Nosocomial Basic
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Transcript of Nosocomial Basic
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A NOSOCOMIAL INFECTION
is: Also known as healthcare acquired inection
Traditionall! reerred as hos"ital acquired
inections
Inections that de#elo" durin$ hos"itali%ation
One o the leadin$ causes o death and
increased &or'idit! or hos"itali%ed "atients
O which are &ostl! caused '! dru$ resistantstrains o 'acteria
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INFECTION (ELATE) TO I*
T+E(A,- )E*ICES
Local Inection
In#asion and &ulti"lication o &icroor$anis&s in
'od! tissues which &a! 'e clinicall! una""arent
or result in local cellular in.ur! due to co&"etiti#e&eta'olis& to/ins0 intracellular re"lication or
anti$en anti'od! res"onse
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S!ste&ic Inection
A s!ste&ic disease caused '! "atho$enic
or$anis&s or their to/ins in the 'loodstrea&
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Local catheter-related infection:
Exit site Infection: purulent drainage from the
catheter e$it site" or erythema" tenderness" ands%elling %ithin &cm of the catheter e$it site#
Port-pocket infection: erythema and necrosis of
the s'in over reservoir of totally implantabledevice" or purulent e$udates in the subcutaneous
poc'et containing the reservoir#
Tunnel infection: erythema" tenderness" andindurations of the tissues overlying the catheter
and more than &cm from the e$it site#
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)einitions
Systemic Catheter infection: isolation of the samemicroorganisms from catheter culture and from theblood of a patient %ith accompanying clinicalsymptoms of a * and no other apparent source ofinfection#
Catheter-related bloodstream infectionis the isolationof the same microbe from blood cultures that is'no%n to be significantly coloni+ing the catheter of a
patient
Primary SIis one that arises %ithout apparent localinfection else%here due to the same microbe#
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Co&&on catheters used or #enous and arterial access
CAT+ETE( T-,E ENT(- SITE LEN1T+ COMMENTS
,eri"heral #enouscatheters 2short3
,eri"heral arterialcatheters
Midline catheters
4suall! inserted in #einso orear& or hand
4suall! inserted in radialarter!5 can 'e "laced ine&oral0 a/illar!0 'rachial0"osterior ti'ial arteries
Inserted #ia theantecu'ital ossa into the"ro/i&al 'asilic or
ce"halic #eins5 does notenter central #eins0"eri"heral catheters
67 inches
67 inches
7 8 inches
,hle'itis with "rolon$eduse5 rarel! associated with9SI
Low inection risk5 rarel!associated with 9SI
(e"orted withana"h!lactoid reactions onelasto&&eric h!dro$elcatheter5 lower rates o"hle'itis than short"eri"heral catheters
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Co&&on catheters used or #enous and arterial access
CAT+ETE( T-,E ENT(- SITE LEN1T+ COMMENTS
Nontunneled C*C ,ercutaneousl!inserted into central#eins 2 su'cla#ian0internal .u$ular0 ore&oral3
8 c& de"endin$ onthe "atient si%e
Account or &a.orit!C(9SI
,ul&onar! arter!catheter
,eri"herall! insertedcentral #enouscatheter 2,ICC3
Inserted throu$h aTelon;introducer in acentral#ein2 su'cla#ian0internal .u$ular0 ore&oral3
Inserted in 'asilic0ce"halic0 or 'rachial#eins and enter thesu"erior #ena ca#a
7< c& de"endin$ onthe "atient si%e
=< c& de"endin$ on"atient si%e
4suall! he"arin'onded5 si&ilar rateso 9SI as C*Cs5su'cla#ian site"reerred to reduceinection risk
Lower rate o inectionthan nontunnelledC*Cs
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Co&&on catheters used or #enous and arterial access
CAT+ETE( T-,E ENT(- SITE LEN1T+ COMMENTS
Tunneled central #enouscatheter
I&"lanted intosu'cla#ian0 internal.u$ular0 or e&oral #eins
8 c& de"endin$ onthe "atient si%e
Cu inhi'its &i$ration oor$anis&s into thecatheter tract5 lower rateo inection than that othe nontunneled C*C
Totall! i&"lanta'le
4&'ilical catheters
Tunnelled 'eneath theskin and ha#esu'cutaneous "ortaccessed with needle5i&"lanted in su'cla#ian0internal .u$ular #ein
Inserted into u&'ilical#ein or u&'ilical arter!
8 c& de"endin$ onthe "atient si%e
>? c& de"endin$ onthe "atient si%e
Lowest rate o C(9SI5i&"ro#ed "atient seli&a$e5 no need or localcatheter site care5sur$er! required orcatheter re&o#al
(isk or C(9SI si&ilarwith catheters "laced inu&'ilical #ein #s arter!
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Other Nosoco&ial Inection
4rinar! tract inection
Sur$ical site inection
*entilator@associated "neu&onia
Intra#ascular de#ice@related 'loodstrea& inection
Clostridium difficile-associated diarrhea
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C+AIN OF INFECTION
CONT(OLInectious A$ent
(eser#oir
,ortal o E/it
Susce"ti'le host
,ortal o Entr!
Mode o Trans&ission
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MO)E OF T(ANSMISSION It is the ðod o transer '! which
or$anis& &o#es or is carried ro& one
"lace to another
E$ +ands o the health care worker &a!
carr! 'acteria ro& one "erson to another
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+ow does catheter@related inection
occurB
Inection o short@ter& catheters is
requentl! 'een due to &icro'es ro& the
skin &o#in$ alon$ the catheter suracewhere the catheter enters the skin
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)ate and Ti&e I*
was InsertedA()ED
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(isk Factors
T!"e o catheter used The nu&'er o lu&en o the catheter has
Total "arenteral nutrition
)uration o catheteri%ation
Catheter site insertion
E/"ertise o the "erson insertin$
Mana$e&ent o catheter ater insertion
1uidewire e/chan$e 4se o dressin$
4se o tri"le anti'iotic oint&ent
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Co&&on "atho$ens o 9SI
Candida albicans
Staphylococcus aureus
Enterobacter cloaceae Staphylococcus epidermidis
Pseudomonas aeruginosa
Enterococcus fecalis
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,(INCI,LES OF ,(E*ENTION
OF INFECTION Consider e#er! "erson 2"atient o sta3 inectious
ash hands the &ost "ractical "rocedure or"re#entin$ cross conta&ination 2"erson to "erson3
ear $lo#es 'eore touchin$ an!thin$ wet 'roken skin0&ucous &e&'ranes0 'lood or other 'od! luids2secretions or e/cretions3 or soiled instru&ents and otherite&s
4se "h!sical 'arriers 2"rotecti#e $o$$les0 ace &asksand a"rons3 i s"lashes and s"ills o an! 'od! luids2secretions or e/cretions3 are antici"ated
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4se sae work "ractices0 such as not reca""in$
or 'endin$ needles0 sael! "assin$ shar"
instru&ents and "ro"erl! dis"osin$ o &edicalwaste
Isolate "atients onl! i secretions 2air'orne3 or
e/cretions 2urine and eces3 cannot 'e contained
)econta&inate "rocess instru&ents and other
ite&s 2deconta&inate0 clean0 hi$h le#eldisinect or sterili%e usin$ Inection ,re#ention
,ractices
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,re#ention
Selection o a su'cla#ian0 'asilic0 or ce"halic #einsite rather than an internal .u$ular or e&oral site
A#oid use o T,N catheters or other inusion"ur"oses
4se o s"ecial tea& or insertion and &aintenanceo catheter
A#oid the use o tri"le anti'iotic oint&ent on central#enous catheter
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(E*IE INFECTION (IS
FACTO(S AN) ,(ACTICES Inection is the "resence and $rowth o a
&icroor$anis&s that "roduces tissue death
ash !our hands (outinel! clean and disinect suraces
+andle and "re"are ood sael!
1et i&&uni%ed
4s anti'iotics a""ro"riatel! ee" "ets health!
A#oid contact with wild ani&als
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,(INCI,LES OF SAFE I* CA(E
,(ACTICES
4se ase"tic technique to a#oid conta&ination o sterilein.ection equi"&ent
)o not ad&inister &edications ro& a s!rin$e to &ulti"le"atients0 e#en i the needle o cannula on the s!rin$e is
chan$ed 4se luid inusion and ad&inistration sets or one "atient
onl! and dis"ose ater use
4se sin$le dose #ials or "arenteral &edicationswhene#er "ossi'le
4se "ro"er "ersonal "rotecti#e equi"&ent 2,,E3
Adhere to saet! waste "rotocol accordin$ to institutionGs"olic!
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*ENI,4NCT4(E TEC+NIH4ES
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*ENI,4NCT4(E TEC+NIH4ES
4SIN1 *A(IO4S CAT+ETE(S
AN) )E*ICES
The 4se o Inusion ,u&"s
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The use o needleless s!ste&
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,ro"er use o shar" containers
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Monitorin$ and Assess&ent
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The use o a""ro"riate dressin$
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+ealth Care orker Education and Trainin$
Sur#eillance or Catheter (elated Inection
+andwashin$
9arriers ,recautions )urin$ Catheter Insertion
and Care
Catheter Insertion
Catheter Site Care Selection and (e"lace&ent o Intra#ascular
)e#ices
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,eneral ecommendations For
*ntravascular .evice Use
+ealth Care orker Education and Trainin$ Sur#eillance or Catheter (elated Inection
+andwashin$
9arriers ,recautions )urin$ Catheter Insertion
and Care
Catheter Insertion
Catheter Site Care
Selection and (e"lace&ent o Intra#ascular
)e#ices
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(e"lace&ent o Ad&inistration Sets and
Intra#enous Fluids
Intra#enous In.ection ,orts
,re"aration and Hualit! Control o Inta#enousAd&i/tures
In line Filters
Intra#enous Thera"! ,ersonnel Needleless Intra#ascular )e#ices
,ro"h!lactic anti&icro'ials
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/reventing Catheter-elated
loodstream *nfections
(eerences:
Centers or )isease Control and ,re#ention
2C)C30 4SA
+ealthcare Inection Control ,ractices Ad#isor!Co&&ittee 2+IC,AC30 4SA
+os"ital E"ide&iolo$! and Inection Control0
Ma!hall 7rd
ed