Nosocomial Infections Flashcards
what are nosocmial infections also known as?
healthcare associated infections or hospital acquired infections
what are hospital acquired infections?
infections which are acquired by patients during hospitalisation
when should an infection be considered hospital acquired?
within 48 hours of hospitalisation or within 30 days of discharge
what are common hospital acquired infections?
UTI pneumonia bloodstream infection SSIs infectious diarrhoea
how many infections has it been suggested that are preventable through infection control measures?
10-70%
what are 5 costs of hospital acquired infection?
client dissatisfaction longer hospitalisation (possibly at cost to practice) Higher morbidity rates Multidrug resistance transmission to humans
what are 6 potential routes of infection?
urinary catheters surgery IV catheters indwelling implants/devices feeding tubes contaminated kennels and equipment
what are the 2 types of urinary catheter?
indwelling or repeat placement
what is an example of an indwelling device/implant?
drains
What patients are more at risk of hospital acquired infection?
elderly young immunocompromised those with endocrine conditions (diabetes/cushings) those with multiple indwelling devices
what are UTIs gained from?
use of urinary catheters either repeated placement for samples or emptying the bladder.
Poor hygiene when placing/managing an indwelling urinary catheter
what must always done before any procedure involving urinary catheter?
hand wash
should sterile gloves be used for placing a catheter?
yes for both indwelling and temporary
why should the vulva/prepuce be cleaned with dilute iodine prior to catheter placement?
mucous membranes so very sensitive but must be clean before catheter can be placed
what system should be used if an indwelling catheter is used?
closed - collection bag attached to the catheter at all times
to avoid UTI, what should be avoided where possible?
catheterisation or repeated catheterisation
when should antibiotics only be given to patients with a catheter?
if they are showing outward signs of of UTI - to reduce antibiotic resistance
what are the signs of a UTI?
pyrexia, change in urine colour, blood in urine
why is pneumonia less common in animals than in humans?
lesser use of mechanical ventilation and less totally recumbent patients
what can animals get pneumonia from?
endotracheal tubes or anesthetic circuits
what can be done to reduce the risk of pneumonia from endotracheal tubes or anesthetic circuits?
SOP for cleaning of ET tubes must be followed
heavily soiled ET tubes and circuits should be disposed of
in what type of animal is aspiration pneumonia a problem?
small animals
what causes aspiration pneumonia?
contents of regurgitation/vomit are inhaled
how can aspiration pneumonia be avoided?
starve patients before procedures requiring sedation or GA
secure airway ASAP once patient is under GA
how can a patient be managed during GA induction if they are at high risk for aspiration pneumonia?
head is kept raised until ET tube is correctly placed with cuff inflated
what are bloodstream infections associated with?
IV catheters, either peripheral or central
what are bloodstream infections mainly due to?
poor skin prep, lack of hand hygiene and contamination of products used
when should hands be washed during an IV placement?
before and after placement
how can bloodstream infections be avoided?
use sterile equipment
take care when using refillable skin prep bottles
avoid repeated IV catheter changes
when should an IV catheter be removed?
as soon as is practical
what should happen if an infection is suspected at IV site?
send catheter tip to the lab for culture
what should happen to the IV catheter sight after removal of IV?
covered
what can surgical sight infections range from?
superficial to affecting whole organs
how can surgical site infections be avoided?
adequate skin preparation techniques adequate preparation of personnel good theatre practice covering of surgical wounds as soon as possible post operatively identification of at risk patients
for how long after surgery should the wound remain covered ideally?
24-48 hours
what must be considered when preparing skin for a surgical procedure?
should be clipped once patient is under GA
correct dilation of disinfectant should be used
when may a patient be clipped prior to GA?
when the length of GA is more dangerous to health than the infection risk of clipping prior to surgery
how can infectious diarrhoea be prevented?
hand hygiene
thorough disinfection and cleaning of accommodation/equipment between cases
regular deep cleaning of facilities
what should be limited on the ward if there is an outbreak?
limit transport in and out of the ward until cases have ceased (48 hours post last symptoms seen)
define infection control
the use of procedures and techniques in the surveillance, investigation and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections
what are the main methods of reducing infection?
questions and information gained during the initial telephone conversation
thorough cleaning of accommodation an equipment in between patients using correct disinfectants at correct dilutions
correct disposal of bodily fluids and wastes
handwashing
barrier nursing where appropriate
infection control team with one person in charge
monitoring of any infections
education of the veterinary team
if the patient has a suspected infection what measures should be taken before they arrive at practice?
attempt to keep the animal outside to avoid spending any time in the waiting room and potential infection of others
what is the single most effective line of defence against HAIs?
handwashing
what handwashing technique is the most effective?
WHO 6 steps
what are the 5 moments for hand hygiene?
before touching a patient after touching a patient after contact with patients surroundings if hands become visibly soiled before carrying out an aseptic technique
can alcohol hand rubs be used?
yes
can alcohol hand rubs be used if hands are soiled?
no, hands must be washed with hand soap
where should animals be housed if they have poor immune status, are very young, very old or unvaccinated?
usual ward area but nurse before other patients (reverse barrier nursing)
where should animals be housed if they are vaccinated and systemically well?
on normal wards
what is reverse barrier nursing?
nursing to protect the compromised patient from others rather than protecting others from that patient. This animal is always nursed first rather than last
where should animals be housed if they have mild infectious disease, prolonged antibiotic use or draining wounds?
either within wards or isolation. If housed on wards then tape off a section in front of the kennel and nurse patients last wearing appropriate PPE.
what extra needs do animals have if they have mild infectious disease, prolonged antibiotic use or draining wounds?
own equipment and clinical waste bin
Where should patients with mild infectious disease, prolonged antibiotic use or draining wounds be housed if there is an immunosuppressed patient on the ward?
they should be isolated rather than risking the immunosuppressed patient
where should animals be housed if they have severe infections or are highly contagious?
isolation with a dedicated nurse
how far away from other patients should isolation facilities be?
at least 5 metres
what should be used to avoid movement of contaminated equipment?
disposable items wherever possible
where should the PPE be located in the isolation area?
at the entrance so ward doesn’t have to be crossed without PPE on
what is the main characteristic of many pathogens implicated in HAIs?
opportunistic - exist normally within the animal but only become problematic when animal is below par
when should multi resistant infection be suspected?
if patient is not responding to antibiotics or if they have significant risk factors
what should be done to determine what bacteria are present so they can be treated appropriately?
culture and sensitivity tests
how can multi resistant infections be avoided?
careful antibiotic use (not an alternative to good hygiene) hand hygiene education of veterinary team clinical audits reporting of incidences
what is MRSA?
methicillin resistant Staphylococcus aureus
what does MRSA infection result in?
non- healing wounds and skin lesions. Can lead to sepsis and death
what is diagnosis of MRSA based on?
swabs/tissue samples
how should suspected MRSA patients be treated?
as diagnosed: strict barrier nursing in isolation facility with limited hospital movement (moved on a trolley if movement required)
how should diagnosed MRSA patients be treated?
strict barrier nursing in isolation facility with limited hospital movement (moved on a trolley if movement required)
which staff members should not nurse MRSA patients?
those with immunosuppression and skin lesions
what happens during infection surveillance?
one staff member assigned
monitoring incidences of infections
investigation of trends
implementation of changes (and review of these changes)
what can be done to increase infection control compliance?
plenty of hand-washing facilities
hand-washing literature (where and how)
regular audits of SOPs and staff compliance
bare below the elbows policy
