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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU. Part I. BACKGROUND VENTILATOR ASSOCIATED PNEUMONIA. Dr. MOUSTAFA ARAFA ASSOSIATE PROF. OF EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTH ALEXANDRIA UNIVERSITY E-mail. MAHA NAGA NURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITAL

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DEVICE RELATED

NOSOCOMIAL

INFECTION IN ICU


Part i

Part I

BACKGROUND

VENTILATOR ASSOCIATED

PNEUMONIA


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

MAHA NAGA

NURSING SPECIALIST

ALEXANDRIA UNIVERSITY STUDENT HOSPITAL

E-mail


Background
BACKGROUND

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.

Patients hospitalized in ICUs are 5 to 10 times more likelyto acquire nosocomial infections than other hospital patients.


On the other hand the Nosocomial infections that are preventable , perhaps

between 30 and 50 percent , are primarily caused by problems in patient care practices , such as the use and care of urinary catheters , and respiratory therapy equipment , as well as hand washing practices and surgical skill.


Definitions
DEFINITIONS preventable , perhaps

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.


Device related nosocomial infection
DEVICE RELATED NOSOCOMIAL INFECTION preventable , perhaps

  • A device-associated infection is an infection in a patient with a device (i.e., central line, ventilator, or indwelling urinary catheter) that was in use within the 48-hour period before onset of infection. If the interval since discontinuation of the device is longer than 48 hours, there must be compelling evidence that infection was associated with device use.


Risk factors
RISK FACTORS preventable , perhaps

  • operative surgery

  • intravascular and urinary catheterization

  • mechanical ventilation of the respiratory tract

  • Other risk factors include traumatic injuries, burns, age (elderly or neonates), immuno-suppression and existing disease


Ventilator assosiated pneumoina
VENTILATOR ASSOSIATED PNEUMOINA preventable , perhaps

Patients receiving continuous, mechanically assisted ventilation have 6-21 times the risk for acquiring nosocomial pneumonia compared with patients not receiving ventilatory support .


Pneumonia cases account for 15 preventable , perhaps

to 20 % of nosocomial infections but is responsible for 24 % of extra hospital days and 39 % of extra cost .

Nosocomial pneumonia is associated with mortality rate up to 50 % in ICUs .


Risk factors1
RISK FACTORS preventable , perhaps

* Intubation .

*altered levels of consciousness , especially those with nasogastric tubes .

*elderly patients .

*chronic lung disease .

*postoperative patients .

*any of the above patients taken H2- blockers or antacid .


Criteria for diagnosis
CRITERIA FOR DIAGNOSIS preventable , perhaps

  • fever.

  • cough.

  • development of purulent sputum, in conjunction with radiologic evidence of a new or progressive pulmonary infiltrate.

  • a suggestive Gram stain, and positive cultures of sputum, tracheal aspirate, pleural fluid, or blood.


Microbiology
MICROBIOLOGY preventable , perhaps

  • Pneumonias are mostly caused by

    Legionella sp.

    Aspergillus sp.

    influenza virus .


Prevention and control measures
PREVENTION AND CONTROL MEASURES preventable , perhaps

Most of the risk factors can be prevented and controlled with a little effort and performing some policies in the unit as :

- use either prophylactic local application of antimicrobial agent(s) or local bacterial interference .

- use Sucralfate, a cytoprotective agent as a substitute for antacids and H-2 blockers.


- Prevent Aspiration of oro-pharyngeal and Gastric Flora by :

1-Placing the patient in a semi-recumbent position.

2-Administering enteral nutrition intermittently in small boluses rather than continuously.

3- Using flexible, small-bore enteral tubes .

4-Placing the enteral tube below the stomach (e.g., in the jejunum).


- : Perform hand washing before any procedure , wear gloves .

-Proper cleaning and sterilization or disinfection of reusable equipment .

-The recommended daily change in ventilator circuits may be extended to greater than or equal to 48 hours.


- : Prophylaxis with Systemic anti-microbial agents.

- Use of "Kinetic Beds" or Continuous Lateral Rotational Therapy (CLRT) for Immobilized Patients.


Suggested further readings
SUGGESTED FURTHER READINGS :

  • Surveillance of nosocomial infections

  • Risk Factors and Outcome of Nosocomial Infections: Results of a Matched Case-control Study of ICU Patients



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