Hospital Acquired Infections Flashcards
Prevalence of hospital acquired infections
Approximately 7%
What is the most common system involved in hospital acquired infections
Gastrointestinal system accounts for 22% of all HAIs.
MRSA bacteraemia and C.difficile associated diarrhoea are only 15% of all HAIs.
MRSA cause of HAI
Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection
C.difficile cause of HAI
Antibiotic associated diarrhoea
E.coli cause of HAI
Urinary catheter associated UTI
Ventilator associated pneumonia
MSSA cause of HAI
Catheter associated BSI
Surgical site infection
Rod gram negatives cause of HAI
Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection
Ventilator associated pneumonia
Yeasts/candica cause of HAI
Catheter associated bloodstream infection (BSI)
Results of hospital microbiome project
Before hospital occupied - main source was environmental
Once occupied - organisms come from people (patients and staff) and things (fomites) in the hospital
What is the importance of surveillance of HAI
Baseline rate
Detect clustering in time and place
Make a case for resources to tackle a problem
Generate hypotheses re risk factors
Identify source of cases with which to test hypotheses re risk factors
Assess impact of prevention and control measures
Guide treatment or prevention strategies
Reinforce practices and procedures
Reduce incidence of HAI
Satisfy patient care standards / guidelines / regulatory requirements
Defend legal action
Conduct research
Compare healthcare systems
Key strategies of infection control
Reduce infection: preventing transmission
Measuring: surveillance and audit
Analysing: data management
Improving infection control activities: feedback and altering practice
C.difficle
Gram positive spore forming anaerobe
Spores transmissible, contaminate environment, persist for long periods
Ingested spores germinate in gut
Gut flora disturbed by abx exposure, to different extents
E.coli
Gram negative rod
Commonest gram negative bacteraemia and rising nationally
Health and Social Care Act 2008, main features
Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them
Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.
Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.
Have and adhere to policies, designed for the individual’s care and provider organisations, that will help to prevent and control infections.
Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.
How to reduce the number of icky bugs in hospital s
On equipment: sterilisation of equipment prior to operation
On environment: cleaning = dilution / reduction but not eradication
On patient: washing, skin preparation pre-op, prophylaxis for contaminated procedures
On staff hands: hand cleaning after contact any surface
On staff skin: ??
How do you reduce the number of resistant bugs in hospitals
Screen patients – segregate those with organism detected from those in whom not detected
- for certain organisms, evidence of organism burden reduction with topical suppression
How do you reduce the transmission of bugs in hospitals
Staff - understand and use hand cleaning
Staff - cleaning environment and equipment
Staff - reduce use of broadest spectrum antibiotics and of unnecessary antibiotics
Systems - better design of surfaces with preventing adherence and transmission in mind
What 3 groups of factors influence surgical site infection risk
Staff, ward category, day of the week
Host defence, host gender, surgeon gender
Host defence, wound environment, pathogens
Virulence of pathogens, antibiotics used, type of suture
Experience of surgeon closing wound, mask use by theatre staff, music played in theatre
Implications of MRSA bloodstream infection
Morbidity Prolonged admission (x 2.5 times longer) Occupancy of beds – affects capacity Repeat surgery Prolonged antibiotics Use of isolation rooms – MRSA, C. difficile Medical complications Death (7.1 times more likely to die)
What is CPE
Carbapenemase-producing enterobacteriacea: triple threat!!! Resistant, deadly and spreads rapidly
CPE have emerged as a serious problem in some parts of the world (notably Greece, Italy and Israel) and have begun to cause outbreaks in the UK. Furthermore, there is one region of the UK (Manchester) where CPE are already endemic. A number of London hospitals have reported small outbreaks.
What is the best management strategy for CPE bacteraemia or invasive infection
Right drug Right dose (renal + critical care) Polypharmacy Penetration and tissue concentrations Therapeutic drug monitoring Duration of therapy
Carbapenem exposure / selective pressure
Challenges for outbreak control measures
Improved screening and isolation, impact of delays to typing results
Laboratory and epidemiological investigations
Internal and external communications. Coordinating briefing and discussions with external stakeholders.
Input from other Trusts addressing CRE
Hand hygiene and equipment focus, ward based adherence monitors
Environmental cleaning and disinfection, attention to pillows and mattresses, HPV usage
External reviews and visits of clinical areas
Antimicrobial usage and stewardship
Expediting discharges
Global challenges RE HAI
No formal infection control policies / programmes
More pressing priorities: political unrest, poverty, natural disaster, war
Clean water, adequate sanitation, consistent electricity supply, clean equipment, facilities for sterilising kit for procedures
Healthcare delivery by family members, rather than trained healthcare workers
Prevention of transmission of infection esp enteric infections often impossible - effective hand hygiene is not achievable
Lack of basic diagnostic labs
No HAI data collection systems, no routine surveillance, and no targets for reduction of HAI rates
Transfusion and injection safety are absent
In 2000, 70 countries did not screen donated blood for HIV, hepatitis B or C
Risk of bacterial infection from transfusion (greater than the risk of BBV)
Reuse of needles or syringes: estd 21 million hep B cases, 2 million hep C cases, >95,000 HIV infections
Needlestick injury of HCW and exposure of patients to infected staff
What is contributing to the changing nature of HAI
Invasive procedures Prosthetic and implantable devices Obesity Diabetes Extremes of age Immunosuppression Emerging organisms/ resistance
Hospital environment and HAIs
Environmental hygiene and cleaning eg C. difficile, Norovirus, Acinetobacter outbreaks
- chlorine agents; use of vapourised Hydrogen peroxide
Control of environmental sources
Water: Legionella- cooling towers; Pseudomonas – all water; unusual Mycobacteria – all water
Building works – Aspergillus
Negative pressure isolation – protection of others from an infectious patient with airborne infection
Positive pressure isolation – protection of transplant patients from organisms from outside the room
