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Infection control in icu setting ( prevention of cross infection)

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Prevention of Cross Infection in Hospital setting

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Infection control in icu setting ( prevention of cross infection)

  1. 1. Also known as Nosocomial infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff.
  2. 2. Why focus on infection prevention and control ?  More than 20 percent of all nosocomial infections are acquired in ICUs  ICU-acquired infections account for substantial morbidity, mortality, and expense.  Improving infection prevention and control in critical care acts as a catalyst for improvement in the rest of the hospital.
  3. 3. Sources of Infection Endogenous sources: 50% Pt’s own flora, such as skin, nose, mouth, GI tract, or genitals ( greatest source of danger) Exogenous sources are: 15% Environment ( Air 5%,Instrument 10%) Cross Infection : 35% patient care personnel, visitors and other patients
  4. 4. EPIDEMIOLOGY  Culture results from ICU-acquired infections at Vidant Medical Center  UTI – Urinary tract infection;  HCAP – Healthcare- associated pneumonia;  CABSI – Catheter- associated bloodstream infection
  5. 5. Epidemiology of HAI
  6. 6.  more chronic comorbidities & more severe acute physiologic derangements.  the high frequency of use of catheters provide a portal of entry of organisms into the bloodstream.  Multidrug-resistant pathogens MRSA and VRE are being isolated with increasing frequency in ICUs
  7. 7. Risk Factors :  Presence of underlying comorbidities such as:  diabetes, renal failure, malignancies predispose patients to colonization and infection with multidrug-resistant bacteria  Presence of indwelling devices, central venous catheters and endotracheal tubes which bypass natural host defense mechanisms and serve as portals of entry for pathogens.  Frequent manipulations and contact with HCWs usually concurrently caring for multiple ICU patients  Hands are the vehicles for transfer of pathogens from patient to patient.  Long hospital courses prior to the ICU admission more Antibiotic Exposure ,…..
  8. 8. 1. MRSA ( Methicillin Resistant Staphylococcus Aureus) Resistant to flucloxacillin May cause: wound infection, bacteremia, skin/soft tissue infection, UTI, Pneumonia Colonization common: nose, axilla, perineum, wound/lession Spread by: hands, fomites, aerosols Control: eradication of carriage, barrier nursing, screening of other patients
  9. 9. 2. Tuberculosis – open pulmonary TB and sputum smear positive for Acid fast bacilli. 3. Viral Infection - chicken pox, Hepatitis B, HIV 4. Gram Negative Organism – resistant to multiple antibiotics. Organism such as: E coli, Proteus, Enterobacter, Acinetobacter, Pseudomonas Aeruginosa Causes: Bacteremia, UTI, Pneumonia, Wound infection Control: Anti-biotic policy Adherence of infection control guidelines prevention of cross infection
  10. 10. an application of scientific and epidemiological principles for infection prevention and reduction in rates of nosocomial infections.
  11. 11. If known or suspected on admission to hospital, or detected following admission: Standard Precaution and Transmission Based Precaution Isolation (barrier precautions) Inform Infection Control team Treatment - if appropriate Regular surveillance
  12. 12. Hand washing is frequently called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions.
  13. 13. Steps of proper Hand Washing
  14. 14. Alcohol Hand Rub An easy way to use because of faster application compared to correct hand washing
  15. 15. Regular Surveillance  Monitor the incidence of epidemiologically-important organisms and targeted HAIs that have substantial impact on outcome and for which effective preventive interventions are available;  use information collected through surveillance of high-risk populations, procedures, devices and highly transmissible infectious agents to detect transmission of infectious
  16. 16. Top CDC Recommendations to Prevent Healthcare- Associated Infections To Prevent Catheter-Associated Urinary Tract Infections (CAUTIs:)  Insert catheters only for appropriate indications  Leave catheters in place only as long as needed  Ensure that only properly trained persons insert and maintain catheters  Insert catheters using aseptic technique and sterile equipment (acute care setting)  Follow aseptic insertion, maintain a closed drainage system  Maintain unobstructed urine flow  Comply with CDC hand hygiene recommendations and Standard Precautions  Also consider:  Alternatives to indwelling urinary catheterization  Use of portable ultrasound devices for assessing urine volume to reduce unnecessary catheterizations  Use of antimicrobial/antiseptic-impregnated catheters
  17. 17. To Prevent Surgical Site Infections Before surgery  Administer antimicrobial prophylaxis in accordance with evidence-based standards and guidelines  Treat remote infections-whenever possible before elective operations  Avoid hair removal at the operative site unless it will interfere with the operation; do not use razors  Use appropriate antiseptic agent and technique for skin preparation During Surgery  Keep OR doors closed during surgery except as needed for passage of equipment, personnel, and the patient After Surgery  Maintain immediate postoperative normothermia  Protect primary closure incisions with sterile dressing  Control blood glucose level during the immediate post-operative period (cardiac)  Discontinue antibiotics according to evidence-based standards and guidelines
  18. 18. Central Line-Associated Bloodstream Infections (CLABSIs) Outside ICUs:  Remove unnecessary central lines  Follow proper insertion practices  Facilitate proper insertion practices  Comply with CDC hand hygiene recommendations  Use appropriate agent for skin antisepsis  Choose proper central line insertion sites  Perform adequate hub/access port disinfection  Provide staff education on central line maintenance and insertion Also consider:  Chlorhexidine bathing  Antimicrobial-impregnated catheters  Chlorhexidine-impregnated dressings
  19. 19. Clostridium difficile Infections  Contact Precautions for duration of diarrhea  Comply with CDC hand hygiene recommendations  Adequate cleaning and disinfection of equipment and environment  Laboratory-based alert system for immediate notification of positive test results  Educate about C. diff infection: healthcare personnel, housekeeping, administration, patients, families Also consider:  Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48 hours)  Presumptive isolation for symptomatic patients pending confirmation of C. diffinfection  Evaluate and optimize testing for C. diff infection  Implement soap and water for hand hygiene before exiting room of a patient with C. diff infection  Implement universal glove use on units with high C. diff infection rates  Use EPA-registered disinfectants with sporicidal claim (e.g., bleach) or sterilants for environmental disinfection  Implement an antimicrobial stewardship program
  20. 20. To Prevent MRSA Infections  Comply with CDC hand hygiene recommendations  Implement Contact Precautions for MRSA colonized and infected patients  Recognize previously MRSA colonized and infected patients  Rapidly report MRSA lab results  Provide MRSA education for healthcare providers Also consider:  Active surveillance testing – screening of patients to detect colonization even if no evidence of infection  Other novel strategies  Decolonization  Chlorhexidine bathing
  21. 21. Conclusion  Although the ICU environment cannot be made microbe free, aggressive measures should be made to reduce HAIs and their associated increased morbidity, mortality, length of stay and financial burden. The majority of these infections are preventable with adequate preventative measures. Healthcare workers are mandated to implement infection control measures in their daily practice. As patients in the ICU are critically ill, infection control measures to avoid complications is a priority and integral part of care. ICU providers must be familiar with their institution’s infection control guidelines for the prevention and management of invasive devices/catheters, endotracheal tubes and tracheostomies.

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