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Infection control > Week 5 > Flashcards

Week 5 Flashcards

1
Q

HAIs include what?

A

-infections acquired in a hospital but appearing after discharge
-infections among staff

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2
Q

In Canada, how many hospital patients contract a HAI?

A

1 in 9

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3
Q

In Canada, how many HAIs are there in hospitals yearly?

A

220,000 cases

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4
Q

In Canada, how many deaths results from HAI yearly?

A

8,000

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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

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6
Q

Surveillance is an organized and ongoing component of a program to improve a specific area of what?

A

Population health

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7
Q

What are the 3 main elements of survelliance?

A
  1. Detect and monitor
  2. Identify risk factors for HAI
  3. Evaluate preventive interventions
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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

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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

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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

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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

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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

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13
Q

what are 5 measures of frequency?

A
  1. Rate
  2. Ratio
  3. Proportion
  4. Incidence
  5. Prevalence
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14
Q

Define rate?

A

an expression of frequency with which an event occurs in a defined population per unit of time

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15
Q

define ratio

A

value obtained by dividing on quantity by another

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16
Q

define proportion

A

type of ration in which the values in the numerator are included in the denominator

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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

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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)

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19
Q

Define attack rate

A

the proportion of persons at risk who become infected over an entire period of exposure

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20
Q

what is the attack rate expressed as?

A

percentage

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21
Q

What does risk stratification allow for?

A

-comparisons
-facilitates utility and validity of interventions

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22
Q

the patient population to be used for analysis can be defined as what?

A

stratum

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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

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24
Q

When calculating device assocaited infection rates, what value would go in the denominator?

A

the number of device-days

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25
Q

define device days

A

total number of days of exposure to a device by all patients in selected population during selected time period

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26
Q

What is the formula for device associated infection rates?

A

x (number of device infections)/Y(number of device days) during given time period x1000

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27
Q

What are SSI (surgical site infection) rates calculated for?

A

A particular type of surgery

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28
Q

the population at risk for SSI rates includes what?

A

Only patients who have had the same type of surgery

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29
Q

SSI rates are expressed in?

A

percentage

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30
Q

What is the formula for SSI rates?

A

x (number of infections)/ Y (number of surgeries) in a given time period x(100)

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31
Q

How long should reporting of rates be done?

A

quarterly and more frequently if there is an issue

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32
Q

what is the epidemic curve?

A

a graph drawn from the outbreal

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33
Q

What is the epidemic curve used to do?

A

-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

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34
Q

what is a common source?

A

it means that all cases have the same origin. The same person or vehicle is the primary reservoir or means of transmission

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35
Q

for a common source outbreak, the epidemic curve approximates what?

A

A normal distribution curve

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36
Q

Exposure for a common source may be?

A

continuous or intermittent

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37
Q

True or false. A propagated or continuing source occurs over a longer period of time

A

True

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38
Q

Can cases be attributed to a single source with propagated sources?

A

No. Infections are transmitted from person to person

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39
Q

When secondary or tertiary cases occur with propagated source outbreaks, intervals between peaks represent what?

A

the average incubation period

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40
Q

what information do you need to determine the period of exposure for a propagated source outbreak? (hint 3 things)

A

-the specific disease involved
-dates of onset of cases
-either mean or median or minimum and maximum incubation periods for the specific disease

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41
Q

How much do AROs increase the annual direct and indirect costs to patients in Canada?

A

40 to 52 million

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42
Q

What are the most common HAIs?

A

-ESBL
-C. diff
-MRSA
-CPE
-VRE
-COVID
-Influenza
-Norovirus

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43
Q

staph aureus rarely infects what?

A

the CNS

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44
Q

MRSA is resistant to what class of antibiotics?

A

B-lactam

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45
Q

True or false. Hospital acquired and community strains of MRSA are difficult to discern?

A

True

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46
Q

How is MRSA transmitted?

A

Direct and indirect contact

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47
Q

What precautions are used for MRSA?

A

Contact in addition to routine practices

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48
Q

Why are contact precautions used for MRSA?

A

because contamination of the environment or intact skin is of concern

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49
Q

What is VRE?

A

strains of Enterococcus faecium and Enterococcus faecalis that have become resistant to high levels of the antibiotic vancomycin

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50
Q

Describe VRE positive blood culture rates in Ontario between January 2009 to July 2015

A

they have doubled

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51
Q

How is VRE transmitted?

A

Contact (direct or indirect)

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52
Q

What precautions would you use for VRE?

A

Contact

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53
Q

What are some risk factors for ESBL?

A

-prolonged/extentsive treatment with third party cephalosporins or fluroquinolones
-prolonged hospital/ICU stay
-clinical status (transplant recipients, indwelling catheters, renal replacement therapy)

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54
Q

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?

A

CPE

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55
Q

what is CPE?

A

an enterobacteriaceae that produce enzymes (carbapenemases) that inactivate carbapenems and a few other classes of antibiotics

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56
Q

With what HAI/ARO is there a mortality of up to 50% of severely infected patients?

A

CPE

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57
Q

Most patients with CPE has links to hospitals with what?

A

recognized endemic or epidmic CPE (like pneumonia with KPC)

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58
Q

What are the most frequency countries of travel for CPE cases?

A

-India
-Pakistan
-Bangladesh
-Egypt
-Sri Lanka
-USA

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59
Q

What are examples of CPE infections?

A

-KPC
-VIM
-NDM

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60
Q

What 2 species account for 70.5% of CPE infection?

A

E. Coli and K. pneumoniae

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61
Q

What is the case definition for C. diff?

A

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

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62
Q

what is diarrhea defined as?

A

-loose/watery stool (takes shape of container)
-bowel movements are unusual for the patient
AND
-there is not other recognized aetiology for the diarrhea

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63
Q

Define a CDI attributive to your facility

A

-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

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64
Q

Define a CDI not attributable to your facility

A

-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
Q

What is the defintion for declaring a CDI outbreak (hint: 3 criteria)

A
  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
Q

When has an ARO outbreak occured?

A

-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
Q

define a cluster

A

2 or more cases with epi link

68
Q

How any new HAI cases require investigation?

A

One

69
Q

what does ARO outbreak investigation involve?

A

Screening of roommates and contacts

70
Q

What are some specimen notes for an MRSA outbreak?

A

ensure all sites have been swabbed as applicable (tracheostomy, stoma, wounds plus nares and rectum)

71
Q

what are some specimen notes for VRE

A

-rectal swab (Can be same swab as MRSA rectal swab if applicable)

72
Q

What are some specimen notes for ESBL and CPE?

A

-rectal swab (must be own swab/requisition)

73
Q

What are the 3 types of Influenza?

A

A, B, and C

74
Q

what types of influenza have been responsible for epidemics?

A

A and B

75
Q

Influenza may be infectious…

A

24 hours prior to symptom onset

76
Q

How is influenza transmitted?

A

droplets

77
Q

what are the influenza precautions?

A

droplet contact

78
Q

when does influenza infectivity peak?

A

-during the first 3 days of illness and ceases within 7 days
-can be longer in young children, the elderly, and immunocomprimised

79
Q

what family does norovirus belong to?

A

Caliciviridae

80
Q

Is norovirus single stranded or double? RNA or DNA? Enveloped or nonenveloped?

A

single stranded, RNA, non-enveloped

81
Q

how long does norovirus shedding last in immunocomprimised hosts?

A

more than 6 months

82
Q

How is norovirus transmitted?

A

oral fecal

83
Q

what precautions would be in place for norovirus?

A

droplet contact

84
Q

how long should norovirus precacutions be maintained?

A

48 hours after symptom resolution

85
Q

How long does norovirus sheding last for in healthy patients?

A

may start before symptom onset and persist for 4 weeks or more

86
Q

what constitutes a Influenza outbreak?

A

-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
Q

What constitues a Norovirus outbreak?

A

-two or more cases of clinical illness compatible with norovirus epidemiologically linked with at least one laboratory confirmed

88
Q

Can norovirus be transmitted through eating contaminated food or drinking contaminated water?

A

Yes

89
Q

What is the management for norovirus?

A

-HH, accommodation, equipment, stool management!!!

90
Q

What is done to manage MRSA and VRE?

A

-HH
-signage
-PPE
-Accommodation
-Transportation
-cleaning
-equipment

91
Q

a COVID-19 outbreak in a public hospital is defined as…

A

-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
Q

a COVID-19 outbreak in a LTCH/RH is defined as

A

-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
Q

What are examples of reasonably acquiring an infection in a home?

A

-no obvious infection outside of the LTCH setting
-known exposure in the LTCH setting

94
Q

What have we done to manage COVID-19?

A

-Accomodation
-HH
-PPE
-Screening
-Education
-Vaccination

95
Q

what constitutes transmission?

A

1 new case with epi link

96
Q

what constitutes a cluster?

A

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
Q

what is an outbreak?

A

it occurs when there is sustained transmission despite the implementation of control measures

98
Q

CDI are defined by what guidelines?

A

provincial

99
Q

Influenza and norovirus outbreak definitions are provided by who?

A

local public health units

100
Q

What is the goal of an outbreak investigation?

A

to identify contributing factors to control the outbreak and prevent similar outbreaks in the future

101
Q

what is the most important tool in any outbreak investigation?

A

Line list

102
Q

What might a line list include?

A

-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
Q

Define routine practices

A

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
Q

Describe the chain of transmission

A

-agent
-reservoir
-portal of exit
-mode of transmission
-portal of entry
-susceptible host

105
Q

what must a routine practices and additional precautions program include?

A

-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
Q

what are some examples of routine practices?

A

-risk assessments
-HH
-PPE
-control of the environment
-administrative controls
-recommendations for routine practices
-routine practices for visitors

107
Q

What are examples of engineering controls?

A

-heating, ventilation, and air conditions systems with sufficient air changes per hour
-barriers (plexiglass, curtains)
-point of care sharps containers and ABHR

108
Q

what are examples of administrative controls?

A

-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
Q

True or false. visitors are less likely to transmit infection in the healthcare setting than staff

A

True

110
Q

What should Routine practices for visitors include?

A

-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
Q

What is the first step in the use of routine practices?

A

performing a risk assessment

112
Q

when is a risk assessment done?

A

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
Q

Why is ABHR preferred?

A

-kills most transiet microorganisms
-less time consuming
-easier on the skin

114
Q

Why is PPE used?

A

to prevent transmission of infectious agents from patient-to-staff, patient-to-patient, staff-to-patient, and staff-to-staff

115
Q

When should PPE be put on?

A

Just prior to the interaction with the patient

116
Q

Gloves are - and - for the task

A

task-specific and single-use

117
Q

when are gloves required?

A

Gloves are not required for routine health care activities in which contact is limited to intact skin

118
Q

should hands be cleaned before putting on gloves for an aseptic procedure?

A

Yes

119
Q

True or false. Gloves should be changes or removed if moving from a contaminated body site to a clean one?

A

True

120
Q

When are gowns worn?

A

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
Q

What does a mask do?

A

protects the mucous membranes of the nose and mouth

122
Q

when are masks required?

A

-in operating theatres and when performing aseptic procedures
-during wound irrigation if there is spalsh risk

123
Q

Should coughing patients when a mask when outside of their room?

A

Yes

124
Q

When should a mask be worm

A

-in operating theatres and during aseptic procedure
-if wound irrigation will involve sprays

125
Q

Should you change your mask is it becomes wet?

A

Yes

126
Q

what is an N95 used for?

A

to prevent inhalation of small particles via the airborne route

127
Q

When should an N95 be worn?

A

during aerosol-genearting procedures shown to expose staff to undiagnosed TB including:
-sputum induction
-diagnostic bronchoscopy
-autopsy examination

128
Q

what are the 4 types of eye protection?

A
  1. safety glass
  2. safety goggles
  3. face shields
  4. visors attached to mask
129
Q

when should eye protection be worn?

A

whenever there is a potential for splashes or sprays to the eyes (wound irrigation, labor and delivery, operating room)

130
Q

What are the 3 main controls of the environment that are part of safe work practices?

A
  1. appropriate accommodation and placement
  2. patient care equipment that is in good repair
  3. effective cleaning practices for equipment and the environment
131
Q

What is the preffered placement for patients?

A

single room with dedicated bathroom and sink

132
Q

Selection of roommates is based on what?

A

-route of transmission
-risk factors for transmission
-availability of single rooms

133
Q

Define hotel clean

A

a measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal, and cleaning of windows and surfaces

134
Q

what is hospital clean?

A

the measure of cleanliness maintianed in patient care areas and consists of hotel clean plus disinfection, increased frequency of cleaning and auditing

135
Q

What are 3 components of hospital clean?

A
  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
Q

What are 3 sporicidal agents?

A
  1. sodium hypochlorite
  2. accelerated hydrogen peroxide
  3. peracetic acid
137
Q

Food preparation must comply with what?

A

the Health protection and promotion act reg, 493/17: FOOD PREMISES

138
Q

True or false. Linen soiled with blood or body fluids should be handled using the same precautions, regardless of additional precations?

A

True

139
Q

what are 4 guidelines for handling linen?

A
  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
Q

Define engineering controls

A

physicial or mechanical measures put in place to reduce the risk of infection to staff or patients

141
Q

what are 2 kinds of engineering controls?

A

handling of sharps and physical barriers

142
Q

How can prevention of sharps injuries be achieved?

A
  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
Q

what are 4 examples of physical barrier?

A
  1. curtains
  2. room dividers
  3. plexiglass
  4. sneeze guards
144
Q

what vaccines are recommended for staff?

A

-annual influenza
-MMR
-varicella
-Hep B
-pertussis
-meningitis
-tetnus/diptheria

145
Q

What are some elements that comprise additional precautions?

A

-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
Q

Who can be cohorted?

A

patients AND staff

147
Q

when is cohorting done?

A

-when single rooms are not available
-during outbreaks

148
Q

Which patients will be cohorted together?

A

-patients infected or colonized with the same microorganism (be careful of strains)
-known exposures to the same source

149
Q

When is staff cohorting commonly used?

A

During outbreaks

150
Q

Describe staff cohorting

A

assigning specified health providers to residents known to have the same organism

151
Q

Is it only the ICPs responsibility to initiate precautions?

A

No

152
Q

Who can discontinue precautions?

A

only the ICP

153
Q

what is the ICP role in terms of the initiation and discontinuation of additonal precautions

A

-must be notified when they are initiated
-must verify they are appropriate
-must be consutled before discontinuation

154
Q

When should additional precautions be initiated?

A

-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
Q

Define direct contact

A

occurs through touching

156
Q

define indirect contact

A

occurs when microorganisms are transferred via contaminated objects

157
Q

When are contact precautions used?

A

when contamination of the environment or intact skin is a particular consideration (includes m.o. with a low infective dose)

158
Q

When does droplet transmission occur?

A

when droplets carrying an infectious agent exit the respiratory tract of a person

159
Q

When does airborne transmission occur?

A

when airborne particles remain suspended in the air, travel on air current

Infection control (7 decks)

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