MISC - Healthcare associated infections

Question 1

Contact transmission

• examples
• 2 types

Answer 1

Direct: person to person
e.g. Scabies, herpes simplex

Indirect: via contaminated intermediate object or person
E.g. MRSA, VRE, influenza, norovirus

Question 2

Droplet transmission

• size
• how is it generated
• examples

Answer 2

–>5 μm
–Generated by coughing, sneezing
–Drop to ground by about 1m

Examples: influenza, pertussis, SARS, Neisseria meningitidis, rhinovirus

Question 3

(4) Who are susceptible to infection?

Answer 3

•Old and young age
•Diabetes, immune compromise, other medical conditions
•Intensive care
•Breech in 1st line defences
–Devices, IV lines, urinary catheters, endotracheal tube, drain tube
–Procedures eg surgery
–Antimicrobial therapy

Question 4

What is MRSA resistant to?

Answer 4

All penicillins & cephalosporins available in Australia

Question 5

What ABx do you give to cover ventilator-associated pneumonia?

Answer 5

IV vancomycin plus several courses of other antibiotics (piperacillin/tazobactam, meropenem, ciprofloxacin)

Question 6

Compare colonisation vs. infection

Answer 6

•Colonisation
–Growth of an organism somewhere in the body WITHOUT causing any clinical illness
–Predisposes person to developing infection
–Can be transmitted to other patients

•Infection
–Growth of an organism causing a clinical illness

I.e. Do not need to treat colonisation

Question 7

What is VRE?

• primary mode of spread
• where is it affected
• Environmental Mx

Answer 7

= vancomycin resistant enterococcus
•Primary mode of spread
–Contaminated hands of healthcare workers
–Environment also important
•Primarily colonises gastrointestinal tract
•Use contact precautions and single rooms

Question 8

What is Multiresistant Gram negative bacilli?

• examples
• resistance against which ABx
• where does it occur

Answer 8

E.g. Klebsiella, Acinetobacter, Enterobacter, Pseudomonas
•Some resistant to all available antibiotics
•Occurring in community, returned travellers
–Eg New Dehli metallo-beta-lactamase in water in India

Question 9

Discuss clostridium difficile in terms of its association with antibiotic use

Answer 9

Due to prolonged use of ABx; fluoroquinolones, cephalosporins, carbapenems, and clindamycin

•Causes diarrhoea ↔ pseudomembanous colitis ↔ toxic megacolon
•Resurgence in recent years
–Major outbreaks in Canada, Europe, US
•Hypervirulent strains
–Increased morbidity and mortality
•More common than MRSA in some places

Question 10

What are the (6) main types/sites of healthcare associated infections?

Answer 10

•Surgical site infection
•Intravascular line associated infection
–Peripheral IV line
–Central line
•Nosocomial pneumonia
–Ventilator associated pneumonia
•Catheter associated urinary tract infection
•Prosthetic joint infection
•Diarrhoea

Question 11

Norovirus

• what system does it affect
• how does it spread

Answer 11

Causes gastroenteritis outbreaks
–Hospitals, nursing homes, rehab facilities, cruise ships, schools etc

•Very contagious
•Spread from person to person
–Through contaminated food or water
–By touching contaminated surfaces
–Via droplets from vomitus

Question 12

How (6) can you prevent hospital associated infections?

Answer 12

–Hand hygiene
–Antibiotic stewardship (systematic approach to using antibiotics prudently)
–Transmission precautions
–Bundles
–Environmental cleaning
–Antibiotic prophylaxis