[MICRO 20] LEC 15 - Healthcare-associated Infections

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Ignaz Semmelweis

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Ignaz Semmelweis

Noticed that babies born in the maternity ward handled by medical students/doctors were most likely to get a fever and die compared to those who were in the ward with midwives.

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Florence Nightingale

Implemented handwashing and hygiene practices in the war hospital. Achieved reduction in infections.

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NOSOCOMIAL INFECTIONS

= infections absent at the time of admission and was acquired in the healthcare setting = Associated with prolonged stay in the hospital or inadequate hygiene practices of personnel

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Cross-infection

Indirect spread of pathogens from one patient to another on inadequately cleaned hands of hospital personnel

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Autoinoculation

Aspiration of oropharyngeal flora into the lungs along the endotracheal tube

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Urinary tract infections

From pathogens that spread up the periurethral space from the patient’s perineum or gastrointestinal tract

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Intraluminal contamination

contamination due to cross infection by caregivers who are irrigating catheters or emptying drainage bags

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pyuria

pus in urine

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catheter-associated UTI or CAUTI

Non-localizing systemic symptoms in a patient with urinary catheter

  • Fever

  • Peripheral leukocytosis

  • Altered mental status

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catheter-associated asymptomatic bacteriuria

Positive urine culture in the absence of urinary symptoms and systemic symptoms related to the urinary tract in a patient with urinary catheter

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D

Some recommended antibiotics for uncomplicated UTI are as follows EXCEPT:

A. Nitrofurantoin B. Fluoroquinolones C. Fosfomycin D. Metronidazole

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TRUE

[TRUE OR FALSE] Place bladder catheters only when absolutely needed (eg. to relieve obstruction), not solely for the providers’ convenience

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Nosocomial Pneumonia

  • Accounts for 10-15% of nosocomial infections

  • associated with more deaths than are infections at any other body site

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Oropharyngeal colonization

  • Elimination of normal flora from antibiotic treatment

  • Aspiration around the time of intubation

  • Gastroesophageal reflux

  • Bacterial overgrowth in the stomach

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False; it belongs to non-MDR pathogens

[TRUE OR FALSE] Klebsiella pneumoniae belongs to MDR pathogens

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True

[TRUE OR FALSE] Legionella pneumoniophila belongs to MDR pathogens

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False; it belongs to non-MDR pathogens

[TRUE OR FALSE] Serratia marcescens belongs to MDR pathogens

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Streptococcus pneumoniae

  • usually seen in community-acquired pneumonia but can also be observed in ventilator-acquired pneumonia

  • Gram-positive, lancet-shaped diplococci

  • Catalase negative

  • Bile and optochin sensitive

  • Positive Quelling reaction

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Positive Quelling reaction

Capsular swelling when mixed with antiserum (antibodies against polysaccharide capsule) and methylene blue on a glass slide

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Septic shock

splenectomy predisposes to sepsis from encapsulated bacteria

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PSEUDOMONAS AERUGINOSA

  • Widely distributed in nature and is commonly present in moist environments in hospitals

  • Known to cause disease in people with altered and decreased host defenses (neutropenia, chemotherapy, and burn wounds)

  • Motile, rod-shaped, Gram-negative; occurs as single bacteria, in pairs, or occasionally in short chains

  • In culture, it produces a sweet or grape-like or taco-like odor

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Burn wounds

First barrier against infection (skin) is compromised

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Pyocyanin

nonfluorescent bluish pigment

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Pyoverdine

gives greenish color to the agar (Mueller-Hinton Agar) when combined with pyocyanin

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Pyorubin

dark red pigment

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Pyomelanin

black pigment

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Exotoxin A

causes tissue necrosis by blocking protein synthesis (blocks elongation factor 2)

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True

[TRUE OR FALSE] P. aeruginosa is pathogenic only when introduced into areas devoid of normal defenses, such as mucous membranes and skin disrupted by direct tissue damage

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meningitis

this disease can occur when P. aeruginosa is introduced by lumbar puncture or neurosurgical procedures

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Mild otitis externa

clinical findings of P. aeruginosa that is mostly found in swimmers

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Ecthyma gangrenosum

hemorrhagic necrosis of the skin

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Folliculitis

clinical findings of P. aeruginosa that is associated with poorly chlorinated hot tubs and swimming pools

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False; P. aeruginosa can destroy beta-lactam antibiotics

[TRUE OR FALSE] Beta-lactamase can be used as a treatment for P. aeruginosa

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Surgical wound infections

Caused by:

  • Patient’s endogenous or hospital acquired and mucosal flora

  • Airborne spread of skin squames that may shed to wound (from OR personnel)

  • Rarely, airborne spread through droplet nuclei from an infected “disseminator” among the staff

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False; should be administered 1 hour before surgery

[TRUE OR FALSE] Administering prophylactic antibiotics within 1 hour after surgery is a must to prevent surgical site infection

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INTRAVASCULAR DEVICE-RELATED BACTEREMIA

Infection is derived from cutaneous microflora of the insertion site, with pathogens migrating extraluminal to the catheter tip

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True

[TRUE OR FALSE] Diagnosis for intravascular device-related bacteremia include: Recovery of the same species of microorganisms from the peripheral blood cultures (2 sites) and from semi quantitative or quantitative cultures of the vascular catheter tip

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True

[TRUE OR FALSE] a devoid of proper handwashing in a hospital setting can produce HAP or VAP

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True

[TRUE OR FALSE] The care bundle approach to providing medical care forms part of a more general philosophical change in the way that medicine is practiced

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True

[TRUE OR FALSE] The choice of inclusion in a care bundle is heavily based on expert opinion

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False; Semmelweis' discovery was hardly accepted because it's merely seen as a simple cure an recommendations

[TRUE OR FALSE] Semmelweis' proposed a practical handwashing measures and his colleagues immediately accepted and practiced it

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Dapat kaya mo, ginusto mo 'to eh

Kaya mo pa ba

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