Session 5 ILOs - Hospital acquired infections and infection prevention

Question 1

Outline the classification of antimicrobials (different types)

Answer 1

• Antibacterial agents
• Antiviral agents
• Antifungal agents
• Antiprotozoal agents

Question 2

Describe the mechanism of action of the main groups of antimicrobials

Answer 2

ANTIBIOTICS:
B-lactams: inhibits transpeptidation enzyme
Glycopeptides: inhibits NAG-NAM-PEP repeat

Tetracyclines: Binds to ribosomes, prevents tRNA binding
Aminoglycosides: Binds to ribosomes, causes misreading of mRNA
Macrolides: Affects ribosomal translocation
Oxazolidinones: not explained
Lincosamides: Affects ribosomal translocation

Sulfonamides: Competes with PABA for enzyme and decreases folic acid production
Trimethoprims: Reversible inhibitor of dihydrofolate reductase and reduces nucleic acid and protein synthesis

ANTI-FUNGAL:
Azoles: Inhibits cP450 3A enzyme reduces replication (reduces ergosterol)
Polyenes: Loges in cell wall and increases cellular permeability

ANTI-VIRAL:
Aciclovir:
Oseltamivir

Question 3

Describe the principles of antimicrobial resistance and its impact on antimicrobial prescribing

Answer 3

3 types of antimicrobial resistance:

1. Intrinsic
   - Naturally resistance (intrinsic to the microbe itself)
2. Acquired
   - Need to acquire new genetic material or mutates
3. Adaptive
   - Organism responds to stress

Antimicrobial resistance is increasing, with few new antimicrobial medicines coming to market. Can lead to:

• Treatment failure
• Prophylaxis failure
• Economic costs

Question 4

Describe the concept of antimicrobial stewardship

Answer 4

Interventions designed to improve and measure the appropriate use of antimicrobials, to optimise clinical outcomes but minimise toxicity and other adverse events, reduce the costs and limit the selection for antimicrobial resistant strains

Question 5

Outline measures to ensure the appropriate use of antimicrobials

Answer 5

Multidisciplinary team and relationships to other quality/safety teams

Surveillance (process measures and outcome measures)

Interventions:

• Persuasive e.g. education, reminders
• Restrictive e.g. prior authorisation
• Structural e.g. quality monitoring

Question 6

Describe the use of Personal Protective Equipment regarding infections in a hospital setting

Answer 6

Gloves should be worn when there may be exposure to blood, bodily fluids, secretions or excretions and when handling contaminated equipment. Gloves should also be worn when patients require transmission based precautions.

Disposable Plastic Aprons are designed to protect uniforms / clothing from moisture / soiling during direct patient care

Provide barrier protection to the wearer from splashes and droplets to the area of the wearer’s nose, mouth and respiratory tract. They do not provide protection against aerosolised particles and are not classified as Respiratory Protective Equipment (instead use FFP3 respirator masks)