HAIs
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Carleton University *
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1001
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Medicine
Date
Jan 9, 2024
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docx
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Uploaded by CaptainBee2160
Infection control guideline for the prevention of healthcare associated pneumonia
https://publications.gc.ca/collections/collection_2012/aspc-phac/HP40-54-2010-eng.pdf
Health care-associated infections in Canadian hospitals: still a major problem:
Alongside an overall decline in health care–associated infections in Canadian hospitals, infections
caused by antimicrobial-resistant organisms, while low in prevalence, are rising.
Antimicrobial-resistant pathogens to watch are carbapenamase-
producing
Enterobacteriaceae
and
Candida auris
.
A rise in vancomycin-resistant
Enterococci
(VRE) infections over time may be linked to recent
discontinuation of targeted VRE control strategies in some hospitals in Canada.
Continued efforts by hospitals to reduce health care–associated infection and antimicrobial
resistance, including surveillance, reporting metrics and targeted control programs, are needed.
A beginner’s guide to interpreting odds ratios, confidence intervals and p-values:
https://s4be.cochrane.org/blog/2013/08/13/a-beginners-guide-to-interpreting-odds-ratios-confidence-
intervals-and-p-values-the-nuts-and-bolts-20-minute-tutorial/
Odds Ratio: An odds ratio is a relative measure of effect, which allows the comparison of the
intervention group of a study relative to the comparison or placebo group.
o
If the OR is > 1 the control is better than the intervention.
o
If the OR is < 1 the intervention is better than the control.
o
Numerator = odds in the intervention group
o
Denominator = odds in the control/ placebo group
Confidence Interval: The confidence interval indicates the level of uncertainty around the
measure of effect (precision of the effect estimate) which in this case is expressed as an OR.
Confidence intervals are used because a study recruits only a small sample of the overall
population so by having an upper and lower confidence limit we can infer that the true
population effect lies between these two points. Most studies report the 95% confidence
interval (95%CI).
o
If the confidence interval crosses 1 (e.g. 95%CI 0.9-1.1) this implies there is no difference
between groups of the study.
P Values: P < 0.05 indicates a statistically significant difference between groups. P>0.05 indicates
there is not a statistically significant difference between groups.
Risk Stratification:
Patients/residents served by differing health care settings have differing risk factors related to the
treatments and procedures that they undergo. These risk factors may be either extrinsic (environment
related) and/or intrinsic (patient-related) risk factors for HAI, including underlying disease condition and
advanced age. Without adjustment for these factors, comparisons within the same health care setting or
inter-facility comparisons may be invalid or misleading. For example, comparison of rates of infection
between a community hospital and a tertiary care hospital may show a substantially higher rate of HAI in
the tertiary care hospital. This difference may be due to several factors (ex: higher degree of
susceptibility to HAI in the more acutely ill population served by the tertiary care hospital)
Stratification is a process to control for differences in the underlying risk factors for infection.
Risk stratification involves categorizing patients/residents with similar susceptibilities to infection
and calculating the HAI rates based on these groupings.
Risk stratification allows for meaningful comparison of rates among patients/residents with
similar risks within a health care setting or between health care settings and at different points in
time
Generally, not used in LTC, usually applied to surgical site infections and occasionally other
infections
Rates of HAI are often stratified by the major non-modifiable
risk factors pertaining to that
infection.
o
Surgeries can be classified by wound class, i.e., the likelihood of contamination of the
surgical site at the time of the operative procedure
HAI lecture:
Colonization vs infection:
Managed the same in terms of infection
Not managed the same in terms of treatment
PIDAC for Perinatology = reference
Heymans
APIC
Perinatology:
Important at all stages of mother’s heath- preconception, antenatal, intrapartal, postpartum
Obstetrics: Surveillance
Adherence to HH
Adherence to routine practices
Adherence to prenatal screening
Adherence to recommendations for immunizations in mothers
Staff influenza vaccination rates
Appropriate antibiotic prophylaxis for C sections
Appropriateness of Abx use
Outcome indicators:
o
C sections SSI rates
Predisposing Factors for HAI in Neonates
Low birth weight
Acute underlying disease
Immature immune system
Immature skin barrier
Abx use changing flora
Examples of Neonate HAI
Skin infections-pustules
Conjunctivitis
Circumcision
Meningitis
CNS infection
Neonatal Surveillance
Adherence to HH
Adherence to routine practices
Adherence to recommendations for immunizations in neonates
Staff influenza rates
Central line insertion and maintenance
Appropriate abx use
Outcome indicators:
o
Central line associated blood stream infections
o
Blood stream infections
o
Necrotizing enterocolitis
CASE STUDY: On Tuesday, January 1, the Infection Control Practitioner received a phone call from the
Nursing Unit Director in the Nursery informing her that over the weekend one of the infants developed a
pustular rash.
The Infection Control Practitioner contacted the laboratory and was informed that Gram-positive cocci
were observed on Gram strain.
1. How can this agent be further differentiated on Gram strain?
How do the cocci organise themselves or their movement, is it clusters or chains?
o
Clusters = Staph
o
Chains
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Is it coagulase negative or positive?
o
If coagulase
2. What would be the most likely source of this organism?
Spread by direct or indirect pr aerosolized and spread by sneezing or coughing
Could be mother, staff, families
Mothers birth canal; staff hands or resp infection, could be skin infections, equipment
30% of people with staph aureus usually in anterior nares, could be other sites though
3. Describe the mode of transmission of this organism
Part 2: The final laboratory report identified the organism as a Staphylococcus aureus. By Monday, two
other babies had also developed a pustular rash.
4. List the steps you would take to determine if a common source is likely.
Typing/ finding out if source is common
5. Describe the infection control interventions and future preventative measures.
Line list of people, place and time
Commincation with all areas, staff, PR, Occ health
Do a point prevalence weekly until three negative screens
6. What would you (the I.C.P.) recommend for:
a. Infant surveillance?
b. Employee surveillance?
c. Environment surveillance?
d. Laboratory follow-up?
BE careful before testing mother for staph aureus if the mother is not the epidemiological link