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Year 3 - Infection > Outbreak > Flashcards

Outbreak Flashcards

1
Q

What is a Healthcare Associate Infection?

A

An infection one might get from a healthcare setting: hospitals, care homes, doctors’ surgeries, health centres or receiving care at home

Most common types: UTI, infections following surgery, skin infections, sickness and diarrhoea

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2
Q

What is a hospital acquired infection?

A

Generally an infection acquired after being in hospital for more than 48 hours or within 48hrs of discharge

This is dependant on the organisms incubation period

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3
Q

Most common causes of hospital acquired infections?

A
  • UTI = 22%
  • Surgical site = 18.6%
  • Respiratory = 17.5%
  • Bloodstream = 10.8%
  • GI = 6.8%
  • Skin and soft tissue = 4%
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4
Q

What is the most common cause of a hospital acquired UTI?

A

Catheterisation

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5
Q

What is the most common cause of a hospital acquired respiratory tract infection?

A

Intubation accounts for almost a 1/4 of these

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6
Q

What is the most common cause of a hospital acquired bloodstream infections?

A

Many Central Venous Catheter related

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7
Q

What is the definition of an outbreak?

A

An outbreak of an infection is defined as 2 or more cases of an infection linked in time and place

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8
Q

What is the purpose of IPCT and surveillance?

A

1) Prevent individual infections, as well as outbreaks

2) Detect and identify possible outbreaks at the earliest opportunity

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9
Q

What is the “chain of infection”?

A

1) Portal of entry
2) Susceptible host
3) Infectious agent
4) Reservoir
5) Portal of Exit
6) Mode of transmission

Start again:
1) Portal of entry
2) Susceptible host
etc

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10
Q

What are examples of infectious agent classes in the “chain of infection”?

A

Bacteria
Virus
Fungi
Prions

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11
Q

What are examples of reservoirsin the “chain of infection”?

A 
Humans
Equipment
Environment 
Food 
Animals
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12
Q

What are examples of portal of exit in the “chain of infection”?

A
  • Blood and body fluids
  • Skin scales/wound
  • Coughing and sneezing
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13
Q

What are examples of mode of transmission in the “chain of infection”?

A
  • Direct or indirect
  • Inhalation
  • Ingestion of contaminated food
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14
Q

What are examples of portal of entry in the “chain of infection”?

A
  • Skin/surgical wound
  • Eyes
  • Mouth
  • Respiratory tract
  • Intestinal tract
  • Tubes
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15
Q

What are examples of susceptible hosts in the “chain of infection”?

A
  • Underdeveloped immune system
  • Decreasing immune system
  • Drugs
  • Diseases
  • Tubes
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16
Q

How can you break the chain of infection in terms of: Contact, ingestion or inhalation?

A
  • Hand hygiene
  • Personal protective equipment
  • Food safety
  • Cleaning, disinfection and sterilisation
  • Isolation
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17
Q

When should hand hygiene be implemented?

A

1) Before touching a patient
2) Before clean/aseptic procedure
3) After touching a patient
4) After exposure to body fluids risk
5) After touching patients surroundings

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18
Q

How can you break the chain of infection in terms of reservoirs: humans, equipment, animals, soil, water etc?

A
  • Cleaning, disinfection and sterilisation
  • Infection prevention policies
  • Pest control
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19
Q

How can you break the chain of infection in terms of portal of entry: broken skin/incision, respiratory tract, mucous membranes, catheters and tubes?

A
  • Hand hygiene
  • Personal protective equipment
  • Personal hygiene
  • First aid
  • Removal of catheters and tubes
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20
Q

What percentage of HAI are SSI?

A

15.9%

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21
Q

What percentage of acute adult inpatients have a SSI?

A

0.8%

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22
Q

What is the median age of an SSI?

A

63 years

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23
Q

What is the most common event leading to a SSI?

A

Surgery (80.5%) - Most commonly general surgery (40.4%)

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24
Q

What is the most common causative agents of an SSI?

A

1) S aureus = 23.9%
2) E coli = 14.1%
3) Anaerobes = 8.5%
4) Other = 53.5%

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25
Q

What percentage of those with SSI have life limiting or end of life prognosis?

A

28.7%

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26
Q

What are the most common prescribed antimicrobials used to treat SSIs?

A
  • Flucloxacillin

- Vancomycin

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27
Q

What are the most common prescribed antimicrobials used to prevent SSIs?

A
  • Gentamicin
  • Cefuroxime
  • Co-amoxiclav
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28
Q

What percentage of antimicrobials were prescribed to treat SSIs?

A

3.2%

29
Q

What are SSIs most likely to lead to ?

A

Deep tissue or organ space infection - 52.8%

30
Q

How can you break the chain of infection in terms of susceptible hosts?

A
  • Immunisation
  • Treatment of the underlying disease
  • Health insurance
  • Patient education
31
Q

How can you break the chain of infection in terms of portal of exit?

A
  • Hand hygiene
  • Personal protective equipment
  • Control of aerosols and splatter
  • Respiratory etiquette
  • Waste disposal
32
Q

How can you break the chain of infection in terms of transmission based precautions - Contact?

A

1) Hand hygiene before entering room
2) Personal protective clothing
- Gloves
- Apron
3) Keep door closed
4) Before leaving:
- Decontaminate equipment
- Discard gloves/apron in appropriate waste bins
- Decontaminate hands

33
Q

How can you break the chain of infection in terms of mode of transmission?

A
  • Hand hygiene
  • Personal protective equipment
  • Food safety
  • Cleaning, disinfection and sterilisation
  • Isolation
34
Q

How can you break the chain of infection in terms of transmission based precautions - Droplet?

A

1) Hand hygiene before entering room
2) Personal protective clothing, before entering:
- Gloves
- Apron
- Fluid resistant surgical mask
- Eye/facial protection
3) Keep door closed
4) Before leaving:
- Decontaminate equipment
- Discard protective clothing in appropriate waste bins
- Decontaminate hands

35
Q

How can you break the chain of infection in terms of infectious agent?

A
  • Early diagnosis and treatment

- Antimicrobial stewardship

36
Q

How can you break the chain of infection in terms of transmission based precautions - airborne?

A

1) Hand hygiene before entering room
2) Personal protective clothing, before entering:
- Gloves
- Apron
- FFP3 respirator
- Eye/facial protection
3) Keep door closed
4) Before leaving:
- Decontaminate equipment
- Discard gloves, apron/gown and eye/facial protection in appropriate waste bins
- Decontaminate hands
5) After leaving:
- Remove FFP3 respirator and discard in appropriate waste bin
- Decontaminate hands

37
Q

What is a droplet?

A
  • > 5um
  • Spread assumed to be about 1 metre
  • Drop to ground
38
Q

What is an aerosol?

A
  • <5um
  • Much more widespread than a droplet
  • Remain suspended in the air
39
Q

What type of infection are more highly transmissible?

A

Airborne spread infection are more highly transmissible and therefore require different precautions

40
Q

What is the limit to the human eye in visibly seeing a droplet?

A

40um

41
Q

What is cleaning?

A

Physical removal of organic material and decrease in microbial load

42
Q

What is disinfection?

A

Large reduction in microbe numbers - spore may remain

43
Q

What is sterilisation?

A

Removal/destruction of ALL microbes and spores

44
Q

What are low risk in terms of HAI and what precaution is used?

A

Low risk = Intact skin contact e.g. stethoscope, cots, mattresses

Precautions = Cleaning compatible with manufacturers instructions

45
Q

What are medium risk in terms of HAI and what precaution is used?

A

Medium risk = Mucous membrane contact e.g. bedpans, vaginal specula, endoscopes

Precautions = Disinfection or sterilisation If possible

46
Q

What are high risk in terms of HAI and what precaution is used?

A

High risk = Surgical instruments

Precautions = Sterilisation

47
Q

Important things to follow during cleaning??

A
  • Follow manufacturer’s instruction
  • Detergent and water
  • Drying is important!
  • Cleaning is essential prior to disinfection or sterilisation
48
Q

Methods of disinfection?

A

1) Heat:
- Pasteurisation e.g. bedpans, linen, dishwashers
- Boiling e.g. vaginal specula, ear syringes

2) Chemical
- Chemicals vary in their organism activity range
- Needs to be equipment compatible
- Examples = Alcohol, chlorhexidine, hydrochlorites, hydrogen peroxide

49
Q

Methods of sterilisation?

A
  • Steam under pressure = Autoclave
  • Hot air oven
  • Gas (Ethylene dioxide)
  • Iodising radiation
50
Q

What are the important aspect of surveillance in infection?

A

Local:

  • Laboratory based
  • Ward/clinical area based

National surveillance

All healthcare workers

51
Q

Approx how many bacteria cells to every human cell in the body?

A

10

52
Q

How many bacteria in the human body?

A

10^14 in an adult human

53
Q

How many different species of bacteria have been isolated from human stool?

A

500 different species of bacteria

54
Q

Examples of outbreaks?

A
  • MRSA
  • MSSA
  • Clostridium difficile
  • Surgical site infections
  • E coli
55
Q

Colonisation versus infection example, S aureus?

A

Approx 30% of the population are colonised with S aureus in their nose yet do not have infection

56
Q

How can S aureus go from colonisation infection?

A

S aureus acts as an opportunistic bacteria and will cause in infection if there is:

  • Break in the skin
  • Vascular device
  • Catheter
  • Ventilation
57
Q

Which microbial factors can encourage infection over colonisation?

A

Increased:

  • Resistance
  • Virulence
  • Transmissability
  • Increased survival ability
  • Ability to evade host defences
58
Q

Which host factors can encourage infection over colonisation?

A
  • Devices: PVC, CVC, Urinary catheter, Ventilation
  • Antibiotics
  • Break in skin surface
  • Foreign body
  • Immunosuppression
  • Gastric acid suppression
  • Age extremes
  • Overcrowding
  • Increased opportunity for transmission e.g. Interventions, - Bad hand hygiene!!!
59
Q

What is the effect of a silk suture presence in terms of infection risk?

A

Drastically increases the risk, demonstrated by Elek and Conon, 1957 - SA inoculated into foreman’s of medical students:

  • 6.5 million bacteria required to cause infection without suture
  • Only 100 bacteria required when silk suture was present
60
Q

Examples of bacteria that take advantage of direct contact?

A

Staphylococcus aureus

Coliforms

61
Q

Examples of bacteria that take advantage of Respiratory/droplets?

A

Neisseria meningitides

Mycobacteria tuberculosis

62
Q

Examples of bacteria that take advantage of faecal-oral route?

A

Clostridium difficile

Salmonella sp.

63
Q

Examples of bacteria that take advantage of penetrating injuries?

A

Group A Streptococcus

Bloodborne viruses

64
Q

Which typing methods may be used in identifying the cause of an outbreak?

A
  • Antibiogram (Antibiotic sensitivity pattern)
  • Phage typing (e.g. S aureus)
  • Pyocin typing(Pseudomonas)
  • Serotyping (Salmonella, Pseudomonas)
  • Molecular typing (DNA typing)
65
Q

What control measures can be used to halt an outbreak?

A
  • Single room isolation
  • Cohorting of cases
  • Clinical area/ward clousre
  • Re-infrocement of IPC measures
  • Staff exclusion (e.g. colonised staff in case of MRSA; non-immune staff in case of VZC, measles etc)
  • Staff decolonisation or other measures
66
Q

Characteristics of C difficile?

A
  • Diarrhoea
  • Faeces have a characteristics odour
  • May have abdominal pain, pyrexia, raised WBC
  • Pseudomembranous colitis
67
Q

Testing C difficile?

A

Positive toxin tes - although this does not always mean disease

68
Q

How to treat C difficile?

A

1) Oral metronidazole
2) If severe or does not respond to metronidazole –> Oral vancomycin
3) Oral fidaxomicin if 2nd episode

Year 3 - Infection (16 decks)

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