Question

1. What is the difference between community acquired infection and nosocomial infection?

2. As a nurse provide measures on how to prevent an infection in an elderly patient in a nursing home.

3. As a nurse provide measures on how to prevent infection on a post-operative patient.

4. Please explain what are multi-drug resistant infection and why is it increasing?

Answer 1

1. What is the difference between community acquired infection and nosocomial infection?

Community acquired infection

Community-acquired infections, or CAIs, are infections that are contracted outside of a healthcare setting. Patients can expose other patients to CAIs upon admission. Unless the chain of infection is broken, a healthcare facility can be put at risk of an infection outbreak.

Symptoms of CAIS

Each type of CAI has its own set of symptoms. General symptoms that apply to a number of infections include muscle aches, fever, fatigue, diarrhea and coughing.

Common types of CAIS

One of the most common CAIs is pneumonia, a leading cause of mortality and morbidity worldwide. Other types of community-acquired infections include:

• Norovirus
• Influenza
• Botulism
• Hepatitis C
• Human immunodeficiency virus (HIV)

Causes of CAIS

Community-acquired infections can be caused by a variety of pathogens such as viruses, bacteria, parasites and fungi. While some infections can be spread from person to person, others are transmitted through bites from animals or insects. Others can be caused by contaminated food ingestion or exposure to harmful environmental organisms.

Nosocomial infection/Healthcare-associated infections

Healthcare-associated infections, or HAIs, are secondary infections patients may acquire while receiving treatment for a different illness at a healthcare facility. Although HAIs are entirely preventable, many patients suffer from them every year. In fact, according to the Centers for Disease Control and Prevention (CDC), about one in 31 hospital patients has at least one HAI on any given day.

Symptoms of HAIS

To classify as an HAI, symptoms must occur up to 48 hours after admission to the healthcare facility, up to three days after discharge or up to 30 days after a surgical procedure. While symptoms may differ depending on the infection, the most common symptoms of HAIs include:

• Discharge from a surgical wound
• Headache
• Diarrhea
• Cough
• Shortness of breath
• Vomiting
• Fever

Common types of HAIS

HAIs can take many forms. The most common types of hospital-acquired infections include:

• Catheter-associated urinary tract infections (CAUTI)
• Surgical site infections (SSIs)
• Central line-associated bloodstream infections (CLABSI)
• Ventilator-associated pneumonia (VAP)

Causes of HAIS

HAIs can be acquired in a variety of ways, including the improper use of medical equipment, improper disinfecting practices, and patient-to-patient contact. Since pathogens that cause HAIs can live on surfaces for long periods of time, it’s crucial to clean and disinfect all surfaces regularly to help prevent them from spreading.

HOW TO PREVENT HAIS AND CAIS

There are many things you can do to protect your staff and patients against HAIs and CAIs. The most important step is to ensure your staff follows proper hand hygiene. Healthcare workers should wash hands both before and after treating a patient. Staff should also use the right personal protective equipment (PPE) when treating patients. This may include wearing masks, gloves and gowns.

The most important step in preventing the spread of infection in a healthcare facility is to thoroughly disinfect surfaces. High-touch surfaces like door knobs, food trays, bed rails, light switches and bathrooms should be disinfected regularly.

2. As a nurse provide measures on how to prevent an infection in an elderly patient in a nursing home.

As a nurse, we can do many things to prevent an infection in an elderly patient in a nursing home. Elderly patients needing support for daily activities present unique challenges to the long-term care facilities who care for them. Today's post will conclude our series on nursing home facilities by focusing on the most common infections faced by their residents. There are some important things you need to know to prevent infections.

• Clean your hands before you eat and after using the bathroom. It should take at least 20 seconds to thoroughly wash your hands. Using an alcohol-based hand sanitizer is a good option if your hands are not visibly dirty.
• If you have open sores, cover them with a bandage. Do not pick at your sores or remove your bandage.
• Cover your mouth with the inside of your elbow when you cough or sneeze. Throw away any used tissues and wash your hands afterwards.
• Don’t share your personal items with other residents.
• Remind your care providers to wash their hands frequently. It’s OK to ask if a care provider has cleaned their hands before caring for you.
• If your doctor prescribes an antibiotic for an infection, take the medication exactly how it is prescribed.
• Follow directions if you are asked to stay in your room.
• Don’t touch any food that will be eaten by someone else.

Ways to Prevent Infections in the Elderly

To help older adults prevent infections and illness, it’s important to keep their immune systems as strong as possible.

Caregivers should remember these tips when working with older adults:

• Cover your cough
• Don’t share personal items
• Get vaccinated
• Prepare your food safely
• Wash your hands often

There are also steps that older adults can take to keep their bodies and immune systems strong, including:

• Eating foods that nourish the body.
• Work on stress management
• Make sure to stay active

3. As a nurse provide measures on how to prevent infection on a post-operative patient.

Post-operative infection was the original healthcare-associated infection; many patients succumbed to postoperative infections in the pre-antisepsis and pre-antibiotic eras. It would be tempting to think that, given the technology available in the average operating theatre suite and the many innovations and techniques that have been developed, SSIs no longer occur - sadly, however, this is not the case.

Risk of Post-operative infection

The risk of Post-operative infection is normally related to the class of surgical procedure undertaken. There are four categories:

• Clean - no microbial contamination has been encountered and none of the body spaces are entered;
• Clean-contaminated - gastrointestinal, respiratory or urinary tracts are entered under controlled conditions and without contamination occurring;
• Contaminated - contamination does occur following entry of the gastrointestinal, respiratory or urinary tracts. Recent acute traumatic wounds will be classed as contaminated for surveillance purposes;
• Dirty - devitalised or infected tissue is present at the site of the surgery

Postoperative care

In the postoperative phase it is important that nurses ensure wounds remain covered with an interactive dressing for at least the first 48 hours post-surgery to ensure the wound seals and becomes impervious to microbial contamination. Modern transparent dressings allow wounds to be observed without disturbance and it is important to ensure any discharge drains freely.

Postoperative wound dressings can be removed after 48 hours, and the wound exposed. Nurses should immediately report and record any signs of discharge or inflammation in a surgical wound. However, it is normal for healing surgical wounds to appear slightly inflamed, so wound swabs should not be sent for analysis unless there are clinical signs of infection. If any wound drains are present, they should be removed at the earliest possible opportunity and patients should be asked to report any problems with their wound as soon as they occur.

4. Please explain what are multi-drug resistant infection and why is it increasing?

Multiple drug resistance (MDR), multidrug resistance or multiresistance is antimicrobial resistance shown by a species of microorganism to at least one antimicrobial drug in three or more antimicrobial categories. Antimicrobial categories are classifications of antimicrobial agents based on their mode of action and specific to target organisms. The MDR types most threatening to public health are MDR bacteria that resist multiple antibiotics; other types include MDR viruses, parasites.

Multidrug resistant (MDR) bacteria are one of the most important current threats to public health. Typically, MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become quite prevalent causes of community-acquired infections. The spread of MDR bacteria into the community is a crucial development, and is associated with increased morbidity, mortality, healthcare costs and antibiotic use. Factors associated with community dissemination of MDR bacteria overlap but are distinct from those associated with nosocomial spread. Community-associated (CA) MDR bacteria have an antibiotic resistance phenotype that is stable in the absence of antibiotic pressure of the type normally observed in hospitals or nursing homes. An exception to this rule may be those CA-MDR bacteria, of which the prevalence is driven by the presence of antibiotics in the food chain. Additionally, the colonization of otherwise healthy hosts is a common characteristic of CA-MDR bacteria. However, subtle immune deficiencies may still be present in the subjects colonized with specific CA-MDR bacteria. Methicillin-resistant S. aureus (MRSA) is the most prevalent of CA-MDR bacteria. CA-MRSA also has the greatest impact on morbidity and mortality. The main threat on the horizon is represented by Enterobacteriaceae. The production of extended spectrum β-lactamases in Enterobacteriaceae encountered in the community is becoming increasingly prevalent. Of great concern is the potential for the acquisition of carbapenemase genes in CA-Enterobacteriaceae. Prevention of further community spread of MDR bacteria is of the utmost importance, and will require a multi-disciplinary approach involving all stakeholders.