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1. NOSOCOMIAL RESPIRATORY INFECTION Compiled by R

2. RISKS FACTORS Extremes of age Severe underlying disease Immunosuppression Depressed sensorium Cardiopulmonary disease Post thoraco-abdominal surgery Mechanically ventilated – ventilated associated pneumonia

3. PREVENT OF PERSON-TO-PERSON TRANSMISSION OF BACTERIA

4. PREVENT OF PERSON-TO-PERSON TRANSMISSION OF BACTERIA

5. Precautions for prevention of aspiration

6. Precautions for prevention of aspiration

7. Prevention of postoperative Pneumonia in high risk group Age ≥ 60 years History of chronic lung disease or smoking On steroids for chronic conditions History of chronic alcohol consumption Impaired sensorium History of cerebrovascular accident with residual neurologic deficit

8. Prevention of postoperative Pneumonia in high risk group General anesthesia Upper abdominal or thoracic surgery Emergency surgery Obesity

9. Assist patient in breathing exercise

11. Change more frequently than every 48 hours an HME that is in use on a patient. Change when it malfunctions mechanically or becomes visibly soiled

12. cont Change of ventilator breathing circuit when visibly soiled Change the oxygen delivery system (tubing, nasal prongs or mask) that is in use on one patient when it malfunctions or becomes visibly contaminated or between uses on different patients Drain and discard periodically any condensate in the circuit. Take precautions not to allow the condensate to drain towards the patient

13. cont Use sterile water to fill bubble-through humidifiers Clean, disinfect, rinse with sterile water and dry nebulizers between treatments on the same patient. Replace nebulizers with those that have undergone sterilization or high-level disinfection between uses on different patients

14. cont Use only sterile fluid for nebulization, and dispense the fluid into the nebulizer aseptically. Use aerosolized medications in single dose vial whenever possible. Change the mouthpiece of a peak flow mrter or the mouthpiece and filter of a spirometer between uses on different patients Change entire length of suction-collection tubing and canisters between uses on different patients

15. cont Between uses on different patients, clean reusable components of the anesthetic breathing system, inspiratory and expiratory breathing tubing, y-piece, reservoir bag, humidifier, and tubing, and then sterilize or subject them to high-level liquid chemical disinfection or pasteurization in accordance with the device manufacturers’ instructions.

16. cont A bacterial-viral filter placed between the y-piece and the mask or endotracheal tube serves to protect the pateint and the anaesthesia delivery system from contamination.

18. Bacteria filter

19. If reusable for other patient, disinfection properly otherwise use once only

20. Clean if visibly soiled or contaminated