L8: Healthcare Infection

Question 1

What do we mean by healthcare infection?

Answer 1

Infection a patient has developed whilst in healthcare
Developed 48hrs after admission
Neither present or incubating on admission
Includes infection in healthcare workers and visitors

Question 2

Why is it important to consider health care infection?

Answer 2

Frequent–> prevalent in 8% patients
Impact on health–> takes longer to recover, wound heeling aesthetic less good
Impact on healthcare organisations–> cost of prolonged stay, investigations, treatment and opportunity costs
Preventable

Question 3

What are some of the different types of healthcare acquired infections?

Answer 3

Urinary tract infection (20%)
Pneumonia (14%)
Surgical wound healing (14%)
Skin and soft tissue (10%)
Primary bloodstream (7%)
Gastrointestinal (21%)
Other (14%)--> meningitis

Question 4

What is the historical background behind infection prevention?

Answer 4

Semmelweis–> Obstertrician
Mother of babies delivered by Drs often died after birth
Babies delivered by midwives mothers survived
Dr Semmelweis asked everyone to wash hands in chlorinated lime solution before and after seeing patients–> Decrease in deaths thereafter

Question 5

What are the different levels for infection prevention intervention?

Answer 5

Prevent pathogen entry to healthcare setting
Prevent pathogen and patient interaction –>infection
Prevent patient to patient transmission

Question 6

What are some examples of different healthcare infection pathogens?

Answer 6

Viruses–> Blood borne, Norovirus, Influenza, chickenpox
Bacterial–> Staphlococcus aureus (cellulitis, MRSA), Clostridium difficile, E. Coli, Myobacterium tuberculosis
Fungi–> Candida albicans, Aspergillus species
Parasites–> Malaria

Question 7

What are the risk factors for patients?

Answer 7

Age--> extremities (neonates and elderly)
Obesity/ malnourished
Diabetes
Cancer
Immunosuppression
Smoker
Surgical patient 
Emergency admission

Question 8

What are the 4P’s of infection prevention and control?

Answer 8

Pathogen
Patient
Practice
Place

Question 9

How does the pathogen impact on the infection prevention and control model?

Answer 9

Pathogens are able to change
Virulence factors 
Ecological interaction (other bacteria, antibiotics/ disinfectants)

Question 10

How do patient have an impact on the infection prevention and control model?

Answer 10

General and specific risk factors for infection

Interaction with other patients, healthcare workers and visitors

Question 11

How does practice impact on the infection prevention and control model?

Answer 11

What do we do?
General and specific activities of healthcare workers
Policies and implementation
Organisational structure and engagement
Regional and national political initiatives
Leadership at all levels from government to the ward

Question 12

How does place impact on the infection prevention and control model?

Answer 12

Environment which patients are in
Fixed and variable features
e.g. Beds too close together, carpeted floor

Question 13

What patient interventions are there to minimise self infection?

Answer 13

Patients transfer pathogens between each other and between themself (commensal bacteria in wrong area)
General interventions
–> Optimise patients condition –> stop smoking, right nutrition, and control diabetes
–> Antimicrobial prophylaxis–> use of antibiotics before surgery to prevent infection
–> Skin preparation–> make sure its clean etc…
–> Hand hygiene–> patients and workers

Specific interventions

• -> MRSA screens
• ->Mupirocin nasal ointment–> reduce MRSA infection in ICU patients
• -> Disinfectant body wash–> kill bacteria on skin

Question 14

How can patient to patient transmission be prevented?

Answer 14

Isolation
Source isolation–> Infected patient kept in isolation
–> low pressure room compared to surroundings
–> Air from surrounding into room containing the bacteria which can then be filtered
Protective isolation–> Protection of susceptible patients
–> High pressure air in room
–> Air moves from room into surrounding
–> Bacteria can’t get in
–> Air is filtered into the room

Question 15

What healthcare worker interventions are there to minimise infection?

Answer 15

Ensure healthy workers

• -> Occupational health if unsure
• -> Disease free
• -> Vaccinated–> prevent getting ill and spreading illness

Good practice

• -> Clinical technique –> sterile, aseptic etc
• -> Hand hygiene
• -> Personal protective equipment
• -> Antimicrobial prescribing –> broad spectrum antibiotic use drives antibiotic resistant bacteria

Question 16

What environmental interventions are there to minimise infection?

Answer 16

Enviroment--> water, food, air, surfaces
Built environment
--> space between patients
--> Toilets
--> Wash hand basin--> make sure in appropriate place
--> Theatres clean
--> Positive and negative pressure rooms
Furniture and furnishings
--> wipe clean
--> resistant to disinfectant
Cleaning
--> Disinfectants
--> Steam cleaning
--> H2O2 vapour--> lethal to humans and bacteria-> only used on ward thats closed down
Medical devices
--> Single use equipment--> not very environmentally friendly
--> Sterilisation of multiuse
--> Decontamination
Food
--> Appropriate facilities, good food hygiene practice

Question 17

What is a good method to identify high risk patients?

Answer 17

Have you I-fived your patient today?
-Identify 
--> Abroad
--> Blood borne infections 
--> Colonised
--> Diarrhoea/vomitting
--> Expectorating--> coughing
--> Funny looking rash
If yes,
-Isolate
-Investigate
-Inform --> Drs etc... infection prevention
-Initiate