TAIBA UNIVERSITYNURSING FACULTY
ICU NOSOCOMIAL INFECTION AND INFECTION CONTROL
Presented by :
Abdul Aziz Abdul Rahman Ali Alfuraidan
Content:
Learning Objectives
Abbreviations
Back ground of hospital acquired infection.
Definition of nosocomial infection.
Epidemiology.
Causative agents of nosocomial infections.
Modes of transmission .
Risk of Infections in ICU.
Why May Be in ICU and Why Do They Come to ICU?
ICU Patients Differ From Many Patients.
ICU Care is more Invasive.
Factors that increase nosocomial infection in ICU
Common nosocomial infection
Common nosocomial infection sites
Risk Factors for Nosocomial UTIs
Prevention of Nosocomial UTIs
Risk Factors for Nosocomial BSIs
Prevention of Nosocomial BSIs
Risk Factors for Nosocomial BSIs
Risk Factors for VAP.
Prevention of VAP.
Critical Care Nursing's Roles in Nosocomial Infection.
References
LEARNING OBECTIVES :
Know the epidemiology of nosocomial infections
Understand the various modes of transmission
of nosocomial infections
Know the various strategies for prevention and
control of nosocomial infections
Abbreviations:
(NSIs) : nosocomial infections
(MODS) :Multiple Organ Dysfunction Syndrome
(SIRS) : Systemic Inflammatory Response Syndrome
(COPD) : chronic obstructive pulmonary disorder .
(UTI): urinary tract infection .
(BSI): blood stream infection .
(VAP): ventilated associated pneumonia.
BACKGROUND OF HOSPITAL AQUIRED INFECCTION
• 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.
• Nosocomial infection comes from Greek
words “nosus” meaning disease and
“komeion” meaning to take care of.
• It is also called : HOSPITAL AQUIRED
INFECTION
DEFINITION OF 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.
EPIDEMOLOGY
•Nosocomial infections can be exogenous (external
organism) and endogenous (opportunist normal flora).
•Host susceptibility Is an important factor in the
development of nosocomial infection.
•Medical equipments and procedures (surgery) are
often responsible for infections.
CAUSATIVE AGENTS OF NOSOCOMIAL INFECTION
Different pathogens may cause nosocomial
Infections:
MODES OF TRANSMISSION:
1- CONTACT TRANSMISSION:
Most important and frequent mode of transmission of
nosocomial infections, is divided into two subgroups :
•Direct-contact transmission
•Indirect-contact transmission.
•Direct-contact transmission:
Involves a direct body surface-to-body surface
contact and physical transfer of microorganisms
between a susceptible host and an infected or
colonized person, such as occurs when a person
turns a patient, gives a patient a bath.
•Indirect-contact transmission:
Involves contact of a susceptible host with a
contaminated intermediate object, usually
inanimate, such as contaminated instruments,
needles , or dressings, or contaminated gloves
that are not changed between patients
2-DROPLET TRANSMISSION:
Droplet generated by sneezing coughing or
respiratory tract procedures like
bronchoscopy or suction.
3-VECTOR TRANSMISSION:
Transmitted through insects and other
invertebrates animals such as mosquitoes
and fleas.
4-AIR BORNE TRANSMISSION:
Tiny droplet nuclei that remain (<5) suspended in air.
5-COMMON VEHICLE TRANSMISSION:
Transmitted indirectly by materials contaminated with
the infections.
Risk of Infections in ICU
Patients hospitalized in ICUs are 5 to 10 times more likely to
acquire nosocomial infections than other hospital patients . The
frequency of infections at different anatomic sites and the risk of
infection vary by the type of ICU, and the frequency of specific
pathogens varies by infection site. Contributing to the seriousness
of nosocomial infections, especially in ICUs, is the increasing
incidence of infections caused by antibiotic-resistant pathogens.
Why May Be in ICU and Why Do They Come to ICU?
They are admitted for :
• Shock (Hypovolemic ,Cardiogenic , Septic Shock and
(SIRS) ).
• Respiratory Failure (Acute (Moderate to severe respiratory
failure, resulting from conditions like pneumonia or
(COPD) and Chronic). They need mechanical support
and mechanical ventilation.
• Renal Failure.
• Neurological Conditions :
A variety of neurological or brain disorders
are seen in ICU. These may include strokes,
infections, lack of oxygen to the brain tissue
(cerebral anoxia) resulting in tissue death,
traumatic injuries or other changes that
occur when a patient is critically ill.
• Bleeding and Clotting :
Bleeding and clotting in critically ill patients
are quite common.
• MODS .
ICU Patients Differ From Many Patients :
We have to pay more attention to those
patient because they are :
• The sickest patients (multiple
diagnoses, multi-organ failure,
immunocompromised, septic and
trauma).
• Move less
• Malnourished
• More obtunded (Glasgow coma
scale)
• Having Diabetics and Heart failure.
ICU Care is more Invasive
• More invasive life lines and procedures
including surgeries .
• Longer length of stay .
• More IV and parenteral drugs.
• More tube feeding and parenteral
nutrition .
• More ventilation.
FACTORS THAT INCREASES CROSS INFECTION IN ICU
• Lack of Hand washing facilities .
• Patient close together or sharing rooms.
• Understaffing.
• Preparation of IVs on the unit.
• Lack of isolation facilities.
• No separation of clean and dirty AREAS.
• Excessive antibiotic use.
• Inadequate decontamination of items & equipment's.
• Inadequate cleaning of environment.
COMMON NOSOCOMAIL INFECTIONS
The following are the most common nosocomial
infections:
•Urinary tract infection
•Catheter associated infection
Pneumonia (ventilator-associated)
•Blood stream infections.
•Surgical sites infection
COMMON SITES OF NSIs INFECTION
Risk Factors for Nosocomial UTIs
•Female gender
•Other active site of infection
•Diabetes mellitus
•Renal insufficiency
•Duration of catheterization
•Insertion of catheter late in hospitalization
•Presence of ureteral stent
•Using catheter to measure urine output
•Disconnection of catheter from drainage
tube
•Retrograde flow of urine from drainage bag
Prevention of Nosocomial UTIs
•Avoid catheter when possible & discontinue ASAP
•Aseptic insertion by trained HCWs
•Maintain closed system of drainage
•Ensure dependent drainage
•Minimize manipulation of the system
•Silver coated catheters
Risk Factors for Nosocomial BSIs
•Heavy skin colonization at the insertion site
•Internal jugular or femoral vein sites
•Duration of placement
•Contamination of the catheter hub
Prevention of Nosocomial BSIs
•Limit duration of use of intravascular catheters
o No advantage to changing catheters routinely
•Maximal barrier precautions for insertion
o Sterile gloves, gown, mask, cap, full-size drape
o Moderately strong supporting evidence
•Chlorhexidine preparation for catheter insertion
o Significantly decreases catheter colonization; less clear
evidence for BSI.
o Disadvantages: possibility of skin sensitivity to
chlorhexidine, potential for chlorhexidine resistance.
Risk Factors for VAP :
•Duration of mechanical ventilation
•Chronic lung disease
•Severity of illness
•Age
•Head trauma•Elevated gastric pH
•Aspiration of gastric contents
•Reintubation
•Upper abdominal or thoracic surgery
•Supine head position
•NG tube
Prevention of VAP
•Semirecumbent position of ventilated patients (head of bed at 45°)
Prevention and control of nosocomial infections generally can be
done by the following ways:
COMMON SITES OF INFECTION
Designed to prevent transmission of microorganisms by common
routes in hospitals. Because agent and host factors are more
difficult to control, interruption of transfer of microorganisms is
directed primarily at transmission.
Critical Care Nursing's Roles in NSIs
Sterilization:
Sterilization of all reusable equipments such
as ventilator, humidifier and any device that
come in contact with the respiratory tract.
Wear Gloves:
They are worn for two reasons:
• Provide a protective barrier and prevent
contamination of hands.
• Reduce the liklihood that microorganism
present on the hands will be transmitted
to the patients during invasive and other
patient care procedure.
•Wear Aprons Wearing an apron during
patient care reduces the risk of infections.
•Apron is must for preventing yourself
from getting disease.
•Reduce the individual susceptibility to
infection by :
• Encourage and maintain caloric intake
and protein in the diet.
• Monitor the use or overuse of
antimicrobial therapy.
• Give antimicrobial therapy was
prescribed in 15 minutes of scheduled
time
• Minimize the length of hospital stay.
• Instruct individuals and families to know
the causes, risks of infection and
transmission power
• Report of infectious diseases.
Get educated:
Learn about your conditions and treatment
is the best way to prevent an error.
Get involved:
Be assertive about your rights To be a part
of the decision process for your medical
care
References:
Wenzel RP. The Lowbury Lecture. The economics of nosocomial infections. J
Hosp Infect. 1995 Oct;31(2):79–87.
Singh-Naz N, Sprague BM, Patel KM, Pollack MM. Risk factors for nosocomial
infection in critically ill children: a prospective cohort study. Crit Care
Med. 1996 May;24(5):875–878.
Gould D. Nurses' hand decontamination practice: results of a local study. J
Hosp Infect. 1994 Sep;28(1):15–30.
Genné D, de Torrenté A, Humair L, Siegrist HH. Taux de contamination des
stéthoscopes en milieu hospitalier. Schweiz Med Wochenschr. 1996 Dec
28;126(51-52):2237–2240.
http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf
http://scholarsresearchlibrary.com/ABR-vol2-iss5/ABR-2011-2-5-172-178.pdf
https://depts.washington.edu/uwmedres/patientcare/objectives/hospitalist/Prevention_of_Hospit
al_Acquired.pdf
http://www.healthline.com/health/hospital-acquired-nosocomial-infections#Treatments7
http://www.slideshare.net/AartiSareen/hospital-acquired-infections-15659553
http://www.slideshare.net/KalpeshZunjarrao/nosocomial-infection-control?related=1
http://www.slideshare.net/amarjit38/nosocomial-infection-7577087?related=1
https://www.fraserhealth.ca/media/Factsheet%20-%20ICU%20Care.pdf
http://nursesnanda.blogspot.com/2012/04/nursing-intervention-for-infection.html
http://www.slideshare.net/MMASSY/nosocomial-infections-8494516
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