbapenemase producing bacteria a problem?
Carbapenems are a last resort Abx
High mortality (difficult to treat) and no optimal strategy
We also don’t know the pharmacokinetics and pharmacodynamics
What drives antimicrobial resistance?
Antimicrobial use
How do we see which HAI are common?
Surveillance and reporting (IPC)
Point prevalence surveys - UK/US
What may be global challenges relating to healthcare associated infections?
No clean water War Safety absent No clean diagnostic labs High reuse of needles
How do we treat/ prevent C Diff recurrent infections?
Fidaxomicin (macrocyclic Abx)
Faecal transfer
Which Gram negatives are more implicated in hospital for UTI?
E Coli
Klebsiella
Proteus
Pseudomonas
What are resistant gram negatives caused by?
Chromosome
Plasmid
E.Coli < Klebsiella < Enterobacter
What are gram positive cocci in clusters?
Staphylococcous Aureus
How do you identify MSSA with sensitivity disks?
Methicillin sensitive staph aureus- use oxacillin to differentiate from MRSA
How do we control infection?
Measure, analyse, feedback, infection control
Why is Hand hygiene bad in hospitals?
Lack of awareness or role models or time or sink lacked
Poor technique
Skin damage
Scepticicsm
Whats the best prevention?
Hand hygiene
Which infections require negative pressure isolation rooms?
TB, chickenpox, RSV
