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Lecture 23: Healthcare- associated Infections Flashcards

1
Q

Define a Healthcare Associated Infection (HAI)

A

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

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2
Q

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

A

= Disease

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3
Q

What are >85% of HAIs linked to?

A

>85% associated with device use

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4
Q

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

A
  1. Lung (26%) 2. Wound (SSI, 25%) 3. GI system (C. Diff, 17%) 4. Urinary tract (13%)
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5
Q

Sources of infection (4 main ones)

A
  1. Patient’s own flora 2. Healthcare worker’s hands 3. Contaminated Environment or Equipment 4. Contaminated products (Rare)
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6
Q

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

A

Bacterial contamination increases linearly with time.

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7
Q

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

A

Handwashing is associated with higher colony counts

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8
Q

How many moments available for hand hygiene?

A

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

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9
Q

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

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

A

Central Lines (>85%)

Bonus:

  1. Coag negative staph (21%)
  2. Enterococcus spp (18%)
  3. Candida spp (15%)
  1. Staph. aureus (12) / 5. Klebsiella pneumoniae (10%)
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10
Q

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

A
  • # 1 Risk is centreal venous catheter use (placement/process)
  • Age <1 or >60
  • Malnutrition
  • Immunosuppresed
  • loss of skin integrity
  • ICU stay
  • Long hospital stay
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11
Q

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

A
  • 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
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12
Q

Risk factors for C. Diff infection

A
  • Age
    • Anti-biotic use
    • Use of PPI’s or H2 blockers (anti-acids)
    • Infection in roommate
    • Long Hospital stays
    • many/bad underlying conditions
    • Immunosuppresed
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13
Q

Antimicrobials by risk for C. Diff infection

A

High Risk

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

Low Risk

  • Aminoglycosides
  • Beta-lactams (plus Beta-lactam inhibitors)
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14
Q

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

A

Wash hands with soap and water

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

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15
Q

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

A
  • Via fecal-oral route
  • Via healthcare workers hands in hospital
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16
Q

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

A
  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

17
Q

Most commonly isolated fungus in SSIs?

A

Candida

Other unusual organisms may suggest an outbreak

Non-TB mycobacteria, Legionella, Rhizopus, etc.

18
Q

List the Personal Reservoirs

A
  • Hands
  • Skin
  • Mucous membranes
  • Rectum/vagina
  • Hair
  • Upper Respiratory Tract
19
Q

List the Host Reservoirs

A
  • Skin
  • Mucous membranes/nares
  • genitourinary
  • Distal infections
20
Q

Risk factors for Symptomatic UTI

A

Prolonged catheterization

Female

Older age

Impared immunity

21
Q

What are the Risk factors for Bacteriuria?

A

Disconnection of drainage system

Less trained prof. inserter

Placement of catheter outside of OR

Incontinence

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

22
Q

Catheter associated UTI; what is associated w/ infection

A

Biofilms are important

Extraluminal: Early @ insertion, Late by capillary action

Intraluminal: Break in closed drainage, contaminated collection bag

23
Q

Catheter associated UTI infectious routes

24
Q

HAI pneumonia (#1 area of HAIs)

What is the top causal organism?

A

1. Staphylococcus aureus 24%

  1. Pseudomonas aeruginosa 17%
  2. Klebsiella pneumoniae 10%
  3. Enterobacter spp. 9%
  4. Acinetobacter baumannii 7%
25
Q

Overall, what do you do to prevent HAIs?

A

•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

26
Q

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

A

Clostridium difficile

27
Q

Ways for CLABSI infections to occur

A

Bacteria contaminate catheter surface.

Biofilms occur, need to pull catheter at that point.

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