Transmission and Antimicrobial Stewardship

Question 1

Contact - Direct

Answer 1

• Herpesvirus
• HIV
• mucous-membrane to mucous membrane

Question 2

Contact - Indirect

Answer 2

• Norovirus, C. difficile (fecal oral)
• resistant organisms (MRSA, VRE)
• healthcare providers hands (MRSA); fomites (VRE)

Question 3

Contact - Droplet

Answer 3

• respiratory viruses (influenza)

- Neisseria meningitidis

Question 4

Non-contact - Airborne

Answer 4

• mycobacterium tuberculosis

- measles, chickenpox

Question 5

Non-contact - Vector

Answer 5

• Zika, malaria, west-nile virus (mosquito)

- Lyme disease (ticks)

Question 6

Public Health Measures (6)

Answer 6

• Vaccination
• Post-exposure prophylaxis:
• -> vaccination (when someone is exposed)
• -> immunoglobulins (give antibodies from community)
• -> anti-toxins (botulism)
• -> anti-retrovirals (for HIV)
• Reportable disease
• -> must report “reportable diseases” to local Health Units (by physicians, laboratories, schools, hospital administrators, institutions)
• -> e.g. meningitis
• Contact tracing:
• -> tracking of all individuals who have been exposed to a person with a communicable disease (during its period of communicability)
• Quarantine:
• -> restriction of well individuals who have been exposed to people with communicable diseases to prevent disease transmission during period of incubation
• -> SARS
• Outbreak Investigation

Question 7

Hospital Infection Control

Answer 7

• Surveillance
• -> C. diff, influenza, MRSA
• -> if hospitals see numbers increasing, they’ll look into it
• Routine Practice
• -> hand hygiene, gloves, mask, gown, handling waste properly, cleaning environment, sharp handling
• Additional Precautions
• -> for certain pathogens (gowns and gloves when see enteric illnesses, antibiotic resistant organisms)
• -> flu-like illnesses, meningitis (droplet precautions)
• -> tb, measles, chicken pox (negative pressure, n95 respirator)
• Decolonization
• -> MRSA, topical/systemic antibiotics, photo-disinfection
• Post-exposure prophylaxis
• -> vaccines, immunoglobulins, antiretrovirals, antibacterials,
• outbreak investigation
• -> line listing, draw on curve, assemble a team, control measures

Question 8

QUIZ Q:

• seeing patient in ER, been there for 6 hours, has neisseria meningitidis meningitis
• in addition to routine practices, what should you do/use? (3 things)

Answer 8

• must report to local Health Unit (Public Health officials)
• notify infection control at hospital given exposure in ED
• use contact droplet precautions