L9 - Infection control

Question 1

Infetions that develop associated with the healthcare system is estimated to cost __ million per year

Answer 1

$40 million

Question 2

How can infections be transferred?

Answer 2

Contact direct/indirect and airbourne

patient –> patient

Patient –> healthcare worker

Visitor –> patient

May be acquired from:

• the environment
• contaminated equipment or therapies

Occasional foodborne source

Question 3

List some examples of healthcare associated infections:

Answer 3

UTI - Especially in people with urinary catheter

Wound infectiom after surgery

Pneumonia - Especially in ICU patients on ventilator

IV related blood stream infection

Question 4

What are the risk factors for healthcare associated infections?

Answer 4

Severity of underlying illness - the sicker you are the worse

invasive medical devices that breach normal defence mechanisms

Frequent contact with healthcare personnel

Prolonged length of stay

Prolonged exposure to antimicrobial agents

Decreased immunity e.g diabetes, chemotherapy

Question 5

which organisms are resistant to all available antibiotics and how are they combated?

Answer 5

CPEs
Acinetobacter
Pseudomonas

need to use antibiotics previously abandoned because of toxicity e.g colistin

Question 6

What is MRSA and what does it cause?

Answer 6

methicillin resistant S. Aureus

causes many different infections

resistant to many antibiotics

carried in nose, throat, groin, intestine - mainly transmitted on contaminated hands

Question 7

What is VRE and what does it cause and how is it transmitted?

Answer 7

Vacomycin-resistant enterococcus

causes UTIs, heart valve infection

Found in GIT, skin

transmitted on

• contaminated hands
• inaminate objects/environment

Question 8

Which virus is responsible for causing explosive outbreaks of diarrhoea and vomiting on hospitals, cruise ships? How is it transmited?

Answer 8

Norovirus

transmitted via contaminated food or water

Environmental contamination important

Question 9

What is the most common cause of antibiotic associated diarrhoea and is more common MRSA in some places

Answer 9

Clostridium difficile

spread from patient to patient on contaminated hands

Question 10

Carbanapenemase-producing enterobacteriaceae (CPE) is resistant to ____ and may be _____

Answer 10

Carbanapenemase-producing enterobacteriaceae (CPE) is resistant to carbapenems and may be untreatable

Question 11

What are examples of droplet transmission?

Answer 11

whooping cough, flu, SARS other resp. viruses

Question 12

Whats the difference between droplet and airborne transmission?

Answer 12

airborne remains airborne - can get into air conditioning

droplets travel

Question 13

What are the two types of control measures for healthcare associated infections - and examples of each?

Answer 13

Non-specific - apply to all patients regardless of disease status

• hand hygiene (esp alcohol)
• standard and additional precautions with blood, body fluids etc
• anitbiotic stewardship
• sterilisation of equipment
• cleaning environment

Patient specific measures - identify individual patients affected by disease by screening

Question 14

Infectious diseases are ________. Must be conducted in context of clinical care. There are many ________ factors

Answer 14

Infectious diseases are transmissible. Must be conducted in context of clinical care. There are many uncontrollable factors

Question 15

What are the problems with randomisation in infectiosu disease sudy?

Answer 15

Feasibility - wards are different

ethics - can’t deny preventionq

Question 16

True or false

there is always an independence of outcomines in infectioous disease research

Answer 16

false

There is a lack of independence of outcomes - and stats usually assumes this

Question 17

What is the problems with infection control literature?

Answer 17

Control of epidemic vs. endemic situation

retrospective studes (they suck)

small numbers

multiple interventions

Bad stats analysis

Assumption that intervention is responsible for fall in numbers

reporting bias

Question 18

What is the Hawthorne effect?

Answer 18

When poeple are being watched they change their behaviour

when the auditors there you’re going to work differently

Question 19

Describe an interupted time series analysis

Answer 19

provides results as change in level of outcome and trend

controls for secular trend and previous interventions

can control for other confounding factors

Question 20

What are the explicit protocols necessary in study design of infectious control?

Answer 20

Nature and timing of intervention
comparison groups

description of participants, setting, confounding factors, other infection control practices, lab procedures

Appropriate stats analysis

Question 21

true or false

Healthcare associated infections cause morbidity/mortaility but many are preventable

Answer 21

true

Question 22

True of false

infeciton control research fits neatly into usual research methods

Answer 22

false

but good clinical research practice essential

• methodology
• ethics