IC9 Nosocomial Infections

Question 1

Nosocomial Infections:

How might one get infected?

Answer 1

Contamination of device:
1. Vascular device-associated bacteremia - colonizaiton of the insertion or access hub
2. Ventilator associated pneumoni bacteremia

Contamination of surgical site:
3. Surgical site infection (*antibiotics given for prophylaxis)

4. MRSA risk - screen for MRSA colonization

Question 2

Nosocomial infections:

Other than sterilization of instruments/devices, what is another method to prevent nosocomial infections?

Answer 2

Coat equipment with antibiotic or disinfectant

e.g., catheter coated with silver sulfadiazine
e.g., chlorhexidine coated central catheter

Question 3

Nosocomial infections:

How to prevent nosocomial infections?

Answer 3

Limit transmission:
1. Adequate cleaning + PPE + training
2. Prophylactic antibiotics
3. Isolation (if possible)

Control environment risks for infection

Limit risk of endogenous infections:
- minimize invasive procedures
- promote optimal antibiotics use

Surveillance, identify and control outbreaks

Prevent infection in staff

Question 4

Nosocomial infections:

Explain risk assessment involved in prevention of nosocomial infections

Answer 4

Categorize patients into risk of acquisition of infection (minimal, medium, high) based on type of patient + type of procedure they are undergoing

Plan infection control interventions according to risk
(include requirements for asepsis, antiseptics, hand clothes, devices)

Question 5

What sterilants can be used for patient at low/medium level risk of infection?

Answer 5

Alcohol
Sodium hypochlorite
Phenols
Iodophor

Question 6

What sterilants can be used for patient at high level risk of infection?

What are they used for?

Answer 6

Glutaraldehyde
Ortho-phthalaldehyde
Hydrogen peroxide gas at 7.5% (corrosive)
Hydrogen peroxide
Peracetic acid

Used for surgical asepsis or high risk of infection (severely immunocompromismed)

Question 7

Explain what patients/procedures are classified as minimal risk of infection

Answer 7

Pt: Not immunocompromised, no significant underlying disease

Procedure: non-invasive, no exposure to biological fluids

Question 8

Describe the infection control interventions for Minimal risk of infection:

Answer 8

Asepsis: clean
Antiseptics: none
Hands: simple handwashing or hand disinfection by rubbing
Clothes: street clothes
Devices: Clean or disinfected at intermediate or low level

Question 9

Explain what patients/procedures are classified as medium risk of infection

Answer 9

Pt: infected, or w some risk factors

Procedure: exposure to biological fluids OR invasive non-surgical procedure (e.g., peripheral venous catheter, introduction of urinary catheter)

Question 10

Describe the infection control interventions for Medium risk of infection:

Answer 10

Asepsis: asepsis
Antiseptics: standard antiseptic products
Hands: hygienic handwashing or hand disinfection by rubbing
Clothes: protection against blood and biological fluids
Devices: disinfected at sterile or high level

Question 11

Explain what patients/procedures are classified as high risk of infection

Answer 11

Pt: severely immunocompromised (<500 WBC per ml), multiple trauma, severe burns, organ transplant

Procedure: surgery OR high risk invasive procedure (e.g., central venous catheter, endotracheal intubation)

Question 12

Describe the infection control interventions for High risk of infection:

Answer 12

Asepsis: surgical asepsis
Antiseptics: specific major products
Hands: surgical handwashing or surgical hand disinfection by rubbing
Clothes: surgical clothes
Devices: disinfected at sterile or high level

Question 13

What information on disinfectant/sterilization agents must pharmacists be able to provide? :((

Answer 13

1. Active properties in relation to conc, temp, length of action, antibiotic spectrum
2. Toxic properties including sensitization or irritation to skin and mucosa
3. Incompatibilities
4. Physical conditions that unfavourably affect potency during storage: temp, light, humidity
5. Harmful effects on materials

Question 14

Describe the 3 categories of disinfection and sterilization based on degree of risk of infection

Answer 14

1. Critical (enters sterile tissue) - must be sterile, sterilization
2. Semicritical (contacts mucous membrane or nonintact skin) - require high level disinfectant
3. Non-critical (contact with intact skin) - low level disinfectant