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Yr5 Infections > Hospital Infections > Flashcards

Hospital Infections Flashcards

1
Q

What type of infections are most common in post-op patients?

A

Respiratory
UTIs
Bacteraemias (cannula associated, MRSA)
Abx related diarrhoea

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2
Q

How are most surgical site infections caused?

A

Contamination of incision w/pt own microorganisms during surgery

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3
Q

How can surgical infections be minimised pre-op?

A
  • Hair removal: Use electric clippers NOT razors (↑ risk)
  • Prophylactic antibiotics
  • Remove all jewellery
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4
Q

How can surgical infections be minimised intra-op?

A
  • Prep the site of incision immediately before op using antiseptic (Chlorhexidine/ Povidone‑iodine)
  • Cover w/appropriate dressing when done
  • use iodophor-impregnated drape
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5
Q

How can surgical infections be minimised post-op?

A
  • Refer to tissue viability nurse for wounds healing by 2° intention
  • Antibiotic Tx post-op for dirty/infected surgery
  • Use sterile saline for wound cleaning <48 hours post-op
  • > 48hours can use tap water for cleaning
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6
Q

When can patients shower post-op?

A

> 48hours

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7
Q

What is post-op fever?

A

Temp >38°C on 2 consecutive days post-op
OR
Temp >39°C on any 1 post-op day

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8
Q

What are the causes of Post-op fever at 0-48hours?

A
  • Pyretic response to surgery- MOST COMMON
  • TSS from Staph Aureus/group A beta-haemolytic Strep infection
  • Drug induced: Heparin, Allopurnol, Ig, Salicylates, PhenyT, Furosemide, Thiazdies, Abx
  • Malignant hyperthermia
  • Transfusion reactions
  • Traumatic surgery
  • Transplant rejection
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9
Q

How is post-op fever treated?

A

Conservative: Self-limiting, resolves in 2-4days
Antipyrexial: Paracetamol
Tx underlying cause

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10
Q

What are the causes of Post-op fever at >48hours-7days?

A

90% infectious cause
-Infection from surgery: Wound cellulitis
-Infection from invasive access: UTI, Pneumonia, Cannula-related thrombophlebitis, catheter related infections
-Infection from blood products: RARE, Yersinia, Pseudomonas, Staph, Salmonella , enterococci, Clostridium
CONSIDER: OH- withdrawal

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11
Q

What infectious cause is likely to cause pyrexia post-op in the first 1-3days?

A

Group A Strep

Clostridium

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12
Q

When are fat emboli post-op most likely to present?

A

48-72hours

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13
Q

What are the causes of Post-op fever at >7-28days?

A

INFECTION:

  • UTI
  • Pneumonia
  • C.Diff
  • Wound cellulitis
  • Foreign-body reaction
  • OSTEOMYELITIS (complication of orthopaedic surgery seen 2w post-op)
  • DVT/PE
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14
Q

What are the causes of Post-op fever at 4weeks?

A
  • Osteomyelitis (implant infection)

- Infective endocarditis

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15
Q

What are the signs of malignant hyperthermia? How is it treated?

A 
Tachycardia
Metabolic acidosis
↑↑temperature
Muscle rigidity
Tx = Dantrolene
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16
Q

How does TSS present?

A 
Fever
Hypotension
Skin Sx: Diffuse macular erythroderma
Shock
Multi-organ failure
17
Q

How is Post-op fever investigated?

A

Fever <48hours DOES NOT need investigating
?TSS = Blood Cultures
>48hrs:
Bloods: FBC, Urine MC&S, CXR, blood & wound cultures

18
Q

What antibiotics is MRSA resistant to?

A

Beta-lactams (penicillins)

Cephalosporins

19
Q

In what type of infections if MRSA commonly found?

A 
Bacteraemias
Pneumonia
Endocarditis
Joint infection
Skin/soft tissue infection- MOST COMMON
20
Q

What are the signs that an infection may be due to MRSA?

A

Not responsive to penicillins
Abscess formation
Fever
Fatigue

21
Q

What are the risk factors for MRSA infection?

A 
Nasal colonisation
>50yo
IVDU
Indwelling device
Current wound
Prev MRSA
Exposure to MRSA +ve pt
HIV infection
22
Q

How is an infection caused by MRSA investigated?

A

Bloods: FBC
Blood, urine, tissue, sputum cultures
PCR

23
Q

How is ongoing MRSA managed?

A

Topical Chlorhexidine 2-4% used as wash in single application
Topical Mupirocin 2% applied to nares BD for 5-7days

24
Q

How is an acute infection by MRSA managed?

A

Debridement of wound
Oral/IV antibiotics: Tetracycline + Clindamycin
or Vancomycin + glycopeptides

25
Q

What investigations are done for MRSA pre-op?

A

Nasal & skin swabs

26
Q

What type of bacteria is C.Diff?

A

Anaerobic

Gram +ve rod

27
Q

How does C.Diff cause diarrhoea?

A

Contagious spores secrete toxins A and B (most potent)
Cytotoxic to mucosal cells of intestinal tract
Disrupts barrier function of colonic mucosa
Can lead to pseudomembranous colitis

28
Q

What are the risk factors for C.Diff

A 
Abx: Cephalosporins, Macrolides, Quinolones (5-10d post-Tx)
↑Hospital stay
PPI
Elderly
Co-morbidities
NG tube
ITU
ImmunoC
29
Q

How does C.Diff present?

A

Watery diarrhoea
Can be blood stained
Colicky abdo cramps
Fever w/rigors

30
Q

How is C.Diff investigated?

A

Stool Sample x3: Stool Cytotoxin Test, Cultures, enzyme linked immunoassay/PCR
Bloods: FBC (↑↑WCC), ↑↑CRP, U&E, LFTs (↓Albumin)
Sigmoid/colonoscopy: Biopsy, visualise colitis/pseudomembranous

31
Q

What is the main problem with stool cultures in C.Diff?

A

Does not differentiate between toxin producing & non-toxin producing

32
Q

How is C.Diff treated?

A 
STOP causative Abx
ISOLATE (>48hrs after diarrhoea stopped)
PO/IV Fluids
Abx: Metronidazole 400mg TDS for 10-14d or Vancomycin 125mg QDS
Faecal transplant
Colectomy = toxic megacolon
33
Q

How is C.Diff managed prophylactically?

A

Wash hands w/soap
Patient isolation & use gown & gloves
Regular room cleaning

34
Q

What is SIRS?

A

Severe inflammatory response syndrome

35
Q

What criteria needs to be met for a diagnosis of SIRS?

A 
>2:
Fever < 36oC or > 38oC
HR >90
RR >20
Glucose >7.7 with no DM
WCC <4 or >12
36
Q

Define severe sepsis?

A

Sepsis w/end organ dysfunction or hypo perfusion:
sBP <90 OR >40mmHg drop
Lactic acidosis
↓Urine output

Yr5 Infections (4 decks)

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