Hospital-acquired Viral Infections

Question 1

What are blood-borne viruses capable of doing? (2)

Answer 1

Persistent viremia or carrier state

Question 2

Example of blood-borne viruses (3)

Answer 2

Hepatitis B

HIV

Hepatitis C

Question 3

How to control the spread of HBV? (2)

Answer 3

HBV immunization and monitor health status if HCW

Non-responders to vaccine offered Hepatitis-B specific immunoglobulin following exposure to positive patient

Question 4

How to control spread of HIV? (1)

Answer 4

Antiretroviral drug —> POST EXPOSURE PROPHYLAXIS (continue for 4 weeks)

Question 5

How can viral hemorrhagic fevers spread? (4)

Answer 5

Spread from person to person through direct contact with:
1- Symptomatic patients
2- Body fluids
3- Cadavers
4- Inadequate infection control in hospital

Question 6

Why do respiratory acquired viruses result in significant nosocomial problems? (2)

Answer 6

1- Ease of spread

2- Short incubation period (1-8 days)

Question 7

Respiratory Syncytial Virus (RSV) (2)

Answer 7

1- Survives >5 hours on surfaces

2- Paediatric wards —> common problem (40% infected in winter)

Question 8

Influenza Viruses (2)

Answer 8

1- Key —> Immunize HCW

2- Severely affects Elderly and Immunocompromised

Question 9

Rhinoviruses (3)

Answer 9

1- Average child —> 4-8 episodes per year
2- Outbreaks at paediatric ward —> Considerable illness and death
3- Premature neonates and children with chronic diseases or Immunocompromised —> Serious

Question 10

Parainfluenza Viruses (4)

Answer 10

1- Type 1 and 2 —> Upper respiratory tract
2- Type 3 —> Nosocomial infections and bronchiolitis/pneumonia
3- Non-absorptive surface (e.g. stainless steel) —>10hrs
4- Absorptive surface (e.g. lab coats and gowns) —> 4hrs

Question 11

Adenovirus (2)

Answer 11

1- Following reaction —> can be acquired both exogenously and endogenously
2- Seen throughout year

Question 12

Coronaviruses (2)

Answer 12

1- Upper Respiratory Tract
1- Alpha coronaviruses
2- Beta coronaviruses
- cause 5-10% of overall common cold / URT cases
- cause 30% of overall common cold outbreaks

2- Lower Respiratory Tract 
     1- MERS
     2- SARS
         - SARS-CoV-1
          -SARS-CoV-2

Question 13

Who’s most at risk for SARS-CoV-1?

Answer 13

Healthcare workers

Question 14

SARS-CoV-2 (2)

Answer 14

1- Covid-19

2- Key —> Immunize Healthcare workers

Question 15

What is unexpected about Measles, Mumps, and Rubella?

Answer 15

As incidence of these infections fall, the risk of nosocomial infections increases, due to failure to recognize these infections in early stages

Question 16

Measles Virus (2)

Answer 16

Highly contagious (90% of susceptible close contacts will be infected)
Immunocompromised —> Severe measles (mortality = 70%)

Question 17

Mumps Virus (4)

Answer 17

Common childhood disease
Characterized by swelling of parotid glands, salivary glands, and other epithelial tissues
High morbidity and in some cases severe complications —> Deafness
Significant outbreaks in recent years

Question 18

Rubella Virus (3)

Answer 18

Often mild (Half people don’t realize they are sick)
Complicated by —> Encephalitis and Thrombocytopenia
Infection during early pregnancy—> Congenital rubella syndrome or miscarriage

Question 19

Parvovirus B19 (2)

Answer 19

Most susceptible —> Immunocompromised, SS disease, Anemia, and pregnant women
Decrease dose of immunosuppressive agents —> Sufficient IgG —> Lifelong protection

Question 20

Herpes Simplex Virus (4)

Answer 20

Most efficient transmission —> Direct contact with lesions or Saliva
Contamination of hands
Neonatal Herpes —> Mother to baby —> During delivery
Reduce risk of infant —> Caesarean section

Question 21

Cytomegalovirus (5)

Answer 21

Direct contact with body fluids —> Vaginal secretions, semen, saliva, whole blood
Primary infection —> Asymptomatic but some —> Glandular fever-like illness
Hospital setting —> Children transmission
Common —> Asymptomatic reactivations
Immunocompromised—> Primary infection and reactivation of LATENT virus

Question 22

EBV, HHV6, HHV7, HHV8

Answer 22

EBV, HHV6, HHV7 —> Oropharynx shedding

Question 23

Varicella Zoster Virus (4)

Answer 23

Droplet spread from respiratory secretions (chickenpox)
Contact with infected lesions (chickenpox and shingles)
Highly infectious
Patients with chickenpox infectious via respiratory route for 2 days before rash appears until it crusts over (usually 5 days)

Question 24

Control Measures for Herpesviruses (5)

Answer 24

Nosocomial unusual —> Except for VZV
Chickenpox (and shingles) —> Negative pressure rooms
VZVIF —> High risk
Acyclovir —> Prophylactically and/or therapeutically
VZV live-attenuated vaccine —> Prophylactically for patients at risk

Question 25

Rotavirus (4)

Answer 25

Important cause of Nosocomial infection —> In infants and children >5 years, elderly, and Immunocompromised In outbreaks —> shed in stool 50% of all cases of nosocomial acquired infectious gastroenteritis in pediatric patients Two new vaccines —> Rotarix and RotaTeq

Question 26

Small Round-Structured Viruses (3)

Answer 26

Norwalk virus, Calcivirus, and Astrovirus Outbreaks of gastroenteritis —> in schools, families, cruise ships, and hospitals (involve any age group) Widespread transmission —> ward or clinical setting

Question 27

Enteroviruses (5)

Answer 27

Coxsackieviruses, Echoviruses, Polioviruses, and Enteroviruses 68 to 71 Shedding continues for 1 month after infection Common in general population Problematic —> Neonatal units and nurseries During delivery —> transmission from infected mother to newborn —>index case of an outbreak —> Meningitis, Encephalitis, Myocarditis

Question 28

Hepatitis A Virus (5)

Answer 28

Nosocomial transmission —> Poor hygienic conditions and crowded wards Transmission in hospital wards —> Unusual Transmission —> contact with Asymptomatic or symptomatic patient with vomiting/diarrhea Food-borne outbreaks in hospitals Administer normal immunoglobulins and apply immunization to prevent HAV in susceptible