Infection control

Question 1

Why are HCAI important?

Answer 1

~300,000 healthcare associated infections (HCAI) in England per year

Estimated 9% of in-patients have a HCAI

Cost approx. £1 billion per year

Cause or contribute to estimated 20,000 deaths.

Question 2

What does the Health Act 2006 state?

Answer 2

Infection control is every health care workers responsibility

The possibility of health care related infections should be considered in all aspects of patient management

Question 3

5 moments of hand hygiene:

Answer 3

1. before touching a patient
2. before clean/aseptic procedure
3. after body fluid exposure risk
4. after touching a patient
5. after touching patient surroundings

Question 4

What bacteria cause problems in hospital settings?

Answer 4

Methicillin resistant S.aureus
Clostridium difficile
Multi-drug resistant gram negatives
Glycopeptide resistant enterococci
Group A streptococcus
Mycobacterium tuberculosis

Question 5

What viruses cause problems in hospital settings?

Answer 5

Influenza
Norovirus
SARS-CoV-2
HIV
Hep B
Hep C
Varicella Zoster Virus
Viral haemorrhagic fevers

Question 6

What other type of infections are worrying in a hospital setting?

Answer 6

Candida Auris
Creutzfeldt–Jakob disease

Question 7

Principles on infection prevention and control

Answer 7

Identification of risks
Routes and modes of transmission
Virulence of organisms
Ease of spread
Likelihood of causing infection
Consequences of infection if it occurs

Minimisation of risks

Question 8

Identifying risks

Answer 8

Risk factors
e.g. recent return from Sierra Leone with fever

Screening
e.g. MRSA admission screening

Clinical diagnosis
e.g. cough and cavity on chest x-ray

Lab diagnosis
Carbapenemase Producing Enterobacteriaceae in urine

Question 9

What are CPEs?

Answer 9

Include E. coli, Klebsiella, Proteus, Serratia, Enterobacter

Colonisers of large bowel, skin below waist and moist sites

Most common causes of UTI, intra-abdominal infection

Historically, the vast majority of these germs were susceptible to the antibiotics that we currently use with Gram negative infection.

Question 10

MRSA

Answer 10

Staph aureus is a common skin and nasal commensal

Most strains are susceptible to flucloxacillin (and other beta-lactam antibiotics)

MRSA was first described in 1971

Huge increase in numbers of cases in 1990s and 2000s

Question 11

Norovirus

Answer 11

High attack rates amongst close contacts
Low infecting dose
Uncontained vomiting and diarrhoea

Short lived immunity only
Staff and patients at risk

Able to persist in the environment

Relatively resistant to conventional cleaning

Question 12

C diff

Answer 12

Bacterial spores

Prolonged hospital stays

Toxic megacolon

Question 13

Endogenous infections

Answer 13

Infections caused by patients own bacterial flora

Important in hospitalised patients, especially those with invasive devices or surgical patients

Question 14

Preventing endogenous HCAI

Answer 14

Good nutrition and hydration

Antisepsis/skin prep where indicated

Good theatre practice

Remove lines and catheters as soon as clinically possible

Change from IV to oral treatment whenever appropriate

Question 15

PPE

Answer 15

Must be worn by all staffwhen there is a risk of contamination to the person or their clothing
e.g. Gloves, Aprons, masks etc

Requirements depend on the organism

Question 16

Disposal of sharps

Answer 16

Disposal is the responsibility of the person using the equipment

Sharps bins must be correctly assembled

Never re-sheath or bend needles

Never overfill a sharps bin