SPR L7 Healthcare Acquired Infections Flashcards
Learning Outcomes (for general perusal)
- Describe the main types of Healthcare associated infections (HCAI)
- Outline actions that junior doctors can take to reduce HCAI
- Describe the principles in managing a hospital outbreak of viral gastroenteritis
- Define ‘risk’ (noun and verb)
- Define ‘Iatrogenic’
- Healthcare associated infection - why is this used?
- Risk (n) a situation involving exposure to danger
- Risk (v) expose (someone or something valued) to danger, harm, loss
- ‘disease caused by the healer’. [Origin: Gr. Iatros: one who heals]
- Is is when the inflammation occurs? How can we tell it was caused in hospital?
Examples of HCAI
What are many of these associated with?
Give examples of these
bioprosthetic material or medical interventions
- Blood Stream Infections
- Urinary Tract Infections
- Respiratory Tract Infections
- GI Tract Infections
- Surgical Site Infections
What is Blood stream infection and what is it associated with?
Blood stream infection:
‘Bacteraemia’
?’Line’ associated - Primary originates in the blood itself due to venous access devices (may be peripheral devices
May be a secondary effect (eg. from a respiratory infection)
Urinary tract infection - what are these associated with in the hospital?
Catheter associated
Respiratory tract infection (pneuomonia and others) - what are these infections associated with?
Mechanical ventilation
More common to get lower RTIs that isnt associated with ventilation.
Very common - poorly mobile recumbent patient, can’t expectorate expiratory secretions, pooling in lungs of secretions.
Diarrhoea - what are the causes in the healthcare setting?
GI Infection - contamination of the environment of infective diarrhoea: outbreaks can occur
viral - typically norovirus
antibiotic associated - clostridium difficile
Surgical Site Infections
Describe these
Can be superficial or deep (abdominal cavity or joint space). Normally sterile tissue are exposed when opened.
What are the main risks for HCAIs?
- Patients
- medical activity
- nursing activity
- care settings
- emergent threats
Risks
Risks that patients come with
What are the two groups of risks to consider?
-
Endogenous flora - may be primed to form difficult infections
- May have been acquired in previous healthcare encounters
-
Co-morbid conditions
- Chronic respiratory conditions
- Urinary tract conditions
- Diabetes
- Cancer
- End stage renal failure
Risks
Which risks can be related to medical activity?
- Immunosuppression
- Local
- systemic
- Interventions
- Surgery
- Antibiotics
- Bioprosthetic material
- Deep and implanted- heart valves, joints, pacemakers
- Superficial devices- Peripheral and central vascular catheters, urinary catheters, drains (non exhaustive list)
Risks
Which risks are related to nursing activity?
- Intimate care
- Maintenance of devices
- Wound care
- surgical
- Pressure sores
- Chronic skin breaks- eg diabetic foot
Risks
What risks can be associated with the care setting?
- Crowded care settings
- Hot beds
- Sleeping, care activity, meals, toileting, working environment- in close proximity
- Correct placement
- side room
- Ensuite
- ventilated
- Staff
- Unwell
- Untrained
Risks
Give examples of some of the new and emergent threats
- Pandemic influenza
- Viral Haemorrhagic fevers
- Ebola
- Multidrug resistant bacteria
- TB
- CPE
Give examples of actions that can be taken to mitigate the risk of HCAIs?
Hand hygiene
ANTT
Device management
patient placement
environment
good doctoring
Minimising Risk
Hand Hygiene - outline the main principles - when should hand washing be carried out?
See picture
5 moments to undertake
Most important intervention
Minimising Risk - Aseptic Technique
- What is asepsis
- What is the aseptic technique?
- When is the aseptic technique used?
- absence of infection, reducing the numbers of pathogenic organisms in contact with vulnerable parts of the patient
- Approach to care that minimises risk of introducing infection to a patient. Often ‘non-touch’ techniques that advocate identifying ‘clean parts’ that are never touched by the operator
- Used for any procedure that could introduce infection to a patient- wound dressing, placing catheters, taking blood etc.
Minimising Risk - Device Management
- How does infection associated with a device occur?
- Outline the three main principles when managing devices
- Bioprosthetic devices become coated with human protein (from blood, urine etc), Biofilm matrix develops on this coating- containing bacteria, this Biofilm cannot be sterilised with antibiotics
- ●Minimum devices necessary for care
●Earliest feasible removal
●Placed and maintained with aseptic technique
Minimising Risk - Patient Placement
- What is the hierarchy of infectiousness matched with?
- Give examples of infections
- Specify where these patients should be placed
- increasingly secure patient settings
- Ebola/ Viral haemorrhagic fevers - High level isolation unit
- Open pulmonary TB (MDR)
- Measles/ Chicken pox - ‘source isolation’- single room, with lobby, at negative pressure to the corridor
- Infective diarrhoeal illness - Single room with en-suite toilet
- MDR organisms - Single room (with/ without ensuite)
How can infection risk be minimised in the enviroment?
- Cleaning- physical removal of organic soiling
- Disinfection- reduction in amount of potentially infectious material
- single use equipment/ Equipment that undergoes automated decontamination processes
How can ‘good doctoring’ minimise risk of HCAI?
- Strive relentlessly to diagnose infections (that can spread)
- clinical and laboratory diagnostics
- Source control
- drain pus, remove infected foreign bodies
- Start SMART then focus
- What is the patients priority?
- ask your patient what is important to them
- What is the patients priority?
What methods can be put into place on an individual level?
●Five moment hand hygiene is non-negotiable
●Learning aseptic technique is fundamental to doing medical procedures
●Critically review the need for any device
●Demand safe patient placement for given conditions
●Clean up after yourself
●Make a diagnosis
●Recruit your patient and co-create care
Example - Viral gastroenteritis
What are the 4 points at which HCAI can be managed?
What actions can be undertaken by the junior doctore?
- Managing the hospital
- Staff resources, Cleaning, Cohort Ward, Reduce Services
- Managing Hospital Cases
- Patient placement and treatment
- Infection Control: Hospital Surveillance
- Data, Lab Diagnosis and Clinical Diagnosis
- Public Health: Community Surveillance
- Staff cases
- Patient Cases
- Data
Staff cases, clinical cases, Lab Diagnosis, Patient Treatment and Placement
