Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Infection control nabicon 13 by Dr. Sunil Keswani, Nat
1. INFECTION CONTROL IN
BURNS
Dr SM Keswani,
National Burns Centre
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
2. Burns … high risk nosocomial infection
Burn wound injury
Respiratory tract injury
Prolonged intubation
Broad spectrum antibiotics
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
3. Burns care - what’s in…..
Aseptic technique
Sterile gowns , gloves, mask
Spatial separation
Cohort patient care
Frequent wound evaluation
Choice of antibiotic dictated by current flora
& specifically by pts wound flora
Aggressive necrotic tissue debridement &
early wound closure
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
4. Burn Wound Infection - BWI
BW Colonization - presence of organisms within
the eschar
BWI - bacterial invasion of viable tissue adjacent
to the eschar
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
5. Diagnosis of BWI
Sine qua non
is Histopath showing tissue invasion
Semiquantitative swabs
1 swab for 10% of open burn
capillary gauze tech
agar contact
Quantitative biopsy >105/gm of tissue
- a negative quant <105 correlates well with HP but a
positive culture & HP may correlate with as low as 37%
- costly & labor intensive
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
6. Organisms causing infections
Endogenous & Exogenous
Staph aureus incl MRSA
Enterococci & Gp A Streptococci
CoNS
Pseudomonas aeruginosa
Enterobacter / E-coli
Klebsiella / Serratia
Candida
Filamentous fungi
Viruses as HSV,VZV,CMV
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
Gram Pos
Gram Neg
7. Prevention of infection in burns
Architectural design
Contained perimeter to limit
through traffic
Individual strict isolation units with all intensive &
burn care procedures (including vent & operative )
within the center
Single room delays colonization by 10 days
Strict compliance with environmental control
- enforced hand wash
- monitoring & diagnostic equipment housed within each
patients room
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
8. Prevention of infection in burns
Cross contamination kept to a minimum
Cohort nursing
Convalescent patients separated from acute
Category specific precautions for
Patients > 30% TBSA &
Resistance isolation
- separate nursing staff
- supplies arranged to maximise care
- physician care from non isolated to isolated areas
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
9. Components of Protocols
1) Care of the unit
2) Care of the Bed space
3) Care at point of staff contact with patient
4) Care of indwelling devices
5) Care of external devices
6) Detection of epidemics
7) Prevention of endogenous infection
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
10. 1.Care of the unit
General Cleaning of unit
– Clean twice daily with detergent
• Thorough machine cleaning once weekly
– Clean with disinfectant
( stabilised hydrogen peroxide )
– May be cleaned with detergent & water
– Hydrotherapy agitators
– Addition of Na hypochlorite to hydrotherapy
Dr. Sunil Keswani, National Burns
water
Centre, www.burns-india.com,
nbcairoli@gmail.com
– Cups, bedpans, urinals etc. to be kept dry
11. 1. Care of the unit - disinfecting solutions
For cleaning contaminated material
– Sputum cups, bedpans, urinals etc.
– Sodium Hypochlorite 5% solution
•
•
•
•
•
75 ml. of this diluted in 12L of water
This gives 325 PPM of Cl
Recommendation is > 100 PPM
Checked for potency with Chlorosticks daily
Fresh solution prepared every shift
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
12. 2.Care of the Bed space
Hand wash solutions at each bedside
Bed / side table / rails / IV poles cleaned with
Na hypochlorite for every new patient & twice
daily
Mattresses covered with a impervious cover
Dedicated equipment
No stuffed toys/flowers
Cooked food Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
13. Handrub.. the best antimicrobial
Hands should be cleaned before donning & after removing gloves
Self
drying solution
Alcohol ( 70 %) +
Chlorhexidine( 0.5 %)
Soap & Water
Cheap ? user friendly
Needs drying
Soap & drying agent
contaminated towel or
Dr. Sunil Keswani, National Burns
tissue
Centre, www.burns-india.com,
nbcairoli@gmail.com
14. 2.Care of the Bed space
Clean floors x 3 daily (with stabilised
hydrogen peroxide)
Walls cleaned daily
Curtains (windows) changed every week
Linen changed daily + SOS
Contaminated dressings/ linen bagged
& removed
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
15. 2.Care of the Bed space…contd
•Separate AMBU bag, face mask , stethoscope &
BP cuff per bed
•Cleaned with disinfectant for each new patient
•Suction bottles cleaned every shift with sod hypo
•New tubing for each patient
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
16. 3. Care of Patient Contact
Wash hands before any patient contact
Re-wash
when contact with
• Vascular catheter & its connections
• Tracheal tube & its connections
Stericath: for tracheal tube suction
Change patients position regularly
– Prevents hypostatic pneumonia, bedsores
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
17. 3. Care of Patient Contact - Procedures
Separate trolley
– NO common trolley
– Separate trolley cleaned and loaded before a
bedside procedure is done
Surface cleaned with disinfectant
Surface completely covered with a sterile
drape
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
18. 4.Care of Indwelling Devices
Appropriate sterile precautions for insertion
Wash hands before (& after contact)
Minimal disconnection
Appropriate dressing care protocol
Discourage line changes over guidewire
Avoid “ routine ” changes
– Urinary catheters
Dr.
– Tracheal tubes Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
19. 5.Care of External Devices-IV sets, Infusions
Suppurative thrombophlebitis decreased by
regular rotation
Care of intravenous infusion sets
– TPN through separate dedicated set / port
– Fluids & drug infusions changed after 24 hours
– Infusion set changed
- on admission
- every 24 hours for TPN and
- every 72 for otherSunil Keswani, National Burns
Dr. fluids
Centre, www.burns-india.com,
nbcairoli@gmail.com
20. 5.Care of External Devices -Ventilator Circuits
Ventilator & tubing
– Disposable circuits if feasible
– No routine change of circuit
HMEF at Y-connection for all patients
– HMEF & catheter mounts to be changed 24-72
hours
– HMEF not to be removed from circuit except at
time of changing
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
21. 5.Care of External Devices - Suction
Aseptic technique
Use sterile gloves
One hand sterile technique
Sequence must be
endotracheal-nasal-
oral
For long term ventilation closed suction
system(stericath) to be used
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
22. 7.Preventing Endogenous Infection
Early wound closure & grafting
Early and complete resuscitation to
ensure adequate bowel & other organ
perfusion
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
23. 7.Preventing Endogenous Infection
Early Enteral nutrition & Immune enhancing
feeds
–
–
–
–
Gut is source of organisms
Gut wall is vulnerable in critical illness
Early nutrition preserves gut function
Modified feeds preserve or enhance gut function
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
24. 7.Preventing Endogenous Infection
Tight Glycemic Control in Medical Patients
NICE study (Normoglycemia in Intensive Care
Evaluation)
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
25. Conclusions - Obsession is the rule
Clear policies & protocols
– Need to be followed by all personnel
– Need to be enforced by director & Infection
Control Committee
Concentrate on point of patient contact
Antibiotics are not a substitute for Infection
Control
General cleanliness important
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com
QC of sterilizing solutions necessary
26. Thank you!
Dr. Sunil Keswani, National Burns
Centre, www.burns-india.com,
nbcairoli@gmail.com