W7 Infection Prevention

Question 1

What is infection prevention?

Answer 1

• Infection prevention and control (IPC) prevents patients and health workers from being harmed by avoidable infections and as a result of antimicrobial resistance.
• Infection prevention also includes vaccination against preventable diseases and antibiotic prophylaxis for surgical procedures and recurrent infection

Question 2

How can we slow antimicrobial resistance?

Answer 2

By preventing infections
The more we use antibiotics, the quicker antimicrobial resistance will develop.

Question 3

How do infections occur? (3)
What 3 things are necessary for an infection to occur?

Answer 3

An infection occurs when micro-organisms enter the body, increase in number, and cause a reaction of the body.

1. Source: Places where micro-organisms live (e.g., sinks, surfaces, human skin)
2. Susceptible Person with a way for micro-organisms to enter the body
3. Transmission: a way microorganisms are moved to the susceptible person

Question 4

Sources:
Where can microorganisms be found?

Answer 4

• Healthcare workers
• Visitors and household members
• Surfaces e.g. bed rails, tables, medical equipment
• Indwelling medical devices (e.g., catheters and IV lines)

Question 5

What is a susceptible person? (2)

Answer 5

1. Not vaccinated or otherwise immune to the micro-organism, or a person with a weakened immune system
2. Who has a way for the micro-organisms to enter the body

Question 6

What is meant by transmission?

Answer 6

• Transmission refers to the way microorganisms are moved to the susceptible person.
• Micro-organisms don’t move themselves, they depend on people,
  the environment, and/or medical equipment to move in healthcare settings.
• There are a few general ways that micro-organisms travel in healthcare settings – through contact (i.e., touching), sprays and splashes, inhalation, and sharps injuries (i.e. when someone is = accidentally stuck with a used needle or sharp instrument).

Question 7

What is contact spread?

Answer 7

• Contact moves micro-organisms by touch (example: MRSA, C.difficile)
• For example, healthcare provider hands become contaminated by touching micro-organisms present on medical equipment or high-touch surfaces and then carry the micro-organisms on their hands and spread to a susceptible person when proper hand hygiene is not performed before touching the susceptible person.

Question 8

What is Droplet respiratory spread?

Answer 8

Sprays and splashes occur when an infected person coughs or sneezes, creating droplets which carry
micro-organisms short distances (within approximately 6 feet). These micro-organisms can land on a susceptible
person’s eyes, nose, or mouth and can cause infection (example: COVID-19).

Question 9

What is Aerosol Respiratory Spread?

Answer 9

Inhalation occurs when microorganisms are aerosolized in tiny particles that survive on air currents over great distances and time and reach a susceptible person.
Airborne transmission can occur when infected patients cough, talk, or sneeze micro-organisms into the air (example:
TB or measles), or when micro-organisms are aerosolized by medical equipment e.g. ventilation, CPAP, CPR

Question 10

What is the PPE for:
Contact transmission?
Droplet transmission?
Aerosol transmission?

Answer 10

• Handwashing gloves and aprons
• Fluid resistant surgical mask
• Eye protection
• FFP3 mask (fit-test required)
• Eye protection

Question 11

Correct use of gloves

Single use only – not a substitute for hand washing

Answer 11

• Clean hands before putting gloves on
• Make sure it fits correctly (various sizes should be available)
• Remove gloves once task is complete
• Avoid touching the outer edges as you remove
• Clean hands afterwards
• Guideline on donning and doffing all PPE

Question 12

What are the 2 tiers of recommended precautions to prevent the spread of infections in healthcare settings?

Answer 12

1. Standard Precautions
   -are used for all patient care. They protect
   healthcare providers from infection and prevent the spread of
   infection from patient to patient
2. Transmission-Based Precautions
   - are the second tier of basic
   infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents. The Personal Protective Equipment (PPE) recommended will be dependent on the mode of transmission

Question 13

Standard precaution

Answer 13

• Hand hygiene
• Bare below the elbow
• Follow respiratory hygiene/cough etiquette principles
• PPE if handling potentially infectious material e.g. body fluids
• Cleaning and disinfecting equipment and the environment appropriately
• Proper handling of needles and other sharp

Question 14

What are the 5 moments of hand hygiene?

Answer 14

1. Before touching a patient
2. Before clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

Question 15

Explain what HCAIs are?
Some examples?

Answer 15

Healthcare-associated infection (HCAI) is defined as any infection acquired in relation to the delivery of healthcare in its widest sense. This includes care in hospitals and in the
community via General Practitioners and health centres.

• Clostridium difficile
• Resistant infections
  -MRSA (Meticillin Resistant Staphylococcus aureus infections)
  -GRE (Glycopeptide resistant enterococci)
  -CPO (Carbapenemase-producing organisms)
• Medical device related e.g. urinary catheters, intravenous cannulae

Question 16

Clostridium difficile

Answer 16

• Bacteria that causes infection when the guts normal flora is disrupted or if immunocompromised
  -Prior treatment with antibiotics (especially broad-spectrum) is one of
  the main risk factors for C.difficile infection
• Produce toxins that damage the lining of the colon
  -Symptoms range from mild, self‑limiting diarrhoea to perforation of the colon, sepsis and death
  *-infection can commonly reoccur in patients
• Can be spread between patients on hospital wards via contact transmission from infected faeces
  -Spores survive in the environment for a long time
  -Spores are not killed by alcohol gel, hands must be washed with soap and water

Question 17

Screening for resistant organisms

Answer 17

• High-risk patients are screened for resistant organisms when they are admitted into hospital or before any operation
• This is to ensure that any patient colonised with a resistant organism is managed with appropriate infection control measures to avoid passing the resistant organisms to other
  patients
• Antibiotic therapy may also need to be adjusted to ensure that treatment given cover this additional resistance

Question 18

Screening; What can patients be screened for?

Answer 18

• Patients can be screened for:
• MRSA (Methicillin Resistant Staphylococcus aureus infections)
  -Nose, throat, groin + any wounds
• GRE (Glycopeptide resistant enterococci)
  -Rectal swab
• CPO (Carbapenemase-producing organisms)
  -Rectal swab
• Risk factors will vary by organism but generally include hospital
  treatment abroad, recent hospital admissions,transfer from other hospitals

Question 19

Decolonisation

Answer 19

If patients are found to be positive for MRSA they will undergo decolonisation therapy as an inpatient or before their operation

• Nasal decolonisation (antibiotic / antiseptic nasal cream)
• Disinfectant skin / hair washes
• For 5 days
• Patients are then re-screened and decolonisation repeated if necessary
• Aim to reduce the risk of spread of resistant organisms and help prevent
  the patient developing an active infection from their colonisation

Question 20

Cleaning and decontamination

Answer 20

• Regular cleaning and disinfection of surfaces and equipment is vital within clinical areas
• Policies and procedures should be in place to guide staff
• This also applies to consultation rooms in GP practices and community pharmacies
• Personal equipment like stethoscopes should also be decontaminated between patients

Question 21

Medical devices

Answer 21

Urinary catheters, IV lines, surgical drains etc. all provide a route in for micro-organisms and so can increase the risk of
infections
* They should be removed as soon as clinically possible to decrease that risk and prevent infections
* Pharmacists can help by prompting for switching from IV to oral antibiotics, once patients are well enough, so that IV lines can be removed ASAP.

Question 22

Isolation

Answer 22

• Whenever possible patients with infectious diseases will be nursed in single rooms
• Each organisation with have a priority list as there are often not enough single rooms available
• If all single rooms are full patients may be barrier nursed in bays instead
• Be aware of signage when entering cubicles and bays so that you can don appropriate PPE as needed
• If unclear always check with one of the nurses first

Question 23

Vaccinations

Answer 23

• Effective vaccinations are available against many viral and bacterial infections
• Many are given in childhood and provide life-time immunity
  e.g. MMR, meningococcal bacteria (meningitis)
• Other needs to be given more frequently to maintain protection and protect against emerging strains e.g. influenza and COVID-19

Question 24

Pneumococcal vaccination

Answer 24

• Pneumococcal vaccines protect against Streptococcus pneumoniae a
  pathogen which can cause severe infections like meningitis, sepsis and
  pneumonia
• The vaccine is now given as part of routine childhood immunisations
• Additional doses are recommended for all patients over the age of 65 and in
  the “at risk groups” detailed in the green book
• The vaccination programme has been highly successful in reducing the
  frequency of invasive pneumococcal infections caused by strains covered by
  the vaccine including near elimination of some strains
  -Additional benefits include reduced number of patients requiring hospital treatment and
  needing antibiotic

Question 25

Antibiotic prophylaxis

Answer 25

• Antibiotics are also used to prevent infections as well as treat them
• Antibiotics are given to cover surgical
  procedures where there is potential for
  contamination
  -Reduces the risk of surgical site infections
• Antibiotic prophylaxis is also used to reduce
  the frequency of recurrent infections e.g. UTI,
  cellulitis
• Recommended by NICE for recurrent UTI or cellulitis
• Daily low dose antibiotics
• Usually used for a limited period (circa. 6 months) in order to break
  the cycle of repeated infections (e.g. allow the bladder wall to heal)
  or whilst improving underlying risk factors e.g. lymphoedema
• Regular review of treatment both in terms of continued need and adverse effect monitoring is required

Question 26

Surgical prophylaxis

Answer 26

• Antibiotics are given intravenously
  immediately before the operation starts
• Antibiotic levels need to be maintained
  through the operation and so repeated
  doses are given for long operations or
  if there is significant blood loss
• Post-op antibiotics are not recommended for the majority of operations