infection - healthcare infections Flashcards
what are healthcare infections?
infections arising as a consequence of PROVIDING healthcare
also includes infections in hospital visitors & healthcare workers
what are the criterias for hospital patients to be classified as healthcare infections?
neither present nor incubating at time of admission
onset at least 48 hours AFTER admission
why are healthcare infections important?
frequent - prevalence 8% patients
impact on health - individual
impact on healthcare organisation - establishment (cost, beds etc.)
preventable
what are examples of HCAI?
UTI - e.g. catheter associated pneumonia - e.g. ventilator associated surgical wound infections GI - e.g. C. diff skin & soft tissue primary bloodstream - e.g. central line
what are viral examples of healthcare infection pathogens?
blood-bourne viruses (hep B, C, HIV)
norovirus
influenza
chickenpox (by herpes varicella)
what are bacterial examples of HCAI?
staph aureus - including MRSA C. diff E. coli, Klebsiella pneumoniae Pseudomonas aeruginosa Mycobacterium tuberculosis
what are fungal examples of HCAI?
candida albicans aspergillus species (breathing dust PCP)
what is a parasitic example of HCAI?
malaria (spread via vector)
what are patient factors pre-disposing to HCAI?
extremes of age obesity / malnourished diabetes cancer immunosuppression smoker surgical patient ED admission
what are the 4 Ps of infection prevention & control?
patient
pathogen
practice
place
what is patient in prevention & control of HCAI?
general & specific patient risk factors
interactions with: other patients, healthcare workers, visitors
what are the pathogen factors in prevention & control of HCAI?
virulence factors
ecological interactions: other bacteria, antibiotics / disinfectants
what are practice factors in prevention & control of HCAI?
general & specific activities of healthcare workers e.g. hand-washing, hygiene
policies & their implementation e.g. staff:pt ratio
organisation structure & engagement - understaffed?
regional & national political initiatives - budget for NHS
leadership at all levels (ward to government) - enforcement of policies
what is place in prevention & control of HCAI?
healthcare environment:
fixed features
variable features e.g. sharing a ward / being isolated, space between beds, how often floor being cleaned etc.
what are general patient interventions for prevention of HCAI?
optimise patient’s condition: smoking, nutrition, diabetes
antimicrobial prophylaxis - pre, post surgery
skin preparation - e.g. surgical scrub?
hand hygiene
what are the specific patient interventions for prevention of HCAI?
MRSA screens
disinfectant body wash
mupirocin nasal ointment
how do you halt patient to patient transmission?
physical barriers:
isolate infected patient
protection of susceptible patients - prophylaxis? isolation? - filter sterilise air using POSITIVE pressure
what are healthcare worker interventions to prevent HCAI?
healthy HC workers: disease free, vaccinated
good practice: good clinical techniques e.g. sterile non-touch, hand hygiene, PPE, antimicrobial prescribing
what are environmental interventions to preventing HCAI?
- environment setup: space/layout, toilets, wash hand basins
- furniture & furnishing - able to decontaminate? no carpet
- cleaning: disinfectants, steam cleaning (high temp), hydrogen peroxide vapour (H2O2) - oxidative burst
- medical devises: single use equipment, sterilisation, decontamination
- appropriate kitchen & ward food facilities, good food hygiene practice
- theatres - scrub up
- positive/negative pressure rooms - immunosuppressed patients
what are the 5 I’s in HCAI?
identify (A-F)
isolate - BEFORE investigate - prevention
investigate
inform - discharing patient to nursing home etc.
initiate - treatment for MRSA (trimethoprim), prophylaxis
what are the A-F of identify in HCAI?
abroad blood borne infections - esp. dialysis colonised - MRSA / previous gram neg? D&V - isolate expectoration - produce sputum funny looking rash - chicken pox? shingles? - contagious?
