DEVICE RELATED NOSOCOMIAL INFECTION IN ICU

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DEVICE RELATED NOSOCOMIAL INFECTION IN ICU
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Part I

• BACKGROUND
• VENTILATOR ASSOCIATED
• PNEUMONIA

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Dr. MOUSTAFA ARAFAASSOSIATE PROF. OF
EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTH
ALEXANDRIA UNIVERSITY E-mail

• MAHA NAGA
• NURSING SPECIALIST
• ALEXANDRIA UNIVERSITY STUDENT HOSPITAL
• E-mail

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BACKGROUND

• Nosocomial infections have been recognized
  for over a century as a critical problem
  affecting the quality of health care and a
  principal source of adverse healthcare outcomes.
• Patients hospitalized in ICUs are 5 to 10
  times more likely to acquire nosocomial
  infections than other hospital patients.

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• On the other hand the Nosocomial infections
  that are preventable , perhaps
• between 30 and 50 percent , are primarily
  caused by problems in patient care practices ,
  such as the use and care of urinary catheters ,
  and respiratory therapy equipment , as well as
  hand washing practices and surgical skill.

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DEFINITIONS

• NOSOCOMIAL INFECTION
• An infection acquired in a patient in a hospital
  or other healthcare facility in whom it was not
  present or incubating at the time of admission or
  the residual of an infection acquired during a
  previous admission.

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DEVICE RELATED NOSOCOMIAL INFECTION

• A device-associated infection is an infection in
  a patient with a device (i.e., central line,
  ventilator, or indwelling urinary catheter) that
  was in use within the 48-hour period before onset
  of infection. If the interval since
  discontinuation of the device is longer than 48
  hours, there must be compelling evidence that
  infection was associated with device use.

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RISK FACTORS

• operative surgery
• intravascular and urinary catheterization
• mechanical ventilation of the respiratory tract
• Other risk factors include traumatic injuries,
  burns, age (elderly or neonates),
  immuno-suppression and existing disease

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VENTILATOR ASSOSIATED PNEUMOINA

• Patients receiving continuous, mechanically
  assisted ventilation have 6-21 times the risk for
  acquiring nosocomial pneumonia compared with
  patients not receiving ventilatory support .

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• Pneumonia cases account for 15
• to 20 of nosocomial infections but is
  responsible for 24 of extra hospital days and
  39 of extra cost .
• Nosocomial pneumonia is associated with
  mortality rate up to 50 in ICUs .

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RISK FACTORS

• Intubation .
• altered levels of consciousness ,
  especially those with nasogastric
  tubes .
• elderly patients .
• chronic lung disease .
• postoperative patients .
• any of the above patients taken H2-
  blockers or antacid .

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CRITERIA FOR DIAGNOSIS

• fever.
• cough.
• development of purulent sputum, in conjunction
  with radiologic evidence of a new or progressive
  pulmonary infiltrate.
• a suggestive Gram stain, and positive cultures
  of sputum, tracheal aspirate, pleural fluid, or
  blood.

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MICROBIOLOGY

• Pneumonias are mostly caused by
• Legionella sp.
• Aspergillus sp.
• influenza virus .

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PREVENTION AND CONTROL MEASURES

• Most of the risk factors can be prevented and
  controlled with a little effort and performing
  some policies in the unit as
• - use either prophylactic local application of
  antimicrobial agent(s) or local bacterial
  interference .
• - use Sucralfate, a cytoprotective agent as a
  substitute for antacids and H-2 blockers.

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• - Prevent Aspiration of oro-pharyngeal and
  Gastric Flora by
• 1-Placing the patient in a semi-recumbent
  position.
• 2-Administering enteral nutrition
  intermittently in small boluses rather than
  continuously.
• 3- Using flexible, small-bore enteral tubes .
• 4-Placing the enteral tube below the stomach
  (e.g., in the jejunum).

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• -Perform hand washing before any procedure , wear
  gloves .
• -Proper cleaning and sterilization or
  disinfection of reusable equipment .
• -The recommended daily change in ventilator
  circuits may be extended to greater than or equal
  to 48 hours.

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• - Prophylaxis with Systemic anti-microbial
  agents.
• - Use of "Kinetic Beds" or Continuous Lateral
  Rotational Therapy (CLRT) for Immobilized
  Patients.

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SUGGESTED FURTHER READINGS

• Surveillance of nosocomial infections
• Risk Factors and Outcome of Nosocomial
  Infections Results of a Matched Case-control
  Study of ICU Patients

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• Guideline for Prevention of Nosocomial Pneumonia
• The Attributable Morbidity and Mortality of
  Ventilator-Associated Pneumonia in the Critically
  Ill Patient