OSCE - Equipment - VRE

Question 1

What is VRE

Answer 1

Vancomycin resistant enterococcus

Bacterial strain of Enterococcus

Enterococci are part of normal flora in gut

Some are naturally vanc resistant. Others acquire this resistance by plasmids and transposons

People are colonised in health and disease.

In hospital - contact with hospital/staff, contaminated surfaces, poor handwashing

Question 2

What infections can VRE cause

Answer 2

Catheter related bloodstream infections CRBSI

Wound infection

UTI

Bacteraemia

Question 3

Management of a new VRE

Answer 3

Identify the source and control it.
Abx
Isolate the patient.

Treat the source - could is be an infected line, valve? Wound?

Abx - linezolid

Also - daptomycin, tigecycline, teicoplanin

Prevention strategies - isolation, hand washing, barrier nursing, sofap and water

Question 4

What is a CRBSI and a CLASBI

Answer 4

CRBSI - Catheter Related
CLASBI - Central line ASSOICATED

CRBSI - blood stream infection attributed to IV line
CLASBI - blood stream infection who had a central line within a 48 hour period before the infection

CRBSI - determined by quant culture of catheter tip.
OR by differences in growth between tip and peripheral blood

Question 5

Identifying CRBSI

Answer 5

Clinical suspicions - spiking temps where chest/urine etc ruled out
Site infectionm, VIP

Lab - raised inflammatory marker, positive cultures
Positive tip cultures

Paired cultures with CVC is 5:1 versus peripheral

OR

Non quant - CVC tip tests positive 2 hours prior to paired peripheral

Question 6

Management of CRBSI

Answer 6

REMOVE THE LINE

Empirical Abx - usually MRSA

Question 7

Prevention of CRBSI

Answer 7

Bundles
Surveillance
Early removal once they aren’t needed

Question 8

What’s in a bundle

Answer 8

Strict aseptic insertion
2% chlorhex
Avoid the femoral site

Question 9

What’s in a central line to prevent CRBSI

Answer 9

Anti-biotic impregnated catheter e.g rifampicin

Silver/chlorhex