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Pathology > SPR L7 Healthcare Acquired Infections > Flashcards

SPR L7 Healthcare Acquired Infections Flashcards

1
Q

Learning Outcomes (for general perusal)

A
  • 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
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2
Q
  1. Define ‘risk’ (noun and verb)
  2. Define ‘Iatrogenic’
  3. Healthcare associated infection - why is this used?
A
  1. Risk (n) a situation involving exposure to danger
    1. Risk (v) expose (someone or something valued) to danger, harm, loss
  2. ‘disease caused by the healer’. [Origin: Gr. Iatros: one who heals]
  3. Is is when the inflammation occurs? How can we tell it was caused in hospital?
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3
Q

Examples of HCAI

What are many of these associated with?

Give examples of these

A

bioprosthetic material or medical interventions

  • Blood Stream Infections
  • Urinary Tract Infections
  • Respiratory Tract Infections
  • GI Tract Infections
  • Surgical Site Infections
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4
Q

What is Blood stream infection and what is it associated with?

A

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)

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5
Q

Urinary tract infection - what are these associated with in the hospital?

A

Catheter associated

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6
Q
A
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7
Q

Respiratory tract infection (pneuomonia and others) - what are these infections associated with?

A

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.

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8
Q

Diarrhoea - what are the causes in the healthcare setting?

A

GI Infection - contamination of the environment of infective diarrhoea: outbreaks can occur

viral - typically norovirus

antibiotic associated - clostridium difficile

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9
Q

Surgical Site Infections

Describe these

A

Can be superficial or deep (abdominal cavity or joint space). Normally sterile tissue are exposed when opened.

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10
Q

What are the main risks for HCAIs?

A
  • Patients
  • medical activity
  • nursing activity
  • care settings
  • emergent threats
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11
Q

Risks

Risks that patients come with

What are the two groups of risks to consider?

A
  • 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
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12
Q

Risks

Which risks can be related to medical activity?

A
  • 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)
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13
Q

Risks

Which risks are related to nursing activity?

A
  • Intimate care
  • Maintenance of devices
  • Wound care
    • surgical
    • Pressure sores
    • Chronic skin breaks- eg diabetic foot
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14
Q

Risks

What risks can be associated with the care setting?

A
  • Crowded care settings
  • Hot beds
  • Sleeping, care activity, meals, toileting, working environment- in close proximity
  • Correct placement
    • side room
    • Ensuite
    • ventilated
  • Staff
    • Unwell
    • Untrained
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15
Q

Risks

Give examples of some of the new and emergent threats

A
  • Pandemic influenza
  • Viral Haemorrhagic fevers
    • Ebola
  • Multidrug resistant bacteria
    • TB
    • CPE
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16
Q

Give examples of actions that can be taken to mitigate the risk of HCAIs?

A

​Hand hygiene

ANTT

Device management

patient placement

environment

good doctoring

17
Q

Minimising Risk

Hand Hygiene - outline the main principles - when should hand washing be carried out?

A

See picture

5 moments to undertake

Most important intervention

18
Q

Minimising Risk - Aseptic Technique

  1. What is asepsis
  2. What is the aseptic technique?
  3. When is the aseptic technique used?
A
  1. absence of infection, reducing the numbers of pathogenic organisms in contact with vulnerable parts of the patient
  2. 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
  3. Used for any procedure that could introduce infection to a patient- wound dressing, placing catheters, taking blood etc.
19
Q

Minimising Risk - Device Management

  1. How does infection associated with a device occur?
  2. Outline the three main principles when managing devices
A
  1. 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
  2. ●Minimum devices necessary for care

●Earliest feasible removal

●Placed and maintained with aseptic technique

20
Q

Minimising Risk - Patient Placement

  1. What is the hierarchy of infectiousness matched with?
  2. Give examples of infections
    1. Specify where these patients should be placed
A
  1. increasingly secure patient settings
  2. Ebola/ Viral haemorrhagic fevers - High level isolation unit
    1. Open pulmonary TB (MDR)
    2. Measles/ Chicken pox - ‘source isolation’- single room, with lobby, at negative pressure to the corridor
    3. Infective diarrhoeal illness - Single room with en-suite toilet
    4. MDR organisms - Single room (with/ without ensuite)
21
Q

How can infection risk be minimised in the enviroment?

A
  • Cleaning- physical removal of organic soiling
  • Disinfection- reduction in amount of potentially infectious material
  • single use equipment/ Equipment that undergoes automated decontamination processes
22
Q

How can ‘good doctoring’ minimise risk of HCAI?

A
  • 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
23
Q

What methods can be put into place on an individual level?

A

●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

24
Q

Example - Viral gastroenteritis

What are the 4 points at which HCAI can be managed?

What actions can be undertaken by the junior doctore?

A
  • 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

Pathology (35 decks)

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