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Infection Surveillance in Intensive Care

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Infection Surveillance in Intensive Care

  1. 1. S Infection surveillance in Intensive care Dr C Clarke Consultant in Intensive Care Medicine & Anaesthesia Craigavon Area Hospital
  2. 2. Positive Blood Cultures: Laboratory Reports, NI 1st Jan 2009 – 31st Dec 2012* Gram Negative Bacteria 2009 2010 2011 2012* Acinetobacter sp 41 31 23 24 Aeromonas sp 4 2 5 5 Brucella sp 0 0 0 0 Campylobacter sp 2 2 2 6 Citrobacter sp 14 13 16 11 Enterobacter sp 63 59 58 46 Escherichia coli 879 891 971 992 Escherichia sp 0 1 0 0 Haemophilus influenzae (all types) 12 17 19 12 Haemophilus parainfluenzae 2 0 2 3 Klebsiella sp 195 197 193 187 Legionella sp 0 0 0 0 Leptospira 0 0 0 0 Neisseria meningitidis 22 17 15 11 Neisseria sp 2 0 0 0 Proteus sp 75 97 95 93 Providencia sp 3 1 2 2 Pseudomonas aeruginosa 75 71 80 73 Pseudomonas sp 38 40 30 16 Salmonella sp 4 3 4 4 Serratia sp 48 40 42 21 Other gram negative bacteria 31 35 14 45 Total 1510 1517 1571 1551
  3. 3. Surveillance S The systematic collection and analysis of data on nosocomial infection occurrences S Incidence of nosocomial infection S ID patterns and potential solutions S Outcome objectives (IHI)
  4. 4. Surveillance S Requires cooperation between infection control and ICU S Agree the aims and goals S Ensure quality of ICU care
  5. 5. Surveillance S Expensive and labour intensive S Accuracy- over and under diagnosis eg miss outbreak/cluster S Benchmarking-eg comparing a cancer hospital with Burns Unit S Potential for data to be hidden S Those that do worst at finding infection-”look the best”
  6. 6. Surveillance S Well established CDC (USA-centre for disease control) S KISS - Krankenhaus Infektions Surveillance Systems S Tend to underestimate S Benchmark infection rates and establish standards of preventative care S Confidential, Voluntary, Methodologically sound
  7. 7. Outcomes S CVC infection rates 2.1-1,5 Bloodstream infections per 1000 CVC days (29% reduction S Neonatal Unit –No change in infection rates over 10 years S Overall the evidence supports this approach
  8. 8. Key points S A surveillance program should be in place to monitor the incidence and features of local nosocomial infection and to help develop strategies to decrease the incidence of infection in the ICU S Handwashing and specific isolation protocols key factors S CVCs, indwelling catheters and ventilation-discontinue ASAP
  9. 9. Quality Indicators-according to ICS S 20 indicators in order of importance S 3 hand hygiene S 6 unit acquired bacteraemias S 7 unit acquired MRSA infection S 8 catheter related blood stream infection S 9 unit acquired C. Difficle S 12 Appropriate infection isolation
  10. 10. Colonisation v infection S Clinical indicators of infection S Colonisation common of respiratory and urinary tracts in ICU S SIRS often present due to non-infective causes S CRP PCT S Quantitative culture (eg >106 cfu/ml of resp secretion) S Immunocompromised?
  11. 11. ICS
  12. 12. CDC Definitions S a nosocomial infection as a localized or systemic condition 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s) and 2) that was not present or incubating at the time of admission to the hospital (7, and NNIS Manual, Section XIII, May 1994, unpublished). For most bacterial nosocomial infections, this means that the infection usually becomes evident 48 hours (i.e., the typical incubation period) or more after admission.
  13. 13. A central line associated blood stream infection is a laboratory-confirmed bloodstream infection (BSI) in a patient who had a central line within the 48 hour period before the development of the BSI and that is not related to an infection at another site.
  14. 14. The CLABSI must meet one of the following criteria: Criterion 1
Patient has a recognised pathogen cultured from one or more blood cultures
and
Organism cultured from blood is not related to an infection at another site. Criterion 2
Patient has at least one of the following signs or symptoms: fever (>38°C), chills, or hypotension
and
signs and symptoms and positive laboratory results are not related to an infection at another site
and
Common skin contaminant is cultured from two or more blood cultures drawn on separate occasions Criterion 3
Patient < 1 year of age has at least one of the following signs or symptoms: fever (>38°C core) hypothermia (<36°C core), apnoea, or bradycardia
and 
Signs and symptoms and positive laboratory results are not related to an infection at another site
and 
Common skin contaminant is cultured from two or more blood cultures drawn on separate occasions.
  15. 15. Summary S Surveillance is an integral of Intensive Care S Dependent of data collection S Definitions are complex S Microbiology must always be interpreted with clinical information.

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