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A NOSOCOMIAL INFECTION is:
Also known as healthcare acquired infection
Traditionally referred as hospital acquired
infections
Infections that develop during hospitalization
One of the leading causes of death and increased
morbidity for hospitalized patients
Of which are mostly caused by drug resistantstrains of bacteria
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INFECTION RELATED TO IV THERAPY
DEVICES
Local Infection
Invasion and multiplication of microorganisms in
body tissues which may be clinically unapparent or
result in local cellular injury due to competitivemetabolism 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 (sonication technique),from a catheter tip or subcutaneous segment in the
absence of simultaneous clinical symptoms.
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Local catheter-related infection:
Exit site Infection: purulent drainage from the catheter
exit site, or erythema, tenderness, and swelling within2cm of the catheter exit site.
Port-pocket infection: erythema and necrosis of the skin
over reservoir of totally implantable device, or purulentexudates in the subcutaneous pocket containing the
reservoir.
Tunnel infection: erythema, tenderness, and indurationsof the tissues overlying the catheter and more than 2cm
from the exit site.
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Definitions
Systemic Catheter infection: isolation of the samemicroorganisms from catheter culture and from the blood of apatient with accompanying clinical symptoms of a BSI and noother apparent source of infection.
Catheter-related bloodstream infection is the isolation of thesame microbe from blood cultures that is known to besignificantly colonizing the catheter of a patient
Primary BSIis one that arises without apparent local infectionelsewhere due to the same microbe.
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Peripheral venouscatheters (short)
Peripheral arterialcatheters
Midline catheters
Usually inserted in veinsof forearm or hand
Usually inserted in radial
artery; can be placed infemoral, axillary, brachial,posterior tibial arteries
Inserted via theantecubital fossa into the
proximal basilic orcephalic veins; does notenter central veins,peripheral catheters
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Nontunneled CVC Percutaneouslyinserted into centralveins ( subclavian,internal jugular, orfemoral)
8 cm depending on
the patient sizeAccount for majorityCRBSI
Pulmonary arterycatheter
Peripherally insertedcentral venouscatheter (PICC)
Inserted through aTeflon introducer in acentral vein(subclavian, internaljugular, or femoral)
Inserted in basilic,cephalic, or brachialveins and enter thesuperior vena cava
30 cm depending on
the patient size
20 cm depending on
patient size
Usually heparinbonded; similar ratesof BSI as CVCs;subclavian sitepreferred to reduceinfection risk
Lower rate of infectionthan nontunnelledCVCs
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Common catheters used for venous and arterial access
CATHETER TYPE ENTRY SITE LENGTH COMMENTS
Tunneled central venouscatheter
Implanted intosubclavian, internal
jugular, or femoral veins
8 cm depending on
the patient size
Cuff inhibits migration oforganisms into thecatheter tract; lower rateof infection than that ofthe nontunneled CVC
Totally implantable
Umbilical catheters
Tunnelled beneath theskin and havesubcutaneous portaccessed with needle;implanted in subclavian,internal jugular vein
Inserted into umbilicalvein or umbilical artery
8 cm depending on
the patient size
6 cm depending on
the patient size
Lowest rate of CRBSI;improved patient selfimage; no need for localcatheter site care;surgery required forcatheter removal
Risk for CRBSI similarwith catheters placed inumbilical 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 microbes from the skin moving
along the catheter surface where the catheterenters the skin.
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Date and Time IV
was InsertedKARDEX
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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
Staphylococcus aureus
Enterobacter cloaceae Staphylococcus epidermidis
Pseudomonas aeruginosa
Enterococcus 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 CausativeAgent
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, standardprecautions
Method or Mode ofTransmission
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, standardprecautions
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 practical procedure for preventingcross contamination (person to person)
Wear gloves before touching anything wet broken skin,mucous membranes, blood or other body fluids (secretions orexcretions) or soiled instruments and other items
Use physical barriers (protective goggles, face masks andaprons) if splashes and spills of any body fluids (secretions orexcretions) are anticipated
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Use safe work practices, such as not recapping or
bending needles, safely passing sharp instruments
and properly disposing of medical waste
Isolate patients only if secretions (airborne) or
excretions (urine and feces) cannot be contained
Decontaminate process instruments and other items
(decontaminate, clean, high level disinfect or
sterilize using Infection Prevention Practices
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Prevention
Selection of a subclavian, basilic, or cephalic vein siterather than an internal jugular or femoral site
Avoid use of TPN catheters for other infusion purposes
Use of special team for insertion and maintenance ofcatheter
Avoid the use of triple antibiotic ointment on centralvenous 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 sterileinjection equipment
Do not administer medications from a syringe to multiplepatients, 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 medications wheneverpossible.
Use proper personal protective equipment (PPE).
Adhere to safety waste protocol according to institutionspolicy.
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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 andCare
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 and Intravenous
Fluids
Intravenous Injection Ports
Preparation and Quality Control of IntavenousAdmixtures
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.
Recommended