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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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DEVICE RELATED

NOSOCOMIAL

INFECTION IN ICU


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PART II

CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI)

CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)


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MAHA NAGANURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITALE-mail

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


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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 .


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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.


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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 .


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MICROBIOLOGY

Blood stream infections are caused by:

  • Coagulase-negative staphylococci, particularly Staphylococcus epidermidis.

  • Candida species.

  • Enterococci .

  • Staphylococcus aureus .


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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


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- 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.


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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.


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66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization .


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RISK FACTORS urinary tract mainly urinary catheterization .

Acquiring a urinary tract infection depend

on the following:

  • the method and duration of catheterization.

  • the quality of catheter care.

  • and host susceptibility.


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Host factors which appear to increase urinary tract mainly urinary catheterization .

the risk of acquiring catheter-associated

urinary tract infections include :

advanced age, debilitation, and the

postpartum state


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CRITERIA FOR DIAGNOSIS urinary tract mainly urinary catheterization .

Symptoms that may occur include

- dysuria.

- urinary frequency.

- incontinence of recent onset.

- flank pain.

- and fever.


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Bacteriologic diagnosis : urinary tract mainly urinary catheterization .

- 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.


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MICROBIOLOGY urinary tract mainly urinary catheterization .

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

- Escherichia coli

- Klebsiella

- Proteus

- Enterococcus


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Other causative micro-organisms: urinary tract mainly urinary catheterization .

- Pseudomonas

- Enterobacter

-Serratia

- Candida.


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PREVENTION AND CONTROL MEASURES urinary tract mainly urinary catheterization .

- 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.


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- Obtain urine samples aseptically. urinary tract mainly urinary catheterization .

- 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.


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- Consider alternative techniques of urinary tract mainly urinary catheterization .

urinary drainage before using an

indwelling urethral catheter.

- Spatially separate infected and uninfected

patients with indwelling catheters.

- Avoid routine bacteriologic monitoring.


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SUGGESTED FURTHER READINGS urinary tract mainly urinary catheterization .

GUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONS

The Impact of Hospital-Acquired Bloodstream Infections


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Guideline for Prevention of Catheter-associated infections - urinary tract infection


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