Infection Prevention And Control Flashcards
What does HCAIs stand for and what are they
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
How common are HCAI
Estimates 10%
Risks vary according to kind of setting ITU, elderly, neonate patient
What types of infection
Pneumonia, UTI, surgical site infection, gastroenteritis, bloodstream infection.
Sources endogenous from patients own flora or exogenous from other patients, staff or the environment
Are they preventable
~15% are
Exogenous more so
Predominantly device associated- catheter, IV, central line
Why is there more of a problem with HCAIs now
More vulnerable patients - older, more high tech treatment
Use of antibiotics, inc resistance and running out of them
What is antibiotic resistance
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
Why is antibiotic resistance a problem now
Small world Overuse of antibiotic Resistance always emerging Patient expectations Media Internet Highlight the increasing HCAIs more
Where is the code of practice now to control HCAIs
Health and social care act 2008
Code of practice hoe to manage HCAIs
Prosecution if you fail to follow it
Typical infection prevention arrangements for NHS organisations
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
What is MRSA
Methicillin resistant staph aureus
Mainly associated with healthcare
Strains carrying the PVL toxins are becoming problematic, and more associated with community transmission
Types of resistance
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
Management of MRSA
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
National strategies to reduce MRSA infection
Search and destroy
Target for reductions in infection and a zero tolerance approach to avoidable infection
Measures to reduce MRSA
Screening Decolonisation treatment Appropriate treatment of colonised patient Care with peripheral and central lines Prevention of pressure sores and ulcers
What we c diff
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
Risk factors
Age Antibiotics PPI Cross infection via poor hand hygiene or contaminated environment Previous CDI
C diff epidemiology
Widespread in the environment and young mammals
Most clinical cases linked to healthcare environments
Recently shown to be found in food, including human strains
Diagnosis and management
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
Prevention of C diff
Isolation of case
Hand washing
Cleaning of the environment
Antibiotic stewardship
What are enterobacteriaceae
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
What are ESBLs
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
Carbapenemase producers
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
What are these strains susceptible to
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
Colistin resistance on China
Used in agriculture high amounts so tributes to resistance in animals
National guidance for the prevention of CPEs
Risk assessment of new admissions
Focus on prevention he’s,theses inhigh risk countries and areas
Isolation and screening of cases
