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ESA 3 > Infection 4 > Flashcards

Infection 4 Flashcards

1
Q

What are healthcare infections?

A

Infections arising as a concequence of providing healthcare that are:

  • Not present nor incubation at admission (onset 48hrs after admission)
  • Found in patient, visitors and healthcare workers
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2
Q

Give some common examples of infections due to medical practice

A

Surgical site infection

Central line associated bloodstream infection

Ventilator associated pnuemonia

Catheter associated UTI

Clostridium difficile Infection

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3
Q

Give some examples of common viruses that cause HAI

A

Hep B, C

HIV

Norovirus

Influenza

Chickenpox

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4
Q

Give some examples of common bacteria that cause HAI

A

Staph aureus

C. difficile

E. coli

Klebsiella pnuemoniae

Pseudomonas aeruginosa

Mycobacterium tuberculosis

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5
Q

Give some common examples of fungi causing HAI

A

Candida albicans

Aspergillus spp.

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6
Q

Give an examples of a common parasite that can cause HAI

A

Malaria

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7
Q

What patient factors predispose to HAI?

A

Extremes of age (young/old)

Obesity/malnourishment

Cancer

Immunosuppression

Smoker

Surgical patient

Emergency admission

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8
Q

What are the 4 Ps of infection control?

A

Patient

Pathogen

Practice

Place

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9
Q

What are the patient factors contributing to infection control?

A

General and specific patient risk factors

Interactions with:

  • Other patients
  • Healthcare workers
  • Visitors
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10
Q

what are the pathogen factors relevant to infection control?

A

Virulence factors

Ecological interactions:

  • Other microbes
  • Antibiotics/disinfectants
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11
Q

What are the healthcare environment factors relevant to infection control?

A

Activities of HCWs directly related to treatment

Policies and their implementation

Organisational structures

Regional and national political initiatives

Leadership from ward to government

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12
Q

What are the general interventions aimed at reducing patient’s risk of acquiring a healthcare infection

A

Optimise condition (Smoking, nutrition, diabetes)

Antimicrobial prophylaxis

Prevention of commensal spread:

  • Skin preparation
  • Hand hygiene
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13
Q

What are the more specific/targetted interventions aimed at reducing patient risk of HAI?

A

MRSA screening

Mupirocin nasla ointment (Prevent aerosol spread of infection)

Disinfectant body wash

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14
Q

Give some examples of how we might halt patient to patient spread of infection?

A

Isolation of infected/susceptible patients:

  • Separate rooms
  • Positive pressure in rooms
  • Air filtration
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15
Q

How do we prevent spread of HAI from healthcare workers?

A

Disease free and vaccinated staff

Good practice:

  • Sterile non-touch techniques

Hand hygiene

Personal protection equipment (Face masks, aprons, gloves)

Antimicrobial prescribing to HCPs

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16
Q

What are the environmental interventions to prevent patient infection from water and food?

A

Appropriate kitchen and ward food facilities

Food food hygiene (sterile food)

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17
Q

What are the environmental interventions that can prevent infection of patients from surfaces?

A

Cleanliness of built environment:

  • Toilets
  • Wash hand basins
  • Furniture

Cleaning:

  • Disinfectant
  • Steam cleaning
  • H2O2 vapour

Medical devices:

  • Single use equipment
  • Sterilisation
  • Decontamination
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18
Q

How can ward layout affect HAI?

A

Overcrowding of bed put patients in closer proximity, aiding spread of infection

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19
Q

How is diagnoses of necrotising fasciitis made?

A

Suspicision of deep seated infection in an acutely unwell patient supported by relevant labs (WBC, CRP etc)

Surgical exploration to confirm

20
Q

What are the common features of someone with a necrotising fasciitis infection?

A

Extreme pain in infected area

High temp, pulse

Hypotensive

Raised WBCs

21
Q

How might we manage a patient with necrotising fasciitis?

A

Supportive care (Fluid resus)

Analgesia

Antibiotics

Surgical/ITU referral

22
Q

Describe the surgical management of necroising fascitis?

A

Initial fasciotomy

Assesment of deep tissue (may require debridement)

May require amputation

Skin grafting if patient survives

23
Q

What factors influence our choice of antibiotic when treating an infection?

A

Severity

Site

Likely pathogens

Route of administration

Adverse affects:

    • Allergy/reaction*
    • Interactions with other drugs*
    • Renal/hepatic impairment*
24
Q

What are the likely pathogens of necrotising fasciitis infection?

A

Group A Beta-haemolytic streptococci (E.g. Strep. pyogenes

25
Q

What is the gram stain appearance of Streptococci?

A

G+

26
Q

Describe the different types of streptococcal haemolysis

Give examples of species of each type

A

Alpha:

Oxidise iron turning dark green in culture

S. Pneumoniae

Beta:

Completely rupture blood cells

S. Pyogenes

Gamma:

Non-haemolytic

27
Q

Give an example of a non-haemolytic cocci

A

Enterococcus Faecalis

28
Q

Describe the pathogenesis of streptococci

Hint: Give toxin/structure and its effect

A

M proteins:

Component of cell wall

Antiphagocytic

Exotoxins:

Pyrogenic exotoxins (Superantigens) - Cause rash

Streptolysin O and S (Cell lysis)

Streptokinase:

Lysis of clots

Streptodornase:

DNAase promoting spread of infection

C5a peptidase:

Inactivation of complement

29
Q

What antibiotics are used to treat Streptococcal infection?

A

B-lactams and glycopeptides

Some macrolides and tetracyclines

30
Q

How might we directly target toxin mediate disease as a result of infection?

A

Anti-toxin therapy:

High dose human Ig

Interfere with toxin synthesis:

Antibiotics that target protein synthesis (E.g. Clindamycin, Rifampicin)

31
Q

Give the specifics of necrotising fasciitis antibiotic treatment

A

Empiric:

Tazocin + Clindamycin

If group A Beta-haemolytic Streptococci (GAS) identified:

Tazocin + Benzylpenicillin

Consider adding high dose Ig

32
Q

Give some other diseases caused by Group A Beta-haemolytic streptococci (GAS)

A

Acute pharyngitis/tonsilitis (With rash = scarlet fever)

Impetigo

Puerperal sepsis

33
Q

Give 2 post-streptococcal infection sequelae

How does each come about?

A

Acute rheumatic fever (2-3 wks post):

Cross reaction between heart/joint tissues and strep antigens (esp M protein)

Acute glomerulonephritis (1 wk post):

Antigen-antibody complexes on basement membrane of glomerulus post infection

34
Q

Give examples of conditions caused by Alpha-haemolytic streptococci (Viridans)

A

Infective endocarditis

Pneumonia, Meningitis (S. Pneumoniae)

35
Q

Give possible infections caused by Gamma-haemolytic ‘streptococci’

A

Enterococcus Faecalis - Abdo sepsis, UTI

36
Q

What are the clinical signs of scarlet fever?

A

Erythematous blanching rash

Circumoral pallor

Strawberry tongue

Tonsilitis/Pharyngitis (sore throat, fever)

37
Q

Give some exampes of common staphylococcal infections

A

Impetigo

Furuncles (boils - E.g. facial ‘spots’)

Surgical wound infections

38
Q

What is impetigo?

Give two common causative organisms

A

Skin infection

Symptoms:

Red rash

Develops into sores that leak pus/fluid

Can cause fluid flilled blisters (Mostly in under 2s)

Organisms:

Staph. aureus

Strep. pyogenes

39
Q

What is the appearance of staphylococci after gram staining?

A

G+

40
Q

What is the coagulase test and what organisms does it differentiate?

A

Differentiation:

Tests staphylococci spp for presence of coagulase enzyme (Converts fibrinogen to fibrin)

Staph aureus is coagulase positive

Most others are coagulase negative

Testing:

Done on a slide or in a tube

Involves inoculation of plasma with staphylococcus organisms

41
Q

What are the common antibitoics used against staphylococcus spp.?

Hint: Remember resistance

A

Flucloxacillin:

Resistant to staphylococcus B-lactamase

Some cephalosporins

Some B-lactamase/B-lactamase inhibitor combos:

Co-amoxiclav, Tazocin

Glycopeptides:

Vancomycin

Often in MRSA infection

42
Q

Describe the pathogensis of C. diff

A

Enterotoxin (C. diff toxin A):

Increases Cl- channel permeability in the mucosal cells of gut lumen (intestines)

Secretory diarrhoea results

Cytotoxin (C. diff toxin B):

Causes actin depolymerisation

Overall:

Infection leads to Dairrhoea and Intestinal inflammation

43
Q

How is the severity of C diff infection assessed?

A

Severe infection (Any of below):

  • Sepsis or temp = >38.3C
  • Albumin < 25g/l, WBC > 15 x 109/L, elevated creatinine (>50% above baseline)
  • Signs of severe colitis or pseudomembranous colitis
44
Q

What antibiotics are reccomended for treatment of C. diff?

A

Non-severe = Metronidazole

Severe = Vancomycin + Metronidazole (if vancomycin underwhelming in effect)

45
Q

What are the concequences of norovirus infection?

A

Viral gastroenteritis:

Vomitting

Diarrhoea

Dehydration

46
Q

How should a patient with norovirus be treated on the ward?

A

Isolated

PPE used by healthcare workers

Sterile/non-touch technique for all procedures where possible

Disinfection of area (Chlorine based)

ESA 3 (54 decks)

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