5. Nosocomial Basic

8/4/2019 5. Nosocomial Basic

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A NOSOCOMIAL INFECTION is:

Also known as healthcare acquired infection

Traditionally referred as hospital acquired

infections

Infections that develop during hospitalization

One of the leading causes of death and increased

morbidity for hospitalized patients

Of which are mostly caused by drug resistantstrains of bacteria


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INFECTION RELATED TO IV THERAPY

DEVICES

Local Infection

Invasion and multiplication of microorganisms in

body tissues which may be clinically unapparent or

result in local cellular injury due to competitivemetabolism toxins, intracellular replication or antigen

antibody response


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Systemic Infection

A systemic disease caused by pathogenic

organisms or their toxins in the bloodstream


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Definitions Catheter Colonization: The isolation of 15 colony

forming units (CFUs) of any microorganism bysemiquantitative culture (roll-plate method) or 103

CFUs by quantitative culture (sonication technique),from a catheter tip or subcutaneous segment in the

absence of simultaneous clinical symptoms.


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Local catheter-related infection:

Exit site Infection: purulent drainage from the catheter

exit site, or erythema, tenderness, and swelling within2cm of the catheter exit site.

Port-pocket infection: erythema and necrosis of the skin

over reservoir of totally implantable device, or purulentexudates in the subcutaneous pocket containing the

reservoir.

Tunnel infection: erythema, tenderness, and indurationsof the tissues overlying the catheter and more than 2cm

from the exit site.


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Definitions

Systemic Catheter infection: isolation of the samemicroorganisms from catheter culture and from the blood of apatient with accompanying clinical symptoms of a BSI and noother apparent source of infection.

Catheter-related bloodstream infection is the isolation of thesame microbe from blood cultures that is known to besignificantly colonizing the catheter of a patient

Primary BSIis one that arises without apparent local infectionelsewhere due to the same microbe.


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Common catheters used for venous and arterial access

CATHETER TYPE ENTRY SITE LENGTH COMMENTS

Peripheral venouscatheters (short)

Peripheral arterialcatheters

Midline catheters

Usually inserted in veinsof forearm or hand

Usually inserted in radial

artery; can be placed infemoral, axillary, brachial,posterior tibial arteries

Inserted via theantecubital fossa into the

proximal basilic orcephalic veins; does notenter central veins,peripheral catheters


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Nontunneled CVC Percutaneouslyinserted into centralveins ( subclavian,internal jugular, orfemoral)

8 cm depending on

the patient sizeAccount for majorityCRBSI

Pulmonary arterycatheter

Peripherally insertedcentral venouscatheter (PICC)

Inserted through aTeflon introducer in acentral vein(subclavian, internaljugular, or femoral)

Inserted in basilic,cephalic, or brachialveins and enter thesuperior vena cava

30 cm depending on

the patient size

20 cm depending on

patient size

Usually heparinbonded; similar ratesof BSI as CVCs;subclavian sitepreferred to reduceinfection risk

Lower rate of infectionthan nontunnelledCVCs


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Tunneled central venouscatheter

Implanted intosubclavian, internal

jugular, or femoral veins

8 cm depending on

the patient size

Cuff inhibits migration oforganisms into thecatheter tract; lower rateof infection than that ofthe nontunneled CVC

Totally implantable

Umbilical catheters

Tunnelled beneath theskin and havesubcutaneous portaccessed with needle;implanted in subclavian,internal jugular vein

Inserted into umbilicalvein or umbilical artery

8 cm depending on

the patient size

6 cm depending on

the patient size

Lowest rate of CRBSI;improved patient selfimage; no need for localcatheter site care;surgery required forcatheter removal

Risk for CRBSI similarwith catheters placed inumbilical vein vs artery


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Other Nosocomial Infection

Urinary tract infection

Surgical site infection

Ventilator-associated pneumonia

Intravascular device-related bloodstream infection

Clostridium difficile- associated diarrhea


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CHAIN OF INFECTION CONTROL

Infectious Agent

Reservoir

Portal of Exit

Susceptible host

Portal of Entry

Mode of Transmission


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MODE OF TRANSMISSION

It is the method of transfer by which organism

moves or is carried from one place to another

E.g. Hands of the health care worker may

carry bacteria from one person to another.


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How does catheter-related infection

occur?

Infection of short-term catheters is frequently

been due to microbes from the skin moving

along the catheter surface where the catheterenters the skin.


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Date and Time IV

was InsertedKARDEX


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Risk Factors

Type of catheter used The number of lumen of the catheter has

Total parenteral nutrition

Duration of catheterization

Catheter site insertion Expertise of the person inserting

Management of catheter after insertion

Guidewire exchange Use of dressing

Use of triple antibiotic ointment


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Common pathogens of BSI

Candida albicans

Staphylococcus aureus

Enterobacter cloaceae Staphylococcus epidermidis

Pseudomonas aeruginosa

Enterococcus fecalis


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Breaking the Chain of Infection Levels of

Aseptic ControlHow Health Care Workers Break the Chain of Infection

Link Intervention

Infectious or CausativeAgent

Accurate and rapid identification of microorganisms

Early recognition of sign and symptoms of infection

Reservoirs Employee health examinations and screenings

Environmental sanitations

Disinfection / Sterilization of instruments

Standard Precautions, Medical Asepsis, Proper Hygiene

Clean gowns, linens, towels, Clean wound dressing

Portal of Exit Handwashing, use of PPE, proper waste disposal, standardprecautions

Method or Mode ofTransmission

Handwashing, Standard Precautions, Safe food handling,isolations, use of PPE, transmission based precautions

Portal of Entry Aseptic technique, medical or surgical asepsis, wound /catheter care, proper disposal, maintain skin integrity, standardprecautions

Susceptible Host Treatment of Disease, Recognition of clients at risk,immunization, exercise, proper nutrition


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PRINCIPLES OF PREVENTION OF

INFECTION

Consider every person (patient of staff) infectious

Wash hands the most practical procedure for preventingcross contamination (person to person)

Wear gloves before touching anything wet broken skin,mucous membranes, blood or other body fluids (secretions orexcretions) or soiled instruments and other items

Use physical barriers (protective goggles, face masks andaprons) if splashes and spills of any body fluids (secretions orexcretions) are anticipated


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Use safe work practices, such as not recapping or

bending needles, safely passing sharp instruments

and properly disposing of medical waste

Isolate patients only if secretions (airborne) or

excretions (urine and feces) cannot be contained

Decontaminate process instruments and other items

(decontaminate, clean, high level disinfect or

sterilize using Infection Prevention Practices


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Prevention

Selection of a subclavian, basilic, or cephalic vein siterather than an internal jugular or femoral site

Avoid use of TPN catheters for other infusion purposes

Use of special team for insertion and maintenance ofcatheter

Avoid the use of triple antibiotic ointment on centralvenous catheter


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REVIEW INFECTION RISK FACTORS AND

PRACTICES Infection is the presence and growth of a

microorganisms that produces tissue death

Wash your hands Routinely clean and disinfect surfaces

Handle and prepare food safely

Get immunized

Us antibiotics appropriately Keep pets healthy

Avoid contact with wild animals


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PRINCIPLES OF SAFE IV CARE / PRACTICES

Use aseptic technique to avoid contamination of sterileinjection equipment

Do not administer medications from a syringe to multiplepatients, even if the needle of cannula on the syringe is

changed Use fluid infusion and administration sets for one patient only

and dispose after use

Use single dose vials for parenteral medications wheneverpossible.

Use proper personal protective equipment (PPE).

Adhere to safety waste protocol according to institutionspolicy.


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VENIPUNCTURE TECHNIQUES USING

VARIOUS CATHETERS AND DEVICES

The Use of Infusion Pumps


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The use of needleless system


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Proper use of sharp containers


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Monitoring and Assessment


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The use of appropriate dressing


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Health Care Worker Education and Training

Surveillance for Catheter Related Infection

Handwashing

Barriers Precautions During Catheter Insertion andCare

Catheter Insertion

Catheter Site Care Selection and Replacement of Intravascular Devices


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General Recommendations For

Intravascular Device Use Health Care Worker Education and Training

Surveillance for Catheter Related Infection

Handwashing

Barriers Precautions During Catheter Insertion and

Care

Catheter Insertion

Catheter Site Care

Selection and Replacement of Intravascular Devices


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Replacement of Administration Sets and Intravenous

Fluids

Intravenous Injection Ports

Preparation and Quality Control of IntavenousAdmixtures

In line Filters

Intravenous Therapy Personnel Needleless Intravascular Devices

Prophylactic antimicrobials


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Preventing Catheter-Related Bloodstream

Infections

References:

Centers for Disease Control and Prevention (CDC), USA

Healthcare Infection Control Practices Advisory

Committee (HICPAC), USA

Hospital Epidemiology and Infection Control, Mayhall

3rd ed.

Documents

5. Nosocomial Basic