Hospital Acquired Infections Flashcards
Healthcare associated infection
Infection occurring as a result of healthcare activity,not incubating at the time of initial exposure
Most common HCAI
Bacteraemia UTI Surgical site infection C.difficile colitis Hospital acquired pneumonia
Impact of HCAI
Morality 5k a year
Affect 10% of hospitalised patients (30% avoidable)
Extends visits
Why does HCAI rate increase over time
Treating older people
Invasive procedures
Prosthetic and implantable devices
Harder to treat resistant organisms
CRO have very few possible interventions
Resistant gram negatives are harder to screen than MRSA
What affects ease of transmission
Invasive device
High occupancy
Poor staffing ratio
Poor infection control
Multiple bed moves
Isolation facilities
Environmental hygiene
Sources of pathogens
Endogenous
Exogenous
Example of endogenous
Skin flora
Gut and urogenital flora
Exogenous examples
Acquired from
Hospital environment
Us and other patients
Ares staph.aures and s.epidermis harmful
Benign on the skin but can be harmful if they get into the blood
Resident flora
Protective function
Not easily removed by routine hand washing
Cause infection via skin breaks
Transient skin flora
Loosely attached to skin surface
Easily transferred by direct contact
Easily removed with routine hand hygiene
Most abundant around finger tips
Important source of cross infection
Modes of transmission
Contact
Respiratory
Common source
Vector borne
Vertical
Direct contact transmission
No intermediary
Indirect contact
Infected/colonised source contaminating environment which contaminates next individual
Eg. Skin cells, hair clothing, bedding
Pathogens can form biofilms on surfaces
Lines have risk of
Bacteraemia and disseminated infection
Scale of line infections
Large
Listaph infections often usually come from
Lines
Line infection prevention
As to ask at insertion
Is line needed
- wash ur hands
- clean site
ANTT
Difference between alcohol gel and soap and water
Alcohol gel kills bacteria twice as fast
Alcohol doesn’t kill
Spore forming bacteria (c.diff)
Most effective method of reducing HCAI and transmission of resistant organisms
Hand hygiene
5 moments hand washing
Before patient contact
Before aseptic task
After body flui d exposure risk
After patient contact
After contact with patient surroundings
How do bugs get in.
Catheters (mostly)
Inhalation of droplets or aerosols
Loss of cuteous integrity can cause bugs to get in how?
Illnesss process: dermatological conditions
Nosocomial: surgical wounds
Central lines
Drains
Important things about dipstick test
Don’t assume UTI just because of old, confusion and positive dipstick test
Hospital acquired pneumonia
48-72 hour cut off excluding bugs incubating at admission
Hospital + antibiotics = gram negative nasopharyngeal colonisation
Confirm radiologically and microbiologically
Environmental transmission
Food: salmonella
Water: cryptosporidium, legionella
Air: cryptococcus
C.difficle is what type of transmission
Environmental
C.difficile can be
Isolated from rooms of ex patients up to 40 days post discharge
Risks of c..difficile acquisitions
Antibiotic exposure
Chemotherapy agents with antibiotic activity Co morbidity Major abdominal surgery Poor host igG response Burns o Older age
Antimicrobial and chemotherapeutic agents for c.diff diarrhoea or colitis
4 Cs
Cephalosporins
Co-amoxiclav
Clindamycin
Ciprofloxacin
Reduce risk of c.difficile
Prudent antibiotic prescribing
Frequent clinical review
Hand hygiene
Environmental cleaning
Isolation
Personal protective equipment
Reps transmission droplet:
20 micrometer
Measles
Influenza
Norovirus
Aerosol
Suspended in air currents indefinitely
<5 micrometer so can penetrate alveoli
Chicken pox ,tb, norovirus
Generate a aerosol from vomiting, toilet flush or a macro meter
