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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

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Title: DEVICE RELATED NOSOCOMIAL INFECTION IN ICU


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 HOSPITAL E-mail

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

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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