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MIIM20002 - Microbes, Infections, Responses > Lecture 23 - Health Care Associated Infection > Flashcards

Lecture 23 - Health Care Associated Infection Flashcards

0
Q

What are some common places where these infections can be gotten?

A

Nursing home
Hospital
Child care centre

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1
Q

What is another word for HCAI?

A

Nosocomial

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2
Q

What is a nosocomial infection?

A

Infection from a health care associated setting

May have delayed onset

We don’t count infections that are already present when first entering the setting

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3
Q

How many deaths are there each year due to HCAI?

A

7000 in Australia annually

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4
Q

How much do HCAI cost Australia each year?

A

180 millions

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5
Q

How many people at any one time in a health care setting have an infection?

A

3-25%

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6
Q

How can infection rates be stemmed?

A

Implementation of infection control programmes

1/3rd

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8
Q

What are infections that result from a medical intervention?

Give some examples

A

Iatrogenic
• The bacteria get a ‘free ride’ into the body, past protective defences

For example:
• urine catheterisation
• hands of medical personnel
• intubation
• ventilation
• IVs (indwelling vascular lines)
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9
Q

What do invasive procedures sometimes cause?

A

Iatrogenic infections

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10
Q

How are iatrogenic infections treated?

A

Antibiotics

Can also be used for prophylaxis

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11
Q

What can antibiotic use in the hospital lead to?

A
  • Resistance

* Antimicrobial associated diarrhoea

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12
Q

What are organisational associated factors?

Name some examples

A 
To do with the way that the hospital is organised
For example:
• air conditioning
• contaminated water systems
• staffing issues
• physical layout of facility
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13
Q

Which organisms are commonly in the water system?

Are these a problem?

A
  • Pseudomonas aeruginosa
  • Serratia

For healthy people, it doesn’t cause disease
People with burns are, however at risk

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14
Q

Which organisms are present in contaminated in the air?

A

• Aspergillus mould

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15
Q

Which organisms are present in contaminated food?

A
  • Salmonella

* Campylobacter

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15
Q

Describe the links in the chain of infection

A 
Pathogen
Source
Transmission
Entry
Host
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16
Q

What are patient associated factors?

A
  • Severity of illness
  • Underlying immunocompromisation
  • Length of stay
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18
Q

What are some common sources of infection?

A 
People:
• other patients
• staff
• visitors
• own normal flora
Environmental
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19
Q

Describe how other patients often spread disease

A

• acute disease

  • person still in incubation period
  • chronic carriers excreting
  • person’s own endogenous flora
  • fomites contaminated with others’ bacteria
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19
Q

Why is anaesthesia a predisposing factor for infection?

How can this be prevented?

A

Because the cilia are immobile

It is important to get the patient moving and coughing to get the cilia working again

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20
Q

What factors predispose someone to infection?

A
  • Trauma (arm out window –> bacteria from road)
  • underlying immunosupression (age, disease)
  • co-morbidity (smoking, influenza)
  • procedures (anaesthesia)
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21
Q

What are someways that the pathogen is transmitted?

A

Direct: person to person

Indirect: surgical instruments, fomites

Airborne: droplets

Vehicle: food, water, drugs, blood transfusion

Vector: mosquitoes, flies, rats

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23
Q

What are patients colonised with soon after admittance to hospital?

Describe the common locations and pathogens

A

Hospital strains of bacteria
These tend to be more resistant

Colonisation of:
• skin
• GIT; VRE
• respiratory tract; Klebsiella

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23
Q

Which hospital strains colonise the GIT?

A

VRE

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24
Q

Which hospital strains colonise the respiratory tract?

A

Klebsiella

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25
Q

Which outbreaks are commonly seen in children’s wards?
When?

How is it spread?

A

1\ Rotavirus outbreaks
In winter
Person to person

2\ Varicella Zoster
Spread by aerosols

27
Q

What other pathogens often cause outbreaks in hospital?

A

1\ Norovirus
Aerosols, surfaces

2\Influenza
Aerosol spread

28
Q

Which infections are most common?

Which are serious?

A
  • UTI 30-45%
  • Surgical wound 15-30%
  • LRT 10-25%
  • Skin 5-10%
  • Blood 5-10%

Serious:
septicaemia, burn infection, LRT infection

Not so serious:
UTI
Surgical wound

29
Q

Which bacteria commonly cause infection in hospitals?

A
  • Staph. aureus
  • Staph. epidermidis
  • Pseudomonas aeruginosa
  • Enterobacteria (Klebsiella, E. coli)
  • Acinetobacter

• Clostridium difficile

30
Q

Which yeast is commonly seen in hospital infection?

Why is it often seen in hospitals?

A

• Candida albicans

Overgrowth due to antibiotics use
The antibiotics clear the bacteria, giving the yeast a chance to grow

30
Q

Describe the main features of C. difficile

A

Spore forming
Gram positive rod
Anaerobic

31
Q

Which mould is commonly seen in hospital infections?

A

• Aspergillus

33
Q

How is C. difficile transmitted?

A
  • Shed from infected people
  • Spores survive on surfaces
  • Hands of health care workers transmit the spores to patients
34
Q

How can we kill spores and remove them from surfaces?

How about from hands?

A

• Bleach
(Resistant to normal methods)
• soap and water
(alcohol gel not enough)

35
Q

What predisposes someone to C. difficile infection?

A
  • Broad spectrum Antibiotics –> disruption of normal flora
  • prolonged hospital stay
  • antacid use
  • sharing room with infected person
  • NG tube
36
Q

What does infection of C. difficile result in?

A

Ranges from:
• Mild diarrhoea
• Pseudo-membranous colitis (sometimes fatal)

37
Q

What are the symptoms of C. difficile infection?

A
  • Cramping abdominal pain

* Watery diarrhoea (can be bloody)

38
Q

How do we treat C. difficile infection?

A

• Removal of antibiotics

Metronidazole

39
Q

What is the hypervirulent strain of C. difficile?

A
  • High rates of nosocomial infection

* Increased production of toxin

39
Q

What is the superbug?

Why is it so called?

A

Staphylococcus aureus

Because it causes wound infections, food poisoning and is quite extensively resistant to antibiotics

40
Q

How does C. difficile cause damage?

A

2 exotoxins:

  • Toxin A- enterotoxin – fluid production, mucosal damage
  • Toxin B- extremely cytopathic – ulceration
42
Q

Describe the features of S. aureus

Where does it colonise?

A

Gram positive cocci
Facultative anaerobe

Colonises:
• URT
• nose
• skin
• vagina
• intestine
42
Q

How does S. aureus colonise?

A

Adhesins

43
Q

What are the virulence factors of S. aureus?

A
  • Exfoliative toxins
  • Enterotoxins
  • Haemolysins
  • Lipases
  • Proteases
  • DNAases
  • Leukocidins
  • Protein A
  • Beta lactamase
44
Q

Discuss antibiotic resistance with S. Aureus

A

This is a big problem because so many people are infected.

1/ Penicillin resistance quickly
- has beta lactamase
2/ MRSA
3/ Starting to see vancomycin resistance

45
Q

Is S. aureus hardy?

Why?

A

Yes, survives well in the environment

Able to form biofilms

46
Q

Where does S. aureus cause disease?

A
  • Endocarditis
  • Osteomyelitis

Many, many more

48
Q

Describe the genome of S. aureus

A

Core genome
Accessory Genome
Plasmids

Pathogenicity island:
• enterotoxins
• superantigens

49
Q

Describe the features of enterococci

Where does it colonise?

A

Gram positive cocci

Commensal in gastrointestinal tract

49
Q

What is VRE?

How did it come about?

A

Vancomycin resistance enterococci

Years of vancomycin use in hospitals

50
Q

Describe resistance of enterococci

A 
Multiple antibiotic resistance:
• penicillins
• cephalosporins
• aminoglycosides
• vancomycin --> VRE
51
Q

What infection is associated with bone marrow transplants?

A

Aspergillus mould

52
Q

What is MRSA?

How is it overcome?

A

Methicillin resistant S. aureus

Big problem for HCAI

MRSA now treated with vancomycin

53
Q

What is MRSA?

How is it overcome?

A

Methicillin resistant S. aureus

Now use Vancomycin

54
Q

Which enterococci cause nosocomial infection?

A

E. faecium

E. faecalis

56
Q

What sort of infections are caused by enterococci?

A
  • Abdominal infections
  • Urinary tract infection
  • Septicaemia
57
Q

What are glycopeptides?

A

Antibiotics

eg. Vancomycin

58
Q

Give an example of transmission via a vehicle

A
  • Blood transfusion
  • Food
  • Water
59
Q

Why are people of poor health more susceptible to Klebsiella?

A

In respiratory tract
Poor health:
• decreased fibronectin in RT
• predisposition to Klebsiella colonisation

60
Q

What is the most important feature of Clostridium difficile for its transmission?

A

Spore formation

61
Q

Describe how broad spectrum antibiotics predisposes someone to C. difficile infection

A
  1. BS antibiotics kill many bacteria in the GIT
  2. C. difficile now has the opportunity to overgrow
  3. Toxin production
  4. Mild diarrhoea / P.M.C.
62
Q

What is haematogenous spread?

A

Spread via circulating blood

63
Q

What is osteomyelitis?

A

Infection & inflammation of the bone or bone marrow

64
Q

Why should we worry about S. aureus antibiotic resistance?

A

Because bacteraemia due to S. aureus is common in Australia.

This is a serious infection.

MIIM20002 - Microbes, Infections, Responses (32 decks)

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