Infections Lecture 4: Infection Prevention and the Role of the Pharmacist

Question 1

What is the role of the community pharmacist in managing infections?

Answer 1

1. Educating the public with anti-bacterial courses
2. Needle exchange program
3. Managing vaccination programs for HepB, Flu
4. Raising awareness, screening STI’s (chlamydia)
5. Pharmacy medicines (anti-septics, first aid)
6. Preparation of medicines (anti-septics and anti-bacteria))

Question 2

What is the role of the hospital pharmacist in managing infections?

Answer 2

As well as the community roles:

1. Ensure Antimicrobial Stewardship
2. Education of Staff and yourself following the teachings of multi disciplinary team in a hospital setting
3. Ensure vaccinated and healthy
4. Follow guidelines and ensure what’s best for workers

Question 3

Define Antiseptic?

Answer 3

The killing/inhibition of micro-organisms on living surfaces (non selective)

Question 4

Define Disinfectant?

Answer 4

The killing/inhibition of micro-organisms on in-animate objects (non selective)

Question 5

Define sterilisation?

Answer 5

Removal and killing of all micro-organisms including spores

Question 6

Define Disinfection?

Answer 6

Killing and inhibition of pathogenic micro-organisms on a surface (non living surface)

Question 7

Define Antibiotics?

Answer 7

Kill and inhibit micro-organisms in the body

Question 8

What is the health act of 2006?

Answer 8

1. Ensure that staff are equipped with facilities of preventing and controlling infections such as Hand washing basins
2. Policies must be put in place for aseptic techniques, disposing of sharps and antimicrobial prescribing
3. Health care workers must be free and protected from infections

Question 9

Define anti-microbial stewardship and why it was introduced?

Answer 9

1. An overreaching program to change and direct anti-microbial use at a health care institution
2. Lack of anti-microbials coming to the market
3. Strains of bacteria such as MRSA

Question 10

Explain the purpose behind the anti-microbial stewardship?

Answer 10

1. Target patient groups and health
2. Reduces the number of antibiotics prescribed and used
3. Increase in appropriate selection, dosing, route and duration of therapy of antibiotic use
4. Improvement in clinical markers (decreased length of stay and mortality rate)

Question 11

Explain how the start and focus scheme works for anti-biotics?

Answer 11

Start:

1. Do not prescribe and provide antibiotics if there isn’t evidence that it’s a bacterial infection
2. Get cultures of bacteria and test anti-biotics on them to choose the right one
3. Document on drug charts and medical notes

Focus:

1. Review every 48 hours with action plan
2. Stop treatment or switch (IV to oral) or change drug or continue treatment
3. Clearly document

Question 12

Define Aspesis?

Answer 12

When something is free of pathogenic micro-organisms

Question 13

Define anti-aspesis?

Answer 13

Use of antiseptics to eliminate micro-organisms

Question 14

What are the three ways to reduce micro-organisms and prevent/control infection?

Answer 14

1. Chemical: Antibiotic use, antiseptics and disinfectants
2. Mechanical: Filtration
3. Physical: Heating and radiation

Question 15

What makes an ideal disinfectant?

Answer 15

1. Easy to use
2. Sterilising and fast acting
3. Cheap
4. Broad spectrum of activity
5. Stability
6. Non corrosive and irritating

Question 16

What makes an ideal antiseptic?

Answer 16

1. Stable and doesn’t react with blood and other human products
2. Sterilising and fast acting
3. Wide spectrum of activity
4. Long acting
5. Non toxic to other people
6. Doesn’t stain and is a acceptable colour

Question 17

What are the made classes of disinfectants and give an example of them?

Answer 17

1. Phenol: Dettol
2. Alcohol: Ethanol
3. Halogens: Iodine
4. Biguanides: chlorhexidine

Question 18

What is the mechanism of action of halogens?

Answer 18

Oxidation of protoplasm

Question 19

What is the mechanism of action of alcohol, halogens, and aldehydes?

Answer 19

Disruption of cell membrane and denaturation of proteins

Question 20

What are alcohols used for and the percentage they have to be?

Answer 20

1. Used as a disinfectant and anti-septic
2. 60 to 90%
3. Broad spectrum but cannot kill spores
4. Irritating for mucous membrane

Question 21

What are biguanides (chlorahexadine) used for and give an example of it?

Answer 21

1. Disrupts bacterial cell wall and denatures proteins
2. General use of antiseptic
3. Non irritating
4. Widely used in dentistry
5. Example: Savlon

Question 22

How are halogens such as iodine used and what are the problems about it?

Answer 22

1. Broad spectrum and RAPID antiseptic
2. burn, blister and toxic to skin
3. Iodinates and oxidises protoplasm

Question 23

How are halogens such as iodophores used?

Answer 23

1. Treatment of burns, cuts, ulcers, post operation

2. Non toxic and long acting

Question 24

Describe what chlorine and chlorophores are used for?

Answer 24

1. Chlorine: used as a germicide and it rapidly acts in water environments
2. Chlorophore (strong disinfectant) Used in products to kill bacteria, viruses and fungi by acting as an oxidiser

Question 25

How does hydrogen peroxide work and what is it used for?

Answer 25

1. Strong oxidiser and disinfectant
2. Liberates oxygen to oxidise and kill bacteria
3. Used in hospitals
4. Can be irritant

Question 26

What are phenols used for, mechanism of action, and the disadvantages behind it?

Answer 26

1. Disinfectants and antiseptics (medicated soaps)
2. Protoplasmic poison that denatures proteins
3. Disinfect e.g. urine, pus, faeces

Disadvantages:
1. Phenol is corrosive, irritant, damages skin and cells

Question 27

What is chloroxylenol and the products it’s used for?

Answer 27

1. A derivative of a phenol that is not irritating
2. Broad range of spectrum for bacteria, viruses, fungi
3. Disrupts cell membrane
4. Safe for humans and other mammals
5. Creams, soaps, and mouth wash (DETTOL)

Question 28

What is TCP and what is it used for?

Answer 28

1. Mix of dilute phenols and halogenated phenols
2. Liquid antiseptic
3. Use: Sore throats (gargling), cuts, ulcers and mouthwash

Question 29

What are quaternary ammonium compounds used for?

Answer 29

1. Used as a disinfectant and antiseptics
2. Broad spectrum for killing bacteria, fungi and viruses
3. Alter membrane permeability
4. Often used as a surface cleaner

Question 30

What are aldehydes used for?

Answer 30

1. Used as a sporadical, bactericidal and virucidal
2. Preserve tissue specimens
3. Used for fumigation and it’s very toxic
4. Denatures proteins, alkylates nucleic acids

Question 31

What are the physical methods used to disinfectant and sterilise?

Answer 31

1. Heat: dry or moist
2. Dry heat kills by oxidation
3. Moist heat sterilisation kills by denaturation (coagulation)
4. Ionising (x ray and gamma) is sterilising
5. Radiation is ionising and non ionising
6. Non ionising (UV) disinfecting

Question 32

What is mechanical filtration?

Answer 32

1. Air or liquids
2. Air: typical disinfection
3. Liquid: e.g. small pores filters (0.2 micrograms) - remove micro-organisms (sterile)

Question 33

What are the four sterilisation methods?

Answer 33

1. Steam
2. Dry heat
3. Cold (chemical)
4. Radiation