icu nosocomail infection and infection control

TAIBA UNIVERSITYNURSING FACULTY

ICU NOSOCOMIAL INFECTION AND INFECTION CONTROL

Presented by :

Abdul Aziz Abdul Rahman Ali Alfuraidan

Content:

Learning Objectives

Abbreviations

Back ground of hospital acquired infection.

Definition of nosocomial infection.

Epidemiology.

Causative agents of nosocomial infections.

Modes of transmission .

Risk of Infections in ICU.

Why May Be in ICU and Why Do They Come to ICU?

ICU Patients Differ From Many Patients.

ICU Care is more Invasive.

Factors that increase nosocomial infection in ICU

Common nosocomial infection

Common nosocomial infection sites

Risk Factors for Nosocomial UTIs

Prevention of Nosocomial UTIs

Risk Factors for Nosocomial BSIs

Prevention of Nosocomial BSIs

Risk Factors for Nosocomial BSIs

Risk Factors for VAP.

Prevention of VAP.

Critical Care Nursing's Roles in Nosocomial Infection.

References

LEARNING OBECTIVES :

Know the epidemiology of nosocomial infections

Understand the various modes of transmission

of nosocomial infections

Know the various strategies for prevention and

control of nosocomial infections

Abbreviations:

(NSIs) : nosocomial infections

(MODS) :Multiple Organ Dysfunction Syndrome

(SIRS) : Systemic Inflammatory Response Syndrome

(COPD) : chronic obstructive pulmonary disorder .

(UTI): urinary tract infection .

(BSI): blood stream infection .

(VAP): ventilated associated pneumonia.

BACKGROUND OF HOSPITAL AQUIRED INFECCTION

• Nosocomial infections have been

recognized for over a century as a

critical problem affecting the quality of

health care and a principal source of

adverse healthcare outcomes.

• Nosocomial infection comes from Greek

words “nosus” meaning disease and

“komeion” meaning to take care of.

• It is also called : HOSPITAL AQUIRED

INFECTION

DEFINITION OF NOSOCOMIAL INFECTION:

An infection acquired in a patient in a

hospital or other healthcare facility in

whom it was not present or incubating at

the time of admission or the residual of an

infection acquired during a previous

admission.

EPIDEMOLOGY

•Nosocomial infections can be exogenous (external

organism) and endogenous (opportunist normal flora).

•Host susceptibility Is an important factor in the

development of nosocomial infection.

•Medical equipments and procedures (surgery) are

often responsible for infections.

CAUSATIVE AGENTS OF NOSOCOMIAL INFECTION

Different pathogens may cause nosocomial

Infections:

MODES OF TRANSMISSION:

1- CONTACT TRANSMISSION:

Most important and frequent mode of transmission of

nosocomial infections, is divided into two subgroups :

•Direct-contact transmission

•Indirect-contact transmission.

•Direct-contact transmission:

Involves a direct body surface-to-body surface

contact and physical transfer of microorganisms

between a susceptible host and an infected or

colonized person, such as occurs when a person

turns a patient, gives a patient a bath.

•Indirect-contact transmission:

Involves contact of a susceptible host with a

contaminated intermediate object, usually

inanimate, such as contaminated instruments,

needles , or dressings, or contaminated gloves

that are not changed between patients

2-DROPLET TRANSMISSION:

Droplet generated by sneezing coughing or

respiratory tract procedures like

bronchoscopy or suction.

3-VECTOR TRANSMISSION:

Transmitted through insects and other

invertebrates animals such as mosquitoes

and fleas.

4-AIR BORNE TRANSMISSION:

Tiny droplet nuclei that remain (<5) suspended in air.

5-COMMON VEHICLE TRANSMISSION:

Transmitted indirectly by materials contaminated with

the infections.

Risk of Infections in ICU

Patients hospitalized in ICUs are 5 to 10 times more likely to

acquire nosocomial infections than other hospital patients . The

frequency of infections at different anatomic sites and the risk of

infection vary by the type of ICU, and the frequency of specific

pathogens varies by infection site. Contributing to the seriousness

of nosocomial infections, especially in ICUs, is the increasing

incidence of infections caused by antibiotic-resistant pathogens.

Why May Be in ICU and Why Do They Come to ICU?

They are admitted for :

• Shock (Hypovolemic ,Cardiogenic , Septic Shock and

(SIRS) ).

• Respiratory Failure (Acute (Moderate to severe respiratory

failure, resulting from conditions like pneumonia or

(COPD) and Chronic). They need mechanical support

and mechanical ventilation.

• Renal Failure.

• Neurological Conditions :

A variety of neurological or brain disorders

are seen in ICU. These may include strokes,

infections, lack of oxygen to the brain tissue

(cerebral anoxia) resulting in tissue death,

traumatic injuries or other changes that

occur when a patient is critically ill.

• Bleeding and Clotting :

Bleeding and clotting in critically ill patients

are quite common.

• MODS .

ICU Patients Differ From Many Patients :

We have to pay more attention to those

patient because they are :

• The sickest patients (multiple

diagnoses, multi-organ failure,

immunocompromised, septic and

trauma).

• Move less

• Malnourished

• More obtunded (Glasgow coma

scale)

• Having Diabetics and Heart failure.

ICU Care is more Invasive

• More invasive life lines and procedures

including surgeries .

• Longer length of stay .

• More IV and parenteral drugs.

• More tube feeding and parenteral

nutrition .

• More ventilation.

FACTORS THAT INCREASES CROSS INFECTION IN ICU

• Lack of Hand washing facilities .

• Patient close together or sharing rooms.

• Understaffing.

• Preparation of IVs on the unit.

• Lack of isolation facilities.

• No separation of clean and dirty AREAS.

• Excessive antibiotic use.

• Inadequate decontamination of items & equipment's.

• Inadequate cleaning of environment.

COMMON NOSOCOMAIL INFECTIONS

The following are the most common nosocomial

infections:

•Urinary tract infection

•Catheter associated infection

Pneumonia (ventilator-associated)

•Blood stream infections.

•Surgical sites infection

COMMON SITES OF NSIs INFECTION

Risk Factors for Nosocomial UTIs

•Female gender

•Other active site of infection

•Diabetes mellitus

•Renal insufficiency

•Duration of catheterization

•Insertion of catheter late in hospitalization

•Presence of ureteral stent

•Using catheter to measure urine output

•Disconnection of catheter from drainage

tube

•Retrograde flow of urine from drainage bag

Prevention of Nosocomial UTIs

•Avoid catheter when possible & discontinue ASAP

•Aseptic insertion by trained HCWs

•Maintain closed system of drainage

•Ensure dependent drainage

•Minimize manipulation of the system

•Silver coated catheters

Risk Factors for Nosocomial BSIs

•Heavy skin colonization at the insertion site

•Internal jugular or femoral vein sites

•Duration of placement

•Contamination of the catheter hub

Prevention of Nosocomial BSIs

•Limit duration of use of intravascular catheters

o No advantage to changing catheters routinely

•Maximal barrier precautions for insertion

o Sterile gloves, gown, mask, cap, full-size drape

o Moderately strong supporting evidence

•Chlorhexidine preparation for catheter insertion

o Significantly decreases catheter colonization; less clear

evidence for BSI.

o Disadvantages: possibility of skin sensitivity to

chlorhexidine, potential for chlorhexidine resistance.

Risk Factors for VAP :

•Duration of mechanical ventilation

•Chronic lung disease

•Severity of illness

•Age

•Head trauma•Elevated gastric pH

•Aspiration of gastric contents

•Reintubation

•Upper abdominal or thoracic surgery

•Supine head position

•NG tube

Prevention of VAP

•Semirecumbent position of ventilated patients (head of bed at 45°)

Prevention and control of nosocomial infections generally can be

done by the following ways:

COMMON SITES OF INFECTION

Designed to prevent transmission of microorganisms by common

routes in hospitals. Because agent and host factors are more

difficult to control, interruption of transfer of microorganisms is

directed primarily at transmission.

Critical Care Nursing's Roles in NSIs

Sterilization:

Sterilization of all reusable equipments such

as ventilator, humidifier and any device that

come in contact with the respiratory tract.

Wear Gloves:

They are worn for two reasons:

• Provide a protective barrier and prevent

contamination of hands.

• Reduce the liklihood that microorganism

present on the hands will be transmitted

to the patients during invasive and other

patient care procedure.

•Wear Aprons Wearing an apron during

patient care reduces the risk of infections.

•Apron is must for preventing yourself

from getting disease.

•Reduce the individual susceptibility to

infection by :

• Encourage and maintain caloric intake

and protein in the diet.

• Monitor the use or overuse of

antimicrobial therapy.

• Give antimicrobial therapy was

prescribed in 15 minutes of scheduled

time

• Minimize the length of hospital stay.

• Instruct individuals and families to know

the causes, risks of infection and

transmission power

• Report of infectious diseases.

Get educated:

Learn about your conditions and treatment

is the best way to prevent an error.

Get involved:

Be assertive about your rights To be a part

of the decision process for your medical

care

References:

Wenzel RP. The Lowbury Lecture. The economics of nosocomial infections. J

Hosp Infect. 1995 Oct;31(2):79–87.

Singh-Naz N, Sprague BM, Patel KM, Pollack MM. Risk factors for nosocomial

infection in critically ill children: a prospective cohort study. Crit Care

Med. 1996 May;24(5):875–878.

Gould D. Nurses' hand decontamination practice: results of a local study. J

Hosp Infect. 1994 Sep;28(1):15–30.

Genné D, de Torrenté A, Humair L, Siegrist HH. Taux de contamination des

stéthoscopes en milieu hospitalier. Schweiz Med Wochenschr. 1996 Dec

28;126(51-52):2237–2240.

http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

http://scholarsresearchlibrary.com/ABR-vol2-iss5/ABR-2011-2-5-172-178.pdf

https://depts.washington.edu/uwmedres/patientcare/objectives/hospitalist/Prevention_of_Hospit

al_Acquired.pdf

http://www.healthline.com/health/hospital-acquired-nosocomial-infections#Treatments7

http://www.slideshare.net/AartiSareen/hospital-acquired-infections-15659553

http://www.slideshare.net/KalpeshZunjarrao/nosocomial-infection-control?related=1

http://www.slideshare.net/amarjit38/nosocomial-infection-7577087?related=1

https://www.fraserhealth.ca/media/Factsheet%20-%20ICU%20Care.pdf

http://nursesnanda.blogspot.com/2012/04/nursing-intervention-for-infection.html

http://www.slideshare.net/MMASSY/nosocomial-infections-8494516

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