L12 - infections in the healthcare setting Flashcards
What is necessary for an infection to be healthcare-acquired?
patient must not have had infection/incubating infection before hospital
How many patients per year UK acquire HCAI?
300,000
What is the government priority for HCAI?
targets for MRSA bacteraemia and C.diff infection
moving towards surveillance for E.coli
Story of Ignaz Semmelweis?
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
What are the majority of HCAIs caused by?
commensal bacteria
What is VRE?
vancomycin resistant enterococci
What are modern day HCAIs?
respiratory UTI surgical site GI bloodstream
When do respiratory tract HCAI become a problem?
ICU
ventilator-associated pneumonia
tube on ventilatory is circumventing natural defence of saliva and coughing up mucus
humidified air
What organisms cause HCAI pneumonia?
P. aeruginosa
MRSA
enterobac
What organisms cause aspiration pneumonia?
S. pneu
S. aureus
H. influenzae
Are HCAI UTIs catheter associated?
YES
catheter breaches normal anatomical defences
What organisms involved in HCAI UTIs?
mostly E.coli
also
enterobacteriaceae
When do HCAI surgical site infections occur?
after invasive procedure
contamination of wound with own microflora
What are HCAI bloodstream infections related to?
IV devices
organisms that colonise catheter hubs and next to insertion site
What organisms cause HCAI bloodstream infections?
MAIN - S. epidermis
also - S. aureus, candida, enterococci
What are the 2 main gastrointestinal illnesses in HCAI?
C. diff (CDI)
norovirus
Why did S.aureus become resistant to penicillin?
B-lactamase production
What does C.diff cause?
self-limiting diarrhoea
TO
pseudomembranous colitis - progress to toxic megacolon = death
Which antibiotics carry greater risk of CDI?
clindamycin
cephalosporins
fluoroquinolones
How can the portal of entry be protected?
aseptic technique
appropriate prophylactic use
appropriate device use
How can cross infection be protected?
clean environment
HAND WASH
isolation procedures
What is antimicrobial stewardship?
strategies to improve use of antimicrobial medications with goal of:
enhancing patient health outcomes
reducing resistance to antibiotics
decrease unnecessary cost
How have covid-19 safety measure affected noroviurs and respiratory disease in 2020/2021?
massive reduction in cases due to great hygiene and mask wearing
What is antibiotic cycling?
everybody gets SAME antibiotic as everyone on that ward and switch each month
What is antibiotic mixing?
giving diff antibiotics at the same time - providing heterogeneity of antibiotics on the ward - environment does not allow resistance to develop
What is ‘Start smart, then focus’
will start with broad spec antibiotic, once test sample they will treat with narrower treatment
