Infection prevention and control

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  • Created by: z
  • Created on: 04-03-16 17:12

Healthcare associated infections (HCAI)

  • any infection acquired as a reuslt of accessing healthcare
  • ~10%
  • sources can be endogenous or exogenous
    • e.g. pneumonia, UTI, SSI, gastroenteritis, bloodstream infection
  • ~15% are preventable (largely exogenous, device associated)
  • particular problem now b/c:
    • vulnerable patients (extremes of life)
    • antibiotic resistance
    • ease of movement bw countries
    • patient expectations
    • media
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Infection prevention procedures

  • job roles
    • Director of infection prevention and control
    • medical microbiologists
    • infection prevention nurses
    • antimicrobial pharmacist
    • decontamintaion specialist
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  • methicillin resistanst staph aureus
    • increasingly community problem too- esp strains carrying PVL toxin
  • clonal resistance- spreads via cross infection
    • most HCAI in UK due to EMRSA-15 and EMRSA-16
    • resistance to all beta-lactams
    • assoc w/ multiple resistance
  • management:
    • glycopeptides 
      • vancomycin (but- poor tissu epenetration, monitoring, slow infusion)
      • teicoplanin (cost, difficult to monitor)
    • fusidic acid, rifampicin
    • linezolid
    • daptomycin
  • measures to reduce MRSA
    • screening + decolonisation treatment for colonised pts
    • care with lines
    • prevention of pressure ulcers and sores
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C. diff

  • clostridium difficile
    • anaerobic gram +ve bacilli
    • spore forming- can withstand disinfection, drying
    • restant to alcohol and other disinfectants
    • commonest cause of HCA diarrhoea
  • RFs - age, ab use, PPIs, cross infection, previous CDI
  • diagnosis and management
    • send sample if any chance (esp elderly, recently hospitalised pts)
    • avoid loperamide or other anti-motility agents
      • may allow toxin to pool- may predispose to toxic megacolon
    • try to stop systemic antibiotics
    • treatment:
      • metronidazole
      • oral vancomycin
      • fidaxomicin
      • faecal donor infusion
    • isolate cases, incr hygeine
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Multiple antibiotic resistant gram negatives (MDRG

  • enterobacteriaceae
    • E.coli, klebsiella, enterobacter
    • UTI, abdo, bloodstream infections
    • beta-lactam atibtiotics have been mainstay
  • ESBLs
    • extended-spectrum beta-lactamases= enzymes produced by some bacteria
    • confer resitsance to cephalosporins (e.g. cefuroxime, cefotaxime)
    • oft cross resistant to ciprofloxacin, gentamicin, trimethoprim
    • treat with carbapenems (meropenem, imipenem)
  • carbapenemase producers
    • difficult to detect- confirm by PCR
  • what to use?
    • tigecycline
      • new tetracycline derivative, IV only, not licensed for UTI or bloodstream infection
    • colistin
      • old antibiotic, renal toxicity in 20%, IV for UTI/bacteraemia, oft last resort (but resistance seen in China...)
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Principles of infection prevention

  • hand hygeine
    • removes transient organisms- breaks chain of infection
  • alcohol hand gel
    • instead of washing if hands visibly clean
    • must use soap and water if caring for pt w/ diarrhoea
  • PPE
    • gloves and apron
      • working w/ blood or bodily fluid or infectious pt
    • mask
      • FFP3 for aerosol generating procedures on pt w/ respiratory Tb, must be fit testes
    • eye protection
      • any procedure w/ risk of splashing
  • decontamination of environement and equipment
  • staff health
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