Download Dr. Holly A.Murphy - Hosp Management ICHM

Infection Control in the ICU
Holly A. Murphy, MD, MPH&TM
Consultant, Clinical Infectious Diseases
CIWEC Travel Medicine Center, Kathmandu
Co-Director GeoSentinel Surveillance Network, Kathmandu Site
Adjunct Asst. Prof, Tulane Medical Center, New Orleans, LA USA
S
Infection Control
Issues in Asia
Aim:
S To discuss “most important” Infection Control practices for
Intensive Care Units (ICUs) in Nepal
S To address the problems of:
S antimicrobial resistance,
S hospital-acquired infections (HAIs) and
S related morbidity and deaths.
Hospital Acquired Infections
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Nosocomial infections/ hospital acquired infections (HAIs)=
infections which develop during hospital stay which were not
present before admission
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Common HAIs include:
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Surgical Site Infections
Catheter associated bloodstream infections
Ventilator associated pneumonia
Catheter related urinary tract infection
ICU: more devices, more vulnerable patients, more HAIs
Antimicrobial Resistance =
Natural process of selection when microorganisms exposed to antibiotics
S Causes:
S Use of antibiotic for inappropriate indication (wrong drug) Ex.
Azithromycin for Strep Throat
S Unnecessarily broad spectrum (‘higher level’) antibiotic use Ex.
Ceftriaxone for Surg Prophylaxis
S Incorrect dose or dosing interval resulting in subtherapeutic levels in the
body Ex. 750mg Vancomycin in adult
S Inappropriate duration of antibiotic treatment (too long or too short)
Ex. Quick switch to oral drug for osteomyelitis
S Transfer of organisms (or their genetic material) within the environment
(healthcare and community settings)
Collateral damage of antibiotics
S “VRE” vancomycin resistant enterococci –
associated with vancomycin/cephalosporin
use
S “MRSA” methicillin-resistant Staph aureus
– assoc with quinolone/cephalosporin use
S “ESBL” extended spectrum beta-lactamase
expression by gram-negative organisms –
assoc with ceftriaxone/quinolone use
Emergence of resistance to
“reserve” antibiotics
S Quinolones (ex. levofloxacin),
carbapenems (ex. meropenem),
vancomycin, colistin
S Limited to no alternatives,
antimicrobial “pipeline” limited
S Untreatable infections with high
morbidity and mortality
Hospital Acquired Infections
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Developed countries: 5-10% of admissions experience HAI
• 2-20 times higher in resource-poor settings
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Frequently involve drug resistant organisms (“superbugs”)
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MDR Acinetobacter
ESBL-producing E coli
MRSA
PREVENTABLE!
Hospital acquired infections kill nearly
100,000 Americans/year with 2 million
patients needing treatment that costs >25
billion USD/ year. ~CDC 2009
BBC News Dec 2014
What is infection control?
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Hospital-wide program to
prevent the spread of
infectious disease within
the hospital
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Multidisciplinary participation of:
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Medical staff (doctors)
Nursing
Laboratory/microbiology
Pharmacy
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Administration
Food Service
Engineering
Housekeeping/Laundry
Central
Supply/Sterilization
Potential Activities of
Infection Control
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Quantify antibiotic resistance and HAIs
S Antibiograms
S
Drug Resistance Index (DRI) : measure that combines the ability of antibiotics to
treat infections with the extent of their use in clinical practice.
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Develop protocols for:
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Appropriate use of antibiotics
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Procedures with high risk of HAIs (central line insertion, urinary
catheter placement)
Develop standardized isolation procedures
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Respiratory isolation (droplet vs. resp)
Contact isolation, i.e. gowns used appropriately
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Assess and strengthen hand hygiene practices
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Antimicrobial stewardship program
What is antimicrobial stewardship?
S Assure appropriate choice, dosing and duration of antibiotics
S Approval of restricted antibiotics requires verification of correct dose,
route, frequency and duration
S Serves as patient safety and quality care function
S Core components
S Restriction of certain antibiotics
S Prospective auditing and feedback on a case-by-case basis
Appropriate use of antimicrobials delay the emergence of resistance and
minimize resistance prevalence once it emerges
Antimicrobial Stewardship
S Strategies
S Provider education
S Hospital treatment guidelines for infectious diseases
S
Antimicrobial order sets
S Prospective review of patients receiving restricted antibiotics to
encourage de-escalation of therapy
S Encourage transition from IV to oral antibiotics when the agent has
excellent oral bioavailability
THE BASICS
S Lab-DR link: antibiogram, well-defined “isolation” pathogens
S Key patogens (MDR Acinetobacter)/key diseases (ie TB)
S Signs designating isolation (I.E. CONTACT PRECAUTIONS,
AIRBORNE or DROPLET PRECAUTIONS)
S Hand washing/hand sanitizer – wall mounted sanitizer/sinks
accessible before and inside ICU
S Gloves for patient contact, Ex ventilator manipulation
S DESIGNATED GOWNS and stethoscope
S Antibiotic Stewardship
Comprehensive Infection
Control
S Some new concepts for Nepal (ex. gowns, antibiotic
restrictions)
S Sensitize doctors, nurses, pharmacists and administration
S Limitations: hospital-based pharmacy, facility (communal
ICU)
S Learning curve: Clinical Infectious Diseases
S Training
S Administrative support is CRITICAL
Even with critical advances in Infection Control, we
will not stop antimicrobial resistance, only slow it
down.
“First do no harm”
S We are in the business of “health”…
S We have a responsibility to prevent
HAIs and HAI-related deaths.
Thank you…
S For making Infection Control a
priority!!
S Thank you Dr. Andrew Trotter–
TUTH/Grande Hospital and Tufts
Univ (USA) for shared slides