Infections IV: Prevention & The Role Of The Pharmacist Flashcards
List 6 roles of the community pharmacist
- Education of the public
- Raise awareness, screening - STIs
- Needle and syringe programmes (NSPs)
- Screening and vaccinations (HPV, HepB, Flu)
- Pharmacy medicines
- Preparation of medicines
List 4 roles of a hospital pharmacist
- Ensure patients are vaccinated and healthy
- Antimicrobial stewardship
- Education of healthcare staff & MDT within the hospital setting
- Follow guidelines and best practice for healthcare workers
Define: Antiseptic
Kills/inhibits micro-organisms on living surfaces
Non-selective
Define: Disinfectant
Kills/inhibits micro-organisms on inanimate objects
Non-selective
Define: Sterilisation
Removal/killing of all micro-organisms (including spores)
Gold standard
Define: Disinfection
Killing/inhibition of pathogenic micro-organisms on a surface (not living)
Define: Antibiotics
Kill/inhibit micro-organisms on and in the body
Define: Antimicrobial stewardship
An overarching programme to change and direct antimicrobial use at a health care institution
What are the reasons for antimicrobial stewardship?
Lack of new antimicrobials coming onto the market
Strains developing resistance to existing antimicrobials
e.g. MRSA, CRE
How is antimicrobial stewardship carried out?
Reduction in total antimicrobial use
Improvement in susceptibility profiles of hospital pathogens
Improvement in clinical markers (decreased length of stay, mortality)
Increase in appropriate antimicrobial use (selection, dose, route, duration)
What does ‘Start Smart Then Focus’ mean?
START:
Don’t start ABx if no evidence of bacterial infection
Get cultures first
Document on drug charts and medical notes
Use guidelines for prompt, effective treatment
FOCUS:
Review every 48 hours with action plan
5 options - Stop/Switch (IV to oral)/Change/Continue/OPAT (out-patient)
Define: Asepsis
Free of pathogenic micro-organisms
Define: Antisepsis
Use of antiseptics to eliminate pathogenic organisms
Define: Aseptic techniques
Techniques to prevent infection
How can asepsis be achieved?
Chemical = covered antibiotics, antisepsis, disinfectants Physical = heat and radiation Mechanical = filtration
List 3 ideal properties of a disinfectant
Sterilising
Fast-acting
Non-toxic to other life
List the different levels of disinfection
Low
Intermediate
High
Describe antiseptics
Wide spectrum of activity (preferably biocidal) Fast-acting Stable Non-toxic to other life Active for a long period of time
List 3 classes of disinfectant/antiseptic and give some examples
Phenols = phenol, cresol, dettol Alcohols = ethanol, isoprenalol Halogens = iodine, chlorine, chlorophores
What are the mechanisms of action of antiseptics/disinfectants?
Oxidation of protoplasm = H2O2, halogens
Denaturation of proteins and disruption to cell membrane = phenols, alcohols
Increased permeability = quaternary ammonium compounds
Describe alcohols as disinfectants/antiseptics
Very effective
Broad-spectrum but not against spores
Precipitate bacterial proteins
Can be irritating for mucous membranes but can often be used on skin
Describe Chlorhexidine (biguanide) as an antiseptic
Disrupts bacterial cell wall and denatures proteins
Non-irritating
Widely used in dentistry
Savlon (+ Cetrimide), Corsodyl
Describe Iodine as an antiseptic
Broad-spectrum
Rapid antiseptic
Iodinates and oxidises protoplasm
But can burn/blister, be toxic and stain
What is an iodophore?
Any disinfectant containing iodine and a surfactant
Describe Chlorine (halogen) as an antiseptic/disinfectant
Potent germicide
Fast acting
Used in water supplies
Describe Chlorophore as a disinfectant
Strong disinfectant
Strong oxidiser
Kills bacteria, fungi, viruses
Found in household bleach
Describe hydrogen peroxide as a disinfectant
Strong oxidiser
Disinfectant
Liberates oxygen that oxidises and kills bacteria
Irritant
Can be used as vapour to disinfect hospitals
Describe Phenols as disinfectants/antiseptics
Protoplasmic poisons - denature proteins
Disinfect e.g. urine, pus, faeces
BUT phenol is corrosive and irritant, damages skin/cells
e.g. Cresol (commonly used as a disinfectant)
Describe Chloroxylenol (Dettol) as a disinfectant/antiseptic
Derivative of phenol
Broad-spectrum = bacteria, fungi, viruses
Disrupts cell membranes
Used as a disinfectant and antiseptic
Describe TCP as an antiseptic
Mix of dilute phenol and halogenated phenols
Liquid antiseptic
Used diluted for sore throats (gargling), cuts, ulcers, mouthwash
Describe Quaternary Ammonium Compounds as antiseptics/disinfectants
Broad-spectrum = bacteria, viruses, fungi
Alter membrane permeability
Often used for surface cleaning
e.g Cetrimide
Describe aldehydes as disinfectants/antiseptics
Denature proteins, alkylate nucleic acids, protoplasmic toxin
Kills bacteria, viruses and spores
Very toxic - used for fumigation
List 2 physical methods of sterilisation
- Heat - dry (kills by oxidation) or moist (kills by denaturation)
- Radiation - ionising (X-ray, gamma = sterilising) and non-ionising (UV = disinfecting)
How does mechanical filtration work sterilise?
Air or liquids
Small pores remove micro-organisms = sterile
Describe the conditions of steam to sterilise
Autoclave
121C
20 minutes
Describe the conditions of dry heat to sterilise
171C
1 hour in dry oven
List 4 examples of personal protective equipment (PPE)
- Aprons
- Gloves
- Masks
- Overshoes
