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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INFECTION IN ICU
CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI)
CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)
Dr. MOUSTAFA ARAFAASSOSIATE PROF. OF EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTHALEXANDRIA UNIVERSITYE-mail
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 .
-The site at which the catheter is placed.
( erythema , induration , tenderness, or purulent drainage ) at the insertion site of catheter.
Blood stream infections are caused by:
PREVENTION AND CONTROL MEASURES
- Health care worker education and
- Surveillance for catheter-related infection
- Hand washing
- Barrier precautions during catheter
insertion and care
- Catheter site care - Selection and replacement of
- 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.
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.
66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization .
Acquiring a urinary tract infection depend
on the following:
Host factors which appear to increase
the risk of acquiring catheter-associated
urinary tract infections include :
advanced age, debilitation, and the
Symptoms that may occur include
- urinary frequency.
- incontinence of recent onset.
- flank pain.
- and fever.
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.
Catheter-associated urinary tract infections are caused by a variety of pathogens, including :
- Escherichia coli
Other causative micro-organisms:
- 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.
- Obtain urine samples aseptically.
- Maintain unobstructed urine flow.
- Periodically re-educate personnel in
- Use smallest suitable bore catheter.
- Avoid irrigation unless needed to prevent
or relieve obstruction.
- Do not change catheters at arbitrary fixed
- 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.
GUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONS
The Impact of Hospital-Acquired Bloodstream Infections