MSALI: IN

FECTI

ONS

INFECTION CONTROL IN HEALTH-CARE AGENCIES

Community-acquired Infection

Nosocomial Infection Hand Hygiene

NOSOCOMIAL INFECTIONS

Infection from Stay in Health-care Agency

Risk FactorsHost’s ConditionMultiple Antibiotic Therapy High-risk Units

NOSOCOMIAL INFECTIONS (CONT’D)

Common PathogensEscherichia coli (E. coli) Staphylococcus aureus Pseudomonas aeruginosa

HAND HYGIENE

Before and After

Patient ContactGlove Use

Antibiotic Resistant Infections

MRSA

Methicillin Resistant staphylococcus areus

- a bacteria

Common sites :NaresSkin

Colonized

TREATMENT

I & D

Contact ISO Precautions

Clindamycin

Tetracyclines

Rifampin

Linezolid

Mupirocin ointment for topical tx

PREVENTION

Hand Hygiene

Decolonization

DECOLINIZATION

Use of daily chlorhexidine baths in ICU

populations may decrease overall rates of

bloodstream infections and MRSA

acquisition, but effect on MRSA infections

less clear

VRE

Vancomycin-resistant Enterococci

- a bacteria

normally present in the human intestines and in the female genital tract and are often found in the environment.

WHAT TYPES OF INFECTIONS DOES VRE CAUSE?

It can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

WHO IS AT RISK?

People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time.

People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.

People with weakened immune systems.

People who have undergone surgical procedures.

People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters.

People who are colonized with VRE.

TREATMENT

People who are colonized do not usually need treatment.

Most VRE infections can be treated successfully with antibiotics other than vancomycin.

Laboratory testing of the VRE sample can determine which antibiotics will successfully treat the infection.

CLOSTRIDIUM DIFFICILE INFECTION

A spore-forming, Gram-positive anaerobic bacillus

The bacteria are found in the feces.

Associated with ABX use.

S/S OF CLOSTRIDIUM DIFFICILE INFECTION?

watery diarrhea (at least three bowel movements per day for two or more days)

fever

loss of appetite

nausea

abdominal pain/tenderness

THE RISK FOR DISEASE INCREASES IN PATIENTS WITH:

antibiotic exposure

proton pump inhibitors

gastrointestinal surgery/manipulation

long length of stay in healthcare settings

a serious underlying illness

immunocompromising conditions

advanced age

TREATMENT

The infection can usually be treated with an appropriate course of antibiotics,

including metronidazole, vancomycin , or recently approved fidaxomicin.

Fecal Transplant

Contact Isolation - Healthcare workers and visitors must use gloves and gowns on entry to a room of a patient with CDI.

Emphasize compliance with the practice of hand hygiene.

COMMUNITY ACQUIRED INFECTIONS

An infection acquired outside health care settings, such as in the home.

FIFTH DISEASE

Erythema Infectiosum

Caused by Parovirus B19.

Usually affects children

Incubation Period: 4-14 days

Communicable period: before rash appears

Transmission: contact and droplet

FIFTH DISEASE CONT…

Signs/Symptoms: cheeks appear “slapped”,

Lace or network pattern rash on limbs, then trunk. Malaise, cough, slight fever, headache.

Sunlight aggravates rash.

Rash lasts ~10 days

Treatment: none, treat symptoms

Complications: pregnant women -> hydrops fetalis

SARSSevere Acute Respiratory Syndrome

Caused by coronavirus (SARS-CoV)

Incubation Period- 2-7 days, very virulent

Transmission: Contact and Droplets

S/S: fever, chills, malaise, headache, cough, diarrhea (20%),

Associated with travelers to China, Hong Kong or Taiwan

Complications: respiratory failure

MERS

Middle East Respiratory Syndrome

First reported in Saudi Arabia in 2012.

On May 2, 2014, the first U.S. imported case of MERS was confirmed in a traveler from Saudi Arabia to the U.S. On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came from Saudi Arabia.

MERS CONT…

It is caused by a coronavirus called MERS-CoV.

Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness. They had fever, cough, and shortness of breath.

About 30% of people confirmed to have MERS-CoV infection have died.

AVIAN FLU

Contagious disease of birds and pigs

Causative agent: H5N1 influenza A virus

Affects susceptible human populations

Transmission: Direct contact with infected poultry or feces.

S/S: Fever, URI, sore throat

AVIAN FLU CONT…

Treatment: Tamiflu, Relenza

MUST be administered within 48 hrs of s/s.

Antibiotics for secondary pneumonia

Complications: respiratory failure

MAJOR concern is that it will mutate and cause pandemic human – human cases

LYME DISEASECaused by spirochete bacteria – Borrelia

burgdorferi

Can affect anyone.

Peak season May-August

Transmission: by tick bite

S/S: 3 stages

Early – erythema migrans – bull’s eye rash

Progresses to diffuse rash, fever, joint pain, headaches, cardiac arrythmias, muscle aches.

Late stage – arthritis, neuro deficits

LYME DISEASE CONT…

Diagnosis: Elisa Blood Test, Western Blot

Treatment: Doxycycline, Rocephin

Complications: Arthritis, Bell’s Palsy, Cardiac Arrhythmias

PREVENTION is KEY

WEST NILE VIRUS

Viral infection spread by a vector

Peaks in summer-fall

Incubation period – 3-14 days

Transmission: mosquitos that feed on infected birds

Not contagious among humans

WEST NILE VIRUS CONT…

S/S:

80% no s/s

20% fever, HA, body aches, N/V, swollen lymph nodes, skin rash

1/150 serious illness – high fevers, neck stiffness, stupor, altered mental status, convulsions, vision loss, paralysis

WEST NILE VIRUS CONT…

Treatment: supportive

Complications: encephalitis, meningitis, polymyelitis

high risk groups - >50 age, comorbidities, outdoors workers,

LEGIONNAIRES DISEASE

Causative agent: bacteria Legionella pneumophilia

Found in H2O distribution systems

Causes respiratory infection

Incubation period: 2-14 days

Transmission: Droplet

S/S; fever, HA, cough, malaise, GI symptoms

Treatment: Antibiotics