Session 7 ILO'S

Question 1

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

Answer 1

• A consequence of natural selection and random mutation of bacteria

3 types of antimicrobial resistance:

1. Intrinsic
   - Natural resistance - the bacteria have no target for the drug to work on e.g. a penicillin can’t act on a microbe without a cell wall as this is its site of action.
2. Acquired
   - this is done either through mutation or horizontal gene transfer.
3. Adaptive
   - Organism responds to stress - The bacteria only are resistant when exposed to an antibiotic as they adapt to the environment

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

• Treatment failure
• Prophylaxis failure
• Economic costs

Question 2

Describe principles relating to infection control in a hospital setting

Answer 2

• Patient interventions- isolation of infected and protection of susceptible
• Healthcare worker interventions- vaccination, aseptic &sterile technique, PPE, antimicrobial prescribing
• Environmental interventions - water, food, air and surfaces

Question 3

To appreciate and describe some of the global concerns relating to hospital acquired infections and drug resistance.

Answer 3

• HA infections affect high proportions(8%) & impacts recovery
• High cost to healthcare organisations - prolonged treatment and stays
• Slower rates of new drug development compared to that resistance rates

Question 4

Describe the use of Personal Protective Equipment with regard to infections in a hospital setting

Answer 4

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)

Question 5

To describe the characteristics of Norovirus and application of infection prevention principles

Answer 5

Small non-enveloped - single stranded RNA
Transmitted faecal-oral or respiratory and causes acute gastroenteritis, vomiting and diarrhoea
Spread can be limited through isolating infected individuals and keeping antiseptic environment by cleaning surfaces and equipment regularly

Question 6

To describe the characteristics of Staphylococcus aureus with regard to hospital acquired infections and drug resistance

Answer 6

MRSA commonly colonises and is usually harmless but can infect those in poor health(more likely in hospitals)
Isolation is ideal for infected as it is easily transmitted bu this can be difficult in hospitals
MRSA has resistance to all beta lactam based drugs so is treated with other types of antibiotics(usually intravenously)e.g.vancomycin/daptomycin

Question 7

Apply the infection model to a patient presenting with a hospital infection.

Answer 7

• Infections arising as a consequence of providing healthcare (affects 8%)
• Risk factors- extremes of age, obesity/malnourished, diabetes, cancer, immunosuppression, smoker, surgical patient (7)
• Common causes- contact with other patients, staff or infectious environments

Question 8

To further expand the description of pathogen/person/practice/place as it applies to hospital acquired infections

Answer 8

Pathogen 
Virulence factors - 
Ecological interactions - other bacteria, antibiotics, disinfectants
Person
Patient factors - extremes of age, obesity/malnourished, diabetes, cancer, immunosuppression, smoker, surgical patient
Practice 
General and specific activities of healthcare workers
Policies and their implementation
Organisational structure and engagement 
Place(healthcare environment)
Fixed features - number of bed in a bay
Variable features

Question 9

Understand the range of hospital acquired infections

Answer 9

Commonly include blood borne viruses, norovirus, influenza, chickenpox, MRSA(staph aureus), clostridium difficile, E.coli, TB, Candida albicans, aspergillus, malaria

Question 10

To describe the characteristics of Clostridioides difficile, its pathogenesis and management

Answer 10

Gram positive bacillus, obligate anaerobe
Pathogenesis - Produces spores that are resistant to heat, acid and antibiotics which attach to environment or can spread faecal-orally where they settle in intestine to cause diarrhoea and colitis
Management - if mild, stopping antibiotics can help, otherwise metrondiazole or vancomycin(faster relief) for 10 days