Patient Safety Lecture Notes PDF

MICROBIOLOGY | TRANS 5 LE Patient Safety NiNA BELTRAN-YAP, MD | Lecture Date (10/07/2024) | Version 1...

MICROBIOLOGY | TRANS 5 LE Patient Safety NiNA BELTRAN-YAP, MD | Lecture Date (10/07/2024) | Version 1 02 OUTLINE → Increased risk for sepsis (23.5%) I. Patient Safety and III. Causes and Transmission of → Increased risk for antimicrobial resistance (AMR) Healthcare-Associated HAI’sTypes of HAI → Increased mortality and morbidity Infections A. Transmission → Prolonged hospital stay A. Patient Safety B. Causes of HAI’s → Increased healthcare cost B. Healthcare-Associated C. Modes of Infection HAI’s are fairly common; it is because of their aggressive Infections (HAI) Transmission nature that they cause increased risk for sepsis and II. Types of HAI IV. Infection, Prevention, and A. Surgical Site Infections Control (IPC) antimicrobial resistance. B. Catheter Associated UTI A. Hand Hygiene To prevent patients from getting HAI’s, advocate early C. Hospital Acquired B. Nail Hygiene discharge from the hospital. Pneumonia/Ventilator C. Standard Precaution Microbes may be small, but when encountering patients Associated Pneumonia D. Expanded Precaution who developed HAI like hospital-acquired pneumonia, (HAP/VAP) E. Levels of Protection where they get Pseudomonas, A. baumannii, MRSA, D. Central Line Associated F. Cough Etiquette Enterococcus faecalis in culture studies, these patients get Bloodstream Infections G.Patient Placement harder to treat. E. C. difficile Infections V. References → Stronger antibiotics will be used, which cost more and is Must Lecturer Book Previous Youtube toxic to the body. ❗️ Know 💬 📖 📋 Trans 🔺 Video II. TYPES OF HEALTHCARE-ASSOCIATED INFECTIONS (HAI) LEARNING OBJECTIVES Surgical site infections (SSI) ✔ Apply the principles of standard precautions, expanded Catheter-associated UTI (CAUTI) precautions, and transmission-based precautions Hospital-acquired pneumonia (HAP) or ✔ Identify common healthcare associated infections (HAIs) ventilator-associated pneumonia (VAP) and their risk factors Bloodstream infections ✔ Apply preventive and control measures for various Clostridium difficile infections (CDI) modes of transmission for infections in healthcare setting ✔ discuss the role of healthcare professionals in minimizing A. SURGICAL SITE INFECTIONS (SSI) infection risks SSI are infections that occur at the surgical site of procedure. I. PATIENT SAFETY AND Soft tissue infections are also under this category. HEALTHCARE-ASSOCIATED INFECTIONS They can involve: A. PATIENT SAFETY → Superficial or affecting only the skin Patient safety is defined as “the absence of preventable → Deeper tissues, organs, or implanted materials harm to a patient and reduction of risk of unnecessary ▪ More serious infections harm associated with healthcare to an acceptable minimum”. Patient safety in the context of infectious diseases refers to the systematic efforts to prevent harm to patients resulting from healthcare-associated infections (HAIs) and to reduce the risk of unnecessary harm with medical care. “Primum non nocere” or “First, do no harm”. B. HEALTHCARE-ASSOCIATED INFECTIONS (HAI) Also called as nosocomial infection. CDC: Infections that occur in patients during the process of receiving healthcare, which were not present or incubating at the time of admission to a healthcare facility. → E.g., hospital, nursing home, hospice, rehab center for long-term care HAI’s may develop 48 hours or more after admission and Figure 1. Surgical Site Infection (SSI) may also appear within 10 days after discharge. COMMON ORGANISMS ASSOCIATED WITH SSI → Clinically, if a patient develops no infection after 48 upon admission or 10 days after discharge, we have to Staphylococcus aureus - (MRSA) consider and rule out, is this nosocomial infection or → Leading cause of SSI HAI? Coagulase-negative staphylococci (CONS) → Staphylococcus epidermidis IMPORTANCE OF PATIENT SAFETY FROM INFECTIOUS → Associated with clean wounds DISEASES Enterococcus species Healthcare-associated HAI’s: → Enterococcus faecalis → Incidence: 1 in 10 admitted patients → Particularly in patients with underlying conditions or → Fairly common undergone complex surgeries can cause SSI Impact on Patient Outcomes: Gram-negative bacilli LE # TG 16 | N. Calayag, A. Chin, A. Chua, W. TE | C. Chua AVPAA | E. Cayabyab PAGE 1 of 9 TRANS # Chua, J. Co VPAA | A. Arcega MICROBIOLOGY | LE 2 Patient Safety | Nina Beltran-Yap, MD → Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae → Notorious in contaminated wounds or in immunocompromised patients Anaerobic bacteria → Bacteroides species → In cases of deep wounds infections, can be implicated in SSIs RISK FACTORS FOR SSII Type of Surgery → Clean contaminated, and contaminated surgeries, all of which pose a risk of developing SSI Patient Factors Figure 3. Ventilator-Associated Pneumonia → Immunocompromised patients → Comorbidities such as diabetes and heart failure COMMON ORGANISMS ASSOCIATED WITH HAP/VAP Surgical Technique Gram-negative bacteria (most common) → Reduce risk of infection → E. coli Antibiotic prophylaxis ▪ A commensal, but can cause infections in → Reduce risk of infection hospitalized patients B. CATHETER ASSOCIATED UTI (CAUTI) → K. pneumoniae ▪ Associated with HAIs as it causes severe pneumonia These are infections found on the urinary tract caused by → P. aeruginosa the use of catheters. ▪ Most problematic because of its innate antibiotic They are one of the most common causes of HAI’s and resistance can lead to a significant morbidity and increased healthcare cost to the patient. Gram-positive bacteria → Staphylococcus aureus (MRSA) → Enterococcus species ▪ Can cause pneumonia in patients with underlying conditions Anaerobic bacteria → Bacteroides ▪ Involved in patients with aspiration pneumonia Fungal → Aspergillus ▪ Cause pneumonia especially in immuno-compromised patients ▪ Hard to treat Figure 2. Catheter-Associated UTI RISK FACTORS FOR HAP/VAP COMMON ORGANISMS ASSOCIATED WITH CAUTI Mechanical ventilation Gram-negative bacteria → Increased risk of developing VAP → E. coli (most common) Aspiration → K. pneumoniae, and P. aeruginosa → Oropharyngeal secretions and gastric content can lead Enterococci to pneumonia → E. faecalis → Keeping patients on high back rest, especially during Staphylococcus aureus feeding, so as to not aspirate Fungal infections Immunocompromised state → Candida spp. Antibiotic use → Prolonged bacterial therapy will disrupt the balance of RISK FACTORS FOR CAUTI the respiratory tract that could increase risk of infection Indwelling Catheter duration Underlying conditions Patient factors → Underlying conditions and comorbidities (i.e. COPD, → Immunocompromised state heart failure and diabetes) increase the risk of → Comorbidities pneumonia Catheter care practices → Stabilize state of patient to better control the infection → Decrease risk of infection NOTE: HAI’s, is it our fault? Antibiotic use An encounter of a medical clerk with Doc writing down a → Decrease risk of infection problem list. Problem: Patient has Health-Care C. HOSPITAL ACQUIRED PNEUMONIA/ Associated Pneumonia (HCAP). VENTILATOR-ASSOCIATED PNEUMONIA (HAP/VAP) → Putting HCAP in the charts. Will there be legal issues These are lung infections that develop in patients, as it looks like it is the doctor’s/hospital’s/institution’s particularly those on mechanical ventilation. fault? It occurs when bacteria enters the lungs through the endotracheal tube which is used for ventilation. MICROBIOLOGY Patient Safety PAGE 2 of 9 MICROBIOLOGY | LE 2 Patient Safety | Nina Beltran-Yap, MD D. CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) These infections occur when bacteria enter the bloodstream through a central line, which is a tube placed into a large vein where fluids and medications are administered. Under this is MRSA, a resistant S. aureus, which causes serious infections. Endocarditis can also develop by bacteria through the use of medical procedures and use of catheters. → It is an infection of the inner lining of heart chambers and valves. Figure 4. Central Line Associated Bloodstream Infections Figure 5. C. difficile Infection Type of IV catheter that inserted into a large vein typically in the neck, chest, or groin C. difficile Deliver medication such as fluids or blood products directly → Spore-forming bacterium that secrete toxins which can into the bloodstream cause severe diarrhea and colitis Central line can be a source of infection if not properly → Common cause of HAIs cared for RISK FACTORS FOR CLABSI Similar to CAUTI, in the sense that CLABSI has the same Antibiotic use common risks and common organisms that are implicated → Prolonged, recent, frequent antibiotic use COMMON ORGANISMS ASSOCIATED WITH CLABSI Advanced age Gram-positive bacteria Recent surgery → Staphylococcus aureus (MRSA) Underlying medical conditions → CONS - S. epidermidis SYMPTOMS OF CDI → Enterococcus Diarrhea, abdominal pain, fever Gram-negative bacteria In severe cases, pseudomembranous colitis → P. aeruginosa → K. pneumoniae III. CAUSES AND TRANSMISSION OF HAI’s → E. coli A. TRANSMISSION Fungal Caused by pathogens that spread through various routes → Candida spp. in healthcare settings Acquired when patients are receiving care RISK FACTORS FOR CLABSI Duration of central line placement THREE COMPONENTS REQUIRED FOR INFECTION Patient factors SPREAD Central line care practices Source Antibiotic use → Places where infectious agents survive as fomites (i.e. sinks, hospital equipment, countertops, medical E. CLOSTRIDIUM DIFFICILE INFECTIONS (CDI) devices) These are infections caused by C. difficile often following Environment many antibiotic treatments, disrupting gut flora. → Patient care areas, equipment, devices It can cause severe diarrhea and colitis. → ICU, patient wards, operating room It is a major concern in healthcare facilities. MICROBIOLOGY Patient Safety PAGE 3 of 9 MICROBIOLOGY | LE 2 Patient Safety | Nina Beltran-Yap, MD People → Patients, healthcare workers, visitors can spread infection B. CAUSES OF HAI’s Figure 6. Cause of HAIs Person to person transmission → Via direct contact through the hands of healthcare providers, patients, and visitors Environmental contamination Figure 8. Examples of Direct and Indirect Infection → Transmit through indirect transmission when touching fomites from surfaces, equipment, and devices NOTE: how dirty our skin is Airborne transmission We shed 106 flat keratinized dead squamous epithelial → Pathogens spread through air via respiratory droplets or cells that contains bacteria daily droplet nuclei → We shed skin cells that contains microbes everyday C. MODES OF INFECTION TRANSMISSION ▪ Shed skin cells become fomites that can be transmitted through direct contact INDIRECT CONTACT Example: Staphylococcus aureus → S. aureus can be transmitted in the form of fomites → An example: how common medical equipment can be sources of infection. → S. aureus can be present in: ▪ Skin as normal flora (survive in the skin up to 30 days if you don’t take a bath) ▪ In contaminated glass (last for 2 days), ▪ In loose change/coins, cell phones, floor (survive up to 7 days if not disinfected) ▪ If exposed to sunlight, S. aureus can only last for 17 hours Susceptible disinfectants: Figure 7. Modes of Infection → 1% Na Hypochlorite → Iodine Direct contact → Alcohol solutions Indirect contact → Formaldehyde Droplet → Glutaraldehyde (Cidex) Airborne → UVC irradiation 1. DIRECT/ INDIRECT CONTACT NOTE: Importance of hand hygiene Touching contaminated individuals (direct) or surfaces Proper hand hygiene rids of transient bacteria, like through fomites (indirect) Pseudomonas and Klebsiella, viruses and fungi that we Example: MRSA infection, C. difficile get from environment through direct contact → MRSA infection can directly transmitted from one Proper rubbing/scrubbing - gets rid of bacteria person to another by skin-to-skin contact when HCW or visitor comes into contact with infected patient and NORMAL FLORA TRANSIENT BACTERIA touch another patient without proper hand hygiene Habitual or normal flora: S. aureus and S. epidermidis Risk factors comprise about 90% of normal skin flora → Colonization: patients already colonized by MRSA are Transient flora: P. aeruginosa can be found in moist areas at high risk of developing infections of the skin that can cause opportunistic infections → Invasive procedures: i.e. surgery, catheterization, → Also include in transient flora are: E. coli, MRSA, breaks in the skin are at increased risk of getting this Serratia and enterococci infection → By proper handwashing, there is decreased risk of → Prolonged or inappropriate antibiotic use: disrupt normal getting these infections skin flora and create more opportunities for MRSA to colonize and cause infection MICROBIOLOGY Patient Safety PAGE 4 of 9 MICROBIOLOGY | LE 2 Patient Safety | Nina Beltran-Yap, MD Table 1. Normal flora Microorganis Transmiss Flora Location ms ion Transient E. coli Entire By contact flora MRSA surface of with Serratia the skin of patients Enterococci the hands and objects around them Habitual Coagulase-neg Sweat Normal flora ative glands flora Figure 11. Droplet Transmission Staphylococcus Droplet transmission often involve agents that are larger Under than in airborne transmission Diphtheroids fingernails >5um: considered to be large organism Droplets are typically large and can be deposited in short distance (2m or 6ft) Examples of droplet transmission: → S. pneumoniae, influenza, Pseudomonas, rhinovirus RESPIRATORY DROPLETS (PREVENTION) Vaccination → To prevent the spread of influenza: annual vaccination Isolation → Prevent spread of bacteria Respiratory hygiene Hand hygiene Environmental cleaning Figure 9. Normal Flora of the Skin DIRECT CONTACT (PREVENTION) Hand hygiene Isolation precautions Decontamination Figure 12. Airborne and Droplet Precautions 3. AIRBORNE TRANSMISSION For infections spread by small particles (