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Infection control in icu setting ( prevention of cross infection)
1.
2.
3. Also known as Nosocomial infection whose
development is favored by a hospital
environment, such as one acquired by a patient
during a hospital visit or one developing among
hospital staff.
4. Why focus on infection prevention
and control ?
More than 20 percent of all nosocomial infections are
acquired in ICUs
ICU-acquired infections account for substantial
morbidity, mortality, and expense.
Improving infection prevention and control in critical
care acts as a catalyst for improvement in the rest of
the hospital.
5. Sources of Infection
Endogenous sources: 50%
Pt’s own flora, such as skin, nose, mouth, GI tract,
or genitals ( greatest source of danger)
Exogenous sources are: 15%
Environment ( Air 5%,Instrument 10%)
Cross Infection : 35%
patient care personnel, visitors and other patients
6. EPIDEMIOLOGY
Culture results
from ICU-acquired
infections at
Vidant Medical
Center
UTI – Urinary tract
infection;
HCAP – Healthcare-
associated
pneumonia;
CABSI – Catheter-
associated
bloodstream
infection
8. more chronic comorbidities & more severe
acute physiologic derangements.
the high frequency of use of catheters provide
a portal of entry of organisms into the
bloodstream.
Multidrug-resistant pathogens MRSA and VRE
are being isolated with increasing frequency
in ICUs
9. Risk Factors :
Presence of underlying comorbidities such as:
diabetes, renal failure, malignancies predispose patients to colonization
and infection with multidrug-resistant bacteria
Presence of indwelling devices, central venous catheters and endotracheal
tubes which bypass natural host defense mechanisms and serve as portals
of entry for pathogens.
Frequent manipulations and contact with HCWs usually concurrently
caring for multiple ICU patients
Hands are the vehicles for transfer of pathogens from patient to patient.
Long hospital courses prior to the ICU admission more Antibiotic Exposure
,…..
10. 1. MRSA ( Methicillin Resistant Staphylococcus Aureus)
Resistant to flucloxacillin
May cause: wound infection, bacteremia, skin/soft tissue infection,
UTI, Pneumonia
Colonization common: nose, axilla, perineum, wound/lession
Spread by: hands, fomites, aerosols
Control: eradication of carriage, barrier nursing, screening of other
patients
11. 2. Tuberculosis – open pulmonary TB and sputum smear positive
for Acid fast bacilli.
3. Viral Infection - chicken pox, Hepatitis B, HIV
4. Gram Negative Organism – resistant to multiple antibiotics.
Organism such as: E coli, Proteus, Enterobacter, Acinetobacter,
Pseudomonas Aeruginosa
Causes: Bacteremia, UTI, Pneumonia, Wound infection
Control: Anti-biotic policy
Adherence of infection control guidelines
prevention of cross infection
12. an application of
scientific and
epidemiological
principles for
infection prevention
and reduction in rates
of nosocomial
infections.
13. If known or suspected on admission to hospital, or
detected following admission:
Standard Precaution and Transmission Based
Precaution
Isolation (barrier precautions)
Inform Infection Control team
Treatment - if appropriate
Regular surveillance
14.
15.
16.
17. Hand washing
is frequently called the single most important
measure to reduce the risks of
transmitting skin microorganisms from one
person to another or from one site to another
on the same patient. Washing hands as
promptly and thoroughly as possible between
patient contacts and after contact
with blood, body
fluids, secretions, excretions, and equipment
or articles contaminated by them is an
important component of infection control and
isolation precautions.
20. Alcohol Hand Rub
An easy way to use because
of faster application
compared to correct hand
washing
21.
22. Regular Surveillance
Monitor the incidence of
epidemiologically-important organisms
and targeted HAIs that have substantial
impact on outcome and for which
effective preventive interventions are
available;
use information collected through
surveillance of high-risk populations,
procedures, devices and highly
transmissible infectious agents to detect
transmission of infectious
23. Top CDC Recommendations to Prevent Healthcare-
Associated Infections
To Prevent Catheter-Associated Urinary Tract Infections
(CAUTIs:)
Insert catheters only for appropriate indications
Leave catheters in place only as long as needed
Ensure that only properly trained persons insert and maintain catheters
Insert catheters using aseptic technique and sterile equipment (acute
care setting)
Follow aseptic insertion, maintain a closed drainage system
Maintain unobstructed urine flow
Comply with CDC hand hygiene recommendations and Standard
Precautions
Also consider:
Alternatives to indwelling urinary catheterization
Use of portable ultrasound devices for assessing urine volume to reduce
unnecessary catheterizations
Use of antimicrobial/antiseptic-impregnated catheters
24. To Prevent Surgical Site Infections
Before surgery
Administer antimicrobial prophylaxis in accordance with evidence-based
standards and guidelines
Treat remote infections-whenever possible before elective operations
Avoid hair removal at the operative site unless it will interfere with the
operation; do not use razors
Use appropriate antiseptic agent and technique for skin preparation
During Surgery
Keep OR doors closed during surgery except as needed for passage of
equipment, personnel, and the patient
After Surgery
Maintain immediate postoperative normothermia
Protect primary closure incisions with sterile dressing
Control blood glucose level during the immediate post-operative period
(cardiac)
Discontinue antibiotics according to evidence-based standards and
guidelines
25. Central Line-Associated Bloodstream Infections
(CLABSIs) Outside ICUs:
Remove unnecessary central lines
Follow proper insertion practices
Facilitate proper insertion practices
Comply with CDC hand hygiene recommendations
Use appropriate agent for skin antisepsis
Choose proper central line insertion sites
Perform adequate hub/access port disinfection
Provide staff education on central line maintenance and insertion
Also consider:
Chlorhexidine bathing
Antimicrobial-impregnated catheters
Chlorhexidine-impregnated dressings
26. Clostridium difficile Infections
Contact Precautions for duration of diarrhea
Comply with CDC hand hygiene recommendations
Adequate cleaning and disinfection of equipment and environment
Laboratory-based alert system for immediate notification of positive test
results
Educate about C. diff infection: healthcare personnel, housekeeping,
administration, patients, families
Also consider:
Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48
hours)
Presumptive isolation for symptomatic patients pending confirmation
of C. diffinfection
Evaluate and optimize testing for C. diff infection
Implement soap and water for hand hygiene before exiting room of a
patient with C. diff infection
Implement universal glove use on units with high C. diff infection rates
Use EPA-registered disinfectants with sporicidal claim (e.g., bleach) or
sterilants for environmental disinfection
Implement an antimicrobial stewardship program
27. To Prevent MRSA Infections
Comply with CDC hand hygiene recommendations
Implement Contact Precautions for MRSA colonized and infected
patients
Recognize previously MRSA colonized and infected patients
Rapidly report MRSA lab results
Provide MRSA education for healthcare providers
Also consider:
Active surveillance testing – screening of patients to detect
colonization even if no evidence of infection
Other novel strategies
Decolonization
Chlorhexidine bathing
28. Conclusion
Although the ICU environment cannot be made microbe
free, aggressive measures should be made to reduce
HAIs and their associated increased morbidity, mortality,
length of stay and financial burden. The majority of
these infections are preventable with adequate
preventative measures. Healthcare workers are
mandated to implement infection control measures in
their daily practice. As patients in the ICU are critically
ill, infection control measures to avoid complications is
a priority and integral part of care. ICU providers must
be familiar with their institution’s infection control
guidelines for the prevention and management of
invasive devices/catheters, endotracheal tubes and
tracheostomies.