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[ ESA 3- Infection and Immunity > Infection Prevention > Flashcards

Infection Prevention Flashcards

1
Q

How do many infections remain tranmissible?

A

Common non-human source
Person-to-person direct
Person-to-person indirect

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2
Q

What is meant by a common non-human source?

A

A common source that a potential host comes into contact with, and acquires the infection

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3
Q

What can happen once a potential host has acquired the infection?

A

It can then be passed from person to person

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4
Q

What are the potential common non-human sources?

A

Environmental source
Food/drink
Animals

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5
Q

Give an example of a disease which has an environmental source?

A

Legionnaires disease

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6
Q

What is legionnaires disease caused by?

A

Legionella pneumophila

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7
Q

Where can Legionella pneumophilia come from?

A

A common water source

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8
Q

How can a common water source spread Legionella pneumophilia?

A

The water source usually creates water droplets, and the bacteria is then spread via the droplet to a person

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9
Q

Give two examples of where a water source can create water droplets

A

Shower

Fountain

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10
Q

Is Legionnaires considered transmissible between people?

A

No

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11
Q

Give an example of a pathogen that can be spread in food or drink

A

E. Coli

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12
Q

Where is E. coli o157 found?

A

In the GI tract of cows

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13
Q

What can E. coli o157 cause?

A

Gastrointestinal disease

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14
Q

When can E. coli o157 cause gastrointestinal disease?

A

If it gets into meat/milk

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15
Q

How can E. coli o157 from meat/milk be transmitted between people?

A

Via faecal oral route

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16
Q

Give an example of a disease that can spread through animals

A

Rabies

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17
Q

How does an animal act as a ‘common source’ for rabies?

A

It bites more than one person

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18
Q

What is meant by person-to-person direct transmission?

A

Spread from one person to another without intermediate, and this newly infected person can go on to infect someone else

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19
Q

Give three examples of disease spread person-to-person direct

A

Norovirus
Influenza
Neisseria gonorrhoea

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20
Q

How high does exposure to norovirus need to be to cause disease?

A

A very minimal exposure of 1 infectious particle is enough to cause infection in 50% of the population

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21
Q

What is meant by 1 infectious particle?

A

A clump of viruses bound by faeces, for example

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22
Q

Where does norovirus spread often occur?

A

In an enclosed environment

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23
Q

How is norovirus transmitted?

A

Faecal/oral route

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24
Q

How is influenza transmitted from person to person

A

By droplet transmission

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25
Q

Can influenza be spread from to humans from animals?

A

Yes

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26
Q

How is Neisseria gonorrhoea spread?

A

Direct contact with another person

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27
Q

What happens in person-to-person indirect transmission?

A

Transmission occurs via a vector and cannot usually be transmitted onwards without one

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28
Q

Give three examples of diseases spread person-to-person indirect

A

Malaria
Guinea worm
Schistosomiasis

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29
Q

How is malaria transmitted?

A

Via a mosquito that bites an infected individual, which then bites another individual

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30
Q

What happens when a mosquito bites an infected individual?

A

It picks up the plasmodium into their blood

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31
Q

How does the mosquito infect another person when it bites them?

A

It injects the infection into them via saliva

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32
Q

What can happen once a person has been infected with malaria?

A

The person can be bitten by another mosquito that can pass the disease on again

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33
Q

How is guinea worm transmitted?

A

A person with the worm washes their feet in water, allowing larvae to be hatched into it.
An aphid then eats the larvae and sits in the water
Ingestion of the aphid allows the larvae to evade digestion and survive in the GI tract, where it burrows to the feet to continue the cycle

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34
Q

How can schistosomiasis be transmitted?

A

Through snails

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35
Q

What is meant by endemic disease?

A

The usual background rate of disease within a community with no extra factors to consider

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36
Q

What does the rate depend on in endemic disease?

A

The disease in question

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37
Q

What is an outbreak?

A

Two or more cases linked in time and place

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38
Q

What must be true for cases to be an outbreak?

A

The causative organisms must be of the same type

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39
Q

What is meant by an epidemic?

A

When a rate of infection is greater than the usual background rate

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40
Q

What is meant by pandemic?

A

A very high rate of infection spreading across many regions, countries, or contients

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41
Q

Give an example of a pandemic

A

Swine flu in 2009

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42
Q

What happened in the 2009 swine flu pandemic?

A

Originated in Mexico and spread throughout the world

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43
Q

What is the problem with pandemics?

A

They can cause large disruption to healthcare

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44
Q

What is how quickly an infection spreads affected by?

A

Its basic reproduction number (R0)

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45
Q

What is R0?

A

The average number of cases one case generates over the course of its infectious period, in an otherwise infected, non-immune population

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46
Q

What happens if R0 > 1?

A

The number of cases will increase

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47
Q

What happens if R0 = 1?

A

The number of cases will remain the same

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48
Q

What happens if R0 < 1?

A

Number of cases will decrease

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49
Q

When will an outbreak stop?

A

If everyone dies

Disease is overcome and immunity is developed

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50
Q

What diseases send to have a high R0?

A

Diseases spread by airborne route

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51
Q

Give two examples of diseases spread by airborne route with a high R0?

A

Measles

Pertussis

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52
Q

What is the R0 of measles?

A

12-18

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53
Q

What is the R0 of pertussis?

A

12-17

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54
Q

Give an example of a disease spread by the airborne route with a low R0

A

Influenza

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55
Q

What is the R0 of influenza?

A

Can be as low as 2-3

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56
Q

What may the low R0 of influenza be a reflection of?

A

The development of personal immunity

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57
Q

What kind of diseases tend to have a low R0?

A

Diseases that are spread through sexual contact

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58
Q

Give an example of a disease spread by sexual contact that has a low R0

A

HIV

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59
Q

What is the R0 of HIV?

A

2-5

60
Q

Why do diseases that spread by sexual contact have a low R0?

A

It is a contact that is less likely to occur

61
Q

What do reasons for outbreaks, epidemics and pandemics relate to?

A

Pathogen
Patient
Practice

62
Q

What pathogen factors can lead to outbreaks, epidemics, and pandemics?

A

The introduction of new pathogens or pathogenic features

63
Q

What pathogenic features can be introduced that lead to outbreaks, epidemics, and pandemics?

A

New antigens on pathogens surface
New virulence factors
Antibacterial resistance

64
Q

Give an example of a pathogen that often mutates its surface antigens

A

Influenza

65
Q

Give an example of a pathogen that may develop new virulence factors to cause outbreaks, epidemics and pandemics

A

C. Diff

66
Q

Give an example of a pathogen that has antibiotic resistance

A

MRSA

67
Q

What patient factors can lead to outbreaks, epidemics, and pandemics?

A

Introduction of new hosts

68
Q

In what form are non-immunes introduced into the communities all the time?

A

Babies that have not yet developed immunity

69
Q

What is the result of non-immunes being introduced into the community?

A

There is more chance of the person becoming infected and spreading it to others

70
Q

How can healthcare cause outbreaks, epidemics, and pandemics?

A

It can bring people into close contact with people that are infected, allowing a route for infection to spread throughout the population

71
Q

What changes in human practice can cause outbreaks, epidemics, and pandemics?

A

Social practices

Healthcare practices

72
Q

Give an example of a social practice that can lead to outbreaks, epidemics, and pandemics

A

Increases in the number of body piercings have caused outbreaks due to unsanitary procedures

73
Q

Give three examples of healthcare practices that can lea to outbreaks, epidemics, and pandemics

A

Surgery
Central line usage
Immunosuppression

74
Q

What is transmissibility affected by?

A

The infectious dose

75
Q

What is the infectious dose?

A

The number of microorganisms required to cause infection

76
Q

What can infectious dose vary depending on?

A

The type of microorganism
Presentation of microorganism
Immunity of potential host

77
Q

What can the immunity of the potential host be affected by?

A

A large number of factors, including genetic disorders, infections like HIV, cancer, and different treatments

78
Q

What is the infectious dose for cholera?

A

10^4 - 10^6 organisms

79
Q

What is the infectious dose of E. Coli o157?

A

<10 organisms

80
Q

What trend to transmissions of infections often follow?

A

An epidemic curve

81
Q

What does the epidemic curve of infection transmission show?

A

The progression of the majority of the population from susceptibility, to infection, and then to recovery

82
Q

What nature of epidemic curve does small scale outbreaks?

A

Stochastic nature

83
Q

Why do small scale infections show a stochastic epidemic curve

A

Due to the random nature of transmission of infection in small populations

84
Q

How can infection be prevented?

A

Via intervention at a number of stages of the infection model

85
Q

What interventions can be made at stages of the infection model to prevent infection?

A

Prevention of pathogens initial existence
Prevention of patient coming into contact with an existing pathogen
Prevention of development of patient/pathogen contact into infection
Prevention of further infection to other individuals

86
Q

What can infection prevention be protein down into?

A

The 4 P’s

87
Q

What are the 4 P’s?

A

Pathogen (and vectors)
Patient
Practice
Place

88
Q

How can infection be prevented when considering the pathogen?

A

Reduction/eradication of a pathogen Reduction/eradication of a vector

89
Q

How can a pathogen be reduced or eradicated?

A

Effective use of antibacterial and disinfectants

90
Q

What does the effective use of antibacterials and disinfectants allow for?

A

Decontamination and sterilisation of surfaces, equipment, and the environment

91
Q

How can a vector be reduced or eradicated?

A

Eliminating breeding sites

Killing or controlling existing vectors

92
Q

What vector can be reduced/eradicated by eliminating breeding sites?

A

Mosquitos

93
Q

What vector can be reduced/eradicated by killing or controlling existing vectors?

A

Rapid animals

94
Q

How can infection be prevented when considering the patient?

A

Improve health

Immunity

95
Q

How can health be improved in the patient to prevent infection?

A

Nutrition and medical treatment

96
Q

What kinds of immunity can be conveyed to the patient to prevent infection?

A

Passive

Active

97
Q

How can passive immunity be conferred to patients?

A

Maternal immunity

Intravenous immunoglobulin

98
Q

How can active immunity be conveyed to the patient to prevent infection?

A

Vaccination

99
Q

How can herd immunity be used?

A

By vaccinating a proportion of the population to reduce the amount of potential people that can cause secondary transmission and thus protecting unvaccinated people by decreasing their likelihood of coming into contact with someone with an infection

100
Q

What does the proportion of the population that needs to be vaccinated for herd immunity to work vary with?

A

The R0 of the infection

101
Q

How can infection be prevented when considering practice?

A

Avoidance of pathogen or its vector

102
Q

In what ways can the pathogen or vector be avoided?

A

Geographic
Protective clothing or equipment
Behavioural

103
Q

What protective clothing or equipment can be used to prevent infection?

A

Long sleeves/trousers against mosquito bites

PPE in hospitals

104
Q

What PPE is used in hospitals?

A

Gowns
Masks
Gloves

105
Q

What behavioural practices can be used to prevent infection?

A

Safe sex
Safe disposal of sharps
Food and drink preperation

106
Q

How can infection be prevented when looking at the place?

A

Environmental engineering

107
Q

How can environmental engineering prevent infection?

A

Safe water
Safe air
Good quality housing
Well designed healthcare facilities

108
Q

How can surveillance be used to prevent infection?

A

Monitor what is happening now

What could happen in the future

109
Q

What are the consequences of good infection control?

A

Decreased incidence of disease/organism

110
Q

What diseases have decreased incidence due to good infection prevention?

A

Smallpox
Polio
Dracunculiasis

111
Q

What is the consequence of bad infection control?

A

Decreased exposure to pathogen

Later average age of exposure

112
Q

What does decreased exposure to pathogen lead to?

A

Decreased immune stimulus

113
Q

What is the result of a decreased immune stimulus?

A

Decreased antibody

114
Q

What is the result of decreased immune antibodies?

A

Increased susceptible people

115
Q

What is the result of increased susceptible people

A

Outbreak

116
Q

What is the result of a later age of exposure to infection?

A

Increased severity

117
Q

What diseases have an increased severity at a later age of exposure?

A 
Polio
Hepatitis A 
Chickenpox
Congenital rubella
Syndrome
118
Q

What does all exposure of bacteria to antimicrobials lead to?

A

A level of antimicrobial resistance

119
Q

Is antimicrobial resistance reversible?

A

Effectively irreversible

120
Q

What is the problem with new antimicrobial development?

A

It is stalled- no new antibiotic classes since 1987

121
Q

What are the consequences of antimicrobial resistance?

A

Treatment failure
Prophylaxis failure
Economic cost

122
Q

How much does antibiotic resistance cost in the EU?

A

Approx €1.5billion a year

123
Q

How many deaths per year are there in the EU from antimicrobial resistance?

A

25,000

124
Q

How many deaths per year due to antimicrobial resistance are there per year in Thailand?

A

> 38,000

125
Q

What does the acronym MDR mean?

A

Multi-drug resistant

126
Q

What is meant by multi-drug resistance?

A

Non-susceptibility to one agent in three or more antimicrobial categories

127
Q

What does the acronym XDR mean?

A

Extensively drug resistant

128
Q

What is meant by extensively drug resistant?

A

Non-susceptibility to at least one agent but two or fewer antimicrobial categories

129
Q

What does PDR mean?

A

Non-susceptibility to all agents in all antimicrobial categories

130
Q

What does antibacterial use lead to?

A

Resistance

131
Q

How can the fact that antibacterial use leads to resistance be backed up?

A

Lab evidence
Ecological studies
Individual level data

132
Q

What is the purpose of lab evidence when determining the link between antibacterial use and resistance?

A

Provides biological plausibility

133
Q

What is the purpose of ecological studies when determining the link between antibacterial use and resistance?

A

Relates levels of antibacterial use in a population with level of resistance

134
Q

What is the purpose of individual level data when determining the link between antibiotic use and resistance?

A

Relates prior antibacterial use in an individual with the subsequent presence of bacterial resistance

135
Q

What does an antimicrobial stewardship programme consist of?

A

Multidisciplinary team and relationships to other quality/safety teams
Surveillance

136
Q

Who does the multidisciplinary team involved with antimicrobial stewardship consist of?

A 
Medical microbiologists/infectious diseases physicians
Antimicrobial pharmacist
Infection control nurse
Hospital epidemiologist 
Information system specialist
137
Q

What does the multidisciplinary team involved in antimicrobial stewardship link in with?

A

Infection prevention and environmental decomination

138
Q

What happens in surveillance in antimicrobial stewardship?

A

Process measures

Outcome measures

139
Q

What process measures are taken in antimicrobial stewardship?

A

Antibacterial use
Over time in same institution
Benchmarking against other institutions

140
Q

What measures are taken of antibacterial use in antimicrobial stewardship programmes?

A

Quantity
Antibacterial classes
Appropriateness

141
Q

Give an example of how quantity of antibacterial use can be measured in antimicrobial stewardship

A

Defined daily doses / 1000 bed days

142
Q

What is meant by appropriateness of antibacterial use in antimicrobial stewardship?

A

Adherence to guidelines

143
Q

What outcome measures are taken in antimicrobial stewardship?

A

Patient outcomes
Emergence of resistance
C. Difficile infection rate

144
Q

What does antimicrobial stewardship aim to do?

A

Ensure appropriate use of antimicrobials
Create optimal clinical outcomes
Minimise toxicity and other adverse events
Reduce costs of health care from infections
Limit the selection for antimicrobial resistant strains

145
Q

What are the requirements for successful antimicrobial stewardship?

A

Long term confirmed and appropriate resources
Hospital leadership support and delegated authority to challenge/change inappropriate antimicrobial therapy
Integration into organisational patient safety and quality of care structure and processes

[ ESA 3- Infection and Immunity (15 decks)

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