Infection Control

Question 1

What is infection?

Answer 1

Deposition and multiplication of bacteria and other micro-organisms in tissue or on surfaces of the body with an associated tissue reaction

Question 2

How can C diff infection develop and spread?

Answer 2

Patient on antibiotics leads to diruption of gut flora which then leads to c dif bacteria proliferating and leading to symptomatic infection i.e. gut becomes the reservoir for infection

Diarrhoea contaminated with c diff leads to spread within hospitals via faecal-oral spread

Question 3

what are the types of healthcare associated infections?

Answer 3

Pneumonia

Urinary infection

Surgical site infection

Gastroenteritis

Bloodstream infections

Question 4

What is MRSA? What are the consequences?

Answer 4

Meticilin resistant Staphylococccus aureus
Ie.. resistant to flucloxacilin

Can cause a range of infections (deep seeded infections) but often colonises without causing infection

• skin infections
• chest infection
• endocarditis
• bone infection
• bacteraemia
• death

Question 5

How can MRSA be detected?

Answer 5

Screening programmes via nasal/groin swabs and wound/urine/line sites and sputum tests

Question 6

Why is surgical prophylaxis important in patients with MRSA?

Answer 6

Used to prevent surgical site infection complications associated with MRSA

Vancomycin is used as prophylaxis when patient has staphylococcus aureus colonisation

Question 7

What is C dif?

Answer 7

Anaerobic gram positive bacilli which lives in gut and produces spores and toxins= toxins result in diarrhoea

Question 8

What are the consequences of c dif infection?

Answer 8

Watery diarrhoea

Abdominal pain

Pseudomembranous colitis

Dehydration

Bowel perforation

Death

Recurrence of c dif infections

Question 9

Why does c dif infection occur?

Answer 9

Colonisation of gut due to cross-infection after antimicrobials taken for an infection

Leads to over-growth of bacteria in the gut leading to toxins causing bowel damage

Question 10

What should be done if patient identified with c dif infection?

Answer 10

Stop antibiotics

Start treatment

Monitor fluids

Specialists review

Terminal clean

Place patient in side room

Question 11

Which drugs can be used to treat C dif?

Answer 11

Metronidazole

Oral vancomycin

Fidaxomicin

FMT i.e. donor faecal treatment

Question 12

What are enterobacteriaceae?

Answer 12

Family of bacteria which live in bowels of healthy individuals

E.coli 
Klebsiellla 
Enterobacter 
Proteus 
Salmonella

Question 13

What are the consequences of enterobacteriaceae?

Answer 13

UTI
Intra-abdominal infections 
Pneumonia 
Bacterial meningitis 
Septic arthritis 
Osteomyelitis 
Endocarditis 
Bacteraemia

Question 14

What is E. coli bacteraemia and what are the most common causes?

Answer 14

Spread of infection into blood from primary source

Causes:

• UTI
• unknown source
• hepatobiliary
• GI

Elderly at greatest risk

Question 15

What is an example of a last resort antibiotics?

Answer 15

Carbapenems

-broad spectrum antibiotics used to treat antibiotic resistant enterobacteriaceae

Question 16

How does carbapenem resistance develops?

Answer 16

Carbapenemase enzymes produced by bacteria which destroy carbapenem antibiotics making the bacteria resistant

Question 17

What are examples of carbapenem-resistant organisms?

Answer 17

CPOs (carbapenem-producing organisms) 
Eg:
-acinetobacter baumannii
-pseudomonas aeruginosa 
-stenotrophomonas maltophilia 

CPEs (carabapenem-producing enterobacteriaceae)

• klebsiella
• pneumonia
• Escherichia coli
• enterobacter cloacae

Question 18

How can MDR gram negatives (CPEs) be controlled?

Answer 18

Screening

Isolation

Hand hygiene

Decontamination of the environment

Antibiotic restriction

Question 19

What are the interventions for CPE prevention?

Answer 19

Antibiotic stewardship
Hand hygiene 
Cleaning + disinfection 
Active screening 
Contact precautions 
Education

Question 20

What type of bacteria is acinetobacter baumanii? Why is this bacteria so difficult to treat? What problems is it associated with?

Answer 20

Gram negative CPO
-hard to treat due to being resistant to multiple antibiotics and can remain on surfaces for 1 year
-adapts to hospital environment and forms biofilm on wards and wounds
-

Associated with wound colonisation and ventilator-associated pneumonia

Question 21

What are the cleaning control measures for a MDR organisms?

Answer 21

Environment screening
Enhanced cleaning
Decant and deep clean
Use of hydrogen peroxide
Implement rapid cleaning team
Commence inter-theatre trip terminal cleaning
Embed an assurance framework for cleaning in theatres

Question 22

Where is pseudomonas aeruginosa commonly found?

Answer 22

Soil, water and moist environments
I.e. can colonise hospital and domestic sinks and colonise patients at moist sites

Water transmission is very serious concern

Question 23

How can pseudomonas aeruginosa spread and prevalence by reduced?

Answer 23

Filters on taps
Replacement of taps
Policies about not disposing of dirty water down sinks

Question 24

What is the appropriate PPE for TB?

Answer 24

Aprons and gloves
Eye protection i.e. full face visor or goggles
FFP3 respirators

Question 25

What are the different mechanisms of antibiotic resistance?

Answer 25

Efflux pump: bacterial pumps antibiotic out of cell

Decreased uptake

Inactivating enzymes

Alterations to drug targets