L4-5 Coomunicable Disease Flashcards
- Chain of infection
- Hand hygiene
- Standard precautions and transmission based precautions
- How are various disease transmitted
- MDROS
- Tetanus & scabies management
- What are community-acquired and hospital acquired infections
- Vaccination, immunization program
Chain of infection
- infectious disease
- Reservoir
- Portal of exit
- Mode of transmission
- Portal of entry
- Susceptible host
HH
5 moments for hh
- Before touching patient
- Before clean / aseptic procedure
- After body fluid exposure
- After touching patient
- After touching patient surrounding
Hh rationales
- Hand wash for visibily soil
- Hand rub 70%
- 7 steps
- Effectively inactivate non-enveloped virus e.g. norovirus, hep A
- No wrist & hand jewellery
- Roll up sleeves
- Cuts shd be covered by waterproof dressing
Standard precauction
Wear PPE ( wear eye protective device to protect eyes, gown to protect skin)
Prevention of sharp injury (use needle safely, if unavoidable, place used needle into sharp box
One hand scoop technique)
Injection safety
Use single-use, disposable needle & syringe for each injection, single-use vial)
Sterilisation: killing all form of microbacteria
For items used to penetrate soft tissues / bones
High level disinfection: remove most microbes but not spores (contacting mucous membrane)
Low level disinfection: contacting intact skin e.g. BP cuff)
Transmission-base precauction ( contact precaution)
Contact precauction
-) touching patient, touching linen
-) MRSA, VRE, Clostridium difficile
-) gastroenteritis norovirus, cholera
-) chickenpo-( airborne too)
Clean hand before touching patient
Wear glove contacting blood / body fluid
Wear PPE if contacting with bodily secretion
Disinfect frequent contact area
Droplet precautions
Spread including
Influenza, rubella, SARS, COVID-19, group
A streptococcus
Prevention
1. Clean hand before & after touching patient
2. Wear surgical mask before contacting with patient ( suctioning -) gown, face shield
3. Education: cover mouth when coughing
Airborne transmission
Spread more than 2m
Measures
1. Negative pressure room
2. Hand hygiene after entering isolation room
3. N95 respirator
4. Limit transportation
Community-associated infections vs hospital-associated infections
Commu: 入院時/ 48內 infected
Hospital: 入院冇, 出院後48小時內有
MULTI-DRUG RESISTANT ORGANISMS
MRSA
MRSA methicillin-resistant staphylococcus aureus
Focus In nasal cavity
Gram+
No s/s
Drug: IV vancomysin
MDROS ESBL
Extended spectrum beta lactamases
E.g. E coli
UT / GI
Transmission:
Wound directly
By worker indirectly
Treatment: carbapenem
MDROS- MDRAS
Multi-drug-resistant-acinetobacter species
Gram-
Sepsis, wound infection
Treatment: carbapenum e.g. meropenum
MDROS- CPE
Carbapenemase-producing enterobacteriaceae
Contain enzyme that can break down antibiotic
Pneumonia, wound infection, UTI
MDROS- VRE
Vancomycin-resistant enterococci
Direct contact to patient / feces / indirectly through hand contamination
S/s: UTI, wound infection, sepsis
Treatment: carbapenum
How to prevent MDRO transmission
Contact precaution+ standard precaution
Minimise patient transport
Metal surface alcohol disinfection
Change patient curtain after discharge
Tetanus
Cause by bacterium clostridium tetani
Attack thru toxin to nervous system
Incubate 4-21 days
S/s painful muscular contraction at jaws & neck
General muscle spasm
More severe: cannot swallow
Management
1. Wound dressing
2. Tetanus toxoid injection IMI 3 doses
(1. Arrive hospital 2. 1-2months later 3. 6-12 months later)
TETANUS PRONE WOUND:
1. Delayed treatment
2. Deep puncture wound
3, heavily contaminated wound
Scabies
Attack ppl with weakened immunity
Mode of transmission
1. Direct skin contact with infected ppl
2. Indirect contact to clothing & bedding carrying eggs
Incubation period: 2-6 weeks (1-4 days if been exposed b4)
S/s:
1. Itchiness
2. Rash
Care:
Topical (膏）permethrin lotion✅✅✅
-) wash off after 8-14hrs
Warm water bath
-) encourage mites coming out
-) increase absorption of scabicides
Norweigan scabies-) put lotion multiple times for 7 days, remove crust with ointment
Scabies infection control, education, precaution
Standard precaution+contact precaution ( glove, gown)
Linen sealed for 3 days before laundry
Norwegian scabies: isolate from single room
Education
1. Infected parents & sex partner should seek help
2. Caring & contact with infected person, wear ppe
3. Wash cloths / linen of infected person above 65oc and more than 10min
4. Non-washable items shd besealed up in plastic bag for 14 days before reuse
5. Disinfect environment with sodium hypochlorite twice a day
Precaution
1. Go thru skin inspection
2. Avoid sharing cloths
3. Environmental hygiene
4. Good personal hygiene
How are various disease transmitted L2 p.29
- Contact transmission
Direct host and infect person
Indirect: transfer of pathogen through contaminated object
(MRSA) - Droplet transmission
-) <3m, influenza, COVID-19 - Airborne transmission
-) dust / dine particles contain pathogen
-) TB - Vector-borne transmission 非人生物
-) flies, mosquito
-) dengue fever, malaria - Vehicle-borne transmission
water-borne-) cholera 霍亂
Food borne-) norovirus - Bloodborne
HIV HBV
Type of vaccines
- Live attenuated vaccine
E.g. measules, rubella
Contain weakened live virus - Killed vaccine
Consist of dead live virus - Recombined protein subunit vaccine
E.g. Hep B
Recombined protein from pathogen - Toxoid vaccine
E.g. tetanus
Contain heated or chemically destroyed toxin - Recombined toxin vaccine
Inactivated exotoxin - mRNA vaccines
Immunization program
New born: BCG, Hep B (1)
1 month: Hep B (2)
2 months DTaP IPV (1), pneumococcal (1)
4 months DTaP IPV (2), Pneumococcal (2)
6 months DTaP IPV (3), Hep B (3)
12 months MMR (1) pneumo (booster) varicella (1)
18months DTaP booster (2) MMR (2)
P1 MMR (2), DTaP (booster)
P5 HPV (1)
P6 DTaP (booster), HPV (2)
