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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
Give four general patient interventions to prevent infection
``` • Optimise patient's condition ○ Smoking, nutrition, diabetes • Anti-microbial prophylaxis • Skin preparation • Hand hygiene ```
26
Give three specific interventions used to prevent infection
* MRSA screening * Mupicorin nasal ointment * Disifectant body wash
27
Give two ways to prevent patient -> patient transmission
* Isolation of infected patients | * Protection of susceptible patients
28
Give two factors which can stop healthcare workers spreading disease
``` • Healthy ○ Disease free ○ Vaccinated • Good practice ○ Good clinical technique ○ Hand hygiene ○ PPE ○ Antimicrobial prescribing ```
29
Give an environmental intervention to prevent infection
``` • Cleaning ○ Disinfectants ○ Steam cleaning ○ Hydrogen peroxide vapour • Medical devices ○ Single use equipment ○ Sterilisation ○ Decontamination • Good food hygiene ○ Appropriate kitchen and ward food facilities ```
30
How does bed positioning effect HAI?
• Bed too close together will cause disease spread
31
What is puerperal fever caused by?
• Streptococcus pyogenes
32
Outline two opportunities to prevent infection
* Prevent patients with a pathogen from passing on | * Prevent the pathogen existing
33
Give five factors which can make a patient susceptible to HCAI
* Extremes of age * Obesity/malnourished * Diabetes * Cancer * Smoker
34
What two types of patient are likely to get HCAI's?
* Surgical patient | * Emergency admissions
35
What is the use of personal protective equipment?
• Protects health professional's and the patient
36
Give three examples of personal protective equipment
* Gowns * Gloves * Masks
37
What is a spore?
• A resistant form of C.diff which can withstand many environmental extremes
38
Why are only certain disinfectants used to treat C.diff?
• Some facilitate the dispersal of spores
39
Give the classification (Shape, gram stain and anaerobic/aerobic) of C.diff
* Rod shaped * Gram positive * Anaerobic
40
How does C.diff cause disease?
* 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
What are the two toxins secreted by C.diff?
* Toxin A | * Toxin B
42
What does toxin A produced by C.diff do?
* Enterotoxin * Causes excessive fluid secretion * Stimulates inflammatory response * Cytopathic effect on some tissues
43
What does toxin B produced by C.diff do?
* Cytoxin * Disrupts protein synthesis * Causes disorganisation of cytoskeleton
44
What are the three key symptoms of C.diff infection?
* Diarrhoea * High temperature * Painful abdominal cramps
45
Give the three drugs most commonly implicated in C.diff
* Clidamycin * Ampicillin * Cephalosporins
46
A patient comes into the emergency department with a suspected C.diff infection. What investigations can you perform to confirm?
* Stool sample | * Enzyme immunoassays for toxins A and B
47
How do you treat a C.diff infection?
• Discontinuance of the pre-disposing drug • Oral administration of vancomycin Reconstitution of colonic flora
48
Give three of the main clostridia and the diseases they cause
``` • Clostridium perfingens ○ Gas gangrene • Clostridium botulism ○ Botulism/neurotoxin • Colstridium tetani ○ Tetanus/anaerobic ```
49
``` How is the severity of C.diff infection assessed? Clinical Laboratory Endoscopic Radiological ```
• 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
What different antibiotics are advised for treatment of C.diff?
* Metrodinazole for non-septic cases | * Vancomycin for serious infection
51
Give the classification (Shape, gram stain and anaerobic/aerobic) of Staphylcoccus Aureus
* Oval * Gram positive * Anaerobic
52
How does Staphylcoccus Aureus cause disease?
• May enter skin or respiratory tract • Causes inflammation - swelling, pus and necrosis Pus filled abscess occurs
53
Give three possible conditions caused directly by Staphylococcus Aureus
* Skin infections * Acute endocarditis * Pneumonia
54
Give three conditions caused by toxins produced by Staph Aureus
* Toxic shock syndrome * Gastroenteritis * Scalded skin syndrome
55
How is Staph Aureus associated with hospital infections?
* Surgical wounds | * Catheters
56
What is MRSA?
* Staph aureus resistant to methicillin or oxacillin | * Some sensitive only to vancomycin

Semester 3 - Infection (14 decks)

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