L12 - infections in the healthcare setting

Question 1

What is necessary for an infection to be healthcare-acquired?

Answer 1

patient must not have had infection/incubating infection before hospital

Question 2

How many patients per year UK acquire HCAI?

Answer 2

300,000

Question 3

What is the government priority for HCAI?

Answer 3

targets for MRSA bacteraemia and C.diff infection

moving towards surveillance for E.coli

Question 4

Story of Ignaz Semmelweis?

Answer 4

Ward 1 by doctors, Ward 2 by midwives

doctors come from post mortem room

ladies dying of purple sepsis

instigates hand washing with chlorinated lime and ward cleaning with calcium chloride

Question 5

What are the majority of HCAIs caused by?

Answer 5

commensal bacteria

Question 6

What is VRE?

Answer 6

vancomycin resistant enterococci

Question 7

What are modern day HCAIs?

Answer 7

respiratory
UTI
surgical site
GI 
bloodstream

Question 8

When do respiratory tract HCAI become a problem?

Answer 8

ICU

ventilator-associated pneumonia

tube on ventilatory is circumventing natural defence of saliva and coughing up mucus

humidified air

Question 9

What organisms cause HCAI pneumonia?

Answer 9

P. aeruginosa
MRSA
enterobac

Question 10

What organisms cause aspiration pneumonia?

Answer 10

S. pneu
S. aureus
H. influenzae

Question 11

Are HCAI UTIs catheter associated?

Answer 11

YES

catheter breaches normal anatomical defences

Question 12

What organisms involved in HCAI UTIs?

Answer 12

mostly E.coli

also
enterobacteriaceae

Question 13

When do HCAI surgical site infections occur?

Answer 13

after invasive procedure

contamination of wound with own microflora

Question 14

What are HCAI bloodstream infections related to?

Answer 14

IV devices

organisms that colonise catheter hubs and next to insertion site

Question 15

What organisms cause HCAI bloodstream infections?

Answer 15

MAIN - S. epidermis

also - S. aureus, candida, enterococci

Question 16

What are the 2 main gastrointestinal illnesses in HCAI?

Answer 16

C. diff (CDI)

norovirus

Question 17

Why did S.aureus become resistant to penicillin?

Answer 17

B-lactamase production

Question 18

What does C.diff cause?

Answer 18

self-limiting diarrhoea

TO

pseudomembranous colitis - progress to toxic megacolon = death

Question 19

Which antibiotics carry greater risk of CDI?

Answer 19

clindamycin
cephalosporins
fluoroquinolones

Question 20

How can the portal of entry be protected?

Answer 20

aseptic technique

appropriate prophylactic use

appropriate device use

Question 21

How can cross infection be protected?

Answer 21

clean environment

HAND WASH

isolation procedures

Question 22

What is antimicrobial stewardship?

Answer 22

strategies to improve use of antimicrobial medications with goal of:

enhancing patient health outcomes

reducing resistance to antibiotics

decrease unnecessary cost

Question 23

How have covid-19 safety measure affected noroviurs and respiratory disease in 2020/2021?

Answer 23

massive reduction in cases due to great hygiene and mask wearing

Question 24

What is antibiotic cycling?

Answer 24

everybody gets SAME antibiotic as everyone on that ward and switch each month

Question 25

What is antibiotic mixing?

Answer 25

giving diff antibiotics at the same time - providing heterogeneity of antibiotics on the ward - environment does not allow resistance to develop

Question 26

What is ‘Start smart, then focus’

Answer 26

will start with broad spec antibiotic, once test sample they will treat with narrower treatment