Hospital Acquired Infections

Question 1

Prevalence of hospital acquired infections

Answer 1

Approximately 7%

Question 2

What is the most common system involved in hospital acquired infections

Answer 2

Gastrointestinal system accounts for 22% of all HAIs.

MRSA bacteraemia and C.difficile associated diarrhoea are only 15% of all HAIs.

Question 3

MRSA cause of HAI

Answer 3

Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection

Question 4

C.difficile cause of HAI

Answer 4

Antibiotic associated diarrhoea

Question 5

E.coli cause of HAI

Answer 5

Urinary catheter associated UTI

Ventilator associated pneumonia

Question 6

MSSA cause of HAI

Answer 6

Catheter associated BSI

Surgical site infection

Question 7

Rod gram negatives cause of HAI

Answer 7

Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection
Ventilator associated pneumonia

Question 8

Yeasts/candica cause of HAI

Answer 8

Catheter associated bloodstream infection (BSI)

Question 9

Results of hospital microbiome project

Answer 9

Before hospital occupied - main source was environmental

Once occupied - organisms come from people (patients and staff) and things (fomites) in the hospital

Question 10

What is the importance of surveillance of HAI

Answer 10

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

Question 11

Key strategies of infection control

Answer 11

Reduce infection: preventing transmission
Measuring: surveillance and audit
Analysing: data management
Improving infection control activities: feedback and altering practice

Question 12

C.difficle

Answer 12

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

Question 13

E.coli

Answer 13

Gram negative rod

Commonest gram negative bacteraemia and rising nationally

Question 14

Health and Social Care Act 2008, main features

Answer 14

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.

Question 15

How to reduce the number of icky bugs in hospital s

Answer 15

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: ??

Question 16

How do you reduce the number of resistant bugs in hospitals

Answer 16

Screen patients – segregate those with organism detected from those in whom not detected
- for certain organisms, evidence of organism burden reduction with topical suppression

Question 17

How do you reduce the transmission of bugs in hospitals

Answer 17

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

Question 18

What 3 groups of factors influence surgical site infection risk

Answer 18

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

Question 19

Implications of MRSA bloodstream infection

Answer 19

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)

Question 20

What is CPE

Answer 20

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.

Question 21

What is the best management strategy for CPE bacteraemia or invasive infection

Answer 21

Right drug
Right dose (renal + critical care)
Polypharmacy
Penetration and tissue concentrations
Therapeutic drug monitoring
Duration of therapy

Carbapenem exposure / selective pressure

Question 22

Challenges for outbreak control measures

Answer 22

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

Question 23

Global challenges RE HAI

Answer 23

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

Question 24

What is contributing to the changing nature of HAI

Answer 24

Invasive procedures
Prosthetic and implantable devices
Obesity
Diabetes
Extremes of age
Immunosuppression
Emerging organisms/ resistance

Question 25

Hospital environment and HAIs

Answer 25

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