Perioperative Prevention and Control of Infection

Question 1

What are the common types of hospital acquired infections?

Answer 1

Catheter-associated UTIs

Surgical site infections

Pneumonia

Clostridium difficile

Septicaemia

Question 2

How do catheter associated UTIs occur?

Answer 2

Skin where catheter was placed is dirty

Organisms from environment travel along the tubes into the bladder. Organisms can also arrive from hand or glove touching the catheter.

Question 3

How common are surgical site infections?

Answer 3

In Aus, infection of surgical site occurs in ~3% of surgical procedures.

Question 4

How long after surgeries do infections arise?

Answer 4

Infections occur up to 30 - 90 days after surgery and affecting either the incision or deep tissue at the operation site.

Question 5

What are the signs of surgical site infections?

Answer 5

Signs of systemic and local inflammation.

Question 6

What is hospital acquired pneumonia caused by? What are the issues caused by it?

Answer 6

Common nosocomial bacterial infection that is common in medical and surgical ICUs and significantly adds to the cost of hospital care and to the length of hospital stay.

Question 7

What causes clostridium difficile infection?

Answer 7

Disruption of normal microbiome due to antibiotics causing the pathogenic bacteria to increase in numbers.

C. difficile can also be transmitted from person to person.

Question 8

What are the symptoms of C. Difficile infection?

Answer 8

Diarrhoea

Stomach pain

Fever

Can be fatal

Question 9

What causes septicaemia?

Answer 9

Bacterial infection elsewhere in the body such as lungs or skin enters the blood stream and so gets spread to the entire body,

Question 10

What are the adverse outcomes of septicaemia

Answer 10

Septicaemia can quickly become life threatening

Question 11

What is the chain of infection?

Answer 11

Infection agent -> Reservoir -> Exit -> transmission -> Entry -> Susceptible host -> Infection agent

Question 12

What intervention can be done at the infectious agent stage of the chain of infection?

Answer 12

Rapid, accurate identification of organisms. (bacteria, fungi, viruses, ricketssiae, and protozoa)

Question 13

What intervention can be done at the reservoir stage of the chain of infection?

Answer 13

Employee health programs

Environmental sanitation

Disinfection/sterilization

Question 14

What are the common reservoirs of infection?

Answer 14

People

Equipment

Water

Question 15

What are the portals of exit?

Answer 15

Excretions

Secretions

Skin

Droplets

Question 16

How can we intervene with the exit stage of the chain of infection?

Answer 16

• Proper attire
• Handwashing

• Control of excretions and
secretions

• Trash and waste disposal

Question 17

What are the means of transmission of infection?

Answer 17

Direct contact

Formites

Ingestion

Airborne

Question 18

What are the interventions that can be done at the transmission stage of the chain of infection?

Answer 18

Isolation

Food handling

Air flow control

Question 19

What are the portals of entry of infection?

Answer 19

Mucous membrane

Gastrointestinal tract

Respiratory tract

Broken skin

Question 20

What are the interventions that can be put in place to control infection at the entry stage of the chain of infection?

Answer 20

Aseptic technique

Catheter care

Wound care

Question 21

What are the factors that make a host susceptible?

Answer 21

Immunosuppression

Diabetes

Surgery

Burns

Cardiopulmonary

Question 22

What interventions can be done at the susceptible host stage of the chain of infection?

Answer 22

Treatment of underlying
diseases

Recognition of high-risk
patients

Question 23

What kinds of infections are caused by staph aureus?

Answer 23

Abscesses

Wounds

UTIs

Septicaemia

Question 24

What kinds of infections are caused by E. Coli?

Answer 24

UTIs

Wound infections

Question 25

What kinds of infections are caused by neisseria meningitidis?

Answer 25

Meningitis

Septicaemia

Question 26

WhIch bacteria that can cause infection are commonly located in the GI tract?

Answer 26

E. coli

C. difficile

Question 27

WhIch bacteria that can cause infection are commonly located in the nasopharynx?

Answer 27

Staph aureus

Neisseria meningitidis

Question 28

How can Infection be prevented and controlled?

Answer 28

Personal protective equipment (PPE)

Hand washing

Surgical scrub

Skin preparation of patient

Maintaining sterile field

Safe operating practice

Question 29

How can skin be prepared for surgery?

Answer 29

Antiseptics (eg chlorhexidine or povidone-iodine applied to surgical site prior to incision)

Question 30

How is waste managed?

Answer 30

Clinical waste is segregated from household wasted to ensure its correct handling, transportation and disposal, to protect staff, patients, the public and the environment

Question 31

What are the risks associated with handling sharps?

Answer 31

Sharps include needles, bone fragments, blades, sutures

Risk of sharps injury during invasive and surgical procedures

Risk of transmission of blood borne pathogen following a
sharps injury in unimmunized healthcare worker
- Hepatitis B 1:3
- Hepatitis C 1:30
- HIV 1: 300

Question 32

What considerations must be taken with prophylactic use of antibiotics?

Answer 32

Timing and dose

Choice of AB

Carriage of resistant organsims and prophylaxis

Prophylaxis for immunosuppressed patients

Question 33

What is the aim of prophylactic antibiotics?

Answer 33

AB prophylaxis aims to prevent infection by achieving high concentrations of antibiotic during surgery.

Question 34

How is antibiotic chosen?

Answer 34

Must cover likely pathogen

Single dose must be enough to cover likely pathogens

Question 35

What should be done if the patient has multi-resistant bacteria or immunocompromised?

Answer 35

The antibiotic choice may need to be modified and expert advice should be sought