This content gives detailed information regarding infection control in CCU, common hospital-acquired infections in CCU role of a critical care nurse in infection control

2. INFECTION
An infection is the entry and multiplication of an
infectious agent in the tissue of host.

3. HOSPITAL ACQUIRED INFECTION

4. HOSPITAL ACQUIRED INFECTION
According to the WHO, “Hospital-acquired
infections are infections acquired during hospital
care which are not present or incubating at
admission”.

5. INFECTION CONTROL
Infection control is the measures practiced by
health care personnel to prevent spread,
transmission and acquisition of infection
between clients, from health care providers, and
from clients to health care practitioners.

6. RISK FACTORS
➢ Age
➢ Prolonged and inappropriate use
of invasive devices and antibiotics.
➢ High-risk and sophisticated
procedures.
➢ Immuno-suppression and other
severe underlying patient conditions

7. RISK FACTORS
➢ Insufficient application of
standard and isolation
precautions.
➢ Malnutrition.
➢ Sleep deprivation.
➢ Prophylaxis for stress ulcers.
➢ Indiscriminate use of antibiotics.
➢ Physiological and psychological
stressors.

9. INFECTION CONTROL MEASURES

11. STANDARD PRECAUTIONS

12. HAND HYGIENE
Recommendations by CDC;
❖ Avoid unnecessary touching of surfaces.
❖ Wash hands.
❖ Decontaminate hands.

13. HAND HYGIENE

14. PERSONAL PROTECTIVE EQUIPMENT
Personal protective equipment is special
equipment wear to create a barrier between
health care providers and germs.

15. COMPONENTS OF PPE
COMPONENTS
OF PPE

16. PRINCIPLES OF PPE
Donning and doffing of PPE

17. AREAS FOR DONNING AND DOFFING
OF PPE
▪Should designated as separate from the patient care
area.
▪Designate two adjacent rooms.
▪Doffing area should large enough.
▪Facilities should ensure that space and layout allow
for clear separation between clean and
contaminated areas.

18. ▪Post signage to highlight key aspects of PPE donning
and doffing;
•Designating clean areas vs. contaminated areas.
•Reminding healthcare workers to wait for a trained
observer before removing PPE.
•Listing each step of the doffing procedure.
•Reinforcing the need for slow and deliberate removal
of PPE to prevent self-contamination.
•Reminding healthcare workers to disinfect gloved
hands in between steps of the doffing procedure.

19. INTENSIVE CARE UNIT ENVIRONMENT
➢ Clean and disinfect surfaces starting from the areas with a lower
contamination (e.g., tray tables, counter tops) to areas with highly
contaminated surfaces.
➢ Methods include wet mopping, and vacuum cleaning with filters
attached.
➢ Changing privacy curtains routinely and upon patient discharge or
transfer.

20. ➢ Clean bed before admitting a patient.
➢ Remove, clean, disinfect or sterilize all patient care items.
➢ Cleaning products;
❑ Should be nontoxic, easy to use, acceptable odor, soluble
in warm and cold water.
❑ Liquid soap, enzymatic cleaners, and detergents.
➢ Disinfectants;
❑ Disinfect after cleaning.
❑ Low-level disinfection is adequate

21. ❑ Common low- and intermediate-level disinfectants;
✓ Sodium hypochlorite 1% in-use dilution; 5% solution to
be diluted 1:5 in clean water.
✓ Bleaching powder 7g/L with 70% available chlorine.
✓ Alcohol (70%) isopropyl, ethyl alcohol, methylated
spirit.
✓ Detergent with enzyme.

22. PREVENTION OF INJURIES FROM
SHARPS
➢ Handle hypodermic needles and other sharps minimally.
➢ Uncapped or unprotected sharps should never be passed
directly.
➢ Do not bend, break or cut hypodermic needles.
➢ Do not recap needles.
➢ Do not remove the needle from the syringe by hand.
➢ Dispose after use in a puncture resistant sharps disposal
container.

23. PREVENTION OF INJURIES FROM
SHARPS
➢ Incinerate when containers become three quarters full.
➢ Decontaminate needles and syringes that cannot be
incinerated using concentrated sodium hypochlorite
(5.25%).
➢ Keep aside of needle cutter and on a height from floor.

24. PREVENTION OF INJURIES FROM
SHARPS
If a health care provider is accidentally exposed to blood or
other body fluids either by a needlestick, an injury from
another sharp object:
➢ Wash the needlestick site or cut with soap and water.
➢ Post exposure prophylaxis.

25. BIOMEDICAL WASTE MANAGEMENT
According to Bio medical waste management
and handling rules 1998 of India,
Biomedical waste means any waste which is
generated during the diagnosis, treatment or
immunization of human being or animals or in
research activities there to or in the production
or of biological.

26. DISPOSAL OF BIOMEDICAL WASTE
Three stages;
I. Collection and segregation
II. Transportation and storage
III. Disposal techniques

28. TRANSMISSION BASED PRECAUTIONS

30. OTHER INFECTION CONTROL MEASURES
OPTIMIZING NUTRITIONAL STATUS
➢ The energy requirement is 25 to 30 kcal/kg body
weight/day.
➢ Protein : 10-15% (4kcal/g)
➢ Carbohydrates : 40-60% (3.4 kcal/g)
➢ Fat : 30-50% (9kcal/g)

31. OPTIMIZING NUTRITIONAL STATUS
The protein requirements is as follows:
• Healthy adults : 0.8 - 1g/kg/day
• Elderly (>65 years) : 1.0 - 1.2g/kg/day
• Elderly with chronic disease : 1.2 - 1.5g/kg/day
• Hypermetabolic state : 1.0 - 2g/kg/day depending on
condition

32. DECOLONIZATION
❖ To reduce or eliminate the bacterial load on
the body.
❖ Two overarching approaches to HAI
prevention
o Horizontal strategies
o Vertical strategies

33. ❖ Various decolonization strategies;
o Nasal topical decolonization strategies
o Topical agents
o Oral agents
o Selective digestive or oropharyngeal
decontamination

34. VENTILATOR ASSOCIATED
PNEUMONIA
➢ VAP is a type of HAP that develops more than 48 hours
after endotracheal intubation.
➢ Intubation increases the risk of pneumonia 6- to 21-fold.
➢ VAP occurs in 9% to 27% of all intubated patients.
➢ Patients with VAP are twice as likely to die compared with
those without VAP.

35. RISK FACTORS
▪ Mechanical ventilation
▪ Postsurgical patients
▪ Presence of multiple organ failure
▪ Age greater than 60 years
▪ Supine patient positioning

36. RISK FACTORS
▪ Decreased gastric pH
▪ Cardiopulmonary resuscitation
▪ Continuous sedation
▪ Reintubation
▪ Presence of nasogastric tube
▪ Enteral feeding
▪ Sinusitis

37. PREVENTION
➢ Use NIPPV
➢ Minimize sedation
➢ Interrupt sedation once a day using spontaneous
awakening trials
➢ exercise and mobilization as early as possible.
➢ Avoid or eliminate pooling of secretions above the ET tube
➢ Elevate the head of the bed by 30–45 degrees

38. ➢ Change the ventilator circuits
➢ Follow CDC’s HICPAC guidelines
➢ Chlorhexidine oral rinse
➢ Limiting the use of sedative and neuromuscular
blockers

39. CAUTI
MODIFIABLE RISK FACTORS
➢ Duration of catheterization
➢ Adherence to aseptic catheter care
➢ Catheter insertion after the sixth day of
hospitalization

40. NONMODIFIABLE RISK FACTORS
➢ Female gender
➢ Severe underlying illness
➢ Nonsurgical disease
➢ Age greater than 50 years
➢ Diabetes mellitus

42. • Follow written policies, protocols, or guidelines
• Require only trained staff be allowed to insert
• Perform hand hygiene before donning sterile
gloves
• Use the smallest-sized urinary catheter
• Secure indwelling urinary catheters
• Maintain a sterile, closed drainage system

43. • Maintain unobstructed urine flow
• Daily assessment and document
• Insert urinary catheters only when necessary
• Use intermittent catheterization whenever
possible
• Perform CAUTI surveillance

44. CLABSI
RISK FACTORS
❑ Patient-related factors
❖ Malnutrition
❖Total parenteral nutrition administration
❖ Previous bloodstream infection
❖ Extremes of age
❖ Loss of skin integrity

45. CLABSI
❖ Immune deficiency, especially neutropenia
❖ Chronic illness
❖ Bone marrow transplantation
❑ Catheter-related factors
❖ Location of catheter insertion
❖ Insertion technique

46. CLABSI
❖ Long duration of catheterization
❖ Conditions of insertion
❖ Catheter-site care
❖ Indication and use
❖ Catheter material type

47. PREVENTION OF CLABSI
• Provide an evidence-based indication
• Educate health care workers
• Bathe patients with chlorhexidine daily
• Establish a process
• Perform hand hygiene prior to manipulating or inserting
• Avoid placing CVC in the femoral vein

48. • Use ultrasound guidance
• Use maximum sterile barrier precautions
• Prepare insertion site
• Provide appropriate nurse-to-patient ratio
• Disinfect injection ports and catheter hubs
• Remove catheters that are no longer essential

49. • Perform site care with a chlorhexidine based
antiseptic every 5–7 days and when soiled or loose
• Apply antimicrobial ointments to hemodialysis
catheter insertion sites
• CLABSI risk assessment

50. MULTIDRUG RESISTANT INFECTIONS

51. DEFINITION
Multidrug resistance (MDR) is defined as
insensitivity or resistance of a
microorganism to the administered
antimicrobial medicines despite earlier
sensitivity to it.

52. CLOSTRIDIUM DIFFICILE COLITIS
It is the most frequent cause of ICU-acquired
infectious diarrhea.
RISK FACTORS
➢ ICU stay
➢ Age greater than 60
➢ Broad-spectrum antibiotic exposure

53. ➢ Longer duration of hospital stay
➢ Severe underlying disease
➢ Gastric acid suppression

54. PREVENTION
1. Measures for health care workers, patients, and
visitors
2. Environmental cleaning and disinfection
3. Antimicrobial use restrictions
4. Use of probiotics

55. MRSA
MRSA is a common human pathogen, refers to S.
aureus that is resistant to methicillin or its
comparable pharmaceutic agents, oxacillin and
nafcillin.
TYPES
❖ Health care associated MRSA
❖ Community-Associated MRSA

56. RISK FACTORS
▪ Surgical wound and/or intravenous (IV) line
▪ Hospitalized for a prolonged period of time
▪ Recent use of antibiotics
▪ Weakened immune system
▪ In close proximity to other patients, family
members, or health care workers

57. INFECTION CONTROL MEASURES
➢ Clean their hands
➢ ICU environment: clean, free of dust and soilage
➢ Use Contact Precautions
➢ healthcare staff should comply with best practice
➢ Test some patients

58. ANTIBIOTIC STEWARDSHIP
➢ Avoid inappropriate and excessive antibiotic
therapy and prophylaxis
➢ Use of glycopeptide antibiotics should be limited
➢ Restrict use of broad-spectrum antibiotics
➢ Institute antibiotic stewardship programs

59. SURVEILLANCE AND SCREENING OF
PATIENTS
✓ Patient who is previously positive and who are
being readmitted to ICU
✓ Admitted from another hospital
✓ During an outbreak
✓ Patients with non-intact skin

60. ✓ Patients due to undergo elective high-risk surgery
✓ Other patients, as determined by local risk
assessment
SURVEILLANCE AND SCREENING OF STAFF
❑ During the investigations of an outbreak where
MRSA persists or where an unusual strain of MRSA is
isolated

61. PATIENT ISOLATION AND COHORTING
o Prevent patient overcrowding
o Patient care equipment should be designated for
use only on a single patient
o Patients’ charts should be kept outside the patients’
room.

62. o Minimum staff only have direct contact with patients
colonised or infected
o Use contact precautions
o Isolate or use contact precautions for all known MRSA
cases
o Isolate patients that are likely to shed MRSA in high
numbers
o Ensure that patients who are found to carry MRSA are
informed

63. ERADICATION OF MRSA CARRIAGE
▪ Decolonisation
▪ Hair should be washed twice weekly with an
antiseptic detergent
▪ Provide new clean clothing, bedding, towels
and flannel after a course of treatment.

64. Antibiotic courses for eradication of throat carriage
• Rifampicin and fusidic acid
Trimethropim combined with either rifampicin or
fusidic acid

65. VANCOMYCIN RESISTANT
ENTEROCOCCUS
Gram-positive bacterium which is part of the normal
flora of the gastrointestinal tract, can produce
significant disease when it infects blood, wounds or
the urinary tract.

66. RISK FACTORS
❖ Prior use of antibiotics
❖ Compromised immune system
❖ Cancer
❖ Chronic disease
❖ Gastrointestinal surgery
❖ Indwelling devices

67. PREVENTION
• Washing hands
• Minimizing the use of intravenous catheters
• Minimize use of urinary catheters
• Removed catheters promptly when no longer
needed
• Antibiotics should be used only for appropriate
indications

68. • Caretakers of infected patients should follow good
hand hygiene principles
• Gloves should be used to clean the bed or the
patient
• Household disinfectants can be used to clean the
environment
• Patient will be placed in "contact precautions.

69. MULTIDRUG RESISTANT INFECTION
CONTROL
✓ Standard precautions
✓ Contact precautions
✓ Decolonization & decontamination

70. NURSING PROCESS IN
INFECTION CONTROL

71. ASSESSMENT
❖ Client’s defense mechanism
❖ Susceptibility and knowledge of
infection

72. NURSING DIAGNOSIS
❖ Disturbed body image
❖ Risk for infection
❖ Risk for injury
❖ Imbalanced nutrition less than body requirements
❖ Risk for impaired skin integrity
❖ Impaired tissue integrity

73. ROLE OF CRITICAL CARE
INCHARGE IN INFECTION
CONTROL

74. LEADER
➢ Leads a shift team of Registered nurses, Registered
midwives and Nursing assistants
➢ Directs, supports families, and patients
➢ She is required to be resilient and acquire effective
communication skills
➢ Influencing others

75. OBSERVER
➢ Managing staff
➢ Overseeing patient care
➢ Ensuring adherence to established policies and
procedures
➢ Assigning staff and monitoring their activities
➢ Interface between her staff, their patients, and the
patients' families

76. Observe;
▪ central catheter insertion site and drainage
▪ Urinary catheter
▪ Ventilator tubing
▪ Hand hygiene facilities
▪ PPE
▪ Sharp instrument disposal

77. ▪ Medication preparation area
▪ Visitor area
▪ Activities of nursing assistants, housekeepers
▪ Biomedical waste management
▪ Documents

78. EDUCATOR
➢ Guiding and educating the fresh employees
regarding the hospital policy in infection control
➢ Give training
➢ Designing, implementing, evaluating and revising
continuing education programs for nurses
➢ Extended to that of nursing assistants,
housekeepers, patients and family members

79. SURVEILLANT
Systematically collecting patient-based, prospective,
priority-directed data that yield risk-adjusted rates of
incidence.

80. TYPES OF SURVEILLANCE
o Active surveillance
o Process and outcome surveillance
o Clinical/patient-based surveillance
o Laboratory-based surveillance
o Priority-directed and comprehensive surveillance

81. IDENTIFYING A POTENTIAL OUTBREAK
➢ To define the magnitude of the outbreak in terms of time, place
and person.
➢ Identify the cause of the outbreak and mode of transmission.
➢ Control the outbreak.
➢ Prevent similar outbreaks in the future.
➢ Evaluate existing infection prevention and control strategies.

82. STEPS INVOLVED IN HAI OUTBREAK
INVESTIGATION
▪ Verification of diagnosis
▪ Confirmation of the outbreak existence
▪ Inform key stakeholders about the investigation
▪ Construct a case definition
▪ Identifying and count the number of cases

83. •Examine descriptive epidemiological features of
cases
•Observations and review of patient care
•Generate hypotheses and test hypotheses
•Collect and test environmental samples
•Implement control and prevention measures
•Follow-up and communicate results

84. RESEARCHER
➢ Study various aspects of health, illness and health
care
➢ Improve health during ICU stay and after discharge
by designing and implementing scientific studies
➢ Utilize the opportunity to incorporates the best
evidence

85. AUDITOR
➢ Encourage the followers to follow infection control measures
➢ Clearly communicates standards of care
➢ Act as role model
➢ Implement appropriate methods to measure those standards of
care
➢ Determine discrepancies between care provided and unit standards
➢ Use quality control findings
➢ Keep abreast of current government and licensing regulations