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PPS - infections > Nosocomial infections > Flashcards

Nosocomial infections Flashcards

1
Q

What is the prevalence of hospital acquired infections?

A

6.4% prevalence in hospital

Significant burden

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2
Q

What are common organisms responsible for HCAIs?

A

MRSA

MSSA

E. coli

C. difficile

Norovirus, Rotavirus, Sapovirus

VPE

Multi-resistant Gram Negatives

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3
Q

What does MRSA stand for?

A

Methicillin resistant S. aureus

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4
Q

What does MSSA stand for?

A

Methicillin sensitive S. aureus

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5
Q

Why are HCAIs so relevant?

A

Often in the news

Legal firms look for patients who developed HCAIs to seek compensation

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6
Q

Why are HCAIs important?

A

Estimated cost > £1 bn

Increased mortality and morbidity

Poor patient experiments

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7
Q

Why do HCAIs have such high costs?

A

Prolonged hospital stays

Further treatments and procedures

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8
Q

What are examples of HCAIs?

A

Urinary tract infections

Respiratory tract infections

Surgical site infections

Indwelling device infections

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9
Q

In which population are UTIs particularly prevalent?

A

Elder population

May be urinary catheter-associated

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10
Q

What is a way of diagnosing UTIs?

A

White blood cells or bacteria in urine sample

Grow bacteria in culture to see what antibiotic used

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11
Q

What are causes of respiratory infections?

A

May be caused by unusual organisms like Pseudomonas or other gram negative bacteria

May be associated with ventilation - bacteria like to stay in ventilators

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12
Q

What are examples of indwelling devices?

A

Venous and arterial catheters

Prosthetic joints

Cardiac pacemakers and prosthetic valves

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13
Q

What do infections of indwelling devices cause?

A

Local infections

Bacteraemia

Sepsis - venous catheter in major arteries or veins can cause wide spread infections

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14
Q

What are examples of multi-resistant gram negatives?

A

Extended spectrum B-lactamases

Carbapenemase producing Enterobacteriaceae

Multiresistant Pseudomonas spp, and Acinetobacter spp.

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15
Q

Where is MRSA found?

A

Present in 10-20% of population asymptomatically

Mostly in nose and perineum

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16
Q

What does MRSA cause?

A

Bacteraemia

SKin and soft tissue infections - indwelling devices

Endocarditis - infection of the heart valves

Osteomyelitis - infection of bones

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17
Q

Are MRSA rates rising or falling?

A

Falling

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18
Q

What new rule has been implemented regarding MRSA infections?

A

Trust requires all infections to be reported

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19
Q

How can hospitals lower the rates of MRSA infections?

A

Screen patients prior to admission/procedures

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20
Q

Which patients are at higher risk of containing MRSA colonies?

A

Patients that have been in health care setting before

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21
Q

What samples are used to test for MRSA?

A

From the nose or perineum

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22
Q

How are the samples screened to test for MRSA?

A

NAAR

Culture with chromogenic media

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23
Q

What is chromogenic media?

A

Only bacteria that are methicilin resistant can grow on these plates

Will show up pink

Quick and easy

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24
Q

What happens to the patients that are found to be carriers of MRSA?

A

Body washing with specific soaps or detergents

Antibiotics

Alternative antibiotics required to treat infections caused by MRSA

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25
Q

Which viruses cause diahrrea and vomiting?

A

Norovirus

Rotavirus

Sapovirus

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26
Q

How many cases of Norovirus are there in the UK per year?

A

600 000 - 1 000 000 cases annually

Normally self-limiting

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27
Q

What is a characteristic of Norovirus?

A

More common in winter

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28
Q

What is the significance of Norovirus?

A

Responsible for outbreaks and closures of hospital wards

Enormous impact on trust

Adds financial burden to the patients

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29
Q

How are Norovirus, Rotavirus, Sapovirus diagnosed?

A

Clinically by NAAT

Specimen of stool sent to the lab

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30
Q

What is done to patients diagnosed with norovirus/ rotavirus/ sapovirus?

A

Controlled by isolation of infected patients and other strict infection control

31
Q

What are examples of infection control?

A

Hand washing

Barrier nursing - staff wearing gloves and disposable aprons

Restriction of visitors

32
Q

Where are C. difficile normally found?

A

Normal biota

GI bacteria - associated with normal microflora

33
Q

What causes C. difficile to increase in population?

A

Antibiotics

Confers resistance to C. difficile

Other bacteria that normally competes with the bacteria and keep them in low numbers are killed off

34
Q

What are the symptoms of C. difficile?

A

Symptoms range from mild, self-limiting diarrhoea to life-threatening pseudomembranous colitis and toxic megacolon

35
Q

What is pseudomembranous colitis?

A

Inflammation of the colon

Occurs in some people who have taken antibiotics

Almost always associated with an overgrowth of the bacteria

36
Q

What is the treatment of C. difficile infection?

A

Depends on severity

Removal of contributing agents

Use of anti-C. difficile agents

37
Q

What are examples anti-C. difficile agents?

A

Metronidaxole

Vancomycin

Fidaxomicin

38
Q

How is C. difficile diagnosed?

A

Assessment of diarrhoea

WBC

Temperature

Evidence of colitis

Evidence of renal impairment

39
Q

What is used to assess diarrhoea?

A

Bristol stool chart

Record their stool habits

40
Q

What is evidence of colitis?

A

Abdominal tenderness or abnormalities in the abdomen

41
Q

How is stool tested for C. difficile?

A

Two stage algorithm

Two of these 3 tests are used:

  • Glutamate dehydrogenase by ELISA
  • Toxin of C. difficile by ELISA
  • Detect the bacterium by NAAT - molecular method
42
Q

What is ELISA?

A

Enzyme-linked immunosorbent assay

43
Q

What is glutamate dehydrogenase?

A

Produced by organism in the stool sample

Can’t guarantee that C. difficile is creating the toxin

44
Q

What is the positive test for glutamate dehydrogenase?

A

Yellow

45
Q

What are the two main species of VRE seen clinically?

A

E. faecium

E. faecalis

46
Q

How do these bacteria obtain resistance?

A

Many mechanisms

47
Q

Where are these organisms found?

A

In the GI tract

48
Q

What type of organism are VREs?

A

Low pathogenicity organisms

49
Q

What do VREs cause?

A

Opportunistic infections

In patients who are immunocompromised

50
Q

What are common types of infections caused by VREs?

A

Indwelling catheters

Intra-abdominal infections post surgery or translocation from gut

Endocarditis

Joint infections

51
Q

What precautions are taken in hospitals to prevent VREs from causing disease?

A

Patients are screened

To know if they have the organism in the gut

So they can be given different antibiotics if they develop the infection

52
Q

What are ways to identify VREs?

A

Can see hazy growth around vancomycin in antibiotic sensitivity testing

Grow using chromogenic media - purple indicates E. faecium/faecalis

53
Q

What are ESBLs?

A

Externded spectrum beta-lactamases

Enzymes expressed by Gram negative organisms

Inactivate penicillin and cephalosporins

54
Q

What are the main ESBLs which are of biggest concert?

A

Enterobacteriaceae

55
Q

Where are Enterobacteriaceae found?

A

Carried in the GI tract as commensal

56
Q

What do Enterobacteriaceae cause?

A

Infections in the same spectrum as other Enterobacteriaceae

57
Q

What type of infections do Enterobacteriaceae cause?

A

Surgical meningitis

UTI

Intra-abdominal sepsis

58
Q

What is a characteristic of ESBLs?

A

Resistant to large spectrum of

  • beta lactam antibiotics
  • 3rd generation cephaloporins
59
Q

What is used to identify ESBLs?

A

Chromogenic media

NAAT

60
Q

What type of chromogenic media is used to identify ESBLs?

A

Media is selective

Antibiotics used that only ESBLs will grow on

Screen for broad set of resistant profiles

61
Q

What antibiotics are used to treat ESBLs?

A

Carbapenems

Fluoroquinolones

Aminoglycosides

Temocillin

62
Q

What are CPEs?

A

Carbapenemase producing Enterobacteriaceae

Multi-resistant gram negative organisms

Resistant to carbapenem drug family

63
Q

What type of infections do CPEs cause?

A

Urinary tract infections

Abdominal sepsis

64
Q

What type of antibiotics are used to treat CPEs?

A

Treated with other, less effective or toxic antibiotics

Leave with few antibiotic options

65
Q

What have public policy schemes done to prevent CPE infection?

A

Public health england have given guides to screen for, investigate and prevent transmission of these organisms

66
Q

How are CPEs identified?

A

Culture or NAAT

67
Q

What is an example of a culture form to identify CPE?

A

Modified Hodge test

68
Q

Describe the modified Hodge test

A

Control strain that is placed in the agar is sensitive

Test strain obtained from the patient is not resistant to the antibiotics when the zone inhibition is a round shape

If the zone of inhibition has a clover-leaf shape = contains carbopenamase

The resistant genes from the CPE have also been transferred to the E. coli found homogenously in the medium

69
Q

What controls are taken once a patient has been identified with CPE?

A

Patients are screened

Give antibiotics that act on the bacteria

Isolate the infected people in rooms

70
Q

What is done to prevent spread of nosocomial infections?

A

Each trust has a named individual responsible for Infection Prevention and Control

Government targets are put for the number of MRSA, MSSA, E.coli and C, difficile cases

Screening for key organisms

Rotavirus vaccination

Policies and guidelines for best practice

71
Q

What happens if trusts breach the governmental targets of nosocomial infections?

A

Trusts are fined if they breach the targets

72
Q

What are examples of policies and guidelines for best practice to prevent nosocomial infections?

A

Hand washing and environmental cleaning

Isolation of patients with infections

Antimicrobial stewardship

73
Q

What is antimicrobial stewardship?

A

Use appropriate antibiotics

Not receive antibiotics if they don’t need them

PPS - infections (8 decks)

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