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Questions and Answers
What is the primary purpose of positive pressure isolation for immunocompromised patients?
What is the primary purpose of positive pressure isolation for immunocompromised patients?
Which of the following practices is NOT recommended for immunocompromised patients?
Which of the following practices is NOT recommended for immunocompromised patients?
What is the recommended frequency for cleaning stethoscopes used on immunocompromised patients?
What is the recommended frequency for cleaning stethoscopes used on immunocompromised patients?
What percentage of the community is affected by unrecognized MRSA infections?
What percentage of the community is affected by unrecognized MRSA infections?
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Which item would be classified as critical according to the Spaulding system?
Which item would be classified as critical according to the Spaulding system?
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What is the primary goal of isolation precautions?
What is the primary goal of isolation precautions?
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Which of the following examples refers to safe waste disposal?
Which of the following examples refers to safe waste disposal?
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What is the recommended duration for effective hand washing?
What is the recommended duration for effective hand washing?
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Which type of precaution is used for patients with respiratory infections like TB and SARS?
Which type of precaution is used for patients with respiratory infections like TB and SARS?
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Which statement is true regarding the use of gloves in hand hygiene?
Which statement is true regarding the use of gloves in hand hygiene?
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What should be done with respiratory secretions to maintain hygiene?
What should be done with respiratory secretions to maintain hygiene?
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Which organisms require droplet precautions to prevent transmission?
Which organisms require droplet precautions to prevent transmission?
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What is the preferred method for hand hygiene in the presence of Clostridium difficile?
What is the preferred method for hand hygiene in the presence of Clostridium difficile?
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What type of disinfection is recommended for non-critical items?
What type of disinfection is recommended for non-critical items?
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Which of the following is NOT a component of surgical asepsis?
Which of the following is NOT a component of surgical asepsis?
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What is the primary purpose of standard precautions in healthcare settings?
What is the primary purpose of standard precautions in healthcare settings?
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Which type of personal protective equipment (PPE) is specifically required for airborne diseases like TB and SARS?
Which type of personal protective equipment (PPE) is specifically required for airborne diseases like TB and SARS?
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What is an important role of the Clinical Microbiology Laboratory (CML) in infection control?
What is an important role of the Clinical Microbiology Laboratory (CML) in infection control?
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What characterizes Healthcare-Associated Infections (HAIs)?
What characterizes Healthcare-Associated Infections (HAIs)?
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Which of the following is a predominant type of Healthcare-Associated Infection?
Which of the following is a predominant type of Healthcare-Associated Infection?
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Which group of patients is most likely to develop Healthcare-Associated Infections?
Which group of patients is most likely to develop Healthcare-Associated Infections?
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What is the most effective initial step for preventing nosocomial infections in healthcare settings?
What is the most effective initial step for preventing nosocomial infections in healthcare settings?
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Which mode of transmission is NOT associated with Healthcare-Associated Infections?
Which mode of transmission is NOT associated with Healthcare-Associated Infections?
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What is a common microbe associated with HAIs that is known for its drug resistance?
What is a common microbe associated with HAIs that is known for its drug resistance?
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Which of the following factors does NOT contribute to the risk of developing HAIs?
Which of the following factors does NOT contribute to the risk of developing HAIs?
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In terms of infection control, what is one significant result of the use of antibiotics in hospitals?
In terms of infection control, what is one significant result of the use of antibiotics in hospitals?
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Study Notes
Healthcare-Associated Infections (HAIs)
- HAIs are infectious diseases acquired in hospitals after 48 hours of hospitalization or 14 days after discharge, except for those acquired during the incubation period.
- Iatrogenic infections (caused by medical/surgical intervention, e.g., catheter infection, surgical site infections) are a type of HAI.
- Community-acquired infections are those present or acquired during the incubation period while hospitalized.
Learning Objectives
- Describe Healthcare-Associated Infections (HAIs)
- Study the frequency and transmission modes of HAIs, along with common encountered microbes.
- Discuss infection control and prevention measures.
- Describe Personal Protective Equipment (PPE) measures.
- Know recommended vaccines for healthcare providers.
- Show different hospital signs of infection control.
Modes of Transmission
- Contact (direct & indirect)
- Droplet
- Airborne
Contributing Factors in HAIs
- Increased number of drug-resistant pathogens
- Failure of healthcare personnel to follow infection control guidelines
- Increased number of immunocompromised patients
Frequency of HAIs
- 5% of hospitalized patients develop HAIs.
- Pneumonia is the most prevalent HAI.
- Bacteria in hospitals are often drug-resistant (70% of HAIs), including multidrug-resistant strains like Pseudomonas, MDR-TB, HIV, and Candida.
Most Common Types of HAIs
- Urinary tract infections (UTIs)
- Surgical site infections
- Lower respiratory tract infections (LRITs), such as pneumonia
- Bloodstream infections (septicemia)
- Clostridium difficile-associated disease (an anaerobic, spore-forming bacterium part of the indigenous gut microbiota that produces enterotoxin and cytotoxin)
Common Organisms in Hospitals
- Gram-positive cocci: Staphylococcus aureus (including methicillin-resistant strains [MRSA]), coagulase-negative staphylococci, Enterococcus spp. (including vancomycin-resistant enterococci [VRE]).
- Gram-negative bacilli: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter baumannii, Klebsiella oxytoca.
- Recently emerged: Carbapenem-resistant Enterobacteriaceae (CRE).
First Aim of Infection Control in Hospitals
- Prevent nosocomial (hospital-acquired) infections through:
- Education (e.g., handwashing)
- Investigations for multi-drug resistant (MDR) organisms.
- Implementing cleaning, disinfection, sterilization, and waste disposal policies.
- Protecting health workers from exposure
- Prudent antibiotic use.
Precaution and Isolation
- Prevent infection transmission to healthcare workers and other patients.
- Hand hygiene (washing/gloves) is standard practice (e.g., Rotavirus, MRSA).
- Before & after contact (even with gloves), use soap/water or alcohol-based gel (e.g., Manugel).
- Use gowns, glasses, and masks for respiratory cases or secretions (e.g., sputum).
Handwashing (Semmelweis, 1865)
- Recommended practice:\
- Before/after touching patients
- Before/after touching patient surroundings
- Before/after entering patient rooms/wards
- After cleaning, aseptic technique, or body fluid exposure.
- Hand washing should be for 30-45 seconds.
- Nails should be cut (microbes grow under nails).
- Finger rings may carry same risk as nails.
Safe Waste Disposal
- Disposable needles.
- Respiratory cases: Mask disposal of secretions, education (cough/sneeze; avoid shaking hands; wash hands).
- Cohort isolation for the same organism (e.g., Rota virus, Extended MDR bacteria).
Droplet Precaution
- Droplets larger than 5 µm travel 1 meter within a minute.
- Masking recommended for: Neisseria meningitides, Bordetella pertussis, Haemophilus influenzae, Mycoplasma pneumoniae, Influenza virus, Adenovirus, and SARS-CoV-2 (with special attention to droplet precautions).
Negative Pressure Room (NPR)
- For patients with droplets that remain in the air for a long time (e.g., tuberculosis, coronaviruses, measles, varicella).
- Air enters from outside and is sterilized by a HEPA filter before expelling.
- Double doors and special location.
Protective Environment
- Protective Isolation/Positive Pressure Isolation to prevent air from entering from the corridor (e.g., bone marrow transplantation (immunosuppressed), IVF technology).
- Sealed-single room with greater internal pressure, air enters through HEPA filters
Protection Precautions for immunocompromised patients (e.g., chemotherapy recipients)
- Positive pressure isolation (see above).
- Hand hygiene.
- Prohibit entry of infected persons (common cold, runny nose, gastroenteritis).
- No flowers/plants (may contain fungi, bacteria or viruses).
- No fruit/vegetables (unless washed very carefully).
Miscellaneous points
- Hidden/unrecognized infections (e.g., MRSA prevalence in community is 20%).
- Most meningitis cases are non-infectious after 24 hours of treatment.
- Cleaning stethoscopes after each exam is a positive practice.
- Washing white coats regularly is highly recommended for healthcare workers.
- Vaccination of healthcare workers is an important practice.
Spaulding System
- Classifies instruments/items for patient care as critical, semicritical, or non-critical based on the need for sterilization or disinfection levels.
- Critical items (surgical instruments): require sterilization (e.g., steam).
- Semicritical items (endoscopes): require high-level disinfection (e.g., glutaraldehyde).
- Non-critical items (patient care items): require low-level disinfection (e.g., 70%-90% ethyl alcohol, bleach).
Surgical Asepsis
- Hair clipping/shaving.
- Skin cleaning/scrubbing (soap/antiseptic).
- Sterile plastic film/cloth to cover skin.
- Hand washing.
- Sterile gloves, caps, masks, shoe covers.
- Sterile instruments, sutures, dressing.
- Disposable needles, syringes, sharps.
- Clean/disinfected floors, walls, and equipment.
Standard Precautions
- Apply to all patients and all healthcare settings.
- Prevent infection transmission.
- Semmelweis (1865) – "Father of Hand Washing."
- "Father of Hospital Epidemiology."
- All blood, body fluids, secretions (not sweat), non-intact skin contain infectious agents.
Role of Clinical Microbiology Laboratory (CML)
- Monitor pathogens isolated & computerized.
- Create antibiotic susceptibility reports.
- Note infectious diseases.
- Environmental sampling/source of infection.
- Biotyping: similar biochemical results?
- Antibiogram: similar pattern?
- Molecular epidemiology (plasmid & chromosomal DNA genotyping).
Vaccines for Healthcare Personnel
- Hepatitis B vaccine
- Annual influenza vaccine
- Measles-mumps-rubella (MMR) vaccine
- Varicella (chickenpox) vaccine
- Tetanus-diphtheria-pertussis (Tdap) vaccine
- Meningococcal vaccine (microbiologists).
Personal Protective Equipment (PPE)
- Gloves (wash hands after use).
- Isolation gown.
- Masks.
- Eye protection (goggles/face shield).
- Respiratory protection (Type N95 respirator).
- Used with TB, Severe Acute Respiratory Syndrome (SARS, COVID-19), smallpox, and influenza.
- Patient-care equipment controlled by PPE.
- Environmental control (clean with standard measures).
- Linens laundered.
- Disposal of sharps (e.g., HIV, HBV, HCV) in containers.
Contact Precautions
- Visitors must report to the nurse before entering.
- Gloves for all entry/touching.
- Hand hygiene.
- Gowns for entry.
- Removing gown with hand hygiene.
- Limitation to transport.
- Clean and dispose contaminated PPE.
Droplet Precautions
- Visitors report to the nurse before entering.
- Personal Protective Equipment (PPE) - masks upon entering patient rooms/cubicles.
- Hand hygiene
- Private Room (if possible), cohort or 3 feet separation.
- Limit patient transport to necessary purposes and instruct patient in respiratory hygiene/cough etiquette.
Airborne Precautions
- Visitors must report to the nurse before entering.
- Use Airborne Precautions for patients with airborne-transmitted infections (e.g., tuberculosis, measles, chickenpox).
- Place patients in a special room.
- Monitor pressure with visual indicators.
- Keep doors closed when not needed.
- Patients should wear a surgical mask and follow respiratory hygiene/cough etiquette.
- Limit patient transport.
- Hand hygiene.
- Personal Protective Equipment (PPE) – fit-tested N95 or higher level respirator for respiratory protection.
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Description
This quiz provides an overview of Healthcare-Associated Infections (HAIs), focusing on their definitions, transmission modes, and infection control measures. Participants will learn about iatrogenic infections, contributing factors, and the importance of Personal Protective Equipment (PPE) in preventing HAIs. Test your knowledge of HAIs and enhance your understanding of infection prevention in healthcare settings.
