Infection Prevention And Control

Question 1

What does HCAIs stand for and what are they

Answer 1

Healthcare associated infection
Any infection as a result of accessing healthcare
Healthcare could include acute hospital, rehab centre, nursing or residential facilities
Staff and visitors as well

Question 2

How common are HCAI

Answer 2

Estimates 10%

Risks vary according to kind of setting ITU, elderly, neonate patient

Question 3

What types of infection

Answer 3

Pneumonia, UTI, surgical site infection, gastroenteritis, bloodstream infection.
Sources endogenous from patients own flora or exogenous from other patients, staff or the environment

Question 4

Are they preventable

Answer 4

~15% are
Exogenous more so
Predominantly device associated- catheter, IV, central line

Question 5

Why is there more of a problem with HCAIs now

Answer 5

More vulnerable patients - older, more high tech treatment

Use of antibiotics, inc resistance and running out of them

Question 6

What is antibiotic resistance

Answer 6

The ability of bacteria to become resistant to antibiotics which may be used fro the treatment of infections
Bacteria learn to make enzymes to the antibiotic and stop it from working
Also stop the antibiotic from getting into the bacteria

Question 7

Why is antibiotic resistance a problem now

Answer 7

Small world 
Overuse of antibiotic 
Resistance always emerging 
Patient expectations
Media
Internet 
Highlight the increasing HCAIs more

Question 8

Where is the code of practice now to control HCAIs

Answer 8

Health and social care act 2008
Code of practice hoe to manage HCAIs
Prosecution if you fail to follow it

Question 9

Typical infection prevention arrangements for NHS organisations

Answer 9

Director of infections and prevention control - report to trust board
Medical microbiologists 
Infection prevention nurses 
Antimicrobial pharmacists 
Decontamination specialist 
They monitor quality and safety -CQC

Question 10

What is MRSA

Answer 10

Methicillin resistant staph aureus
Mainly associated with healthcare
Strains carrying the PVL toxins are becoming problematic, and more associated with community transmission

Question 11

Types of resistance

Answer 11

Clonal - spreads via cross infection
Most HCAIs in U.K. Due to 2 strains, EMRSa 15 and 16
Related to additional penicillins binding protein in the cell wall
Implies resistance to all beta lactams
Association with multiple resistance

Question 12

Management of MRSA

Answer 12

Difficult
Limited no of antimicrobials
Glycopeptides - vancomycin (poor tissue penetration, monitoring of levels, slow infusion)
Teicoplanin - difficulty in dosing, role of monitoring and cost
Fusidic acid
Linezolid
Daptomycin

Question 13

National strategies to reduce MRSA infection

Answer 13

Search and destroy

Target for reductions in infection and a zero tolerance approach to avoidable infection

Question 14

Measures to reduce MRSA

Answer 14

Screening 
Decolonisation treatment 
Appropriate treatment of colonised patient 
Care with peripheral and central lines 
Prevention of pressure sores and ulcers

Question 15

What we c diff

Answer 15

Anaerobic Gram pos bacilli
Spore forming - results in ability to withstand disinfection, drying, adverse conditions
Note relatively resistant to effects of alcohol and other frequent,y used disinfection
Commonest cause of healthcare associated diarrhoea

Question 16

Risk factors

Answer 16

Age 
Antibiotics 
PPI 
Cross infection via poor hand hygiene or contaminated environment 
Previous CDI

Question 17

C diff epidemiology

Answer 17

Widespread in the environment and young mammals
Most clinical cases linked to healthcare environments
Recently shown to be found in food, including human strains

Question 18

Diagnosis and management

Answer 18

Think about c diff as a diagnosis
Always send a sample if any chance of a case - esp elderly or recently hospitalised
Avoid loperamide or any other anyimotilith agents they may allow the toxin to pool and predispose to toxic megacolon
Try to stop systemic abtiobiotcs
Specific c diff treatment
Metronidazole, oral vancomycin, fidaxomicin, faecal donor infusion

Question 19

Prevention of C diff

Answer 19

Isolation of case
Hand washing
Cleaning of the environment
Antibiotic stewardship

Question 20

What are enterobacteriaceae

Answer 20

Family of organisms which live in the GI tract of man an dotter animals somis widespread in the environment
E.g. E. coli, klebsiella, enterobacteriaceae
Common causes of human infection - urinary tract, abdominal, bloodstream
Beta -lactam antiobiotic have been the mainstay of treatment

Question 21

What are ESBLs

Answer 21

Extended spectrum beta lactamases
Bacteria with emzymes which break down broad spectrum cephalosporins such as cefuroxime, gentamicin, trimethoprim
AI stay if treatment are carbapenems such as meropenem, imipenem

Question 22

Carbapenemase producers

Answer 22

Initially limited to a few countries - NDM in Indian sub continent, KPC in Greece and Middle East but now widespread
Difficult to detect in lab
Final confirmation by OCR to detect type of carbapenemase

Question 23

What are these strains susceptible to

Answer 23

Currently majority of isolates susceptible to tigecycline and colistin only
Tigecycline - new tetracycline derivative, IV form only, not licensed for UTI or bloodstream levels because of poor levels
Colistin old antibiotics for last resort for the resistant strains , renal toxicity 20% , IV for UTI/bacteraemia

Question 24

Colistin resistance on China

Answer 24

Used in agriculture high amounts so tributes to resistance in animals

Question 25

National guidance for the prevention of CPEs

Answer 25

Risk assessment of new admissions
Focus on prevention he’s,theses inhigh risk countries and areas
Isolation and screening of cases