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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INFECTION IN ICU
ALEXANDRIA UNIVERSITY STUDENT HOSPITAL
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.
NOSOCOMIAL INFECTION :
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 .
* 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 .
influenza virus .
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.
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.