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Download What are nosocomial (hospital acquired) infections?
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Risks of hospitalization Petra Sedlářová Jana Heřmanová Sentinel events http://www.youtube.com/watch?v=2kCG IcFEB68&feature=related What are nosocomial (hospital acquired) infections? All infections that the patient acquires during hospitalization The patient did not have any signs of the disease (obvious or latent) before hospitalization, it is not related to the admitting diagnosis The cost of nosocomial infections Increase in morbidity and mortality Worsening of life quality Prolonged hospitalization Increase in health care costs Loss of life Most common infection sites Urinary tract Respiratory tract Bloodstream Wounds Contributing factors Insufficient preventive measures Overuse of antibiotics Aging population Development of diagnostic and treatment technologies Complicated surgical procedures Intensive care Oncology treatments Transplantations ... Patient’s factors Immunodefficiency Invasive procedures Resistant bacteria The place of origin Exogenous – hospital environment or personnel Endogenous – the patient himself – Normal flora that becomes aggressive in case of immunity impairment – Escherichia coli, Staphylococcus aureus, enterococci Prevention of endogenous infections Proper antibiotic therapy, based on culture results Immunostimulation therapy Prevention of exogenous infections Obeying hygiene and epidemiologic guidelines Barrier nursing care Prevention can decrease the occurrence of the infections by 1/3 Reporting infections It is obligatory – the hospital epidemiologist What to do during admission Thorough medical history If the infection cannot be ruled out the patient is admitted to the observation room + further examinations When the infection is confirmed the patient is put in isolation or admitted to infectious diseases department Barrier nursing Protects the patients as well as the staff Handwashing Cleaning, disinfecting and sterilizing Using protective equipment – gloves – uniform (washed in the hospital laundry) – lab coats, drapes, face shields, goggles, caps Bed linen – Place into proper containers – Do not mix with clean linen (the storage and transport) Body fluids, used instruments, other material – Prevent contamination of outer surfaces of lab tubes – Use safe equipment (eliminate injuries) – Sharps and needles into special containers – Red bag for infectious waste Do not cause infectious aerosol and dust Individual equipment for patients Isolate infectious patients or patients at risk Thorough sterilization of used instruments, equipment, material Disinfection of the environment Specific measures in preventing respiratory infections Prevent aspiration of contaminated material Change ventilation systems and nebulizers every 24 – 48 hours Use sterile water into nebulizers Use disposable or separate inhalers for patients, dry thoroughly after cleaning Aseptic suctioning technique Prevention of UTI Keep urinary catheterization to a minimum Proper insertion and care of indwelling catheter Good perineal care Prevention of infections related to intravascular cannulas and catheters Aseptic insertion technique Proper insertion site care – Dressing – Changing insertion sites every 2 – 3 days – Tubing changes – Strict aseptic procedure when handling central venous catheters Prevention of wound infections Good operative technique, wound debridement, aseptic techniques during dressing changes, personnel with active infection will not take care of patients in surgery Antibiotic prophylaxis Antibiotic therapy Cleaning and disinfection Standard units –1x daily OR – at the beginning of shift and after each client ICU, labs - 3x daily Following disinfection guidelines Painting and „big cleaning“ – 1-2x yearly or more often when needed Waste disposal All waste removed from unit daily Remove waste immediately from patient’s bedside Mark waste that can cause injuries – hard, locked containers that can be disposed of in furnace What about the staff? It is obligatory to report infectious disease in family Dress code Use gloves any time there may be contact with body fluids Before cleaning equipment decontaminate it with anti-viral agent Personal hygiene guidelines Disinfecting Disinfectants and antiseptics are chemical solutions with bactericidal or bacteriostatic properties Disinfectant is used on inanimate objects Antiseptics are used on skin or tissue Disinfections protocols Use proper disinfectant (targeting) Consider recommended concentration and time of exposure Remove soap first, some disinfectants are ineffective with soap Remove organic material (blood, saliva, sputum, pus, excretions) Treat all surfaces and areas Sterilization Destroys all organisms including spores and viruses Common methods: – Heat – Gas – Boiling water – Radiation Moist heat Steam under pressure (autoclaves, 121 - 123ºC, pressure 15 to 17 pounds Free steam 100ºC (when autoclave would destroy objects) Gas Ethylene oxide gas interferes with metabolic processes of microorganisms, effective against spores Can be used for heat-sensitive items It is toxic to humans Boiling water Practical and inexpensive in the home Does not kill viruses and spores Boil for minimum of 15 minutes Radiation Ionizing and nonionizing (ultraviolet light) Ionizing is used to sterilize food, drugs and other items sensitive to heat It can be very expensive Isolation precautions (CDC and prevention) Measures designed to prevent spread of microorganisms to patients, personnel and visitors Several types of precautions – – – – – – Category specific Disease specific Universal Body substance isolation Standard Transmission based Universal precautions (1987) Used with all patients Targeted to blood/borne pathogens – Hepatitis B, C – HIV Used in conjunction with other precautions Category specific Strict isolation Contact isolation Respiratory isolation Tuberculosis isolation Enteric precautions Drainage/secretions precautions Blood/body fluid precautions Disease specific Specially equipped rooms Sharing rooms with patients with same pathogens Wearing gowns by personnel Body substance isolation (1993) For all clients except those with diseases spread through the air Based on three premises: – All people have an increased risk for infection placed on their mucous membranes and nonintact skin – All people are likely to have potentially infectious microorganisms in their moist body sites and substances – An unknown number of clients and staff will be always colonized or infected Standard precautions (1996) Used with all hospitalized patients Apply to blood, all body fluids, secretions, excretions except sweat, non/intact skin, mucous membranes Transmission based precautions Airborne precautions – droplets <5 microns (measles, varicella, tuberculosis) Droplet precautions – droplets >5 microns (diphteria, pertussis, mumps, rubella, streptococcal pharyngitis, pneumonia, scarlet fever in infants and young children) …transmission based Contact precautions – transmission by direct client contact or by contact with items in the client’s environment GI, respiratory, skin, wound infections or colonization with multidrug-resistant bacteria (Clostridium difficile, enterohemorrhagic E.coli, Shigela, hepatitis A, respiratory syncytial virus, parainfluenza virus, scabies, herpes simplex, impetigo etc.), VRE, MRSA Risk for fall http://www.youtube.com/watch?v=DhPZ MUfU6Ps Causes, assessment, prevention