Hospital Acquired Infections and Infection Control
Discuss the estimate of impact of nosocomial infections
100,000 infections per year in UK 5,000 deaths per year directly causation Contributing factor in 15,000 further deaths / year Increase the morbidity and length of stay/cost of care Economic impact: £1 billion per year Reductions with improved practice-?30%?
Discuss the various pathogens that cause surgical site infections
20% Staphylococcus aureus 16% Pseudomonas spp 15% coagulase-negative staphylococci <10% Enterococcus spp <10% Escherichia coli <10% Enterobacter spp <10% fungi
Describe the blood infections caused by common pathogens
35% coagulase-negative staphylococci 25% Staphylococcus aureus 11.2% Enterococci 9.7% Fungi 6.2% Enterobacter species 4.9% Pseudomonas spp
Rank the various noscominal infection by mortality (highest to lowest)
Bacteraemia (bloodstream infection) Pneumonia Surgical site infection Urinary tract infection
Describe the high impact intervention
Central venous catheter care Peripheral intravenous canula care Renal dialysis catheter care Prevention of surgical site infection Care for ventilated patients (or tracheostomies where appropriate) Urinary catheter care Reducing the risk of Clostridium difficile
Describe the environmental risk factors
Contaminated water systems Staffing and physical layout of the facility (eg, nurse-to- patient ratio, open beds close together) Air-conditioning systems or air handling units Devices- endoscopes/sterile instruments
What is the role of the infection control teams
Education and training Development and dissemination of infection control policy Monitoring and audit of hygiene Clinical audit Managing outbreaks Investigating incidents such MRSA bacteraemias Surveillance
Describe the host risk factors
Extremes of age Immunocompromised ◦ (primary or acquired immunodeficiency, cancer, chemotherapy, diabetes, alcoholism) Surgery/interventions Impaired blood supply (peripheral vascular disease) Medical devices (urinary catheters, drains,intravascular catheters, prosthetic joints or heart valves, endotracheal tubes etc)
Describe the prevention of nosocominal infections
Hand washing Prudent use of antibiotics Isolation & barrier precautions Decontamination of equipment Decontamination of environment Antimicrobial coatings Surveillance and feedback
What are the common nosocomial infections
Health care associated pneumonia Urinary tract infection Bloodstream infection Surgical site infection Antibiotic associated diarrhoea - C. difficile colitis
What are the other factors that contribute to hospital infectios
Host risk factors Environmental risk factors Hospital micro-organisms Treatment/interventions
WHat does MRSA stand for
Methicillin-resistant Staphylococcus aureus
Describe the various Resistant micro-organisms
Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin-resistant enterococci (VRE) Extended-spectrum beta-lactamase producing organisms (ESBL) Carbapenemase producing Organisms Acinetobacter spp Stenotrophomonas maltophilia
Discuss the devices and biofilms for microbes
Microbial communities living attached to a solid support (eg medical devices) Held together by extracellular polymeric substances or "EPS." Involved in up to 60% of nosocomial infections 1,500 times more resistant to antibiotics than planktonic (free floating) bacteria
Describe the various types of hospital micro-organisms
Opportunistic pathogens Resistance Environmental bacteria
Describe the various Opportunistic pathogens
Pseudomonas aeruginosa Coagulase-negative staphylococci Acinetobacter baumanii Enterococcus faecium/E. faecalis Stenotrophomonas maltophilia Candida albicans
Describe the characteristics of a wound infection
Risk factors: ◦ Loss of integrity - trauma or surgery. ◦ Saureusnasalcarriage ◦ Diabetes, cirrhosis or alcoholism Clinical features: ◦ erythema, warmth, tenderness, swelling and purulent exudate. Fever and failure to heal Organisms: ◦ S. aureus and GAS commonest. ◦ also coliforms, anaerobes, clostridia, streptococcus anginosus group Antibiotic treatment: ◦ Flucloxacillin.
Describe the treatment of MRSA
Screen, identify, isolate if necessary Decolonisation ◦ Nasal mupirocin ◦ skin antiseptic agents- octenisan or skinsan Systemic antibiotics ◦ Vancomycin ◦ Teicoplanin ◦ Linezolide,Daptomycin ◦ Tetracyclines
Discuss the transmission of organisms
Contact - most common Direct (physical contact) Indirect (via contaminated objects) Airborne Transmission Respiratorydroplets Inhalation of infectious particles Blood-borne transmission Food-borne
What is the Hickman line
A Hickman line is a central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis
Describe the urinary catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
What is the advantage of transparent dressing
Allows easy monitoring of wound infection
what are the common pathogens involved in UTI
Coliforms Yeast(candida) Enterococci
Describe the characteristics of clostridium difficile
Gram-positive rods Causes watery diarrhoea with crampy abdominal pain and fever Produces spores, which are resistant to many disinfectants and spread in the hospital environment causing outbreaks Produces toxins A, B, binary toxin Can cause severe infection of the large bowel (pseudomembranous colitis) Risk factors old age, antibiotic therapy, immunosuppression, chemotherapy and others
What are nosocomial infections
Infections that are acquired from a hospital that is >48 hours after admission Infections may occur even after discharge Approx 9% of patients affected - risk increases with length of stay, devices or interventions,co morbidities Significant financial burden on NHS(estimates 1 billion)
Describe the various antimicrobials that are emergence of resistance
MRSA, VRE, ESBLs, CROs
Describe the various environmental Mycobacteria
◦ Clostridium difficile spores or Acinetobacter spp.Legionella,