intro to HAI Flashcards
( intro not rly important) glossary:
—– : the process of inserting an endotracheal tube into the airway
—— : a machine that takes over the work of breathing
intubation
ventilation
( intro not rly important)
glossary ( continued) - surgery types:
1- —- surgery which has no breach of tract as —–
2- —– which has break of breach of GI/ GU/ Respiratory
3- —– surgery operating in a contaminated field as —-
clean surgery as:excision of a
skin lump
Clean- contaminated surgery
Contaminated surgery as post GI perforation
infections acquired by patients
during their stay in a hospital or
another healthcare setting, which
were not present or incubating at
the point of admission defined by WHO is known as:
—– is an infection that is acquired after contact with the healthcare services. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing
homes and other healthcare settings. ( another definition by health protection )
HAI healthcare associated infection
microbes that cause HCAI come from —- and —-
1- exogenous which can be acquired from environment parents or staff which are all potentially preventable
2- endogenous: acquired from the patients own flora which is more difficult to prevent
importance of HCAIS:
1- increased —-
2- increased —-
3- increased —- which includes :
4- increased —-
5- associated w —-
- Increased mortality: 25% of S. aureus BSI patients die
- Increased morbidity: patients with post-operative surgical wound
infection spend longer in hospital & suffer - Increased costs which includes :
a) Hospital/healthcare, e.g. antibiotics, X-rays
b) Patient, e.g. delayed return to work
c) Society, e.g. disability allowances, reduced income tax - Increased awareness by public & authorities
- Associated with antimicrobial resistance
why do HCAI occur:
1- the – adapts which leads to:
- antimicrobial —-
- —- production
- —– production
2- host —- such as:
3- the —- :
1- microbes adapts leading to :
- antimicrobial resistance
- biofilm production
- spore production
2- host vulnerability as:
- immunosuppression
- underlying illness
- extreme age
- devices as: iv lines , urinary catheters , ventilators
- wounds
3- the environment which can be from:
- humans: other patients or staff
- inanimate as: equipment , infrastructure ( multi-bedded bays)
types of HCAI :
1- Respiratory
o Pneumonia
o Viral RTI, e.g. influenza, COVID-19, RSV
2- Gastrointestinal
o Clostridioides difficile
o Viral, e.g. norovirus, rotavirus
3- Skin/soft tissue
o Peripheral/central IV catheter infections
4- Surgical site infections
5- Device-associated infections
o Cardiac implantable electronic devices, dialysis catheters,
ventriculoperitoneal shunts, drains, VAP
6- Urinary tract
o Catheter-associated UTI
respiratory tract infection in healthcare associated infection as —- which is predisposed by risk factors as:
1- recent — which leads to compromised — and altered — due to —
2- decreased level of —-
3- —- and —- which can bypass the upper respiratory —- , —- . example:
peneimnia (HAP )
surgery
breathing ( abdominal )
flora
antibiotics
consciousness
intubation and ventilation
defences
coughing
as:ventilation-associated pneumonia (VAP)
( info: NB Aetiology different to community-acquired pneumonia where S. pneumoniae is the commonest)
causes of HAP and VAP:
- Gram negative bacilli (GNB): including multidrug resistant ones
* E. coli
* Klebsiella spp.
* Enterobacter spp.
* Pseudomonas spp. - Staphylococcus aureus: including MRSA
- Legionella pneumophila (most cases though are community-acquired and not healthcare)
- Viruses: COVID-19, influenza, RSV
surgical site ( wound) infections aka SSI predisposed by risk factors as:
1- — factor which is —- ex:
2- —- factors which is via —- or – and is partly prevented by —-
3- —-: during dressing applications /
changes from air, hands, etc. (exogenous) –prevented by good practice, e.g. —-
patient
endogenously
perforated viscus
operating theatre
air from environment or staff which is exogenous
controlled air
post operatively
hand hygiene
classification of SSI are:
pathogens include:
1- superficial
2- deep/incisional
3- organ/space
pathogens include:
* Staph. aureus (most common irrespective of type of surgery)
* Beta-haemolytic streptococci
* GNB (mostly only seen post-clean-contaminated or contaminated surgery)
* Anaerobes (post-clean-contaminated or contaminated
surgery)
* Coagulase-negative staphylococci (if prosthetic material)
urinary tract infection:
1- predisposed by :
2- commonly caused by:
3- prevention by:
– Catheterisation / surgical intervention /instrumentation
– Stasis, e.g. tumour
– Dehydration
caused by:
1. E. coli, Proteus, Ps. aeruginosa
2. Enterococci
prevention:
- Standard precautions including hand hygiene
- Transmission based precautions
- Decontamination
elements of standard precautions:
- Hand hygiene
- Respiratory hygiene and cough etiquette
- Safe patient placement
- Use of appropriate PPE: gloves, gowns, face & eye protection
- Cleaning and decontamination of reusable medical devices
- Environmental hygiene
- Safe injection practices
- Disposal of waste
- Correct use and disposal of sharps
- Management of occupational blood / body fluid exposure (OBE) including sharps injury
- Management of blood and body fluid spills
- Management of linen
what’s on our hands:
1- —– : organisms that are picked up easily from the environment or during patient contact. Can then be easily transferred from your hands on to others
2- —- : organisms
that live naturally within the skin normal flora. That are not easily
transferred.
transient organisms
resident organisms
- Healthcare-associated pathogens are most often transmitted from patient to patient on the —- of healthcare workers
- —— before and after patient contact is one of the most important measures for preventing the spread of microorganisms in
healthcare settings
hands
cleaning your hands
you should clean it when:
1- before touching patient
2- before clean/aspetic procedure
3- after body fluid exposure risk
4- after touching patient surroundings
the purpose of safe patient placement :
1- reduce risk of spread of —- to other patients
2- protective —- of immunosuppressed patient the options include:
—– : Single room with ensuite toilet, hand hygiene sink
—– : If insufficient numbers of isolation rooms, patients may be grouped together, e.g.
all MRSA patients in the one 6-bed area
micro-organism
isolation
isolation room
cohosting
personal protective equipments:
1- apron/long sleeved gowns:
- should be worn when in contact w — or —-
- also as a part of —– precautions
- are — use item and should be changed between — and between —-
blood or body fluids
transmission based
single
patients and procedures
personal protective ( continued ):
2- gloves:
- always when dealing w — as :
- also a part of —– precautions
- — use items
- always perfume —- following removal
- be aware of —-
sharps as taking blood or giving iv
transmission based
single , change between patients
hand hygien
latex sensitivity and allergy
personal protective ( continued ):
3- face protection which include :
1 —-:
* Single use
* Use when body fluid
splash to face anticipated
2- —-:
* Single use
* Risk of splash of body
fluids
* Also as part of
transmission-based
precautions
goggles / face visor
masks
- in —– are additional to use when Standard Precautions alone may not be sufficient to prevent the transmission of certain infectious agents.
- The type of transmission-based precaution you use depends on the specific —– of the infecting microorganism which can be by:
transmission based precautions
mode of transmission which includes:
- contact
- droplets
- airborne
-microbes can be spread by contact by —- which is directly from person-to-person e.g. —- or by —- which is via inanimate objects; equipment and surfaces or via environment as soil dust air.
-micorbes spred through contact as a person w diarrhoea could be from ( the infectious origin ) :
- also these microbes can be from : —- with antibiotic resistant pathogens
direct
hand
indirect
infectious orgins includes:
* C. difficile infection
* Food poisoning
* Norovirus / rotavirus infection
Colonisation/infection
contact precautions include :
- Single room / cohort isolation
- Before patient contact
– Perform hand hygiene
– Put on single use apron/gown and gloves - Preferably dedicated equipment or clean and disinfect equipment after each use
- Remove gloves & apron / gown, perform hand hygiene after patient contact / leaving patient area
through air:
1- droplets:
- Respiratory droplets transmitted by infectious patient over a —-
- examples:
- —– ballistics
2- airborne
- Small particles that contain — are suspended in the air.
Can travel over —- and be —- .
- example:
- short distance less than 2 metres
- mumps, influenza, pertussis (whooping cough)
- Short-range ballistics
- pathogens
extended distances
inhaled
tuberculosis, measles, chickenpox (varicella)
droplet precaution:
* Respiratory droplets can be transmitted from an infectious patient over — distance;
* — room
* Respiratory protection; use —
* Before patient contact perform hand hygiene, use single use — ,— and —
- Remove PPE, perform hand hygiene — leaving
the isolation area / patient zone
- you need to know which microbes as:
short
signle
surgical mask
apron gloves surgical masks
after
microbes include:
- Influenza
- COVID-19
- Pertussis (whooping cough)
- Mumps
- Rubella
- Diphtheria
airborne precuations:
- Fine airborne particles with pathogens . suspended in air over distance and time and inhaled
- controlled — — rooms
- respiratory protection use —–
- microbes include:
controlled ventilation isolation rooms
FFP2/N95 respirator mask
microbes include:
– Tuberculosis
– Measles
– Chicken pox (varicella)
– Patients with respiratory infections undergoing aerosol generating procedures e.g. COVID-19/Influenza
—– : Single-occupancy isolation rooms with specifically
designed ventilation (airflow)
3 types are:
– —- pressure rooms -> prevents entry of airborne pathogens
and thus protects the — e.g. protective isolation for neutropenic patients
– —- pressure rooms -> prevents escape of airborne pathogens from the room, protects other — e.g.
patient with airborne infection like TB, measles, chickenpox
– —— -> room at normal pressure
but has an entrance lobby at positive pressure -> prevents
spread of airborne pathogens in both directions
controlled ventilation rooms
positive
patient
negative
patients/staff
Positive pressure ventilated lobby
—– refers to a single-occupancy patient-care room used to isolate those with a suspected/confirmed airborne infectious disease, by managing air-flow and air removal to avoid transmission to those outside the room
controlled ventilation room
check graph 40
- Specialised units/wards for isolation of patients with high
consequence infectious diseases - Examples: Viral haemorrhagic fevers (VHFs – Ebola,
Marburg), SARS, MERS - Only certain hospitals have these types of wards
are known as
high level isolation unit
decontamination :
1- — :
Removal of organisms with water & simple detergent
2- —– : Significant reduction in total number of organisms, especially pathogens
- Moist heat
- Chemicals
3- —: Complete eradication or removal of all microbes (apart from prions), including bacterial
spores
- Heat
- Radiation
- Other (ethylene oxide)
cleaning
disinfection
sterilisation
- Level of cleaning/decontamination depends on —–
- high risk is when contact w —- as: — by which we use —-
- moderate risk is contact w —- or —- as —- and we use —– or —-
- low risk is contact w — or —- as —– which is when we use — or —
item and its use
sterile site as surgical instrument
we use sterilisation
musics membranes or broken skin as endoscope
we use Sterilisation or high-level disinfection
intact skin or environment as trolly
we use disinfection or cleaning