Week 5 Flashcards
1
Q
HAIs include what?
A
-infections acquired in a hospital but appearing after discharge
-infections among staff
2
Q
In Canada, how many hospital patients contract a HAI?
A
1 in 9
3
Q
In Canada, how many HAIs are there in hospitals yearly?
A
220,000 cases
4
Q
In Canada, how many deaths results from HAI yearly?
A
8,000
5
Q
Define survelliance
A
The ongoing systematic collection, analysis, interpretation, and evaluation of health data closely integrated with the timely dissemination of these data to those who need it
6
Q
Surveillance is an organized and ongoing component of a program to improve a specific area of what?
A
Population health
7
Q
What are the 3 main elements of survelliance?
A
- Detect and monitor
- Identify risk factors for HAI
- Evaluate preventive interventions
8
Q
The first element of surveillance is detecting and monitoring. What does this involve?
A
Establishing a baseline rate of HAI in healthcare setting
9
Q
The second element of surveillance is identifying risk factors for HAI. Describe what this means
A
The data collected can be used to identify patients at high risk for HAIs or practices associated with high risk of HAI
10
Q
The third element of surveillance is to evaluate preventive interventions.
A
-investigate is preventative measures put in place improved the intended outcomes
-Provide information to inform, educate, and reinforce practice
11
Q
What are some general steps to setting up surveillance?
A
-assess the population to be surveyed
-select the outcomes for surveillance
-Use standardized, validated case definitions for infections
-Use case definitions consistently over time
-Calculate and analyze survelliance rates
-apply risk straticiation methodology
-Interpret HAI rates
-communicate surveillance information to stakeholders
-Use information to improve practice
-evaluate the surveillance system
12
Q
HAIs are expressed as rates which are calculated using what for the numerator and what for the denominator?
A
numerator: number of cases
denominator: population at risk over time period
13
Q
what are 5 measures of frequency?
A
- Rate
- Ratio
- Proportion
- Incidence
- Prevalence
14
Q
Define rate?
A
an expression of frequency with which an event occurs in a defined population per unit of time
15
Q
define ratio
A
value obtained by dividing on quantity by another
16
Q
define proportion
A
type of ration in which the values in the numerator are included in the denominator
17
Q
What is the incidence rate?
A
measure of frequency with which an event occurs in a population over defined time period. Number is number of new cases, denominator is population at risk
18
Q
What is the prevalence rate?
A
the proportion of all persons in a population who have a particular disease or condition at a specified point in time (point prevalence) or over a specified period of time (period prevalence)
19
Q
Define attack rate
A
the proportion of persons at risk who become infected over an entire period of exposure
20
Q
what is the attack rate expressed as?
A
percentage
21
Q
What does risk stratification allow for?
A
-comparisons
-facilitates utility and validity of interventions
22
Q
the patient population to be used for analysis can be defined as what?
A
stratum
23
Q
When calculating device associated infection rates you must select infections to be used in the numerator. What are some characteristics of this?
A
-must be site-specific
-must have ocurred in selected patient population
-date of onset must be during the selected time period
24
Q
When calculating device assocaited infection rates, what value would go in the denominator?
A
the number of device-days
25
define device days
total number of days of exposure to a device by all patients in selected population during selected time period
26
What is the formula for device associated infection rates?
x (number of device infections)/Y(number of device days) during given time period x1000
27
What are SSI (surgical site infection) rates calculated for?
A particular type of surgery
28
the population at risk for SSI rates includes what?
Only patients who have had the same type of surgery
29
SSI rates are expressed in?
percentage
30
What is the formula for SSI rates?
x (number of infections)/ Y (number of surgeries) in a given time period x(100)
31
How long should reporting of rates be done?
quarterly and more frequently if there is an issue
32
what is the epidemic curve?
a graph drawn from the outbreal
33
What is the epidemic curve used to do?
-determine whether the source of infection was common, propagated (continuing), or both
-identify the probably time of exposure of the cases to the source of infection
-identify the probable incubation period
-determine if the problem is ongoing
34
what is a common source?
it means that all cases have the same origin. The same person or vehicle is the primary reservoir or means of transmission
35
for a common source outbreak, the epidemic curve approximates what?
A normal distribution curve
36
Exposure for a common source may be?
continuous or intermittent
37
True or false. A propagated or continuing source occurs over a longer period of time
True
38
Can cases be attributed to a single source with propagated sources?
No. Infections are transmitted from person to person
39
When secondary or tertiary cases occur with propagated source outbreaks, intervals between peaks represent what?
the average incubation period
40
what information do you need to determine the period of exposure for a propagated source outbreak? (hint 3 things)
-the specific disease involved
-dates of onset of cases
-either mean or median or minimum and maximum incubation periods for the specific disease
41
How much do AROs increase the annual direct and indirect costs to patients in Canada?
40 to 52 million
42
What are the most common HAIs?
-ESBL
-C. diff
-MRSA
-CPE
-VRE
-COVID
-Influenza
-Norovirus
43
staph aureus rarely infects what?
the CNS
44
MRSA is resistant to what class of antibiotics?
B-lactam
45
True or false. Hospital acquired and community strains of MRSA are difficult to discern?
True
46
How is MRSA transmitted?
Direct and indirect contact
47
What precautions are used for MRSA?
Contact in addition to routine practices
48
Why are contact precautions used for MRSA?
because contamination of the environment or intact skin is of concern
49
What is VRE?
strains of Enterococcus faecium and Enterococcus faecalis that have become resistant to high levels of the antibiotic vancomycin
50
Describe VRE positive blood culture rates in Ontario between January 2009 to July 2015
they have doubled
51
How is VRE transmitted?
Contact (direct or indirect)
52
What precautions would you use for VRE?
Contact
53
What are some risk factors for ESBL?
-prolonged/extentsive treatment with third party cephalosporins or fluroquinolones
-prolonged hospital/ICU stay
-clinical status (transplant recipients, indwelling catheters, renal replacement therapy)
54
Which HAI/ARO is an emerging threat to global health which requires a coordinated approach to prevention and control among public health, infection control, clinical, and laboratory professionals?
CPE
55
what is CPE?
an enterobacteriaceae that produce enzymes (carbapenemases) that inactivate carbapenems and a few other classes of antibiotics
56
With what HAI/ARO is there a mortality of up to 50% of severely infected patients?
CPE
57
Most patients with CPE has links to hospitals with what?
recognized endemic or epidmic CPE (like pneumonia with KPC)
58
What are the most frequency countries of travel for CPE cases?
-India
-Pakistan
-Bangladesh
-Egypt
-Sri Lanka
-USA
59
What are examples of CPE infections?
-KPC
-VIM
-NDM
60
What 2 species account for 70.5% of CPE infection?
E. Coli and K. pneumoniae
61
What is the case definition for C. diff?
A lab confirmation together with diarrhea or
1. visualization of psudomembranes on sigmoidoscopy or colonoscopy OR
2. histological/pathological diagnosis of pseudomembranous colitis OR
3. Diagnosis of toxic megacolon
62
what is diarrhea defined as?
-loose/watery stool (takes shape of container)
-bowel movements are unusual for the patient
AND
-there is not other recognized aetiology for the diarrhea
63
Define a CDI attributive to your facility
-the symptoms were not present on admission
-symptoms began greater than 72 hours after admission
-the infection is present at the time of admission but is related to a previous admission to your facility within the last 4 weeks
64
Define a CDI not attributable to your facility
-symptoms were present on admission
-less than 72 hours after admission and there was no admission to your facility within the last 4 weeks
-the symptoms of CDI recur within 2 months of the last infection (relapse)
65
What is the defintion for declaring a CDI outbreak (hint: 3 criteria)
1. for wards with >20 beds, 3 new cases of nosocomial CDI identified on one war/unit within a 7 day period or 5 new cases of nosocomial CDI within a 4 week period
2. For wards/units with <20 beds, 2 new cases of nosocmial CDI identified in one ward.unit within a 7 day period or 4 new cases of nosocomial CDI within a 4 week period
3. facilities that have a facility nosocomial CDI rate that exceeds their annual nosocomial baseline rate for a period of two consecutive months
66
When has an ARO outbreak occured?
-when there is an increase in the rate of new cases of either infection of colonization
-when a cluster of new cases had been identified
67
define a cluster
2 or more cases with epi link
68
How any new HAI cases require investigation?
One
69
what does ARO outbreak investigation involve?
Screening of roommates and contacts
70
What are some specimen notes for an MRSA outbreak?
ensure all sites have been swabbed as applicable (tracheostomy, stoma, wounds plus nares and rectum)
71
what are some specimen notes for VRE
-rectal swab (Can be same swab as MRSA rectal swab if applicable)
72
What are some specimen notes for ESBL and CPE?
-rectal swab (must be own swab/requisition)
73
What are the 3 types of Influenza?
A, B, and C
74
what types of influenza have been responsible for epidemics?
A and B
75
Influenza may be infectious...
24 hours prior to symptom onset
76
How is influenza transmitted?
droplets
77
what are the influenza precautions?
droplet contact
78
when does influenza infectivity peak?
-during the first 3 days of illness and ceases within 7 days
-can be longer in young children, the elderly, and immunocomprimised
79
what family does norovirus belong to?
Caliciviridae
80
Is norovirus single stranded or double? RNA or DNA? Enveloped or nonenveloped?
single stranded, RNA, non-enveloped
81
how long does norovirus shedding last in immunocomprimised hosts?
more than 6 months
82
How is norovirus transmitted?
oral fecal
83
what precautions would be in place for norovirus?
droplet contact
84
how long should norovirus precacutions be maintained?
48 hours after symptom resolution
85
How long does norovirus sheding last for in healthy patients?
may start before symptom onset and persist for 4 weeks or more
86
what constitutes a Influenza outbreak?
-2 cases of acute respiratory infections within 48 hours with any common epidemiological link (unit, floor), at least one of which must be lab confirmed
OR
-3 cases of ARI (lab confirmation not necessary) occuring within 48 hours with any common epidemioogical link
87
What constitues a Norovirus outbreak?
-two or more cases of clinical illness compatible with norovirus epidemiologically linked with at least one laboratory confirmed
88
Can norovirus be transmitted through eating contaminated food or drinking contaminated water?
Yes
89
What is the management for norovirus?
-HH, accommodation, equipment, stool management!!!
90
What is done to manage MRSA and VRE?
-HH
-signage
-PPE
-Accommodation
-Transportation
-cleaning
-equipment
91
a COVID-19 outbreak in a public hospital is defined as...
-two or more lab-confirmed COVID-19 cases (patients or staff) within a specified area within a 14 day period where both cases could have reasonably acquired their infection in the hospital
92
a COVID-19 outbreak in a LTCH/RH is defined as
-a suspect outbreak is one lab confirmed COVID-19 case in a resident
-a confirmed outbreak in a home is defined as 2 or more lab confirmed cases in residents or staff or other visitors in a home with an epi link, within a 14-day period could have reasonably acquired infection in the home
93
What are examples of reasonably acquiring an infection in a home?
-no obvious infection outside of the LTCH setting
-known exposure in the LTCH setting
94
What have we done to manage COVID-19?
-Accomodation
-HH
-PPE
-Screening
-Education
-Vaccination
95
what constitutes transmission?
1 new case with epi link
96
what constitutes a cluster?
transmission of new HAI case to more than one patient on the same unit. Two or more cases closely related by time and epi link to an inpatient unit
97
what is an outbreak?
it occurs when there is sustained transmission despite the implementation of control measures
98
CDI are defined by what guidelines?
provincial
99
Influenza and norovirus outbreak definitions are provided by who?
local public health units
100
What is the goal of an outbreak investigation?
to identify contributing factors to control the outbreak and prevent similar outbreaks in the future
101
what is the most important tool in any outbreak investigation?
Line list
102
What might a line list include?
-signs or symptoms
-medications
-procedures
-patient locations
-host factors that might have predisposed the patients to the adverse event under investigation
-continue to reassess and update the information
103
Define routine practices
based on the premise that all patients are potentially infectious, even when asymptomatic, and that the same safe standards of practice should be used routinely to prevent exposure to blood, body fluids, secretions, or soiled items and to prevent the spread of microorganisms
104
Describe the chain of transmission
-agent
-reservoir
-portal of exit
-mode of transmission
-portal of entry
-susceptible host
105
what must a routine practices and additional precautions program include?
-written policies and procedures that include risk assessment
-staff education
-measure compliance
-sufficient and easily accessible PPE
-healthy workplace policies
-staff immunization
-control of the environment to reduce risks of transmission of microorganisms
106
what are some examples of routine practices?
-risk assessments
-HH
-PPE
-control of the environment
-administrative controls
-recommendations for routine practices
-routine practices for visitors
107
What are examples of engineering controls?
-heating, ventilation, and air conditions systems with sufficient air changes per hour
-barriers (plexiglass, curtains)
-point of care sharps containers and ABHR
108
what are examples of administrative controls?
-staff education
-healthy workplace policies (exclude staff from working ill)
-policies and procedures that ensure staff are able to deal effectively with transmission risks
109
True or false. visitors are less likely to transmit infection in the healthcare setting than staff
True
110
What should Routine practices for visitors include?
-they should not enter if they are sick or unable to comply with hand hygiene
-HH before and after visiting should be emphasized
-If PPE is required, donning and doffing education should be provided
111
What is the first step in the use of routine practices?
performing a risk assessment
112
when is a risk assessment done?
before each interactions with a patient or their environment to determine which interventions are required to prevent transmission during the interaction because their status can change
113
Why is ABHR preferred?
-kills most transiet microorganisms
-less time consuming
-easier on the skin
114
Why is PPE used?
to prevent transmission of infectious agents from patient-to-staff, patient-to-patient, staff-to-patient, and staff-to-staff
115
When should PPE be put on?
Just prior to the interaction with the patient
116
Gloves are _-_ and _-_ for the task
task-specific and single-use
117
when are gloves required?
Gloves are not required for routine health care activities in which contact is limited to intact skin
118
should hands be cleaned before putting on gloves for an aseptic procedure?
Yes
119
True or false. Gloves should be changes or removed if moving from a contaminated body site to a clean one?
True
120
When are gowns worn?
when an activity is likely to generate splashes or sprays of blood, body fluids, secretions, or excretions to protect the arms and clothing of the health providers
121
What does a mask do?
protects the mucous membranes of the nose and mouth
122
when are masks required?
-in operating theatres and when performing aseptic procedures
-during wound irrigation if there is spalsh risk
123
Should coughing patients when a mask when outside of their room?
Yes
124
When should a mask be worm
-in operating theatres and during aseptic procedure
-if wound irrigation will involve sprays
125
Should you change your mask is it becomes wet?
Yes
126
what is an N95 used for?
to prevent inhalation of small particles via the airborne route
127
When should an N95 be worn?
during aerosol-genearting procedures shown to expose staff to undiagnosed TB including:
-sputum induction
-diagnostic bronchoscopy
-autopsy examination
128
what are the 4 types of eye protection?
1. safety glass
2. safety goggles
3. face shields
4. visors attached to mask
129
when should eye protection be worn?
whenever there is a potential for splashes or sprays to the eyes (wound irrigation, labor and delivery, operating room)
130
What are the 3 main controls of the environment that are part of safe work practices?
1. appropriate accommodation and placement
2. patient care equipment that is in good repair
3. effective cleaning practices for equipment and the environment
131
What is the preffered placement for patients?
single room with dedicated bathroom and sink
132
Selection of roommates is based on what?
-route of transmission
-risk factors for transmission
-availability of single rooms
133
Define hotel clean
a measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal, and cleaning of windows and surfaces
134
what is hospital clean?
the measure of cleanliness maintianed in patient care areas and consists of hotel clean plus disinfection, increased frequency of cleaning and auditing
135
What are 3 components of hospital clean?
1. High touch surfaces cleaned with hospital grade disinfectant
2. non-critical medical equipment cleaned between each patient
3. cleaning practices are periodically monitored and audited with feedback and education
136
What are 3 sporicidal agents?
1. sodium hypochlorite
2. accelerated hydrogen peroxide
3. peracetic acid
137
Food preparation must comply with what?
the Health protection and promotion act reg, 493/17: FOOD PREMISES
138
True or false. Linen soiled with blood or body fluids should be handled using the same precautions, regardless of additional precations?
True
139
what are 4 guidelines for handling linen?
1. bag or contain contaminated laundry at the site of collection
2. laundry contaminated with blood or body substances should be place in leak proof hampers (double bagging not recommended)
3. laundry carts or hampers must have a lid
4. linen bags should be tied securely and not overfilled
140
Define engineering controls
physicial or mechanical measures put in place to reduce the risk of infection to staff or patients
141
what are 2 kinds of engineering controls?
handling of sharps and physical barriers
142
How can prevention of sharps injuries be achieved?
1. use of safety-engeered needles and sharps
2. puncture resistant sharps contaienrs at point of care
3. staff education on risks of unsafe procedures
143
what are 4 examples of physical barrier?
1. curtains
2. room dividers
3. plexiglass
4. sneeze guards
144
what vaccines are recommended for staff?
-annual influenza
-MMR
-varicella
-Hep B
-pertussis
-meningitis
-tetnus/diptheria
145
What are some elements that comprise additional precautions?
-cohorting
-contact/droplet/airborne precautions or a combination
-impact of AP on quality of care
-signage
-PPE
-dedicated equipment
-additional cleaning measures
-limited transportation
-communication
146
Who can be cohorted?
patients AND staff
147
when is cohorting done?
-when single rooms are not available
-during outbreaks
148
Which patients will be cohorted together?
-patients infected or colonized with the same microorganism (be careful of strains)
-known exposures to the same source
149
When is staff cohorting commonly used?
During outbreaks
150
Describe staff cohorting
assigning specified health providers to residents known to have the same organism
151
Is it only the ICPs responsibility to initiate precautions?
No
152
Who can discontinue precautions?
only the ICP
153
what is the ICP role in terms of the initiation and discontinuation of additonal precautions
-must be notified when they are initiated
-must verify they are appropriate
-must be consutled before discontinuation
154
When should additional precautions be initiated?
-as soon as symptoms suggestive of a transmissible infection are noted
-known to have or suspected to be at high risk of having an ARO
155
Define direct contact
occurs through touching
156
define indirect contact
occurs when microorganisms are transferred via contaminated objects
157
When are contact precautions used?
when contamination of the environment or intact skin is a particular consideration (includes m.o. with a low infective dose)
158
When does droplet transmission occur?
when droplets carrying an infectious agent exit the respiratory tract of a person
159
When does airborne transmission occur?
when airborne particles remain suspended in the air, travel on air current
