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



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



Systemic Infection

A systemic disease caused by pathogenic

organisms or their toxins in the bloodstream



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.



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.



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.



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





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





Tunneled central

venous catheter

Implanted into


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


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



Other Nosocomial Infection

Urinary tract infection

Surgical site infection

Ventilator-associated pneumonia

Intravascular device-related bloodstream infection

Clostridium difficile- associated diarrhea





CHAIN OF INFECTION CONTROL

Infectious Agent

Reservoir

Portal of Exit

Susceptible host

Portal of Entry

Mode of

Transmission



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.



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.





Date and Time IV

was Inserted

KARDEX



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



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



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



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



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



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



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



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.





VENIPUNCTURE TECHNIQUES

USING VARIOUS CATHETERS AND

DEVICES

The Use of Infusion Pumps



The use of needleless system



Proper use of sharp containers



Monitoring and Assessment



The use of appropriate dressing





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



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



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



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.

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11. Nosocomial Infection Basic