Nosocomial Basic

8/12/2019 Nosocomial Basic

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A NOSOCOMIAL INFECTION

is: Also known as healthcare acquired inection

Traditionall! reerred as hos"ital acquired

inections

Inections that de#elo" durin$ hos"itali%ation

One o the leadin$ causes o death and

increased &or'idit! or hos"itali%ed "atients

O which are &ostl! caused '! dru$ resistantstrains o 'acteria


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INFECTION (ELATE) TO I*

T+E(A,- )E*ICES

Local Inection

In#asion and &ulti"lication o &icroor$anis&s in

'od! tissues which &a! 'e clinicall! una""arent

or result in local cellular in.ur! due to co&"etiti#e&eta'olis& to/ins0 intracellular re"lication or

anti$en anti'od! res"onse


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S!ste&ic Inection

A s!ste&ic disease caused '! "atho$enic

or$anis&s or their to/ins in the 'loodstrea&


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Local catheter-related infection:

Exit site Infection: purulent drainage from the

catheter e$it site" or erythema" tenderness" ands%elling %ithin &cm of the catheter e$it site#

Port-pocket infection: erythema and necrosis of

the s'in over reservoir of totally implantabledevice" or purulent e$udates in the subcutaneous

poc'et containing the reservoir#

Tunnel infection: erythema" tenderness" andindurations of the tissues overlying the catheter

and more than &cm from the e$it site#


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)einitions

Systemic Catheter infection: isolation of the samemicroorganisms from catheter culture and from theblood of a patient %ith accompanying clinicalsymptoms of a * and no other apparent source ofinfection#

Catheter-related bloodstream infectionis the isolationof the same microbe from blood cultures that is'no%n to be significantly coloni+ing the catheter of a

patient

Primary SIis one that arises %ithout apparent localinfection else%here due to the same microbe#


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Co&&on catheters used or #enous and arterial access

CAT+ETE( T-,E ENT(- SITE LEN1T+ COMMENTS

,eri"heral #enouscatheters 2short3

,eri"heral arterialcatheters

Midline catheters

4suall! inserted in #einso orear& or hand

4suall! inserted in radialarter!5 can 'e "laced ine&oral0 a/illar!0 'rachial0"osterior ti'ial arteries

Inserted #ia theantecu'ital ossa into the"ro/i&al 'asilic or

ce"halic #eins5 does notenter central #eins0"eri"heral catheters

67 inches

67 inches

7 8 inches

,hle'itis with "rolon$eduse5 rarel! associated with9SI

Low inection risk5 rarel!associated with 9SI

(e"orted withana"h!lactoid reactions onelasto&&eric h!dro$elcatheter5 lower rates o"hle'itis than short"eri"heral catheters


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Nontunneled C*C ,ercutaneousl!inserted into central#eins 2 su'cla#ian0internal .u$ular0 ore&oral3

8 c& de"endin$ onthe "atient si%e

Account or &a.orit!C(9SI

,ul&onar! arter!catheter

,eri"herall! insertedcentral #enouscatheter 2,ICC3

Inserted throu$h aTelon;introducer in acentral#ein2 su'cla#ian0internal .u$ular0 ore&oral3

Inserted in 'asilic0ce"halic0 or 'rachial#eins and enter thesu"erior #ena ca#a

7< c& de"endin$ onthe "atient si%e

=< c& de"endin$ on"atient si%e

4suall! he"arin'onded5 si&ilar rateso 9SI as C*Cs5su'cla#ian site"reerred to reduceinection risk

Lower rate o inectionthan nontunnelledC*Cs


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Tunneled central #enouscatheter

I&"lanted intosu'cla#ian0 internal.u$ular0 or e&oral #eins


Cu inhi'its &i$ration oor$anis&s into thecatheter tract5 lower rateo inection than that othe nontunneled C*C

Totall! i&"lanta'le

4&'ilical catheters

Tunnelled 'eneath theskin and ha#esu'cutaneous "ortaccessed with needle5i&"lanted in su'cla#ian0internal .u$ular #ein

Inserted into u&'ilical#ein or u&'ilical arter!


>? c& de"endin$ onthe "atient si%e

Lowest rate o C(9SI5i&"ro#ed "atient seli&a$e5 no need or localcatheter site care5sur$er! required orcatheter re&o#al

(isk or C(9SI si&ilarwith catheters "laced inu&'ilical #ein #s arter!


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Other Nosoco&ial Inection

4rinar! tract inection

Sur$ical site inection

*entilator@associated "neu&onia

Intra#ascular de#ice@related 'loodstrea& inection

Clostridium difficile-associated diarrhea


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C+AIN OF INFECTION

CONT(OLInectious A$ent

(eser#oir

,ortal o E/it

Susce"ti'le host

,ortal o Entr!

Mode o Trans&ission


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MO)E OF T(ANSMISSION It is the &ethod o transer '! which

or$anis& &o#es or is carried ro& one

"lace to another

E$ +ands o the health care worker &a!

carr! 'acteria ro& one "erson to another


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+ow does catheter@related inection

occurB

Inection o short@ter& catheters is

requentl! 'een due to &icro'es ro& the

skin &o#in$ alon$ the catheter suracewhere the catheter enters the skin


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)ate and Ti&e I*

was InsertedA()ED


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(isk Factors

T!"e o catheter used The nu&'er o lu&en o the catheter has

Total "arenteral nutrition

)uration o catheteri%ation

Catheter site insertion

E/"ertise o the "erson insertin$

Mana$e&ent o catheter ater insertion

1uidewire e/chan$e 4se o dressin$

4se o tri"le anti'iotic oint&ent


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Co&&on "atho$ens o 9SI

Candida albicans

Staphylococcus aureus

Enterobacter cloaceae Staphylococcus epidermidis

Pseudomonas aeruginosa

Enterococcus fecalis


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,(INCI,LES OF ,(E*ENTION

OF INFECTION Consider e#er! "erson 2"atient o sta3 inectious

ash hands the &ost "ractical "rocedure or"re#entin$ cross conta&ination 2"erson to "erson3

ear $lo#es 'eore touchin$ an!thin$ wet 'roken skin0&ucous &e&'ranes0 'lood or other 'od! luids2secretions or e/cretions3 or soiled instru&ents and otherite&s

4se "h!sical 'arriers 2"rotecti#e $o$$les0 ace &asksand a"rons3 i s"lashes and s"ills o an! 'od! luids2secretions or e/cretions3 are antici"ated


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4se sae work "ractices0 such as not reca""in$

or 'endin$ needles0 sael! "assin$ shar"

instru&ents and "ro"erl! dis"osin$ o &edicalwaste

Isolate "atients onl! i secretions 2air'orne3 or

e/cretions 2urine and eces3 cannot 'e contained

)econta&inate "rocess instru&ents and other

ite&s 2deconta&inate0 clean0 hi$h le#eldisinect or sterili%e usin$ Inection ,re#ention

,ractices


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,re#ention

Selection o a su'cla#ian0 'asilic0 or ce"halic #einsite rather than an internal .u$ular or e&oral site

A#oid use o T,N catheters or other inusion"ur"oses

4se o s"ecial tea& or insertion and &aintenanceo catheter

A#oid the use o tri"le anti'iotic oint&ent on central#enous catheter


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(E*IE INFECTION (IS

FACTO(S AN) ,(ACTICES Inection is the "resence and $rowth o a

&icroor$anis&s that "roduces tissue death

ash !our hands (outinel! clean and disinect suraces

+andle and "re"are ood sael!

1et i&&uni%ed

4s anti'iotics a""ro"riatel! ee" "ets health!

A#oid contact with wild ani&als


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,(INCI,LES OF SAFE I* CA(E

,(ACTICES

4se ase"tic technique to a#oid conta&ination o sterilein.ection equi"&ent

)o not ad&inister &edications ro& a s!rin$e to &ulti"le"atients0 e#en i the needle o cannula on the s!rin$e is

chan$ed 4se luid inusion and ad&inistration sets or one "atient

onl! and dis"ose ater use

4se sin$le dose #ials or "arenteral &edicationswhene#er "ossi'le

4se "ro"er "ersonal "rotecti#e equi"&ent 2,,E3

Adhere to saet! waste "rotocol accordin$ to institutionGs"olic!


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*ENI,4NCT4(E TEC+NIH4ES


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*ENI,4NCT4(E TEC+NIH4ES

4SIN1 *A(IO4S CAT+ETE(S

AN) )E*ICES

The 4se o Inusion ,u&"s


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The use o needleless s!ste&


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,ro"er use o shar" containers


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Monitorin$ and Assess&ent


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The use o a""ro"riate dressin$


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+ealth Care orker Education and Trainin$

Sur#eillance or Catheter (elated Inection

+andwashin$

9arriers ,recautions )urin$ Catheter Insertion

and Care

Catheter Insertion

Catheter Site Care Selection and (e"lace&ent o Intra#ascular

)e#ices


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,eneral ecommendations For

*ntravascular .evice Use

+ealth Care orker Education and Trainin$ Sur#eillance or Catheter (elated Inection

+andwashin$

9arriers ,recautions )urin$ Catheter Insertion

and Care

Catheter Insertion

Catheter Site Care

Selection and (e"lace&ent o Intra#ascular

)e#ices


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(e"lace&ent o Ad&inistration Sets and

Intra#enous Fluids

Intra#enous In.ection ,orts

,re"aration and Hualit! Control o Inta#enousAd&i/tures

In line Filters

Intra#enous Thera"! ,ersonnel Needleless Intra#ascular )e#ices

,ro"h!lactic anti&icro'ials


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/reventing Catheter-elated

loodstream *nfections

(eerences:

Centers or )isease Control and ,re#ention

2C)C30 4SA

+ealthcare Inection Control ,ractices Ad#isor!Co&&ittee 2+IC,AC30 4SA

+os"ital E"ide&iolo$! and Inection Control0

Ma!hall 7rd

ed

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Nosocomial Basic