Infection prevention and control

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

1 of 6

2 of 6

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

3 of 6

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

4 of 6

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...)

5 of 6

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

6 of 6