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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU. PART II. CATHETER RELATED BLOOD STREAM INFECTION (CR - BSI) CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI). MAHA NAGA NURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITAL E-mail.

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Presentation Transcript
slide1

DEVICE RELATED

NOSOCOMIAL

INFECTION IN ICU

part ii
PART II

CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI)

CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)

maha naga nursing specialist alexandria university student hospital e mail
MAHA NAGANURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITALE-mail

Dr. MOUSTAFA ARAFAASSOSIATE PROF. OF EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTHALEXANDRIA UNIVERSITYE-mail

cvc related blood stream infection
CVC RELATED BLOOD STREAM INFECTION

Blood stream infection is associated with the use of intravascular catheters.

Catheter related blood stream infection

(CR-BSIs), are associated with increased morbidity, mortality rate of 10% to 20 %, prolonged hospitalization (mean of 7 days ) and increased medical costs .

risk factors
RISK FACTORS

-The site at which the catheter is placed.

  • The type of barrier precautions used during catheter insertion.
  • The skill of the person inserting the catheter.
  • The use of a guide wire to replace an existing catheter.
criteria for diagnosis
CRITERIA FOR DIAGNOSIS
  • Fever.
  • Signs of cutaneous involvement

( erythema , induration , tenderness, or purulent drainage ) at the insertion site of catheter.

  • Positive blood or tip of catheter culture .
microbiology
MICROBIOLOGY

Blood stream infections are caused by:

  • Coagulase-negative staphylococci, particularly Staphylococcus epidermidis.
  • Candida species.
  • Enterococci .
  • Staphylococcus aureus .
slide8

PREVENTION AND CONTROL MEASURES

- Health care worker education and

training

- Surveillance for catheter-related infection

- Hand washing

- Barrier precautions during catheter

insertion and care

- Catheter site care - Selection and replacement of

intravascular devices

slide9

- Replacement of administration sets and intravenous fluids - Clean injection parts with 70% alcohol or povidone-iodine before accessing the system

- Do not use filters routinely for infection control purposes

- Do not administer anti-microbials routinely before insertion or during use of an intravascular device to prevent catheter colonization or bloodstream infection.

catherter related uti
CATHERTER RELATED UTI

The urinary tract accounting for more than 40% of the total number reported by acute-care hospitals

( 40 – 45 % of nosocomial infections ) and affecting an estimated 600,000 patients per year , they contribute only 10 to 15 percent to prolongation of hospital stay and to extra costs.

slide11
66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization .
risk factors12
RISK FACTORS

Acquiring a urinary tract infection depend

on the following:

  • the method and duration of catheterization.
  • the quality of catheter care.
  • and host susceptibility.
slide13

Host factors which appear to increase

the risk of acquiring catheter-associated

urinary tract infections include :

advanced age, debilitation, and the

postpartum state

criteria for diagnosis14
CRITERIA FOR DIAGNOSIS

Symptoms that may occur include

- dysuria.

- urinary frequency.

- incontinence of recent onset.

- flank pain.

- and fever.

slide15

Bacteriologic diagnosis :

- For complicated, recurrent UTIs, asymptomatic bacteriuria is defined as

> 105 CFU/mL in a midstream urine sample after > 4 hours of bladder incubation.

- For women with uncomplicated symptomatic cystitis bacteriuria is defined as > 102 CFU/mL with pyuria.

microbiology16
MICROBIOLOGY

Catheter-associated urinary tract infections are caused by a variety of pathogens, including :

- Escherichia coli

- Klebsiella

- Proteus

- Enterococcus

slide17
Other causative micro-organisms:

- Pseudomonas

- Enterobacter

-Serratia

- Candida.

prevention and control measures
PREVENTION AND CONTROL MEASURES

- Educate personnel in correct techniques of catheter insertion and care.

- Catheterize only when necessary.

- Emphasize hand washing.

- Insert catheter using aseptic technique and sterile equipment.

- Secure catheter properly.

- Maintain closed sterile drainage.

slide19

- Obtain urine samples aseptically.

- Maintain unobstructed urine flow.

- Periodically re-educate personnel in

catheter care.

- Use smallest suitable bore catheter.

- Avoid irrigation unless needed to prevent

or relieve obstruction.

- Do not change catheters at arbitrary fixed

intervals.

slide20

- Consider alternative techniques of

urinary drainage before using an

indwelling urethral catheter.

- Spatially separate infected and uninfected

patients with indwelling catheters.

- Avoid routine bacteriologic monitoring.

suggested further readings
SUGGESTED FURTHER READINGS

GUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONS

The Impact of Hospital-Acquired Bloodstream Infections

guideline for prevention of catheter associated infections urinary tract infection
Guideline for Prevention of Catheter-associated infections - urinary tract infection
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