Hospital-Acquired Infections (HAIs) - Nosocomial Infections

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Hospital-Acquired Infections (HAIs)";
pres.author = "Orris Medical";

// Color palette - deep teal/navy medical theme
const C = {
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  accent:  "0EA5E9",  // bright sky blue accent
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  white:   "FFFFFF",
  yellow:  "FBBF24",
  red:     "EF4444",
  green:   "22C55E",
  gray:    "94A3B8",
  dark:    "0F172A",
};

// ─────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────
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s1.addShape(pres.ShapeType.rect, { x: 0, y: 4.1, w: 10, h: 1.525, fill: { color: C.teal } });
s1.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });

s1.addText("HOSPITAL-ACQUIRED", {
  x: 0.35, y: 0.7, w: 9.3, h: 0.8,
  fontSize: 36, bold: true, color: C.white, fontFace: "Calibri",
  charSpacing: 4, align: "center"
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s1.addText("INFECTIONS (HAIs)", {
  x: 0.35, y: 1.45, w: 9.3, h: 0.8,
  fontSize: 36, bold: true, color: C.accent, fontFace: "Calibri",
  charSpacing: 4, align: "center"
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s1.addText("Nosocomial Infections — Epidemiology · Types · Prevention · 2024–25 Guidelines", {
  x: 0.5, y: 2.5, w: 9, h: 0.55,
  fontSize: 15, color: C.gray, fontFace: "Calibri", align: "center", italic: true
});
s1.addText("Sources: Park's Preventive Medicine · CDC NHSN 2024 · ISID 2024 · ESCMID 2024", {
  x: 0.5, y: 4.35, w: 9, h: 0.4,
  fontSize: 11, color: C.gray, fontFace: "Calibri", align: "center"
});

// ─────────────────────────────────────────────
// SLIDE 2 — DEFINITION & EPIDEMIOLOGY
// ─────────────────────────────────────────────
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s2.addText("DEFINITION & EPIDEMIOLOGY", {
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// Left box — Definition
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s2.addText("DEFINITION", { x: 0.3, y: 0.95, w: 4.4, h: 0.35, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri" });
s2.addText([
  { text: "Infection acquired during hospital care, ", options: {} },
  { text: "NOT present or incubating at admission.", options: { bold: true } },
  { text: "\n\nOnset: ", options: {} },
  { text: ">48 hours after admission", options: { bold: true, color: C.teal } },
  { text: "\n\nAlso includes infections in any healthcare setting (WHO/CDC).", options: {} },
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// Right box — Key Stats
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s2.addText("CDC 2024 KEY STATISTICS", { x: 5.2, y: 0.95, w: 4.4, h: 0.35, fontSize: 12, bold: true, color: "B45309", fontFace: "Calibri" });
s2.addText([
  { text: "1 in 31", options: { bold: true, fontSize: 18, color: C.red } },
  { text: " US hospital patients gets an HAI daily\n", options: { fontSize: 12 } },
  { text: "3rd consecutive year", options: { bold: true, color: "166534" } },
  { text: " of declining HAI rates (2024)\n", options: { fontSize: 12 } },
  { text: ">38,000", options: { bold: true, color: C.teal } },
  { text: " US facilities report to NHSN", options: { fontSize: 12 } },
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// Types row
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s2.addText("TYPES: Endemic (common) vs. Epidemic (outbreak — unusual rise above baseline)", {
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// Bottom stat boxes
const stats2 = [
  { val: "UTI", sub: "Most common\nnosocomial site", col: C.accent },
  { val: "VAP", sub: "Highest mortality\nin ICU", col: C.red },
  { val: "CLABSI", sub: "Most costly\nHAI type", col: "7C3AED" },
  { val: "SSI", sub: "30-day post-op\ncriterion", col: C.green },
];
stats2.forEach((st, i) => {
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  s2.addText(st.sub, { x, y: 4.35, w: 2.2, h: 0.9, fontSize: 11, color: C.white, fontFace: "Calibri", align: "center" });
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// ─────────────────────────────────────────────
// SLIDE 3 — COMMON SITES (with distribution)
// ─────────────────────────────────────────────
let s3 = pres.addSlide();
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s3.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s3.addText("COMMON SITES OF NOSOCOMIAL INFECTION", {
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const sites = [
  { site: "Urinary Tract", pct: "30–40%", bug: "E. coli, Enterococcus, Candida", col: C.accent, x: 0.2, y: 0.95 },
  { site: "Lower Respiratory Tract", pct: "15–20%", bug: "Pseudomonas, Klebsiella, S. aureus", col: "7C3AED", x: 0.2, y: 1.8 },
  { site: "Surgical Site", pct: "14–16%", bug: "S. aureus, MRSA, CoNS", col: C.green, x: 0.2, y: 2.65 },
  { site: "Bloodstream / Bacteremia", pct: "10–14%", bug: "CoNS, S. aureus, Gram-negatives", col: C.red, x: 0.2, y: 3.5 },
  { site: "Skin & Soft Tissue / Catheter site", pct: "8–10%", bug: "S. aureus, Streptococcus", col: C.yellow, x: 0.2, y: 4.35 },
];

sites.forEach(s => {
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  // site name + %
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  s3.addText("Pathogens: " + s.bug, { x: 0.45, y: s.y + 0.35, w: 4.8, h: 0.28, fontSize: 10.5, color: C.gray, fontFace: "Calibri", align: "right" });
  // horizontal line
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// Right info panel
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s3.addText("HIGH-RISK SETTINGS", { x: 5.6, y: 1.0, w: 4.0, h: 0.35, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri" });
s3.addText([
  { text: "• Intensive Care Units (ICU)\n", options: { bullet: false } },
  { text: "• Urological wards\n", options: {} },
  { text: "• Neonatal ICU / Special baby care\n", options: {} },
  { text: "• Geriatric wards\n", options: {} },
  { text: "• Burns units\n", options: {} },
  { text: "• Oncology / Haematology wards", options: {} },
], { x: 5.6, y: 1.4, w: 4.0, h: 2.5, fontSize: 12, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.3 });

// ─────────────────────────────────────────────
// SLIDE 4 — SOURCES & ROUTES OF TRANSMISSION
// ─────────────────────────────────────────────
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s4.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.navy } });
s4.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s4.addText("SOURCES & ROUTES OF TRANSMISSION", {
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  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
});

// 3 source boxes
const sources = [
  { title: "PATIENTS", icon: "👤", items: ["Infectious diseases (measles, influenza, TB)", "Discharging wounds / infected lesions", "Urinary tract infections", "Viral hepatitis"], col: C.accent },
  { title: "STAFF", icon: "🏥", items: ["S. aureus — nasal/skin carriage", "Haemolytic streptococci — throat", "Salmonella — gut carriage", "Infected skin lesions, diarrhea"], col: "7C3AED" },
  { title: "ENVIRONMENT", icon: "🏨", items: ["Hospital dust & air particles", "Linen, bedclothes, furniture", "Sinks, basins, door handles", "IV lines, catheters, dressings"], col: C.green },
];
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// Routes section
s4.addShape(pres.ShapeType.rect, { x: 0.2, y: 3.45, w: 9.5, h: 0.35, fill: { color: C.teal } });
s4.addText("ROUTES OF SPREAD", { x: 0.25, y: 3.47, w: 9.4, h: 0.3, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri" });

const routes = [
  { r: "Direct Contact", d: "HCW hands → patient (most common)" },
  { r: "Droplet", d: "Coughing/sneezing (>5 µm particles)" },
  { r: "Airborne", d: "Droplet nuclei <5 µm (TB, measles, varicella)" },
  { r: "Invasive Procedures", d: "Catheters, IV lines, endoscopy, surgery" },
  { r: "Hospital Dust / Fomites", d: "Environmental surfaces, linen, equipment" },
];
routes.forEach((r, i) => {
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  const y = 3.9 + Math.floor(i / 3) * 0.55;
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    { text: r.r + ": ", options: { bold: true, color: C.teal } },
    { text: r.d, options: { color: C.dark } }
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});

// ─────────────────────────────────────────────
// SLIDE 5 — THE BIG 5 HAIs
// ─────────────────────────────────────────────
let s5 = pres.addSlide();
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s5.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s5.addText("THE 'BIG 5' HAI CATEGORIES (CDC/NHSN)", {
  x: 0.25, y: 0.1, w: 9.5, h: 0.55,
  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
});

const big5 = [
  { abbr: "CAUTI", full: "Catheter-Associated UTI", col: C.accent, crit: "≥10⁵ CFU/mL + catheter in situ", prev: "Avoid/remove catheter early; closed drainage" },
  { abbr: "CLABSI", full: "Central Line Bloodstream Infxn", col: "7C3AED", crit: "Bacteremia, no other source, CVC present", prev: "Sterile insertion; CHG antisepsis; daily review" },
  { abbr: "VAP", full: "Ventilator-Associated Pneumonia", col: C.red, crit: "New infiltrate + ≥2 signs after 48h ventilation", prev: "HOB 30-45°; oral CHG; subglottic drainage" },
  { abbr: "SSI", full: "Surgical Site Infection", col: C.green, crit: "Purulent discharge/abscess within 30 days", prev: "Pre-op antibiotics; normothermia; glycemic control" },
  { abbr: "CDI", full: "C. difficile Infection", col: C.yellow, crit: "+ve toxin + ≥3 loose stools/day", prev: "Contact precautions; bleach cleaning; stewardship" },
];

big5.forEach((item, i) => {
  const y = 0.88 + i * 0.93;
  // left colored block
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  s5.addText(item.abbr, { x: 0.2, y: y + 0.05, w: 1.3, h: 0.4, fontSize: 15, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
  s5.addText(item.full, { x: 0.2, y: y + 0.42, w: 1.3, h: 0.3, fontSize: 8, color: C.white, fontFace: "Calibri", align: "center" });

  // middle — criterion
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  s5.addText("Criterion:", { x: 1.75, y: y + 0.04, w: 3.55, h: 0.25, fontSize: 9, bold: true, color: C.gray, fontFace: "Calibri" });
  s5.addText(item.crit, { x: 1.75, y: y + 0.26, w: 3.55, h: 0.46, fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top" });

  // right — prevention
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  s5.addText("Prevention:", { x: 5.65, y: y + 0.04, w: 4.0, h: 0.25, fontSize: 9, bold: true, color: "166534", fontFace: "Calibri" });
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// ─────────────────────────────────────────────
// SLIDE 6 — PREVENTION BUNDLES
// ─────────────────────────────────────────────
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s6.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s6.addText("PREVENTION BUNDLES (ISID 2024 / SHEA / CDC)", {
  x: 0.25, y: 0.1, w: 9.5, h: 0.55,
  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
});

// CLABSI bundle
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s6.addText("CLABSI BUNDLE", { x: 0.3, y: 0.9, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: "5B21B6", fontFace: "Calibri" });
s6.addText([
  { text: "• Maximal sterile barrier (cap, mask, gown, drape)\n", options: {} },
  { text: "• Chlorhexidine (CHG) skin antisepsis\n", options: {} },
  { text: "• Subclavian vein preferred site\n", options: {} },
  { text: "• Daily necessity review → remove ASAP\n", options: {} },
  { text: "• CHG-impregnated dressings", options: {} },
], { x: 0.3, y: 1.28, w: 4.4, h: 1.7, fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.25 });

// VAP bundle
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s6.addText("VAP BUNDLE", { x: 5.2, y: 0.9, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: "B91C1C", fontFace: "Calibri" });
s6.addText([
  { text: "• Head-of-bed elevation 30–45°\n", options: {} },
  { text: "• Oral decontamination with CHG\n", options: {} },
  { text: "• Subglottic secretion drainage\n", options: {} },
  { text: "• Daily sedation interruption + weaning\n", options: {} },
  { text: "• Early mobilization where feasible", options: {} },
], { x: 5.2, y: 1.28, w: 4.4, h: 1.7, fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.25 });

// CAUTI bundle
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s6.addText("CAUTI BUNDLE", { x: 0.3, y: 3.25, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: "0369A1", fontFace: "Calibri" });
s6.addText([
  { text: "• Avoid catheterization unless indicated\n", options: {} },
  { text: "• Smallest effective catheter size\n", options: {} },
  { text: "• Maintain closed drainage system\n", options: {} },
  { text: "• Unobstructed urine flow\n", options: {} },
  { text: "• Remove catheter at earliest opportunity", options: {} },
], { x: 0.3, y: 3.63, w: 4.4, h: 1.7, fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.25 });

// SSI bundle
s6.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 3.2, w: 4.6, h: 2.2, fill: { color: "F0FDF4" }, line: { color: C.green, width: 1.5 }, rectRadius: 0.08 });
s6.addText("SSI BUNDLE", { x: 5.2, y: 3.25, w: 4.4, h: 0.35, fontSize: 13, bold: true, color: "166534", fontFace: "Calibri" });
s6.addText([
  { text: "• Prophylactic antibiotics within 60 min\n", options: {} },
  { text: "• Clippers not razors for hair removal\n", options: {} },
  { text: "• Maintain normothermia (avoid hypothermia)\n", options: {} },
  { text: "• Strict glycemic control\n", options: {} },
  { text: "• CHG pre-op bathing", options: {} },
], { x: 5.2, y: 3.63, w: 4.4, h: 1.7, fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.25 });

// ─────────────────────────────────────────────
// SLIDE 7 — STANDARD PRECAUTIONS & ISOLATION
// ─────────────────────────────────────────────
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s7.addText("STANDARD PRECAUTIONS & ISOLATION", {
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  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
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// Hand hygiene box (hero)
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s7.addText("HAND HYGIENE — The SINGLE Most Important HAI Prevention Measure", {
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s7.addText("WHO 5 Moments: Before pt contact | Before aseptic procedure | After body fluid exposure | After pt contact | After pt surroundings", {
  x: 0.3, y: 1.22, w: 9.2, h: 0.4, fontSize: 11, color: C.light, fontFace: "Calibri", align: "center"
});

// Standard precautions table
const prec = [
  ["Precaution", "When to Use", "Equipment"],
  ["Gloves", "Contact with blood/body fluids/mucous membranes", "Non-sterile gloves"],
  ["Mask + Eye protection", "Splash/aerosol risk", "Surgical mask, goggles/visor"],
  ["Gown/Apron", "Soiling of clothes likely", "Disposable gown"],
  ["Sharps safety", "All procedures", "Safety devices, sharps bins"],
  ["Waste management", "All clinical waste", "Colour-coded bags/bins"],
];
prec.forEach((row, ri) => {
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  [row[0], row[1], row[2]].forEach((cell, ci) => {
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    const cw = ci === 0 ? 1.85 : ci === 1 ? 4.7 : 2.6;
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  });
});

// Isolation types row
s7.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.2, w: 9.5, h: 1.25, fill: { color: C.light } });
const isoTypes = [
  { t: "CONTACT", d: "MRSA, VRE, CDI,\nMDR organisms", col: C.red },
  { t: "DROPLET", d: "Influenza,\nMeningococcal", col: C.yellow },
  { t: "AIRBORNE", d: "TB, Measles,\nVaricella (–ve pressure)", col: "7C3AED" },
  { t: "PROTECTIVE", d: "Immunocompromised\npatients (reverse isolation)", col: C.green },
];
isoTypes.forEach((it, i) => {
  const x = 0.3 + i * 2.35;
  s7.addShape(pres.ShapeType.roundRect, { x, y: 4.28, w: 2.15, h: 1.1, fill: { color: it.col }, rectRadius: 0.07 });
  s7.addText(it.t, { x, y: 4.3, w: 2.15, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
  s7.addText(it.d, { x, y: 4.66, w: 2.15, h: 0.65, fontSize: 10, color: C.white, fontFace: "Calibri", align: "center" });
});

// ─────────────────────────────────────────────
// SLIDE 8 — ANTIMICROBIAL STEWARDSHIP & STAFF HEALTH
// ─────────────────────────────────────────────
let s8 = pres.addSlide();
s8.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.navy } });
s8.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s8.addText("ANTIMICROBIAL STEWARDSHIP & STAFF HEALTH", {
  x: 0.25, y: 0.1, w: 9.5, h: 0.55,
  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
});

// AMS
s8.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.85, w: 4.6, h: 4.55, fill: { color: "FFFBEB" }, line: { color: C.yellow, width: 1.5 }, rectRadius: 0.08 });
s8.addText("ANTIMICROBIAL STEWARDSHIP\n(ESCMID 2024 / CDC Core Elements)", {
  x: 0.3, y: 0.9, w: 4.4, h: 0.6, fontSize: 12, bold: true, color: "92400E", fontFace: "Calibri"
});
const amsPoints = [
  "Use shortest effective antibiotic duration",
  "De-escalate based on culture/sensitivity results",
  "Antibiogram-guided empiric therapy",
  "IV-to-oral switch at earliest opportunity",
  "Restrict broad-spectrum agents (carbapenems, colistin)",
  "Pharmacist/ID physician review of antimicrobials",
  "Audit and feedback to prescribers",
  "Education on antibiotic resistance",
];
s8.addText(amsPoints.map(p => "• " + p).join("\n"), {
  x: 0.3, y: 1.55, w: 4.4, h: 3.7,
  fontSize: 11, color: C.dark, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.3
});

// Staff health
s8.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 0.85, w: 4.6, h: 4.55, fill: { color: "F0FDF4" }, line: { color: C.green, width: 1.5 }, rectRadius: 0.08 });
s8.addText("STAFF HEALTH PROGRAMME", {
  x: 5.2, y: 0.9, w: 4.4, h: 0.4, fontSize: 12, bold: true, color: "166534", fontFace: "Calibri"
});
const staffPoints = [
  ["Pre-employment review", "Immunization history, Mantoux test"],
  ["HCW Vaccines", "Hep A+B, Influenza (annual), MMR, Td, Varicella"],
  ["Work restrictions", "Exclude staff with skin infections, diarrhea, sore throat"],
  ["Personal hygiene", "Regular apron changes, hand hygiene compliance"],
  ["Post-exposure protocols", "HIV, HBV, HCV, TB, VZV, Meningococcus, Pertussis, Rabies"],
];
let sy = 1.38;
staffPoints.forEach(sp => {
  s8.addText(sp[0], { x: 5.2, y: sy, w: 4.4, h: 0.28, fontSize: 11.5, bold: true, color: C.teal, fontFace: "Calibri" });
  s8.addText(sp[1], { x: 5.3, y: sy + 0.27, w: 4.2, h: 0.3, fontSize: 10.5, color: C.dark, fontFace: "Calibri" });
  sy += 0.72;
});

// ─────────────────────────────────────────────
// SLIDE 9 — RECENT GUIDELINES SUMMARY
// ─────────────────────────────────────────────
let s9 = pres.addSlide();
s9.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.navy } });
s9.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s9.addText("RECENT GUIDELINES (2023–2025)", {
  x: 0.25, y: 0.1, w: 9.5, h: 0.55,
  fontSize: 20, bold: true, color: C.white, fontFace: "Calibri"
});

const guidelines = [
  { year: "2025", org: "ISID", topic: "VAP Prevention — 2024 Position Paper", detail: "Evidence-based VAP bundle; HOB elevation; oral CHG; differences in high vs. LMICs highlighted. PMID 39551087", col: C.red },
  { year: "2025", org: "ISID", topic: "CLABSI Prevention — 2024 Position Paper", detail: "Maximal sterile barriers; CHG antisepsis; subclavian preference; daily necessity review. PMID 39505252", col: "7C3AED" },
  { year: "2025", org: "Cochrane", topic: "Probiotics for CDI Prevention", detail: "Supports probiotic use for primary CDI prevention in antibiotic-exposed adults and children. PMID 40931979", col: C.green },
  { year: "2024", org: "ESCMID", topic: "Decolonization Before Surgery (MDR organisms)", detail: "Pre-operative decolonization in patients colonized with MRSA/MDR Gram-positives. PMID 39154859", col: C.yellow },
  { year: "2024", org: "ESCMID", topic: "Antimicrobial Stewardship in Emergency Depts", detail: "Shortest effective duration; antibiogram-guided empirics; IV→oral switch. PMID 39029872", col: C.accent },
  { year: "2024", org: "CDC NHSN", topic: "HAI Progress Report 2024", detail: "3rd consecutive year of HAI declines. 1 in 31 patients affected daily. Data from 38,000+ facilities.", col: "0F766E" },
];

guidelines.forEach((g, i) => {
  const y = 0.9 + i * 0.78;
  s9.addShape(pres.ShapeType.roundRect, { x: 0.2, y, w: 1.0, h: 0.65, fill: { color: g.col }, rectRadius: 0.07 });
  s9.addText(g.year, { x: 0.2, y: y + 0.02, w: 1.0, h: 0.3, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center" });
  s9.addText(g.org, { x: 0.2, y: y + 0.33, w: 1.0, h: 0.28, fontSize: 10, color: C.white, fontFace: "Calibri", align: "center" });

  s9.addShape(pres.ShapeType.roundRect, { x: 1.35, y, w: 8.4, h: 0.65, fill: { color: "F8FAFC" }, line: { color: "E2E8F0", width: 0.5 }, rectRadius: 0.07 });
  s9.addText(g.topic, { x: 1.45, y: y + 0.02, w: 8.2, h: 0.28, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri" });
  s9.addText(g.detail, { x: 1.45, y: y + 0.3, w: 8.2, h: 0.3, fontSize: 10, color: C.gray, fontFace: "Calibri" });
});

// ─────────────────────────────────────────────
// SLIDE 10 — SURVEILLANCE & KEY TAKEAWAYS
// ─────────────────────────────────────────────
let s10 = pres.addSlide();
s10.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.dark } });
s10.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.12, h: 5.625, fill: { color: C.accent } });
s10.addShape(pres.ShapeType.rect, { x: 0, y: 4.7, w: 10, h: 0.925, fill: { color: C.navy } });

s10.addText("KEY TAKEAWAYS", {
  x: 0.3, y: 0.2, w: 9.4, h: 0.6,
  fontSize: 26, bold: true, color: C.accent, fontFace: "Calibri", charSpacing: 3
});

const takeaways = [
  { num: "01", text: "HAI = infection >48h after admission; NOT present on admission. Affects 1 in 31 hospital patients daily." },
  { num: "02", text: "UTI is the most common site; VAP carries the highest mortality. ICU patients are at greatest risk." },
  { num: "03", text: "The Big 5 — CAUTI, CLABSI, VAP, SSI, CDI — are all measurable, reportable, and largely preventable." },
  { num: "04", text: "Hand hygiene remains the single most effective intervention. WHO 5 Moments should guide practice." },
  { num: "05", text: "Use disease-specific bundles: CLABSI (sterile insertion + CHG), VAP (HOB 30-45° + subglottic drainage), CAUTI (early removal)." },
  { num: "06", text: "Antimicrobial stewardship is integral — shortest duration, de-escalation, IV→oral switch (ESCMID 2024)." },
];

takeaways.forEach((tk, i) => {
  const y = 0.95 + i * 0.6;
  s10.addShape(pres.ShapeType.roundRect, { x: 0.3, y, w: 0.55, h: 0.45, fill: { color: C.accent }, rectRadius: 0.05 });
  s10.addText(tk.num, { x: 0.3, y: y + 0.02, w: 0.55, h: 0.4, fontSize: 13, bold: true, color: C.dark, fontFace: "Calibri", align: "center" });
  s10.addText(tk.text, { x: 1.0, y, w: 8.7, h: 0.5, fontSize: 11.5, color: C.light, fontFace: "Calibri", valign: "middle" });
});

s10.addText("Sources: Park's Preventive Medicine | CDC NHSN 2024 HAI Progress Report | ISID 2024 (PMID 39551087, 39505252) | ESCMID 2024 (PMID 39154859, 39029872) | Cochrane 2025 (PMID 40931979)", {
  x: 0.3, y: 4.75, w: 9.4, h: 0.45, fontSize: 8.5, color: C.gray, fontFace: "Calibri", align: "center"
});

// ─────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/hai-presentation/HAI_Hospital_Acquired_Infections.pptx" })
  .then(() => console.log("✅ PPTX created successfully"))
  .catch(err => console.error("❌ Error:", err));

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.pdfgen import canvas
from reportlab.lib.colors import HexColor
import math

OUTPUT = "/home/daytona/workspace/hai-presentation/HAI_Flashcards.pdf"

# Card size: half-A4 landscape (148.5 x 105 mm), 2 per A4 page
PAGE_W, PAGE_H = A4  # 210 x 297 mm in points
CARD_W = PAGE_W - 20*mm
CARD_H = 105*mm

# Colors
NAVY   = HexColor("#0B2447")
TEAL   = HexColor("#19376D")
ACCENT = HexColor("#0EA5E9")
LIGHT  = HexColor("#E0F2FE")
WHITE  = colors.white
DARK   = HexColor("#0F172A")
GRAY   = HexColor("#64748B")
RED    = HexColor("#EF4444")
GREEN  = HexColor("#22C55E")
PURPLE = HexColor("#7C3AED")
YELLOW = HexColor("#FBBF24")
LTGRAY = HexColor("#F1F5F9")

flashcards = [
    {
        "q": "What is the definition of a\nHospital-Acquired Infection (HAI)?",
        "a": [
            ("Definition:", "Infection acquired during hospital care, NOT present or incubating at admission."),
            ("Time criterion:", ">48 hours after admission"),
            ("Also called:", "Nosocomial infection"),
            ("WHO scope:", "Any healthcare setting, including outpatient, LTCF"),
        ],
        "tag": "DEFINITION",
        "col": TEAL,
    },
    {
        "q": "What are the 3 sources of\nHospital-Acquired Infections?",
        "a": [
            ("1. Patients:", "Infected wounds, TB, influenza, UTI, viral hepatitis"),
            ("2. Staff:", "S. aureus (nose/skin), Streptococci (throat), Salmonella (gut)"),
            ("3. Environment:", "Dust, linen, beds, sinks, door handles, air, IV equipment"),
            ("Key insight:", "Staff hands are the most common transmission vector"),
        ],
        "tag": "SOURCES",
        "col": ACCENT,
    },
    {
        "q": "What are the 5 routes of\ntransmission of HAIs?",
        "a": [
            ("1. Direct contact:", "HCW hands → patient (MOST COMMON)"),
            ("2. Droplet:", "Coughing/sneezing, particles >5 µm"),
            ("3. Airborne:", "Droplet nuclei <5 µm (TB, Measles, Varicella)"),
            ("4. Invasive procedures:", "Catheters, IV lines, surgery, endoscopy"),
            ("5. Fomites/dust:", "Contaminated surfaces & hospital environment"),
        ],
        "tag": "TRANSMISSION",
        "col": PURPLE,
    },
    {
        "q": "Name the 5 CDC/NHSN HAI types\nand their diagnostic criteria",
        "a": [
            ("CAUTI:", "≥10⁵ CFU/mL urine + urinary catheter in situ"),
            ("CLABSI:", "Bacteremia with no other source + central line in situ"),
            ("VAP:", "New infiltrate + ≥2 clinical signs after 48h ventilation"),
            ("SSI:", "Purulent discharge/abscess within 30 days of surgery"),
            ("CDI:", "Positive C. diff toxin + ≥3 loose stools/day"),
        ],
        "tag": "BIG 5 HAIs",
        "col": RED,
    },
    {
        "q": "What is the CLABSI prevention bundle?\n(ISID 2024, PMID 39505252)",
        "a": [
            ("1.", "Maximal sterile barrier (cap, mask, gown, full drape)"),
            ("2.", "Chlorhexidine (CHG) skin antisepsis at insertion site"),
            ("3.", "Subclavian vein — preferred insertion site"),
            ("4.", "Daily necessity review → remove catheter ASAP"),
            ("5.", "CHG-impregnated dressings; antimicrobial catheter if high-risk"),
        ],
        "tag": "CLABSI BUNDLE",
        "col": PURPLE,
    },
    {
        "q": "What is the VAP prevention bundle?\n(ISID 2024, PMID 39551087)",
        "a": [
            ("1.", "Head-of-bed elevation 30–45° (optimal ~30–35°)"),
            ("2.", "Oral decontamination with Chlorhexidine (CHG)"),
            ("3.", "Subglottic secretion drainage (continuous/intermittent)"),
            ("4.", "Daily sedation interruption + weaning protocol assessment"),
            ("5.", "Early mobilization; avoid unnecessary ETT changes"),
        ],
        "tag": "VAP BUNDLE",
        "col": RED,
    },
    {
        "q": "What is the CAUTI prevention bundle?\n(Li et al. 2025, PMID 41059852)",
        "a": [
            ("1.", "Avoid catheterization unless strictly indicated"),
            ("2.", "Use smallest effective catheter size"),
            ("3.", "Maintain closed, sterile drainage system"),
            ("4.", "Keep unobstructed urine flow; bag below bladder level"),
            ("5.", "Remove catheter at earliest opportunity (daily review)"),
        ],
        "tag": "CAUTI BUNDLE",
        "col": ACCENT,
    },
    {
        "q": "What is the SSI prevention bundle?\n(WHO / SHEA guidelines)",
        "a": [
            ("1.", "Prophylactic antibiotics within 60 min of incision"),
            ("2.", "Hair removal with clippers ONLY (not razors)"),
            ("3.", "Maintain normothermia (prevent intraoperative hypothermia)"),
            ("4.", "Strict perioperative glycemic control (<180 mg/dL)"),
            ("5.", "CHG pre-operative bathing the night before surgery"),
        ],
        "tag": "SSI BUNDLE",
        "col": GREEN,
    },
    {
        "q": "What are the WHO 5 Moments\nfor Hand Hygiene?",
        "a": [
            ("Moment 1:", "BEFORE touching a patient"),
            ("Moment 2:", "BEFORE performing an aseptic/clean procedure"),
            ("Moment 3:", "AFTER body fluid / blood exposure risk"),
            ("Moment 4:", "AFTER touching a patient"),
            ("Moment 5:", "AFTER touching patient surroundings"),
        ],
        "tag": "HAND HYGIENE",
        "col": TEAL,
    },
    {
        "q": "What type of isolation precautions\nare used for each pathogen?",
        "a": [
            ("CONTACT:", "MRSA, VRE, C. difficile, MDR organisms — gloves + gown"),
            ("DROPLET:", "Influenza, Meningococcal, Mumps — mask within 1 m"),
            ("AIRBORNE:", "TB, Measles, Varicella — N95 + negative pressure room"),
            ("PROTECTIVE:", "Immunocompromised patients — reverse isolation"),
            ("STANDARD:", "ALL patients, ALL the time (baseline precautions)"),
        ],
        "tag": "ISOLATION",
        "col": PURPLE,
    },
    {
        "q": "Which patients are at highest risk\nfor HAIs?",
        "a": [
            ("Settings:", "ICU, Neonatal ICU, Urological wards, Geriatric wards"),
            ("Host factors:", "Immunocompromised (cancer, HIV, steroids, transplant)"),
            ("Procedures:", "Invasive devices (catheter, CVC, ventilator, drains)"),
            ("Age extremes:", "Neonates and elderly are highest risk"),
            ("Other:", "Prolonged hospitalisation, prior antibiotic exposure"),
        ],
        "tag": "RISK FACTORS",
        "col": YELLOW,
    },
    {
        "q": "What vaccinations are recommended\nfor healthcare workers?",
        "a": [
            ("Mandatory:", "Hepatitis B (3-dose series)"),
            ("Annual:", "Influenza (seasonal; updated each year)"),
            ("MMR:", "Measles, Mumps, Rubella — 2 doses if non-immune"),
            ("Td/Tdap:", "Tetanus-diphtheria ± pertussis booster"),
            ("Others:", "Varicella (if seronegative); Hepatitis A; Mantoux baseline"),
        ],
        "tag": "HCW VACCINES",
        "col": GREEN,
    },
    {
        "q": "What are the key principles of\nAntimicrobial Stewardship (AMS)?",
        "a": [
            ("1.", "Use SHORTEST effective antibiotic duration"),
            ("2.", "DE-ESCALATE therapy based on culture/sensitivity results"),
            ("3.", "Use local antibiogram for empiric antibiotic selection"),
            ("4.", "IV-to-ORAL switch at earliest clinical opportunity"),
            ("5.", "Restrict broad-spectrum agents (carbapenems, colistin)"),
        ],
        "tag": "AMS",
        "col": YELLOW,
    },
    {
        "q": "What does the CDC 2024 HAI\nProgress Report show?",
        "a": [
            ("Coverage:", ">38,000 US healthcare facilities reporting to NHSN"),
            ("Burden:", "1 in 31 hospital patients acquires an HAI daily"),
            ("Trend:", "3rd consecutive year of declining HAI rates (2022–2024)"),
            ("LTACH:", "23% ↓ VAEs, 15% ↓ CDI infections in LTACHs"),
            ("IRF:", "18% ↓ CDI, 8% ↓ CAUTI in inpatient rehab facilities"),
        ],
        "tag": "CDC 2024 DATA",
        "col": TEAL,
    },
    {
        "q": "What is the C. difficile (CDI)\nprevention strategy?",
        "a": [
            ("Precautions:", "Contact precautions (gloves + gown) for ALL CDI cases"),
            ("Cleaning:", "Sporicidal disinfectants (sodium hypochlorite/bleach-based)"),
            ("Hand hygiene:", "Soap and water preferred — alcohol gel NOT effective vs spores"),
            ("Stewardship:", "Restrict unnecessary antibiotics (especially fluoroquinolones)"),
            ("Probiotics:", "Cochrane 2025 supports probiotics for primary CDI prevention (PMID 40931979)"),
        ],
        "tag": "CDI PREVENTION",
        "col": RED,
    },
    {
        "q": "What simplified criteria are used\nfor nosocomial infection surveillance?",
        "a": [
            ("UTI:", "≥10⁵ bacteria/mL on urine culture (1–2 species)"),
            ("Respiratory:", "≥2 signs: cough, purulent sputum, new CXR infiltrate"),
            ("Surgical site:", "Purulent discharge, abscess, or cellulitis at wound site"),
            ("Catheter site:", "Inflammation, lymphangitis, or pus at catheter insertion site"),
            ("Septicaemia:", "Fever/rigors + ≥1 positive blood culture"),
        ],
        "tag": "SURVEILLANCE CRITERIA",
        "col": ACCENT,
    },
]

def draw_card(c, card, x, y):
    cw = CARD_W
    ch = CARD_H
    pad = 6*mm

    # Card background
    c.setFillColor(WHITE)
    c.roundRect(x, y, cw, ch, 6*mm, fill=1, stroke=0)

    col = card["col"]

    # Left colored stripe
    c.setFillColor(col)
    c.roundRect(x, y, 8*mm, ch, 6*mm, fill=1, stroke=0)
    c.setFillColor(col)
    c.rect(x + 4*mm, y, 4*mm, ch, fill=1, stroke=0)

    # Tag pill
    c.setFillColor(col)
    c.roundRect(x + 12*mm, y + ch - 10*mm, 35*mm, 7*mm, 2*mm, fill=1, stroke=0)
    c.setFillColor(WHITE)
    c.setFont("Helvetica-Bold", 7)
    c.drawCentredString(x + 29.5*mm, y + ch - 5.5*mm, card["tag"])

    # Question (front style — shown on top half)
    c.setFillColor(DARK)
    c.setFont("Helvetica-Bold", 11)
    q_lines = card["q"].split("\n")
    q_y = y + ch - 20*mm
    for ql in q_lines:
        c.drawString(x + 12*mm + pad, q_y, ql)
        q_y -= 6*mm

    # Divider
    c.setStrokeColor(HexColor("#E2E8F0"))
    c.setLineWidth(0.5)
    c.line(x + 12*mm, y + ch - 28*mm, x + cw - 3*mm, y + ch - 28*mm)

    # Answer rows
    a_y = y + ch - 36*mm
    for label, detail in card["a"]:
        if a_y < y + 6*mm:
            break
        c.setFillColor(col)
        c.setFont("Helvetica-Bold", 9)
        c.drawString(x + 12*mm + pad, a_y, label)

        c.setFillColor(DARK)
        c.setFont("Helvetica", 9)
        # wrap long detail
        max_chars = 72
        if len(detail) > max_chars:
            mid = detail[:max_chars].rfind(" ")
            if mid == -1:
                mid = max_chars
            c.drawString(x + 12*mm + pad + 28*mm, a_y, detail[:mid])
            a_y -= 5*mm
            c.drawString(x + 12*mm + pad + 28*mm, a_y, detail[mid+1:])
        else:
            c.drawString(x + 12*mm + pad + 28*mm, a_y, detail)
        a_y -= 6.5*mm

    # Card border
    c.setStrokeColor(HexColor("#E2E8F0"))
    c.setLineWidth(0.8)
    c.roundRect(x, y, cw, ch, 6*mm, fill=0, stroke=1)


c = canvas.Canvas(OUTPUT, pagesize=A4)
c.setTitle("HAI Flashcards")
c.setAuthor("Orris Medical")

MARGIN_X = 10*mm
MARGIN_Y = 10*mm
GAP = 8*mm

cards_per_col = 2
card_h_with_gap = CARD_H + GAP
num_pages = math.ceil(len(flashcards) / cards_per_col)

for page_i in range(num_pages):
    start = page_i * cards_per_col
    page_cards = flashcards[start:start + cards_per_col]

    for ci, card in enumerate(page_cards):
        card_y = PAGE_H - MARGIN_Y - CARD_H - ci * (CARD_H + GAP)
        draw_card(c, card, MARGIN_X, card_y)

    c.showPage()

c.save()
print("✅ Flashcards PDF created successfully")