Download DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

PART II
CATHETER RELATED BLOOD
STREAM INFECTION (CR-BSI)
CATHETER RELATED URINARY
TRACT INFECTIN (CR-UTI)
MAHA NAGA
NURSING SPECIALIST
ALEXANDRIA UNIVERSITY
STUDENT HOSPITAL
E-mail
Dr. MOUSTAFA ARAFA
ASSOSIATE PROF. OF EPIDEMIOLOGY
HIGH INSTITUTE OF PUBLIC HEALTH
ALEXANDRIA UNIVERSITY
E-mail
CVC RELATED BLOOD
STREAM INFECTION
Blood stream infection is associated with
the use of intravascular catheters.
Catheter related blood stream infection
(CR-BSIs), are associated with increased
morbidity, mortality rate of 10% to 20 %,
prolonged hospitalization (mean of 7 days )
and increased medical costs .
RISK FACTORS
The site at which the catheter is
placed.
- The type of barrier precautions
used during catheter insertion.
- The skill of the person inserting
the catheter.
- The use of a guide wire to
replace an existing catheter.
-
CRITERIA FOR DIAGNOSIS
- Fever.
- Signs of cutaneous involvement
( erythema , induration , tenderness,
or purulent drainage ) at the
insertion site of catheter.
- Positive blood or tip of catheter
culture .
MICROBIOLOGY
Blood stream infections are caused by:
• Coagulase-negative staphylococci,
particularly Staphylococcus
epidermidis.
• Candida species.
• Enterococci .
• Staphylococcus aureus .
PREVENTION AND CONTROL
MEASURES
- Health care worker education and
training
- Surveillance for catheter-related infection
- Hand washing
- Barrier precautions during catheter
insertion and care
- Catheter site care
- Selection and replacement of
intravascular devices
- Replacement of administration sets and
intravenous fluids
- Clean injection parts with 70% alcohol or
povidone-iodine before accessing the
system
- Do not use filters routinely for infection
control purposes
- Do not administer anti-microbials
routinely before insertion or during use of
an intravascular device to prevent catheter
colonization or bloodstream infection.
CATHERTER
RELATED UTI
The urinary tract accounting for more
than 40% of the total number
reported by acute-care hospitals
( 40 – 45 % of nosocomial infections )
and affecting an estimated 600,000
patients per year , they contribute
only 10 to 15 percent to prolongation
of hospital stay and to extra costs .
66% to 86% of these infections
follow instrumentation of the
urinary tract mainly urinary
catheterization .
RISK FACTORS
Acquiring a urinary tract infection depend
on the following:
- the method and duration of
catheterization.
- the quality of catheter care.
- and host susceptibility.
Host factors which appear to increase
the risk of acquiring catheter-associated
urinary tract infections include :
advanced age, debilitation, and the
postpartum state
CRITERIA FOR DIAGNOSIS
Symptoms that may occur include
- dysuria.
- urinary frequency.
- incontinence of recent onset.
- flank pain.
- and fever.
Bacteriologic diagnosis :
- For complicated, recurrent UTIs,
asymptomatic bacteriuria is defined as
> 105 CFU/mL in a midstream urine
sample after > 4 hours of bladder
incubation.
- For women with uncomplicated
symptomatic cystitis bacteriuria is
defined as > 102 CFU/mL with pyuria.
MICROBIOLOGY
Catheter-associated urinary tract
infections are caused by a variety
of pathogens, including :
- Escherichia coli
- Klebsiella
- Proteus
- Enterococcus
Other causative micro-organisms:
- Pseudomonas
- Enterobacter
- Serratia
- Candida.
PREVENTION AND
CONTROL MEASURES
- Educate personnel in correct techniques of
catheter insertion and care.
- Catheterize only when necessary.
- Emphasize hand washing.
- Insert catheter using aseptic technique
and sterile equipment.
- Secure catheter properly.
- Maintain closed sterile drainage.
- Obtain urine samples aseptically.
- Maintain unobstructed urine flow.
- Periodically re-educate personnel in
catheter care.
- Use smallest suitable bore catheter.
- Avoid irrigation unless needed to prevent
or relieve obstruction.
- Do not change catheters at arbitrary fixed
intervals.
- Consider alternative techniques of
urinary drainage before using an
indwelling urethral catheter.
- Spatially separate infected and uninfected
patients with indwelling catheters.
- Avoid routine bacteriologic monitoring.
SUGGESTED FURTHER
READINGS
GUIDELINE FOR PREVENTION OF
INTRAVASCULAR DEVICE-RELATED
INFECTIONS
The Impact of Hospital-Acquired Bloodstream
Infections
- Guideline for Prevention of
Catheter-associated infections
- urinary tract infection