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a path 3 > MICRO: Healthcare associated infections > Flashcards

MICRO: Healthcare associated infections Flashcards

1
Q

What are HAI?

A

Healthcare associated infections; they are categorised by organism (1) or by syndrome (2).

(used to be hospital acquired infections)

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2
Q

How common are HAIs in the UK?

  • 8%
  • 22%
  • 40%
  • 55%
A

8% - approximately 8% of patient have a HAI at any one time

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3
Q

List some syndromes of HAI.

A
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4
Q

List some organisms causing HAI.

A
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5
Q

How many people die as a result of HAI each year in Europe?

A

37,000

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6
Q

Which syndromes are these infections associated with?

  • MRSA
  • C diff
  • E coli
  • MSSA
  • R gram -ve
  • Yeast/candida
A
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7
Q

What are the 3 most common HAI syndromes?

A

HAP > surgical site infections> UTI > BSI > GI

NB: this may vary with locations/wards.

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8
Q

What % of HAI are made up by C diff and MRSA?

A

15% of all HAI

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9
Q

Which is the most common syndrome of HAI?

  • Bloodstream infections
  • Norovirus gastroenteritis
  • Hospital acquired pneumonia
  • Urinary tract infection with catheter
  • Clostridium difficile
A

HAP

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10
Q

What was the purpose of the Hospital Microbiome Project? What was the result?

A

Determine where the organisms in hospital were originating - collected samples from surfaces, air, staff and patients. Aimed to determine which parameters were most important.

  • 1st day - from surfaces in room to patient
  • 2+ days - from the patient to the room, patient’s microbiome takes over patient’s space
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11
Q

Where do organisms in a hospital come from?

A

Mainly the environment

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12
Q

C. difficile is?

  • Gram positive anaerobe
  • Gram negative aerobe
  • Gram variable coccobacillus
  • Gram positive spore-forming anaerobe
  • Other not listed
A

C. difficile is a Gram-positive spore-forming anaerobe that colonises the gut. It produces toxins to have its effect and cause disease.

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13
Q

What causes diarrhoea/colitis in C diff infection?

A
  • Toxinotype III/ Toxins A and B
  • Pro-inflammatory
  • Cytotoxic
  • Enterotoxic
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14
Q

What is the range of symptoms in C difficile?

A

Mild diarrhoea/asymptomatic –> severe colitis with dehydration, pseudomembraneous colitis and perforation

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15
Q

What is the assessment for antibiotics for C diff infection?

A

Severe C difficile - oral vancomycin (used to be metronidazole)

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16
Q

What is the use of fidaxomysin?

A
17
Q

What is a non-drug management for C difficile?

A

Faecal transfer

18
Q

What is the most common UTI in the community and in hospital?

A

Community - E coli (82%)

Hospital - E coli(55%) but more due to other causes too.

19
Q

What % of catheters causing UTI become colonised within the first 96 hours?

A

60%

20
Q

What 3 groups of factors influence risk for surgical site infection (SSI)?

  • Staff, ward, category, day of week
  • Host defence, host gender, surgeon gender
  • Host defence, wound environment, pathogens
  • Virulence of pathogens, antibiotics used, type of suture
  • Experience of surgeon closing wound, mask used by theatre staff, music played in theatre
A

Host defence, wound environment, pathogens

21
Q

What are the main resistance mechanisms in resistant gram negatives?

A
  1. Chromosomal
  2. Plasmid mediated

(E coli< Klebsiella < Enterobacter etc)

22
Q

Which 4 infection control strategies are used to reduce HAI?

A
  • Reduce number of bugs (i.e. sterilise, washing, etc.)
  • Reduce number of resistance bugs (i.e. screen patients)
  • Prioritise side rooms + reduce transmission of bugs (i.e. for fever + rash in ED; for homeless man with cough and abnormal CXR)
  • Medical education (i.e. hand cleaning technique)

Key strategies:

  1. measure infection
  2. analyse for trends
  3. feedback and alter practice
  4. improve infection control and reduce infection
23
Q

What does this gram stain show?

A

Gram +ve cocci in clusters = MRSA

24
Q

What are the implications of MRSA infection?

A
25
Q

Often patients are colonised and therefore screened for MRSA on admission. How are they decolonised?

A

Chlorhexidine washes

26
Q

Why are HAI becoming more common?

A
  • We do more invasive procedures
  • Prosthetic and implantable devices
  • Obesity
  • Diabetes
  • Extremes of age
  • Immunosuppression
  • Emerging organisms and resistance
27
Q

How is environmental hygiene ensured in hospitals?

A
  • Environmental hygiene and cleaning
  • Control of environmental sources e.g. testing water (Legionella- cooling towers, Pseudomonas- all water)
  • Building works (Aspergillus)
  • Negative pressure isolation- protect others from an infectious patient with airborne infection
  • Positive pressure isolation- protection of transplant patients from organisms outside of the room
28
Q

What % of HAI are preventable?

A

33%

a path 3 (89 decks)

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