Download Infection Control Practices to Improve Patient Care

Nosocomial Infections in Solid
Organ Transplant Recipients
Focus On Prevention
Through the Reduction of
Alterable Risk Factors
Gonzalo Bearman MD, MPH
Assistant Professor of Medicine, Epidemiology and
Community Health
Associate Hospital Epidemiologist
Virginia Commonwealth University
Outline
• Why are nosocomial infections important?
• Nosocomial infections in transplants
– Data From VCU
– Alterable risk factors and preventive measures
• BSI
• Hospital acquired pneumonia
• UTI
– Transplant specific antibiotic prophylaxis
• Heart/Lung, Renal and Liver transplants
– Hand Hygiene
• Importance of system level changes involving the
measurement and feedback of new technologies and
NI process measures that minimize patient risk
What this presentation will not
cover:
• Opportunistic infections!
– Fungal, Viral, Parasitic Infections, Prion
diseases
• Hospital associated or community
outbreaks!
– Legionella
– Aspergillus, etc, etc, etc
Nosocomial Infections
• 5-10% of patients admitted to acute care
hospitals acquire infections
– 2 million patients/year
– ¼ of nosocomial infections occur in ICUs
– 90,000 deaths/year
– Attributable annual cost: $4.5 – $5.7 billion
• Cost is largely borne by the healthcare facility not
3rd party payors
Weinstein RA. Emerg Infect Dis 1998;4:416-420.
Jarvis WR. Emerg Infect Dis 2001;7:170-173.
Major Sites of Nosocomial
Infections
•
•
•
•
Urinary tract infection
Surgical site infection
Bloodstream infection
Pneumonia (ventilator-associated)
Nosocomial Infections
• 70% are due to antibiotic-resistant
organisms
• Invasive devices are more important
than underlying diseases in determining
susceptibility to nosocomial infection
Burke JP. New Engl J Med 2003;348:651-656.
Safdar N et al. Current Infect Dis Reports 2001;3:487-495.
Nosocomial Infections in the US
1975
1995
Number of admissions (millions)
37.7
35.9
Number of patient days (millions)
299.0
190.0
7.9
5.3
2.1
1.9
7.2
9.8
Average length of stay (days)
Number of nosocomial infections
(millions)
Incidence of nosocomial infections
(per 1,000 patient-days)
Burke JP. New Engl J Med 2003;348:651-656.
Attributable Costs of Nosocomial
Infections
Cost per Infection
Wound infections
$3,000 - $27,000
Sternal wound infection
$20,000 - $80,000
Catheter-associated BSI
$5,000 - $34,000
Pneumonia
Urinary tract infection
$10,000 - $29,000
$700
Nettleman M. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections,
4th ed. 2003:36.
Shifting Vantage Points on
Nosocomial Infections
Many infections are
inevitable, although
some can be
prevented
Each infection is
potentially
preventable unless
proven otherwise
Even in solid organ transplant recipients, many of the NI
risk factors, pathogens and the preventive measures are
the same as for non-transplant recipients
Gerberding JL. Ann Intern Med 2002;137:665-670.
Nosocomial BSI in Solid
Organ Transplant Recipients
Most infections during the first
month after transplantation
are related to surgical
complications. These
infections are similar to those
occurring in general surgical
patients.
Snydman, D. Clinical Infectious Diseases, 2001;33 (supplement):S5-S8.
Bacteremia in transplant
recipients
• Prospective analysis of 125 bacteremic
episodes in 111 transplant recipients:
– Recipients:
• 18 heart transplants
• 26 Kidney transplants
• 80 liver transplants
Wagener et al. AJIC 1992;20: 239-47
Bacteremia in transplant recipients
125 total
episodes
Proportion
(of episodes)
Heart
18/125
14%
Early Onset
(< 14 days)
Late Onset
(> 14 days)
32/125
(26%)
93/125
(74%)
4
14
28
52
0
27
(% of episodes)
Liver
80/125
64%
(% of episodes)
Kidney
27/125
22%
(% of episodes)
Wagener et al. AJIC 1992;20: 239-47
Bacteremia in transplant recipients
Kidney
Transplant
Liver
Transplant
Heart
Transplant
Aerobic Gram
Negative Rods
(48% of pathogens)
48% of blood
cultures:
E.coli, Klebesiella,
Enterobacteriaciae
49% of blood
cultures:
P.aeruginosa
Enterobacter sps
39% of blood
cultures:
E.Coli
P.aeruginosa
Gram Positive
Organisms
(50% of pathogens)
50 % of blood
cultures
S.epidermidis
S.aureus
50 % of blood
cultures
S.aureus
S.epidermidis
50 % of blood
cultures
S.epidermidis
0% of blood cultures
6% of Blood
cultures:
All Candida species
11% of blood
cultures:
All Candida species
11% of bacteremias
6% in heart
transplants
Fungi
(6% of positive
blood cultures)
Polymicrobial
(10% of positive
blood cultures)
7% in Kidney
transplants
Wagener et al. AJIC 1992;20: 239-47
Bacteremia in transplant recipients
Survival
Severity of
illness
Microbilogy
Community
acquired
Nosocomial
19/21
(90%)
78/104
(75%)
Lower APACHE II
Score
Higher APACHE II
Score
E.coli
S.aureus
Enterobacteriaciae
S.aureus
P.aeruginosa
Enterobacter sps
S.epidermidis
Wagener et al. AJIC 1992;20: 239-47
Comparative Risk of Bloodstream
Infection in Organ Transplant Recipients
• Purpose:
– Determine the relative rates of BSI in solid
organ transplant recipients
• Method
– Data collected on 277 consecutive patients
over a 33 month period in a Canadian,
Tertiary Care Medical Center
McClean et al. Infect Control Hosp Epi. Vol 15.No 9, September 1994
Comparative Risk of Bloodstream
Infection in Organ Transplant Recipients
Transplant
Total patients
Patients
Infected
Episodes
Liver
50
14 (28%)
20
Kidney
175
9 (5%)
13
Heart or
Heart/Lung
50
5 (10%)
7
Total
275
28 (10%)
40
McClean et al. Infect Control Hosp Epi. Vol 15.No 9, September 1994
Comparative Risk of Bloodstream
Infection in Organ Transplant Recipients
Transplant
Primary
(CVC)
WND
PN
GI
UTI
Liver
11 (55%)
4
2
2
1
Kidney
7 (54%)
0
1
1
4
Heart or
Heart/Lung
6 (86%)
0
0
1
0
Total
25 (60%)
4
3
4
5
•The majority
of BSIs were
Primary
•The majority
of Primary
BSIs were
attributable to
intravascular
lines
McClean et al. Infect Control Hosp Epi. Vol 15.No 9, September 1994
Comparative Risk of Bloodstream
Infection in Organ Transplant Recipients
Organism
Gram Positive
aerobes
Liver
Kidney
Heart
Total
13 (62%)
7 (47%)
6 (75%)
26 (59%)
5 (24%)
5 (33%)
2 (25%)
12 (27%)
3 (14%)
3 (20%)
0
6 (13%)
21
15
8
44
S.aureus
S.epidermidis
Gram negative
aerobes
E.coli, Klebesiella,
Enterobacteriaciae
P.aeruginosa
Other
Candida
Bacteriodes
Total
McClean et al. Infect Control Hosp Epi. Vol 15.No 9, September 1994
Nosocomial Bloodstream Infections,
1995-2002
Rank
N= 20,978
Pathogen
Percent
1
Coagulase-negative Staph
31.3%
2
S. aureus
20.2%
3
Enterococci
9.4%
4
Candida spp
9.0%
5
E. coli
5.6%
6
Klebsiella spp
4.8%
7
Pseudomonas aeruginosa
4.3%
8
Enterobacter spp
3.9%
9
Serratia spp
1.7%
10
Acinetobacter spp
1.3%
Edmond M. SCOPE Project.
Preventive Measures for
Nosocomial BSI
The risk factors
interact in a
dynamic fashion
El Host
The CVC is the
greatest risk
factor for
Nosocomial BSI
The CVC: Subclavian, Femoral and IJ sites
The intensity of the Catheter Manipulation
As the host cannot be altered, preventive measures are focused on risk factor
modification of catheter use, duration, placement and manipulation
Risk Factors for Nosocomial BSIs
• Heavy skin colonization at the insertion
site
• Internal jugular or femoral vein sites
• Duration of placement
• Contamination of the catheter hub
Nosocomial Bloodstream Infections
• 12-25% attributable mortality
• Risk for bloodstream infection:
BSI per 1,000
catheter/days
Subclavian or internal jugular CVC
5-7
Hickman/Broviac (cuffed, tunneled)
1
PICC
0.2 - 2.2
Catheter type and expected duration of use should be
taken into consideration
Prevention of Nosocomial BSIs
• Limit duration of use of intravascular catheters
– No advantage to changing catheters routinely
• Maximal barrier precautions for insertion
– Sterile gloves, gown, mask, cap, full-size drape
– Moderately strong supporting evidence
• Chlorhexidine prep for catheter insertion
– Significantly decreases catheter colonization; less
clear evidence for BSI
– Disadvantages: possibility of skin sensitivity to
chlorhexidine, potential for chlorhexidine resistance
Putting BSI preventive
strategies into practice….
Eliminating catheter-related bloodstream
infections in the intensive care unit
– Purpose:
– To determine whether a multifaceted systems
intervention would eliminate catheter-related
bloodstream infections (CR-BSIs)
– Method:
– Prospective cohort study in a surgical intensive
care unit (ICU) with a concurrent control ICU.
–Patients:
– All patients with a central venous catheter in the
ICU
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Eliminating catheter-related bloodstream
infections in the intensive care unit
Interventions
Staff Education
Creation of a
catheter insertion
cart
Example
•all physicians or physician extenders who insert
central catheters were required to complete a Webbased training module and successfully complete a
ten-question test before they were allowed to insert a
central venous catheter.
hand hygiene
•central catheter insertion cart that contains the
equipment and supplies needed
• reduced the number of steps required for
compliance
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Eliminating catheter-related bloodstream
infections in the intensive care unit
Promotion of daily
Catheter Removal
Evidence based checklist
CVC insertion and for BSI
risk reduction
Nurses empowered
to stop the catheter
insertion procedure
if a violation of the
guidelines occurred
•Asked daily during patient rounds whether any
catheters or tubes could be removed.
•This was added it to the rounding form, called the
daily goals form, which is used to develop daily care
plans for patients in our SICU
•Hand hygiene prior to procedure
•chlorhexidine skin preparation
•Full-barrier precautions during central venous
catheter insertion
•Subclavian vein placement as the preferred site,
maintaining a sterile field while inserting the catheter
•Use of antiseptic impregnated catheter
Procedure aborted if they observed a violation in
compliance with the evidence-based guidelines.
The nurse paged the SICU attending physician if the
resident/operator violated the procedure
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Eliminating catheter-related bloodstream
infections in the intensive care unit
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Eliminating catheter-related bloodstream
infections in the intensive care unit
• Results:
– During the first month nursing completed
the checklist for 38 procedures:
• eight (24%) for new central venous access,
• 30 (79%) for catheter exchanges over a wire,
• three (8%) were emergent.
– nursing intervention was required in 32%
(12/38) of central venous catheter
insertions
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Eliminating catheter-related bloodstream
infections in the intensive care unit
Study ICU
BSI Rate 1st
quarter
1998
BSI Rate 4th
quarter
2002
January 2003April 2004
11.3/1,000
catheter days
0/1,000
catheter days
0.54/1,000
catheter days
No crBSI over 9
month s
Control ICU
5.7/1,000
catheter days
1.6/1,000
catheter days
Multifaceted, comprehensive program requiring CVC insertion education, with
safety checks for proper hand hygiene, aseptic insertion procedure and operator
responsibility can result in reduction of nosocomial BSI in an ICU setting.
Pronovost et al. Crit Care Med. 2004 Oct;32(10):2014-20.
Hospital Acquired Pneumonia
in Solid Organ Transplant
Recipients
Nosocomial Pneumonia
(non-transplant)
• Cumulative incidence = 1-3% per day of
intubation
• Early onset (first 3-4 days of mechanical
ventilation)
– Antibiotic sensitive, community organisms
(S. pneumoniae, H. influenzae, S. aureus)
• Late onset
– Antibiotic resistant, nosocomial organisms (MRSA,
Ps. aeruginosa, Acinetobacter spp, Enterobacter
spp)
Hospital Acquired Pneumonia
Infections after Liver Transplantation
Bacterial
Pneumonia
N=15
Hospital
Acquired
N=10
Community
Acquired
N=5
Pathophysiology
Nosocomial Organisms
(episodes)
7 (70%) where
ventilator
associated
3 aspiration
S.aureus (1)
P. Aeruginosa (4)
Enterobacter cloacae (2)
Acinetobacter (2)
E.coli (1)
2 aspiration
Kusne et al. Medicine, Vol 67, No.2, 132-153. 1988
Hospital Acquired Pneumonia
Risk Factor
Risk Factors
for Nosocomial
Pneumonia
Approx.
Magnitude of
Increased Risk
Gastric
aspiration
10.6
Intubation
6.7
Decreased
consciousness
5.8
Thoracic or
abdominal
surgery
4.7
Chronic Lung
Disease
3.7
Age>70
2.3
Alterable
NonAlterable
Prevention of VAP
• Semirecumbent position of ventilated
patients (head of bed at 45°) is the most
effective measure for decreasing
bronchoaspiration
Prevention of Nosocomial
Pneumonia
Head of bed elevation at 30-45 degrees
This Intervention is :
•Easy
•Simple
•cheap
Semi-elevated position prevents bronchoaspiration
Nosocomial Pneumonia in
Lung Transplantation
Transplant Type
Lung Transplant
Heart/Lung
Transplant
(anastamotic
colonization)
Organisms
S.aureus
P.aeruginosa
B.Cepacia
GNR
Prophylaxis
IDSA(A-III) Rec.
CF Patients:
Culture specific
(targeted
therapy) for 2
weeks post
transplant or
until purulent
secretions
disappear
Soave R. Clinical Infectious Diseases, 2001;33 (supplement):S26-31
Nosocomial UTI
Nosocomial Urinary Tract Infections
• Most common hospital-acquired infection (40%
of all nosocomial infections)
– 1 million cases of nosocomial UTI per year in the US
• Of nosocomial infections, lowest mortality &
cost
• >80% associated with urinary catheter
Nosocomial Urinary Tract Infections
• 25% of hospitalized patients will
have a urinary catheter for part of
their stay
• Incidence of nosocomial UTI is
~5% per catheterized day
• Virtually all patients develop
bacteriuria by 30 days of
catheterization
– Of these: 3% will develop bacteremia
Safdar N et al. Current Infect Dis Reports 2001;3:487-495.
The principal risk factor is duration if urinary
catheterization
Table 3. Risk factors for catheter-associated urinary tract infection, based on prospective
studies and use of multivariable statistical modeling.
Factor
Relative risk
Prolonged catheterization >6 days
5.1-6.8
Female gender
2.5-3.7
Catheter insertion outside operating room
2.0-5.3
Urology service
2.0-4.0
Other active sites of infection
2.3-2.4
Diabetes
2.2-2.3
Malnutrition
Azotemia (creatinine >2.0 mg/dL
2.4
2.1-2.6
Ureteral stent
2.5
Monitoring of urine output
2.0
Drainage tube below level of bladder and
above collection bag
1.9
Dennis G. Maki* and Paul A. Tambyah, Emerging Infectious Diseases, 2001
Prevention of Nosocomial UTIs
• Avoid catheter when possible &
discontinue ASAP
• Aseptic insertion by trained HCWspreferably in OR
• Maintain closed system of drainage
• Ensure dependent drainage
• Minimize manipulation of the system
• Silver coated catheters
Nosocomial UTI:
Silver Impregnated Urinary Catheters
Nosocomial UTI:
Silver Impregnated Urinary Catheters
Dennis G. Maki* and Paul A. Tambyah, Emerging Infectious Diseases, 2001
Nosocomial Urinary Tract Infections:
Silver Alloy Catheters
• Advantages:
– Most studies have demonstrated a significant decrease in
incidence of UTI
– Insertion, care no different than for 1st generation catheter
• Disadvantage:
– Cost
• Supporting evidence: reasonably strong (high
strength of evidence for impact & effectiveness at low
cost & complexity)
• Primary goal should still remain avoiding the use of
catheters when possible & discontinuing as soon as
possible
UTI in Kidney Transplantation
Transplant Type
Incidence
Organisms
Prophylaxis/Treatment
IDSA-Recommendations
Kidney
Transplantation
- Early infections
associated with
pyelonephritis
and urospepsis
5%-36 %
Majority
within the first
3 months
Enterbacteriaciae
Enterococci
S.aureus
P.aeruginosa
Salmonella
•Treatment of asymptomatic
UTI and surveillance urine
culture (BII) recommendation
–Prolonged prophylaxis
reduces rates of
UTI/Bacteremia but no impact
on patient and graft survival
•TMP/Sulfa or
Ciprofloxacin
•Salmonelluria- 6 weeks of Rx
(BII)
• Asymptomatic Candiduria Rx
recommended (A-II)
Soave R. Clinical Infectious Diseases, 2001;33 (supplement):S26-31
Special Concerns: Liver Transplantation
Transplant
Type
Liver
Transplantation
Infections
•Intrahepatic
and
extrahepatic
abscesses
•Cholangitis
•Peritonitis
•SSI
•BSI
Organisms
Prophylaxis/treatment
Selective Bowel
Decontamination (SBD)
•Non-absorbable/topical
antibiotics
Enterbacteriaciae
Enterococci
–Decreased bacterial
VRE
infections in 2 randomized,
S.aureus
controlled trials OLT
recipients
Anaerobes
•Antibiotic prophylaxis
Candida
warranted before/after each
post transplant cholangiogram
, liver biopsy (IDSA A1)
Badger et al, Transplant Proceedings. 1991;23:1460-1
Smith SD et al, Transplantation. 1993;55:1306-9
30%-40% of all Nosocomial
Infections are Attributed to
Cross Transmission
The inanimate environment is a
reservoir of pathogens
X represents a positive Enterococcus
culture
The pathogens are ubiquitous
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with
a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
The inanimate environment is a
reservoir of pathogens
Recovery of MRSA, VRE, C.diff CNS and GNR
Devine et al. Journal of Hospital Infection. 2001;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2002
Walther et al. Biol Review, 2004:849-869
The inanimate environment is a
reservoir of pathogens
Recovery of MRSA, VRE, CNS. C.diff and GNR
Devine et al. Journal of Hospital Infection. 2001;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2002
Walther et al. Biol Review, 2004:849-869
The inanimate environment is a
reservoir of pathogens
Recovery of MRSA, VRE, CNS. C.diff and GNR
Devine et al. Journal of Hospital Infection. 2001;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2002
Walther et al. Biol Review, 2004:849-869
Transfer of VRE via HCW Hands
16 transfers (10.6%) occurred in 151
opportunities.
•13 transfers occurred in rooms of
unconscious patients who were unable to
spontaneously touch their immediate
environment
Duckro et al. Archive of Int Med. Vol.165,2005
Alcohol based hand hygiene
Easy to use
Quick
solutions
Very effective antisepsis due to bactericidal properties of alcohol
Impact of alcohol based hand
sanitizers at VCU: can this
improve hand hygiene?
Study Algorithm
Incremental Increase in Alcohol
Dispensers
Hand Hygiene
Educational
Program
Implemented
Direct Observation of Hand Hygiene
Arch Intern Med. 2000;160:1017-1021.
Results
Hand hygiene practice can be improved with education
and greater accessibility of alcohol hand sanitizers
•Improvement in Hand Hygiene Compliance
Arch Intern Med. 2000;160:1017-1021.
Hand Hygiene
• Single most important method to limit cross
transmission of nosocomial pathogens
• Multiple opportunities exist for HCW hand
contamination
– Direct patient care
– Inanimate environment
• Alcohol based hand sanitizers are ubiquitous
– USE THEM BEFORE AND AFTER PATIENT
CARE ACTIVITIES
How are we improving
compliance with IC
recommendations for your
patients in the ICU?
Measurement and
feedback of
infection control
process measures
in the intensive
care unit: impact on
compliance.
Mezgebe Berhe MD1, Mike Edmond MD, MHA, MPH1,2,
Gonzalo Bearman MD, MPH1,2
Divisions of Infectious Diseases1 and Quality Health
Care2
Department of Internal Medicine
Virginia Commonwealth University School of Medicine
Richmond, VA, USA
Conferencia anual de SHEA, Los Angeles, California
Measurement and feedback of infection control process
measures in the intensive care unit: impact on
compliance.
-
• To measure selected infection control
process measures
• To feedback the results of process indicator
measurement to ICU leadership
• To assess the impact of feedback on
compliance with infection control process
measures
Mezgebe Berhe MD1, Mike Edmond MD, MHA, MPH1,2, Gonzalo Bearman MD, MPH1,2
Measurement and feedback of infection control
process measures in the intensive care unit: impact
on compliance.
• Selected Infection Control Process Measures:
– Hand Hygiene
– Femoral Catheter use as proportion of CVC days
– Proportion of Head of bed (HOB) elevations in medical
(MRICU) and Surgical (STICU) Intensive Care Units
• All Data Collected by ICPs
– Baseline data- April-June 2004
– Follow up- 3rd, 4th quarters of 2004, 1st quarter 2005
– Baseline and follow up data presented to ICU nurses
and Physician staff
• Differences in proportions analyzed for
significance by Chi-Square Method
Mezgebe Berhe MD1, Mike Edmond MD, MHA, MPH1,2, Gonzalo Bearman MD, MPH1,2
Measurement and feedback of infection
control process measures in the intensive
care unit: impact on compliance.
MRICU
STICU
Baseli
ne
Q22004
Q3
(2004
Q4
(2004)
Q1
(2005)
P
value*
Process
Measure
Baseline
Q2-2004
Q3
(2004)
Q4
(2004)
Q1
(2005)
P
value*
HH %
Opp
14/44
(32%)
31/91
(37%)
33/91
(36%)
50/108
(46%)
0.101
19/38
(50%)
42/80
(53%)
40/80
(50%)
49/100
(49%)
0.916
HOB %
Opp
28/51
(55%)
320/333
(96%)
450/45
4
(99%)
551/556
<0.001
20/43
(47%)
229/30
7
(75%)
389/48
8
(79%)
275/36
1
(76%)
<0.001
Fem.
CVC
% of
Days
195/1093
(18%)
130/769
(16%)
80/879
(9.1%)
51/951
(5.4%
<0.001
93/110
9
(8.4%)
49/970
(5.1%)
14/107
7
(1.3%)
26/920
(2.8%)
0.01
(99%)
Mezgebe Berhe MD1, Mike Edmond MD, MHA, MPH1,2, Gonzalo Bearman MD, MPH1,2
Measurement and feedback of infection control process
measures in the intensive care unit: impact on compliance.
• Feedback of process measures:
• lowered the use of femoral catheters
• Improved the proportion of elevated HOBs in
both ICUs
• There was no significant improvement in hand
hygiene.
• System level changes such as catheter
placement and HOB elevation appears to be
impacted by feedback whereas individual level
practices such as hand hygiene were not affected
Mezgebe Berhe MD1, Mike Edmond MD, MHA, MPH1,2, Gonzalo Bearman MD, MPH1,2
Conclusion
• Much like other critically ill patients, solid organ
transplant recipients are prone to nosocomial
infections.
• Even in solid organ transplant recipients, the NI risk
factors, pathogens and the preventive measures are
the same as for non-transplant recipients
• The major nosocomial infections are:
– BSI
– Hospital acquired pneumonia
– Hospital acquired UTI
• The principal NI pathogens are bacterial and
represent colonizing or nosocomial pathogens
–
–
–
–
S.aureus
Enterococci- VRE
Enterobacteriaciae
P.aeruginosa
Conclusion
• Risk reduction strategies are well defined in the
literature
– Lack of adherence to IC measures is recognized as
important in the pathogenesis of NIs
• System level changes involving the measurement
and feedback of adherence to IC measures are
needed to implement risk reduction strategies
consistently
– BSI: comprehensive catheter use/care
– VAP: HOB elevation
– UTI: catheter insertion, care and silver impregnated
catheters
– Hand Hygiene- alcohol based sanitizers
• Selective antibiotic prophylaxis may be warranted in
certain cases involving:
• Lung transplants, Liver Transplants, Kidney Transplants