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Semester 3 - Infection > Session 4 - Healthcare acquired infection > Flashcards

Session 4 - Healthcare acquired infection Flashcards

1
Q

Define healthcare infection

A

• Infections arising as a consequence of providing healthcare

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2
Q

How do we know if an infection is hospital derived?

A
  • Neither present or incubating at time of admission

* Means onset is at least 48 hours after admission

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3
Q

What groups of people can receive healthcare infections?

A
  • Hospital visitors
  • Healthcare workers
  • Patients
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4
Q

What are the 4 Ps of infection prevention and control

A
  • Patient
  • Pathogen
  • Practice
  • Place
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5
Q

What general factors render a patient susceptible to HCAIs

A 
• General and specific risk factors for infection
• Interactions with 
	○ Other patients
	○ Healthcare workers
	○ Visitors
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6
Q

What factors effect pathogen infection?

A
  • Virulence factors
  • Ecological interaction
    ○ Other bacteria
  • Antibiotics/disinfectants
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7
Q

Give five practices which aid prevention and control of infection

A

• General and specific activities of healthcare workers
• Policies and their implementation
• Organisational structure and engagement
• Regional and national political initiatives
Leadership at all levels from government to ward

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8
Q

What two factors in place effect prevention and control

A
  • Where are we delivering healthcare and how?
  • Fixed features - Single rooms -> Nightingale wards
  • Variable features
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9
Q

What is the prevalence of healthcare infections?

A

• 8%

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10
Q

Give three reasons why healthcare infections are important

A
  • Impact on health
  • Impact on healthcare organisations
  • Preventable - 40/50%
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11
Q

What is the most common type of HCAI?

A

• Gastrointestinal

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12
Q

Give four types of viral HCAI’s

A
  • Blood borne virus (Hep B, C, HIV)
  • Norovirus
  • Influenza
  • Chicken pox
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13
Q

Give three types of bacterial HCAI’s

A
  • Staph aureus (MRSA/MSSA)
  • Clostridium difficile
  • Escherichia coli
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14
Q

Give two types of fungi which cause HCAIs

A
  • Candida albicans

* Aspergillus species

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15
Q

Give a parasite which can HCAIs

A

• Malaria

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16
Q

How does antibiotic resistance come about?

A
  • Overuse of antibiotics
  • Courses of antibiotics not completed
  • Selective pressure on antibiotic resistant bacterium
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17
Q

Give three ways in which genes can be transferred from one bacterium to another

A
  • Conjugation
  • Transduction
  • Transformation
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18
Q

What is conjugation of bacterium?

A

• Transfer of genes between two bacterium via a pilus

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19
Q

Give five ways in which bacteria can become resistant to an antibiotic or drug

A 
• High rate of division
• Decreased influx
• Increased efflux
• Increased transcription of target
- Altered target
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20
Q

How does a high rate of division predispose bacteria to antibiotic resistance?

A

High rate of division in both bacteria and cancer cells means that there is a higher rate of mutation.
Positive mutations, such as drug resistance will be positively selected for and breed a population of drug resistant cells.

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21
Q

How does decreased influx in bacteria cause them to become drug resistant?

A
  • Some drugs need to be taken up by target cells to take effect (rifampicin)
  • Reduced expression of carrier protein reduces effect of antibiotic on bacteria
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22
Q

How does increased efflux work?

A
  • Upregulation of multi-drug resistant protein 1

* Efflux of anti-biotics from cell

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23
Q

How does increased transcription of target in bacteria increase AB resistance?

A

• If drug targets a specific target (ribosome/enzyme) cell can acquire resistance by increasing the transcription of target

24
Q

How does having an altered target increase drug resistance

A

• Specific target of drug acquired a mutation, lowering affinity of drug for it

25
Q

Give four general patient interventions to prevent infection

A 
• Optimise patient's condition 
	○ Smoking, nutrition, diabetes
• Anti-microbial prophylaxis
• Skin preparation
• Hand hygiene
26
Q

Give three specific interventions used to prevent infection

A
  • MRSA screening
  • Mupicorin nasal ointment
  • Disifectant body wash
27
Q

Give two ways to prevent patient -> patient transmission

A
  • Isolation of infected patients

* Protection of susceptible patients

28
Q

Give two factors which can stop healthcare workers spreading disease

A 
• Healthy 
	○ Disease free 
	○ Vaccinated
• Good practice
	○ Good clinical technique
	○ Hand hygiene
	○ PPE 
	○ Antimicrobial prescribing
29
Q

Give an environmental intervention to prevent infection

A 
• Cleaning 
	○ Disinfectants
	○ Steam cleaning 
	○ Hydrogen peroxide vapour
• Medical devices
	○ Single use equipment
	○ Sterilisation 
	○ Decontamination
• Good food hygiene
	○ Appropriate kitchen and ward food facilities
30
Q

How does bed positioning effect HAI?

A

• Bed too close together will cause disease spread

31
Q

What is puerperal fever caused by?

A

• Streptococcus pyogenes

32
Q

Outline two opportunities to prevent infection

A
  • Prevent patients with a pathogen from passing on

* Prevent the pathogen existing

33
Q

Give five factors which can make a patient susceptible to HCAI

A
  • Extremes of age
  • Obesity/malnourished
  • Diabetes
  • Cancer
  • Smoker
34
Q

What two types of patient are likely to get HCAI’s?

A
  • Surgical patient

* Emergency admissions

35
Q

What is the use of personal protective equipment?

A

• Protects health professional’s and the patient

36
Q

Give three examples of personal protective equipment

A
  • Gowns
  • Gloves
  • Masks
37
Q

What is a spore?

A

• A resistant form of C.diff which can withstand many environmental extremes

38
Q

Why are only certain disinfectants used to treat C.diff?

A

• Some facilitate the dispersal of spores

39
Q

Give the classification (Shape, gram stain and anaerobic/aerobic) of C.diff

A
  • Rod shaped
  • Gram positive
  • Anaerobic
40
Q

How does C.diff cause disease?

A
  • Normal part of gut flora
  • Anti-microbial treatment can suppress more predominate species, allowing C.diff to proliferate
  • Releases toxins which cause various symptoms
41
Q

What are the two toxins secreted by C.diff?

A
  • Toxin A

* Toxin B

42
Q

What does toxin A produced by C.diff do?

A
  • Enterotoxin
  • Causes excessive fluid secretion
  • Stimulates inflammatory response
  • Cytopathic effect on some tissues
43
Q

What does toxin B produced by C.diff do?

A
  • Cytoxin
  • Disrupts protein synthesis
  • Causes disorganisation of cytoskeleton
44
Q

What are the three key symptoms of C.diff infection?

A
  • Diarrhoea
  • High temperature
  • Painful abdominal cramps
45
Q

Give the three drugs most commonly implicated in C.diff

A
  • Clidamycin
  • Ampicillin
  • Cephalosporins
46
Q

A patient comes into the emergency department with a suspected C.diff infection. What investigations can you perform to confirm?

A
  • Stool sample

* Enzyme immunoassays for toxins A and B

47
Q

How do you treat a C.diff infection?

A

• Discontinuance of the pre-disposing drug
• Oral administration of vancomycin
Reconstitution of colonic flora

48
Q

Give three of the main clostridia and the diseases they cause

A 
• Clostridium perfingens 
	○ Gas gangrene
• Clostridium botulism
	○ Botulism/neurotoxin
• Colstridium tetani
	○ Tetanus/anaerobic
49
Q 
How is the severity of C.diff infection assessed?
Clinical 
Laboratory
Endoscopic 
Radiological
A

• Clinical: sepsis or temp >38.3
• Laboratory:albumin < 25g/l, WBC > 15 x 109/L, elevated creatinine (>50% above baseline)
• Endoscopic:signs of severe colitis or pseudomembranous colitis
Radiological:evidence of severe colitis

50
Q

What different antibiotics are advised for treatment of C.diff?

A
  • Metrodinazole for non-septic cases

* Vancomycin for serious infection

51
Q

Give the classification (Shape, gram stain and anaerobic/aerobic) of Staphylcoccus Aureus

A
  • Oval
  • Gram positive
  • Anaerobic
52
Q

How does Staphylcoccus Aureus cause disease?

A

• May enter skin or respiratory tract
• Causes inflammation - swelling, pus and necrosis
Pus filled abscess occurs

53
Q

Give three possible conditions caused directly by Staphylococcus Aureus

A
  • Skin infections
  • Acute endocarditis
  • Pneumonia
54
Q

Give three conditions caused by toxins produced by Staph Aureus

A
  • Toxic shock syndrome
  • Gastroenteritis
  • Scalded skin syndrome
55
Q

How is Staph Aureus associated with hospital infections?

A
  • Surgical wounds

* Catheters

56
Q

What is MRSA?

A
  • Staph aureus resistant to methicillin or oxacillin

* Some sensitive only to vancomycin

Semester 3 - Infection (14 decks)

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