Hospital Acquired Infections

Question 1

What are HAI?

Answer 1

Healthcare Associated Infections

Not present on admission

Question 2

How much do HAI cost?

Answer 2

Lots

£1 bn/ year

300,000 HAI pa

Question 3

Are HAI preventable?

Answer 3

About 15-30% - up to 33% are

Question 4

How common are HAI in the UK?

Answer 4

About 8%

Question 5

How common are HAI in the globally?

Answer 5

3.5- 10.5% of hospitalised patients in industrialised countries

May be greater than 25% of hospitalised patients in developing world nations

Question 6

Which HAI is the most common?

Answer 6

•	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

Question 7

What % of HAI are MRSA and C Diff?

Answer 7

15%

Question 8

What is MRSA associated with?

Answer 8

Catheters/ urinary catheters

Surgical site infections

Question 9

What is C Diff associated with?

Answer 9

Antibiotic associated Diarrhoea

Question 10

What is E. coli associated with?

Answer 10

Urinary catheter UTI - only treat Sepsis

Ventilator associated pneumonia

Question 11

What is MSSA associated with?

Answer 11

Central Catheters (blood)
Surgical site infection

Question 12

What is R Gram negs associated with?

Answer 12

Catheter/ urinary catheter

Surgical site

Question 13

What is Yeasts/ Candida associated with?

Answer 13

Catheter/ urinary catheter

Question 14

What type of infection is C Difficile?

Answer 14

Gram positive spore forming Anaerobe

Question 15

What is the hospital microbiome project?

Answer 15

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

Question 16

Why is E. coli bacteraemia increasing?

Answer 16

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)

Question 17

How do we reduce E. coli?

Answer 17

> Reduce number of bugs
Reduce number of resistant bugs
Prioritisation of side rooms
Reducing transmission of bugs

Question 18

How we reduce transmission of bugs?

Answer 18

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

Question 19

What are the main contributors to surgical site infections?

Answer 19

Host defence
Wound environment
Pathogens

Question 20

Why are HAI’s increasing?

Answer 20

• We do more invasive procedures
• Prosthetic and implantable devices
• Obesity
• Diabetes
• Extremes of age
• Immunosuppression
• Emerging organisms and resistance

Question 21

How do we manage hospital environments?

Answer 21

• 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

Question 22

How does MRSA bacteraemia affect hospital inpatient stay?

Answer 22

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)

Question 23

Why is Carbapenemase producing bacteria a problem?

Answer 23

Carbapenems are a last resort Abx

High mortality (difficult to treat) and no optimal strategy

We also don’t know the pharmacokinetics and pharmacodynamics

Question 24

What drives antimicrobial resistance?

Answer 24

Antimicrobial use

Question 25

How do we see which HAI are common?

Answer 25

Surveillance and reporting (IPC)

Point prevalence surveys - UK/US

Question 26

What may be global challenges relating to healthcare associated infections?

Answer 26

No clean water
War
Safety absent
No clean diagnostic labs
High reuse of needles

Question 27

How do we treat/ prevent C Diff recurrent infections?

Answer 27

Fidaxomicin (macrocyclic Abx)

Faecal transfer

Question 28

Which Gram negatives are more implicated in hospital for UTI?

Answer 28

E Coli
Klebsiella
Proteus
Pseudomonas

Question 29

What are resistant gram negatives caused by?

Answer 29

Chromosome
Plasmid

E.Coli < Klebsiella < Enterobacter

Question 30

What are gram positive cocci in clusters?

Answer 30

Staphylococcous Aureus

Question 31

How do you identify MSSA with sensitivity disks?

Answer 31

Methicillin sensitive staph aureus- use oxacillin to differentiate from MRSA

Question 32

How do we control infection?

Answer 32

Measure, analyse, feedback, infection control

Question 33

Why is Hand hygiene bad in hospitals?

Answer 33

Lack of awareness or role models or time or sink lacked
Poor technique
Skin damage
Scepticicsm

Question 34

Whats the best prevention?

Answer 34

Hand hygiene

Question 35

Which infections require negative pressure isolation rooms?

Answer 35

TB, chickenpox, RSV