Hospital-Acquired Infections

Question 1

Examples of HAI organisms and clinical syndromes

Answer 1

Question 2

Definition of HAI

Answer 2

• Onset within certain period from contact, not present on admission, possible acquired in hospital

Question 3

Most common HAI syndromes

Answer 3

HAP → SSI → UTI → BSI → GII (25, 19, 17, 14,8)

Question 4

Impacts of HAI

Answer 4

• high cost (£1bn/year), increase length of stay
  
  • 3.5-10.5% of all hospitalised patients in industrialised countries get HAIs
  • 8% of all UK infections are HAI
  • 4m/year HAIs in Europe → 37,000 die as a result

Question 5

Role of surveillance

Answer 5

• … baseline rate, detect clustering, resource allocation, assess impact
  
  • E.G. C difficile spore surveillance – gram positive spore-forming anaerobe
  • E.G. E. coli bacteraemia surveillance – incidence increasing due to ABx resistance, methods to reduce increase:
    
    • Reduce number of bugs (i.e. sterilise, washing, etc.)
    • Reduce number of resistance bugs (i.e. screen patients)
    • Prioritise side rooms (i.e. for fever + rash in ED; for homeless man with cough and abnormal CXR)
    • Medical education (i.e. hand cleaning technique)

Question 6

3 groups of doctors for the influence of an SSI

Answer 6

host defence

wound environment

pathogens

Question 7

MRSA BSI → implications

Answer 7

• Morbidity Prolonged infection
• Affects bed capacity Repeat surgery
• Prolonged antibiotics Use of isolation rooms
• Complications

Question 8

Infection control strategies

Answer 8

Reduced infection →measuring → analysing → improving infection control activities

Question 9

Carbapenemase-producing Enterobacteriaceae (CPE)

Answer 9

• Triple threat = Resistance, Rapid spread, Mortality
• Management = right drug, PKPD (right dose, polypharmacy, penetration/tissue conc., therapeutic drug monitoring), duration of therapy
• The landscape for HCAIs is changing… invasive procedures, prosthetics, obesity, diabetes, extremes of age, etc.

Question 10

Influences on HAI

Answer 10

• Ward layout/design (i.e. 1 basin per 6 beds)
• Cleaning responsibility
• Staffing ratio
• Clarity of roles
• Organisational structures