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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

DEVICE RELATED NOSOCOMIAL INFECTION IN ICU. PART II. CATHETER RELATED BLOOD STREAM INFECTION (CR - BSI) CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI). MAHA NAGA NURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITAL E-mail.

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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

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  1. DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

  2. PART II CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI) CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)

  3. MAHA NAGANURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITALE-mail Dr. MOUSTAFA ARAFAASSOSIATE PROF. OF EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTHALEXANDRIA UNIVERSITYE-mail

  4. CVC RELATED BLOOD STREAM INFECTION Blood stream infection is associated with the use of intravascular catheters. Catheter related blood stream infection (CR-BSIs), are associated with increased morbidity, mortality rate of 10% to 20 %, prolonged hospitalization (mean of 7 days ) and increased medical costs .

  5. RISK FACTORS -The site at which the catheter is placed. • The type of barrier precautions used during catheter insertion. • The skill of the person inserting the catheter. • The use of a guide wire to replace an existing catheter.

  6. CRITERIA FOR DIAGNOSIS • Fever. • Signs of cutaneous involvement ( erythema , induration , tenderness, or purulent drainage ) at the insertion site of catheter. • Positive blood or tip of catheter culture .

  7. MICROBIOLOGY Blood stream infections are caused by: • Coagulase-negative staphylococci, particularly Staphylococcus epidermidis. • Candida species. • Enterococci . • Staphylococcus aureus .

  8. PREVENTION AND CONTROL MEASURES - Health care worker education and training - Surveillance for catheter-related infection - Hand washing - Barrier precautions during catheter insertion and care - Catheter site care - Selection and replacement of intravascular devices

  9. - Replacement of administration sets and intravenous fluids - Clean injection parts with 70% alcohol or povidone-iodine before accessing the system - Do not use filters routinely for infection control purposes - Do not administer anti-microbials routinely before insertion or during use of an intravascular device to prevent catheter colonization or bloodstream infection.

  10. CATHERTER RELATED UTI The urinary tract accounting for more than 40% of the total number reported by acute-care hospitals ( 40 – 45 % of nosocomial infections ) and affecting an estimated 600,000 patients per year , they contribute only 10 to 15 percent to prolongation of hospital stay and to extra costs.

  11. 66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization .

  12. RISK FACTORS Acquiring a urinary tract infection depend on the following: • the method and duration of catheterization. • the quality of catheter care. • and host susceptibility.

  13. Host factors which appear to increase the risk of acquiring catheter-associated urinary tract infections include : advanced age, debilitation, and the postpartum state

  14. CRITERIA FOR DIAGNOSIS Symptoms that may occur include - dysuria. - urinary frequency. - incontinence of recent onset. - flank pain. - and fever.

  15. Bacteriologic diagnosis : - For complicated, recurrent UTIs, asymptomatic bacteriuria is defined as > 105 CFU/mL in a midstream urine sample after > 4 hours of bladder incubation. - For women with uncomplicated symptomatic cystitis bacteriuria is defined as > 102 CFU/mL with pyuria.

  16. MICROBIOLOGY Catheter-associated urinary tract infections are caused by a variety of pathogens, including : - Escherichia coli - Klebsiella - Proteus - Enterococcus

  17. Other causative micro-organisms: - Pseudomonas - Enterobacter -Serratia - Candida.

  18. PREVENTION AND CONTROL MEASURES - Educate personnel in correct techniques of catheter insertion and care. - Catheterize only when necessary. - Emphasize hand washing. - Insert catheter using aseptic technique and sterile equipment. - Secure catheter properly. - Maintain closed sterile drainage.

  19. - Obtain urine samples aseptically. - Maintain unobstructed urine flow. - Periodically re-educate personnel in catheter care. - Use smallest suitable bore catheter. - Avoid irrigation unless needed to prevent or relieve obstruction. - Do not change catheters at arbitrary fixed intervals.

  20. - Consider alternative techniques of urinary drainage before using an indwelling urethral catheter. - Spatially separate infected and uninfected patients with indwelling catheters. - Avoid routine bacteriologic monitoring.

  21. SUGGESTED FURTHER READINGS GUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONS The Impact of Hospital-Acquired Bloodstream Infections

  22. Guideline for Prevention of Catheter-associated infections - urinary tract infection

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