infection - healthcare infections

Question 1

what are healthcare infections?

Answer 1

infections arising as a consequence of PROVIDING healthcare

also includes infections in hospital visitors & healthcare workers

Question 2

what are the criterias for hospital patients to be classified as healthcare infections?

Answer 2

neither present nor incubating at time of admission

onset at least 48 hours AFTER admission

Question 3

why are healthcare infections important?

Answer 3

frequent - prevalence 8% patients
impact on health - individual
impact on healthcare organisation - establishment (cost, beds etc.)
preventable

Question 4

what are examples of HCAI?

Answer 4

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

Question 5

what are viral examples of healthcare infection pathogens?

Answer 5

blood-bourne viruses (hep B, C, HIV)
norovirus
influenza
chickenpox (by herpes varicella)

Question 6

what are bacterial examples of HCAI?

Answer 6

staph aureus - including MRSA
C. diff
E. coli, Klebsiella pneumoniae
Pseudomonas aeruginosa
Mycobacterium tuberculosis

Question 7

what are fungal examples of HCAI?

Answer 7

candida albicans
aspergillus species (breathing dust PCP)

Question 8

what is a parasitic example of HCAI?

Answer 8

malaria (spread via vector)

Question 9

what are patient factors pre-disposing to HCAI?

Answer 9

extremes of age
obesity / malnourished
diabetes
cancer
immunosuppression
smoker
surgical patient
ED admission

Question 10

what are the 4 Ps of infection prevention & control?

Answer 10

patient
pathogen
practice
place

Question 11

what is patient in prevention & control of HCAI?

Answer 11

general & specific patient risk factors

interactions with: other patients, healthcare workers, visitors

Question 12

what are the pathogen factors in prevention & control of HCAI?

Answer 12

virulence factors

ecological interactions: other bacteria, antibiotics / disinfectants

Question 13

what are practice factors in prevention & control of HCAI?

Answer 13

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

Question 14

what is place in prevention & control of HCAI?

Answer 14

healthcare environment:
fixed features
variable features e.g. sharing a ward / being isolated, space between beds, how often floor being cleaned etc.

Question 15

what are general patient interventions for prevention of HCAI?

Answer 15

optimise patient’s condition: smoking, nutrition, diabetes
antimicrobial prophylaxis - pre, post surgery
skin preparation - e.g. surgical scrub?
hand hygiene

Question 16

what are the specific patient interventions for prevention of HCAI?

Answer 16

MRSA screens
disinfectant body wash
mupirocin nasal ointment

Question 17

how do you halt patient to patient transmission?

Answer 17

physical barriers:
isolate infected patient
protection of susceptible patients - prophylaxis? isolation? - filter sterilise air using POSITIVE pressure

Question 18

what are healthcare worker interventions to prevent HCAI?

Answer 18

healthy HC workers: disease free, vaccinated

good practice: good clinical techniques e.g. sterile non-touch, hand hygiene, PPE, antimicrobial prescribing

Question 19

what are environmental interventions to preventing HCAI?

Answer 19

1. environment setup: space/layout, toilets, wash hand basins
2. furniture & furnishing - able to decontaminate? no carpet
3. cleaning: disinfectants, steam cleaning (high temp), hydrogen peroxide vapour (H2O2) - oxidative burst
4. medical devises: single use equipment, sterilisation, decontamination
5. appropriate kitchen & ward food facilities, good food hygiene practice
6. theatres - scrub up
7. positive/negative pressure rooms - immunosuppressed patients

Question 20

what are the 5 I’s in HCAI?

Answer 20

identify (A-F)
isolate - BEFORE investigate - prevention
investigate
inform - discharing patient to nursing home etc.
initiate - treatment for MRSA (trimethoprim), prophylaxis

Question 21

what are the A-F of identify in HCAI?

Answer 21

abroad
blood borne infections - esp. dialysis
colonised - MRSA / previous gram neg?
D&V - isolate
expectoration - produce sputum
funny looking rash - chicken pox? shingles? - contagious?