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8/3/2019 11. Nosocomial Infection Basic
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A NOSOCOMIAL INFECTION is:
Also known as healthcare ±acquired infection
Traditionally referred as
hospital ± acquired infections
Infections that develop duringhospitalization
One of the leading causes of
death and increased morbidity
for hospitalized patients
Of which are mostly caused by
drug ± resistant strains of
bacteria
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IV THERAPY DEVICES RELATED INFECTION
Local Infection
Invasion and multiplication of microorganisms in body
tissues which may be clinically unapparent or result in
local cellular injury due to competitive metabolism
toxins, intracellular replication or antigen antibody
response
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Systemic Infection
A systemic disease caused by pathogenic
organisms or their toxins in the bloodstream
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Definitions Catheter Colonization: The isolation of 15 colony
forming units (CFUs) of any microorganism bysemiquantitative culture (roll-plate method) or 103
CFUs by quantitative culture (sonicationtechnique), from a catheter tip or subcutaneoussegment in the absence of simultaneous clinical
symptoms.
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Local catheter-related infection:
Exit site Infection: purulent drainage from thecatheter exit site, or erythema, tenderness, and
swelling within 2cm of the catheter exit site.
P ort-pocket infection: erythema and necrosis of the skin over reservoir of totally implantable
device, or purulent exudates in the
subcutaneous pocket containing the reservoir.
Tu nnel infection: erythema, tenderness, and
indurations of the tissues overlying the catheter
and more than 2cm from the exit site.
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Definitions
Sy stemic Catheter infection: isolation of the samemicroorganisms from catheter culture and from theblood of a patient with accompanying clinicalsymptoms of a BSI and no other apparent source of infection.
Catheter-related bloodstream infection is the isolationof the same microbe from blood cultures that isknown to be significantly colonizing the catheter of a
patient
P rimar y BS I is one that arises without apparent localinfection elsewhere due to the same microbe.
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Peripheral venous
catheters (short)
Peripheral arterial
catheters
Midline catheters
Usually inserted in
veins of forearm or
hand
Usually inserted in
radial artery; can be
placed in femoral,
axillary, brachial,
posterior tibial arteries
Inserted via theantecubital fossa into
the proximal basilic or
cephalic veins; does
not enter central veins,
peripheral catheters
<3 inches
<3 inches
3 ± 8 inches
Phlebitis with prolonged
use; rarely associated
with BSI
Low infection risk; rarely
associated with BSI
Reported with
anaphylactoid reactions
on elastommeric
hydrogel catheter; lower
rates of phlebitis than
short peripheral
catheters
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Nontunneled CVC Percutaneously
inserted into central
veins ( subclavian,
internal jugular, or
femoral)
8 cm depending on
the patient size
Account for majority
CRBSI
Pulmonary artery
catheter
Peripherally inserted
central venous
catheter (PICC)
Inserted through a
Teflon ® introducer in
a central vein(
subclavian, internal
jugular, or femoral)
Inserted in basilic,
cephalic, or brachial
veins and enter the
superior vena cava
30 cm depending
on the patient size
20 cm depending
on patient size
Usually heparin
bonded; similar rates
of BSI as CVCs;
subclavian site
preferred to reduce
infection risk
Lower rate of
infection than
nontunnelled CVCs
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Tunneled central
venous catheter
Implanted into
subclavian, internal
jugular, or femoral
veins
8 cm depending on
the patient size
Cuff inhibits migration
of organisms into the
catheter tract; lower
rate of infection than
that of the nontunneled
CVC
Totally implantable
Umbilical catheters
Tunnelled beneath the
skin and have
subcutaneous port
accessed with needle;
implanted in
subclavian, internal
jugular vein
Inserted into umbilical
vein or umbilical artery
8 cm depending on
the patient size
6 cm depending on
the patient size
Lowest rate of CRBSI;
improved patient self
image; no need for
local catheter site care;
surgery required for
catheter removal
Risk for CRBSI similar
with catheters placed in
umbilical vein vs artery
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Other Nosocomial Infection
Urinary tract infection
Surgical site infection
Ventilator-associated pneumonia
Intravascular device-related bloodstream infection
Clostridium difficile- associated diarrhea
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CHAIN OF INFECTION CONTROL
Infectious Agent
Reservoir
Portal of Exit
Susceptible host
Portal of Entry
Mode of
Transmission
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MODE OF TRANSMISSION
It is the method of transfer by which organism moves or
is carried from one place to another E.g. Hands of the health care worker may carry bacteria
from one person to another.
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How does catheter-related infection
occur?
Infection of short-term catheters is
frequently been due to microbesfrom the skin moving along the
catheter surface where the
catheter enters the skin.
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Date and Time IV
was Inserted
KARDEX
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Risk Factors
Type of catheter used The number of lumen of the catheter has
Total parenteral nutrition
Duration of catheterization
Catheter site insertion
Expertise of the person inserting
Management of catheter after insertion
Guidewire exchange Use of dressing
Use of triple antibiotic ointment
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Common pathogens of BSI
Candida albicans
S taphy lococc u s au reu s
Enterobacter cloaceae S taphy lococc u s epidermidis
P seu domonas aer ug inosa
Enterococc u s fecalis
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Breaking the Chain of Infection ±
Levels of Aseptic ControlHow Health Care Workers Break the Chain of Infection
Link Intervention
Infectious or Causative
Agent
Accurate and rapid identification of microorganisms
Early recognition of sign and symptoms of infection
Reservoirs Employee health examinations and screenings
Environmental sanitations Disinfection / Sterilization of instruments
Standard Precautions, Medical Asepsis, Proper Hygiene
Clean gowns, linens, towels, Clean wound dressing
Portal of Exit Handwashing, use of PPE, proper waste disposal,
standard precautions
Method or Mode of
Transmission
Handwashing, Standard Precautions, Safe food handling,
isolations, use of PPE, transmission based precautions
Portal of Entry Aseptic technique, medical or surgical asepsis, wound /
catheter care, proper disposal, maintain skin integrity,
standard precautions
Susceptible Host Treatment of Disease, Recognition of clients at risk,
immunization, exercise, proper nutrition
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PRINCIPLES OF PREVENTION OF INFECTION Consider every person (patient of staff)
infectious
Wash hands ± the most practicalprocedure for preventing cross ±contamination (person to person)
Wear gloves before touching anything wet ± broken skin, mucous membranes, bloodor other body fluids (secretions or excretions) or soiled instruments and
other items
Use physical barriers (protective goggles,face masks and aprons) if splashes andspills of any body fluids (secretions or
excretions) are anticipated
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Use safe work practices, such as not
recapping or bending needles, safely
passing sharp instruments and properlydisposing of medical waste
Isolate patients only if secretions (airborne)or excretions (urine and feces) cannot be
contained
Decontaminate process instruments andother items (decontaminate, clean, high ±
level disinfect or sterilize using Infection
Prevention Practices
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Prevention
Selection of a subclavian, basilic, or cephalicvein site rather than an internal jugular or femoral site
Avoid use of TPN catheters for other infusionpurposes
Use of special team for insertion and
maintenance of catheter
Avoid the use of triple antibiotic ointment oncentral venous catheter
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REVIEW INFECTION RISK FACTORS and
PRACTICES
Infection is the presence and growth of a
microorganisms that produces tissue death
± Wash your hands
± Routinely clean and disinfect surfaces
± Handle and prepare food safely
± Get immunized
± Us antibiotics appropriately
± Keep pets healthy
± Avoid contact with wild animals
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PRINCIPLES OF SAFE IV CARE / PRACTICES
Use aseptic technique to avoid contamination of sterile injection equipment
Do not administer medications from a syringe tomultiple patients, even if the needle of cannula on
the syringe is changed Use fluid infusion and administration sets for one
patient only and dispose after use
Use single ± dose vials for parenteral medicationswhenever possible.
Use proper personal protective equipment (PPE).
Adhere to safety waste protocol according toinstitution¶s policy.
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VENIPUNCTURE TECHNIQUES
USING VARIOUS CATHETERS AND
DEVICES
The Use of Infusion Pumps
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The use of needleless system
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Proper use of sharp containers
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Monitoring and Assessment
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The use of appropriate dressing
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Health Care Worker Education and Training
Surveillance for Catheter ± Related
Infection
Handwashing
Barriers Precautions During Catheter Insertion and Care
Catheter Insertion
Catheter Site Care Selection and Replacement of Intravascular
Devices
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General Recommendations For
Intravascular Device Use
Health Care Worker Education and Training
Surveillance for Catheter ± Related Infection
Handwashing Barriers Precautions During Catheter
Insertion and Care
Catheter Insertion
Catheter Site Care
Selection and Replacement of Intravascular
Devices
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Replacement of Administration Sets andIntravenous Fluids
Intravenous Injection Ports
Preparation and Quality Control of Intavenous Admixtures
In ± line Filters
Intravenous Therapy Personnel
Needleless Intravascular Devices
Prophylactic antimicrobials
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Preventing Catheter-Related
Bloodstream Infections
References:
Centers for Disease Control and Prevention
(CDC), USA
Healthcare Infection Control Practices
Advisory Committee (HICPAC), USA
Hospital Epidemiology and Infection Control,Mayhall 3rd ed.