DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU
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PART II

• CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI)
• CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)

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MAHA NAGANURSING SPECIALIST ALEXANDRIA
UNIVERSITY STUDENT HOSPITAL E-mail

Dr. MOUSTAFA ARAFAASSOSIATE PROF. OF
EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTH
ALEXANDRIA UNIVERSITY E-mail
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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 .

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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.

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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 .

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MICROBIOLOGY

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

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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
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- 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.
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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 .

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

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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.

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

• Symptoms that may occur include
• - dysuria.
• - urinary frequency.
• - incontinence of recent onset.
• - flank pain.
• - and fever.

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

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MICROBIOLOGY

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

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• Other causative micro-organisms
• - Pseudomonas
• - Enterobacter
• - Serratia
• - Candida.

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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.

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- 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.
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- 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.
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SUGGESTED FURTHER READINGS

• GUIDELINE FOR PREVENTION OF INTRAVASCULAR
  DEVICE-RELATED INFECTIONS
• The Impact of Hospital-Acquired Bloodstream
  Infections

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