Lecture 23: Healthcare- associated Infections

Question 1

Define a Healthcare Associated Infection (HAI)

Answer 1

Infection that is acquired in a hospital or healthcare facility. Termed “nosocomial” in acute care. - onset of S(x) may appear after discharged

Question 2

(Organism x Org. Number) / Host Defense = ____?____

Answer 2

= Disease

Question 3

What are >85% of HAIs linked to?

Answer 3

>85% associated with device use

Question 4

Top 4 places in the body for HAIs to set up shop?

Answer 4

1. Lung (26%) 2. Wound (SSI, 25%) 3. GI system (C. Diff, 17%) 4. Urinary tract (13%)

Question 5

Sources of infection (4 main ones)

Answer 5

1. Patient’s own flora 2. Healthcare worker’s hands 3. Contaminated Environment or Equipment 4. Contaminated products (Rare)

Question 6

Bacterial Contamination of Hands during Patient Care: What increases linearly with time during patient care?

Answer 6

Bacterial contamination increases linearly with time.

Question 7

Hand antisepsis (Etoh) vs. Handwashing: which is associated with higher colony counts?

Answer 7

Handwashing is associated with higher colony counts

Question 8

How many moments available for hand hygiene?

Answer 8

5 moments for Hand Hygiene (Sax H, et al. J Hosp Infect 2007;67:9-21.)

Question 9

What are HAI’s of the bloodstream primarily associated with?

Bonus: what are the top 3 organisms associated with bloodstream HAI’s?

Answer 9

Central Lines (>85%)

Bonus:

1. Coag negative staph (21%)
2. Enterococcus spp (18%)
3. Candida spp (15%)

4. Staph. aureus (12) / 5. Klebsiella pneumoniae (10%)

Question 10

HAI’s of blood: What are the top risk factors?

Answer 10

• # 1 Risk is centreal venous catheter use (placement/process)
• Age <1 or >60
• Malnutrition
• Immunosuppresed
• loss of skin integrity
• ICU stay
• Long hospital stay

Question 11

Centreal line infections (CLABSI) Prevention Bundles: name 5 practices

Answer 11

• Decrease catheter use
• Use full barriers with inserting catheters / aseptic technique (gloves, mask, drapes)
• Use Chlorhexidine
• Use subclavian vein (over the IJ or femoral veins)
• Better hand hygiene

Question 12

Risk factors for C. Diff infection

Answer 12

• Age
  
  • Anti-biotic use
  • Use of PPI’s or H2 blockers (anti-acids)
  • Infection in roommate
  • Long Hospital stays
  • many/bad underlying conditions
  • Immunosuppresed

Question 13

Antimicrobials by risk for C. Diff infection

Answer 13

High Risk

• 2nd/3rd gen. cephalosporins
• Clindamycin
• Fluoroquinolones

Low Risk

• Aminoglycosides
• Beta-lactams (plus Beta-lactam inhibitors)

Question 14

To prevent C. Diff spread by hands, do you use Alcohol hand antiseptics or wash hands with soap and water?

Answer 14

Wash hands with soap and water

(different than usual recommendation cause resistance to many commonly used cleaning agents + detergents don’t eliminate spores)

Question 15

Transmission of C. diff.: what are the two main ways C. diff is spread?

Answer 15

• Via fecal-oral route
• Via healthcare workers hands in hospital

Question 16

Surgical Site infections (SSI): Top 5 organisms associated with SSI…

Answer 16

1. Staph aureus (30%)
2. Coagulase negative Staph (12%)
3. Enterococcus spp. (11%)
4. E. coli (9%)
5. Psuedomonas aeruginosa (5%)

*2nd most common HAI and over half Identified post-discharge

Question 17

Most commonly isolated fungus in SSIs?

Answer 17

Candida

Other unusual organisms may suggest an outbreak

Non-TB mycobacteria, Legionella, Rhizopus, etc.

Question 18

List the Personal Reservoirs

Answer 18

• Hands
• Skin
• Mucous membranes
• Rectum/vagina
• Hair
• Upper Respiratory Tract

Question 19

List the Host Reservoirs

Answer 19

• Skin
• Mucous membranes/nares
• genitourinary
• Distal infections

Question 20

Risk factors for Symptomatic UTI

Answer 20

Prolonged catheterization

Female

Older age

Impared immunity

Question 21

What are the Risk factors for Bacteriuria?

Answer 21

Disconnection of drainage system

Less trained prof. inserter

Placement of catheter outside of OR

Incontinence

(also: Diabetes, Meatal colonization, Renal dysfunction, ortho/neuro services)

Question 22

Catheter associated UTI; what is associated w/ infection

Answer 22

Biofilms are important

Extraluminal: Early @ insertion, Late by capillary action

Intraluminal: Break in closed drainage, contaminated collection bag

Question 23

Catheter associated UTI infectious routes

Question 24

HAI pneumonia (#1 area of HAIs)

What is the top causal organism?

Answer 24

1. Staphylococcus aureus 24%

2. Pseudomonas aeruginosa 17%
3. Klebsiella pneumoniae 10%
4. Enterobacter spp. 9%
5. Acinetobacter baumannii 7%

Question 25

Overall, what do you do to prevent HAIs?

Answer 25

•Hand hygiene

–In + out of room

–While giving care

•Ask others:

–Does the patient still need this device?

–Does the patient still need this anti-biotic?

•Make prevention a priority

Question 26

What is the most commonly found organism in HAIs these days?

Answer 26

Clostridium difficile

Question 27

Ways for CLABSI infections to occur

Answer 27

Bacteria contaminate catheter surface.

Biofilms occur, need to pull catheter at that point.