ICU INFECTIONS                BASIS, DIAGNOSIS, AND PREVENTION                         Dr.T.V.Rao MDDR.T.V.RAO MD         ...
DEFINITIONS            NOSOCOMIAL INFECTION :• An infection acquired in a patient in a  hospital or other healthcare facil...
BACKGROUND OF                HOSPITAL INFECTIONS   Nosocomial infections   have been recognized   for over a century as a ...
RISK OF INFECTIONS IN ICU• Patients hospitalized in ICUs are 5 to 10 times     more likely to acquire nosocomial infection...
WHY ONE MAY BE IN ICU                 WITH       And why do     they come to the ICU                   Ventilator suppor...
ICU : FACTORS THAT INCREASE CROSS-                       INFECTIONS• Lack of Hand washing facilities• Patient close togeth...
NOSOCOMIAL FEVERS• Hospital-acquired  fevers occur in  one-third of all  medical inpatients• Nosocomial fevers  even more ...
INFECTIOUS CAUSES OF            FEVER WHILST IN ICU    Ventilator associated     pneumonia    Catheter related blood    ...
FEVER IN THE ICU• ICU patients have several underlying  medical/surgical conditions• ICU patients undergo many invasive di...
CAUSES OF FEVER IN THE ICU• Surgical site infections   • Urinary catheter-• Intravenous-line             associated  infec...
THE OBVIOUS FOCUS       Community acquired pneumonia       Acute CNS infection       Urinary tract infection       Abd...
DEVICE RELATED NOSOCOMIAL INFECTION• A device-associated infection is an infection in a  patient with a device (i.e., cent...
ICU PATIENTS DIFFERS FROM MANY PATIENTS                PAY MORE ATTENTION• Sickest patients (multiple diagnoses, multi-  o...
INFECTIOUS CAUSES OF            FEVER WHILST IN ICU Ventilator associated  pneumonia Catheter related blood  stream infe...
PATIENT PRESENTING         TO ICU WITH FEVER  Patient with an     Acute un-differentiated  obvious focus of  infection    ...
RISK FACTORS• operative surgery• intravascular and urinary catheterization• mechanical ventilation of the respiratory trac...
ICU CARE IS MORE        INVASIVE• More invasive life lines  and procedures  including surgeries• Longer length of stay• Mo...
FACTORS INFLUENCING INCREASED                 INFECTIONS IN ICU•     Hand washing facilities•     Patient close together o...
THE INANIMATE ENVIRONMENT IS A           RESERVOIR OF PATHOGENS                                X represents a positive Ent...
SOME HEALTH-CARE ASSOCIATED                 INFECTIONS• UTI associated with Foley  catheters• Lower respiratory tract  inf...
MANAGING FEVER IN ICU PATIENTS• Fever in the ICU can have many infectious and  noninfectious etiologies• Crucial to identi...
DEVICE RELATED NOSOCOMIAL INFECTION• A device-associated infection is an infection in a  patient with a device (i.e., cent...
Sources of Infection                  Intrinsic contamination of                  infusion fluid Port for additives      C...
1. Extra luminal Spread        Patient’s own skin micro flora                   Sources of                                ...
PREVENTION OF CR-BSIWritten Protocol   Must be performed by trained staff according to   written guidelinesSterile procedu...
FUNGI TOO INFECTIVE IN                    ICU PATIENTSDR.T.V.RAO MD                            26
RISK FACTORS FOR                 ASPERGILLOSIS• Neutropenia• steroids• Environmental  exposure      • Building work      •...
INVASIVE ASPERGILLOSIS• incidence increasing• commonest cause of  infectious death in  many transplant  units• commonest c...
PROTECTED ENVIRONMENT• HEPA (for allogeneic HSCT patients only)      •   99.97% of all particles >3u diam)      •   >/=12 ...
BASIC POLICIES IN MICROBIOLOGICAL                DIAGNOSIS OF ICU INFECTIONSDR.T.V.RAO MD                                 30
CRITERIA FOR DIAGNOSIS• fever.• cough.• development of purulent sputum, in conjunction  with radiologic evidence of a new ...
DR.T.V.RAO MD   32
HOW TO DIAGNOSE?• A positive result of semi quantitative Culture ( 15 CFU per  catheter segment) Maki D, et al NEJM 1977;2...
REMEMBER………….• If You put a central line in a  patient with documented  Bacteremia, then later next  day somebody may obta...
DEALING WITH STAPHYLOCOCCUS AUREUS• REMOVE the central line .• Systemic antibiotics for minimal 14 days.• Failure to clear...
COAGULASE NEGATIVE STAPHYLOCOCCI• CVC can be retained, if necessary, in patients with  uncomplicated, catheter-related, bl...
A RANDOMIZED AND PROSPECTIVE STUDY OF 3 PROCEDURES FOR THE DIAGNOSIS OF CATHETER-RELATED BLOODSTREAM INFECTION WITHOUT    ...
DO NOT TREAT COLONIZED CENTRAL LINES GET GUIDED BY MICROBIOLOGY REPORTS• A central line is  removed and it is  growing les...
PROBLEMS WITH AIR SAMPLING       HAS LIMITATIONS ???• Incubation period of IPA  unknown   • Estimates vary from 48     hou...
NEW FRONTIERS ON INCREASING           ICU INFECTIONS• Emphasis on patient safety• Move from inpatient to outpatient enviro...
STRATEGY FOR PREVENTION• Hand washing• Use gloves to prevent contamination of the hands  when handling respiratory secreti...
STRATEGY FOR PREVENTION• Clean and decontaminate all equipment after use• Sterilise or use high-level disinfection for all...
INFECTION CONTROL MEASURES• 1 Identify reservoir Colonized and infected  patients Environnemental contamination;  Common s...
INFECTION CONTROL MEASURES• 3. Halt progression from colonization to infection  Discontinue compromising factors when poss...
TRADITIONAL ICP ACTIVITIES• Surveillance• Outbreak investigations• Policy development and implementation• Environmental/in...
NEW ICP RESPONSIBILITIES• Increased regulations (OSHA, FDA)• Emerging pathogens (avian influenza)• IHI campaign• Increase ...
CONCLUSIONS :          STRATEGY FOR INFECTION PREVENTION•     Strict attention to Hand hygiene•     Prudent Antibiotic use...
GROWING CONCERNS WITH INFECTIONS IN                ICU• Nosocomial infections, especially those caused by  antibiotic-resi...
CAN WE CONTROL ICU INFECTIONS• The key to control of antibiotic-resistant pathogens in  the ICU is rigorous adherence to i...
WISH WIN THE PROBLEM                 FACE THE CHALLENGES• Increase infection control resources are a win-win-win  investme...
MICROBES ON SKIN PLAY A MAJOR ROLE    SKIN DISINFECTION A MAJOR PREVENTIVE                   MEASURE• The major cause of  ...
USING CHLORHEXIDINE 0.5% FOR          SKIN DISINFECTION• A meta-analysis  determined that  chlorhexidine gluconate  signif...
CHLORHEXIDINE SKIN ANTISEPSIS•   Prepare skin with    antiseptic/detergent    chlorhexidine 2% in 70%    isopropyl alcohol...
ALCOHOL BASED HAND SANITIZERS • Recommended by CDC   based   on strong experimental,   clinical, epidemiologic and   micro...
AN INTERVENTION TO DECREASE CATHETER-RELATED BLOODSTREAM INFECTIONS IN                                THE ICU.            ...
WARNING   Nosocomial Infections in ICU are WaitingDR.T.V.RAO MD                                 56
BE KIND TO YOUR PATIENTS   REMEMBER ONE THING•PLEASE WASH YOUR      HANDS
• Programme created by Dr.T.V.Rao MD for     Health care Workers in the Developing world                       • Email    ...
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ICU Infections , Infection Control in ICU's

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ICU Infections , Infection Control in ICU's

  1. 1. ICU INFECTIONS BASIS, DIAGNOSIS, AND PREVENTION Dr.T.V.Rao MDDR.T.V.RAO MD 1
  2. 2. DEFINITIONS NOSOCOMIAL INFECTION :• An infection acquired in a patient in a hospital or other healthcare facility in whom it was not present or incubating at the time of admission or the residual of an infection acquired during a previous admission. DR.T.V.RAO MD 2
  3. 3. BACKGROUND OF HOSPITAL INFECTIONS Nosocomial infections have been recognized for over a century as a critical problem affecting the quality of health care and a principal source of adverse healthcare outcomes.DR.T.V.RAO MD 3
  4. 4. RISK OF INFECTIONS IN ICU• Patients hospitalized in ICUs are 5 to 10 times more likely to acquire nosocomial infections than other hospital patients. The frequency of infections at different anatomic sites and the risk of infection vary by the type of ICU, and the frequency of specific pathogens varies by infection site. Contributing to the seriousness of nosocomial infections, especially in ICUs, is the increasing incidence of infections caused by antibiotic- resistant pathogensDR.T.V.RAO MD 4
  5. 5. WHY ONE MAY BE IN ICU WITH  And why do they come to the ICU  Ventilator support – respiratory failure – pneumonia  Hemodynamic support – shock  Renal replacement therapy – renal failure, severe acidosis  Monitoring, Neurological dysfunction, HematologicDR.T.V.RAO MD 5
  6. 6. ICU : FACTORS THAT INCREASE CROSS- INFECTIONS• Lack of Hand washing facilities• Patient close together or sharing rooms• Understaffing• Preparation of IVs on the unit• Lack of isolation facilities• No separation of clean and dirty AREAS• Excessive antibiotic use• Inadequate decontamination of items & equipments• Inadequate cleaning of environment DR.T.V.RAO MD 6
  7. 7. NOSOCOMIAL FEVERS• Hospital-acquired fevers occur in one-third of all medical inpatients• Nosocomial fevers even more common in the ICUDR.T.V.RAO MD 7
  8. 8. INFECTIOUS CAUSES OF FEVER WHILST IN ICU Ventilator associated pneumonia Catheter related blood stream infections Urosepsis Intra-abdominal infections Sinus infections DiarrhoeaDR.T.V.RAO MD 8
  9. 9. FEVER IN THE ICU• ICU patients have several underlying medical/surgical conditions• ICU patients undergo many invasive diagnostic and therapeutic procedures• Therefore, fever in ICU patients must be thoroughly and promptly evaluated to discriminate infectious from non-infectious etiologies DR.T.V.RAO MD 9
  10. 10. CAUSES OF FEVER IN THE ICU• Surgical site infections • Urinary catheter-• Intravenous-line associated infections bacteriuria• Nosocomial pneumonia • Drug fever• Nosocomial sinusitis• Intraabdominal • Post-operative fever infections • Neurosurgical causes DR.T.V.RAO MD 10
  11. 11. THE OBVIOUS FOCUS  Community acquired pneumonia  Acute CNS infection  Urinary tract infection  Abdominal focus of infection  Wound infection / Pus collections  Trauma with infectionDR.T.V.RAO MD 11
  12. 12. DEVICE RELATED NOSOCOMIAL INFECTION• A device-associated infection is an infection in a patient with a device (i.e., central line, ventilator, or indwelling urinary catheter) that was in use within the 48-hour period before onset of infection. If the interval since discontinuation of the device is longer than 48 hours, there must be compelling evidence that infection was associated with device use. DR.T.V.RAO MD 12
  13. 13. ICU PATIENTS DIFFERS FROM MANY PATIENTS PAY MORE ATTENTION• Sickest patients (multiple diagnoses, multi- organ failure, immunocompromised, septic and trauma)• Move less• Malnourished• More obtunded (Glasgow coma scale)• Diabetics and Heart failureDR.T.V.RAO MD 13
  14. 14. INFECTIOUS CAUSES OF FEVER WHILST IN ICU Ventilator associated pneumonia Catheter related blood stream infections Urosepsis Intra-abdominal infections Sinus infections DiarrhoeaDR.T.V.RAO MD 14
  15. 15. PATIENT PRESENTING TO ICU WITH FEVER Patient with an Acute un-differentiated obvious focus of infection feverWhere is the focus? What is causing this fever? DR.T.V.RAO MD 15
  16. 16. RISK FACTORS• operative surgery• intravascular and urinary catheterization• mechanical ventilation of the respiratory tract• Other risk factors include traumatic injuries, burns, age (elderly or neonates), immuno- suppression and existing disease DR.T.V.RAO MD 16
  17. 17. ICU CARE IS MORE INVASIVE• More invasive life lines and procedures including surgeries• Longer length of stay• More IV and parenteral drugs• More tube feeding and Parenteral nutrition• More ventilation DR.T.V.RAO MD 17
  18. 18. FACTORS INFLUENCING INCREASED INFECTIONS IN ICU• Hand washing facilities• Patient close together or sharing rooms• Understaffing• Preparation of IVs on the unit• Lack of isolation facilities• No separation of clean and dirty AREAS• Excessive antibiotic use• Inadequate decontamination of items & equipments• Inadequate cleaning of environment DR.T.V.RAO MD 18
  19. 19. THE INANIMATE ENVIRONMENT IS A RESERVOIR OF PATHOGENS X represents a positive Enterococcus culture The pathogens are ubiquitous~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) PatientEnvironment. Hayden M, ICAAC, 2001, Chicago, IL.
  20. 20. SOME HEALTH-CARE ASSOCIATED INFECTIONS• UTI associated with Foley catheters• Lower respiratory tract infection (post-op and ventilator dependent)• Skin necrosis (skin breakdown)• Blood stream infection (and line associated)• Surgical-site infection• Nutrition-related and malnutrition DR.T.V.RAO MD 20
  21. 21. MANAGING FEVER IN ICU PATIENTS• Fever in the ICU can have many infectious and noninfectious etiologies• Crucial to identify the precise cause as some of the conditions in each groups are life-threatening, while others require no treatment• “Routine fever work-up” not cost-effective• If initial evaluation shows no infection, antibiotics should be withheld• Empiric antibiotics may be started in the unstable patient, but stopped if infection is not evident later DR.T.V.RAO MD 21
  22. 22. DEVICE RELATED NOSOCOMIAL INFECTION• A device-associated infection is an infection in a patient with a device (i.e., central line, ventilator, or indwelling urinary catheter) that was in use within the 48-hour period before onset of infection. If the interval since discontinuation of the device is longer than 48 hours, there must be compelling evidence that infection was associated with device use. DR.T.V.RAO MD 22
  23. 23. Sources of Infection Intrinsic contamination of infusion fluid Port for additives Connection with administration set Insertion site Injection ports Administration set connection with IV catheterDR.T.V.RAO MD 23
  24. 24. 1. Extra luminal Spread Patient’s own skin micro flora Sources of Infection Microorganism transferred by the hands of Health Care Worker Contaminated entry port, catheter tip 2. Intraluminal Spread Intralumunal Spread prior or during insertion Contaminated infusate Contaminated infusate Contaminated disinfectant solutions (fluid, medication) (fluid, medication) Invading wound Skin attachment Skin Fibrin Vein 3. Haematogenous Spread Infection from distant focusDR.T.V.RAO MD 24
  25. 25. PREVENTION OF CR-BSIWritten Protocol Must be performed by trained staff according to written guidelinesSterile procedure Sterile gown, Sterile gloves, Sterile large drapes Dont shave the siteHand disinfection With an antiseptic solution eg Chlorhexidine gluconate DR.T.V.RAO MD 25
  26. 26. FUNGI TOO INFECTIVE IN ICU PATIENTSDR.T.V.RAO MD 26
  27. 27. RISK FACTORS FOR ASPERGILLOSIS• Neutropenia• steroids• Environmental exposure • Building work • Compost heaps • Marijuana smokingDR.T.V.RAO MD 27
  28. 28. INVASIVE ASPERGILLOSIS• incidence increasing• commonest cause of infectious death in many transplant units• commonest cause of death in childhood leukaemiaDR.T.V.RAO MD 28
  29. 29. PROTECTED ENVIRONMENT• HEPA (for allogeneic HSCT patients only) • 99.97% of all particles >3u diam) • >/=12 ACH • Pressure differential >2 Pa • Directed air flow • Sealed rooms • Respiratory protection (N95 respirator) if leaving room only during periods of building construction• Standard hygiene barrier precautions• No flowers, potted plants, carpets• Vacuums to have HEPA filters HICPAC guidelines CDC 2004DR.T.V.RAO MD 29
  30. 30. BASIC POLICIES IN MICROBIOLOGICAL DIAGNOSIS OF ICU INFECTIONSDR.T.V.RAO MD 30
  31. 31. CRITERIA FOR DIAGNOSIS• fever.• cough.• development of purulent sputum, in conjunction with radiologic evidence of a new or progressive pulmonary infiltrate.• a suggestive Gram stain, and positive cultures of sputum, tracheal aspirate, pleural fluid, or blood.DR.T.V.RAO MD 31
  32. 32. DR.T.V.RAO MD 32
  33. 33. HOW TO DIAGNOSE?• A positive result of semi quantitative Culture ( 15 CFU per catheter segment) Maki D, et al NEJM 1977;296:1305 or quantitative ( 102 CFU per catheter segment) catheter culture, whereby the same organism isolated from a catheter segment and a peripheral blood sample• Simultaneous quantitative cultures of blood samples with a ratio of 5 : 1 (CVC vs. peripheral)• Differential time to positivity :positive result of culture from a CVC is obtained at least 2 hr earlier than is a positive result of culture from peripheral blood ) DR.T.V.RAO MD 33
  34. 34. REMEMBER………….• If You put a central line in a patient with documented Bacteremia, then later next day somebody may obtain a blood culture from both the central lien and from periphery, >>>>>>> a positive blood culture from both sites, does not mean that the central lien is the source. DR.T.V.RAO MD 34
  35. 35. DEALING WITH STAPHYLOCOCCUS AUREUS• REMOVE the central line .• Systemic antibiotics for minimal 14 days.• Failure to clear bacteremia within 72 hours Or patient with high risk for endovascular infection or having prosthesis may be indicative for longer 3-6 weeks of treatment.• TTE or TEE are strongly advised.• Blood Culture should be repeated during therapy and1-2 weeks after completion of therapy, looking for relapses.
  36. 36. COAGULASE NEGATIVE STAPHYLOCOCCI• CVC can be retained, if necessary, in patients with uncomplicated, catheter-related, bloodstream infection.• If the CVC is retained, patients should be treated with systemic antibiotic therapy for 7 days.• Treatment failure is a clear indication for removal of the catheter .
  37. 37. A RANDOMIZED AND PROSPECTIVE STUDY OF 3 PROCEDURES FOR THE DIAGNOSIS OF CATHETER-RELATED BLOODSTREAM INFECTION WITHOUT CATHETER WITHDRAWAL CID MARCH 2007 • Conclusions. CR-BSI can be assessed without catheter withdrawal in patients without neutropenia or blood disorders who have catheters inserted for a short time and are hospitalized in the intensive care unit. Because of ease of performance, low cost, and wide availability, we recommend combining semi quantitative superficial cultures and peripheral vein blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique .DR.T.V.RAO MD 37
  38. 38. DO NOT TREAT COLONIZED CENTRAL LINES GET GUIDED BY MICROBIOLOGY REPORTS• A central line is removed and it is growing less than 15 CFU.• Patient is not septic and blood Culture is negative.• >>> No indication to treat the infected or colonized central line.DR.T.V.RAO MD 38
  39. 39. PROBLEMS WITH AIR SAMPLING HAS LIMITATIONS ???• Incubation period of IPA unknown • Estimates vary from 48 hours -3 months• Geographical and seasonal variation in spore counts and predominant species• Variable efficiency of different air samplers• May not take account of surface contamination • Settle plates, contact plates, honey jars
  40. 40. NEW FRONTIERS ON INCREASING ICU INFECTIONS• Emphasis on patient safety• Move from inpatient to outpatient environment• Increase in population age • Persons >65yo numbered 36 million in 2004 and by 2030 there will be 72 million• Increase in antimicrobial resistance (e.g., MRSA)DR.T.V.RAO MD 40
  41. 41. STRATEGY FOR PREVENTION• Hand washing• Use gloves to prevent contamination of the hands when handling respiratory secretions• Wear gloves and gowns (contact precautions) during all contact with patients and fomites potentially contaminated with respiratory secretions• Use aseptic techniqueDR.T.V.RAO MD 41
  42. 42. STRATEGY FOR PREVENTION• Clean and decontaminate all equipment after use• Sterilise or use high-level disinfection for all items that come into direct or indirect contact with mucous membranes• Rinse and dry items that have been chemically disinfected• Package and store items to prevent contamination before use• Keep environment clean, dry and dust free DR.T.V.RAO MD 42
  43. 43. INFECTION CONTROL MEASURES• 1 Identify reservoir Colonized and infected patients Environnemental contamination; Common sources• 2. Halt transmission among patient Improve hand washing and asepsis Barrier precautions (gloves, gown) for colonized and infected Patients Eliminate any common source; disinfect environment Separate susceptible patients Close unit to new admissions if necessaryDR.T.V.RAO MD 43
  44. 44. INFECTION CONTROL MEASURES• 3. Halt progression from colonization to infection Discontinue compromising factors when possible (eg, extubate, remove nasogastric tube, discontinue bladder catheters, as clinically indicated; rotate IV catheter sites; proper ventilator and pulmonary care)• 4. Modify host factors Treat underlying disease and complications Control antibiotic use (rotate, restrict, or cease)DR.T.V.RAO MD 44
  45. 45. TRADITIONAL ICP ACTIVITIES• Surveillance• Outbreak investigations• Policy development and implementation• Environmental/infection control rounds• Education (infection control, blood borne pathogen, TB)• Regulatory compliance• Committee participationDR.T.V.RAO MD 45
  46. 46. NEW ICP RESPONSIBILITIES• Increased regulations (OSHA, FDA)• Emerging pathogens (avian influenza)• IHI campaign• Increase training/education requirements• Post-exposure prophylaxis (HIV, HBV)• Epidemiologic typing of outbreak pathogens• Interpreting screening cultures (MRSA, VRE)• Risk adjusted surveillance (SSI, CR-BSI, VAP)• Sentinel event analysisDR.T.V.RAO MD 46
  47. 47. CONCLUSIONS : STRATEGY FOR INFECTION PREVENTION• Strict attention to Hand hygiene• Prudent Antibiotic use• Aseptic technique• Disinfection/Sterilization of items and equipment• Education of staff infection control awareness• Keep Environment Clean, Dry and dust free• Surveillance of nosocomial infection to identify problems areas & set priorities DR.T.V.RAO MD 47
  48. 48. GROWING CONCERNS WITH INFECTIONS IN ICU• Nosocomial infections, especially those caused by antibiotic-resistant pathogens, represent an important source of morbidity and mortality for the patient hospitalized in an ICU. Important antibiotic-resistant nosocomial pathogens include MRSA, VRE, Gram- negative bacilli (especially, Klebsiella and Enterobacter) producing extended-spectrum b-lactamases, multiple drug-resistant M tuberculosis, and fluconazole-resistant Candida sp.DR.T.V.RAO MD 48
  49. 49. CAN WE CONTROL ICU INFECTIONS• The key to control of antibiotic-resistant pathogens in the ICU is rigorous adherence to infection control guidelines and prevention of antibiotic misuse. Antibiotic restriction policies clearly result in reduced drug costs. Evidence suggests that reducing use of certain antibiotics may lead to a decreased prevalence of antibiotic-resistant pathogens: vancomycin, VRE; gentamicin, gentamicin-resistant Gram-negative bacilli; and, ceftazidime, Gram-negativeDR.T.V.RAO MD 49
  50. 50. WISH WIN THE PROBLEM FACE THE CHALLENGES• Increase infection control resources are a win-win-win investment • Reduced patient morbidity and mortality • Net cost savings to institution, society and patient • Improve patient satisfaction• From the standpoint of the hospital and society, the benefits exceed the costs• Hospitals should support a ratio of ICP per beds of 1:150DR.T.V.RAO MD 50
  51. 51. MICROBES ON SKIN PLAY A MAJOR ROLE SKIN DISINFECTION A MAJOR PREVENTIVE MEASURE• The major cause of infection during the first weeks of indwelling time is from skin microorganisms. • Rannem, et. al., 1990 • Maki, et. al., 1991 • Maki (review), 1994 • Widmer (review), 1997
  52. 52. USING CHLORHEXIDINE 0.5% FOR SKIN DISINFECTION• A meta-analysis determined that chlorhexidine gluconate significantly reduces the incidence of bacteremia in patients with central venous catheters compared to povidone- iodine for insertion-site skin disinfection.• Chaiyakunapruk et al. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis. Ann Intern Med. 2002;136:792 .
  53. 53. CHLORHEXIDINE SKIN ANTISEPSIS• Prepare skin with antiseptic/detergent chlorhexidine 2% in 70% isopropyl alcohol.• Pinch wings on the applicator to pop the ampule. Hold the applicator down to allow the solution to saturate the pad.• Press sponge against skin, apply chlorhexidine solution using a back and forth friction scrub for at least 30 seconds. Do not wipe or blot.• Allow antiseptic solution time to dry completely before puncturing the site (~ 2 minutes).
  54. 54. ALCOHOL BASED HAND SANITIZERS • Recommended by CDC based on strong experimental, clinical, epidemiologic and microbiologic data • Antimicrobial superiority • Greater microbicidal effect • Prolonged residual effect • Ease of use and application
  55. 55. AN INTERVENTION TO DECREASE CATHETER-RELATED BLOODSTREAM INFECTIONS IN THE ICU. N ENGL J MED PRONOVOST P, ET AL: 355(26):2725-2732, 2006• (1) hand washing,• (2) use of full-barrier precautions during placement of catheters,• (3) cleansing of the skin with chlorhexidine,• (4) use of sites other than the femoral vein when possible,• (5) removal of catheters that were no longer needed. The analysis included almost 2000 ICU-months and >375,750 catheter-days of data.
  56. 56. WARNING Nosocomial Infections in ICU are WaitingDR.T.V.RAO MD 56
  57. 57. BE KIND TO YOUR PATIENTS REMEMBER ONE THING•PLEASE WASH YOUR HANDS
  58. 58. • Programme created by Dr.T.V.Rao MD for Health care Workers in the Developing world • Email • doctortvrao@gmail.comDR.T.V.RAO MD 58
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