Health care associated infection


  • Hospital care associated infection

Nosocomial infection

Definition

These are the infections that occur in a healthcare setting that a patient didn’t have before they come in.

Characteristics of HCAI

With-in 48 or more hrs. after admission.

Within 3 days after discharge.

With-in 30 days after an operation. 

Source of infection

Host susceptibility

Intrinsic factor

Immunocompromised state

Immunosuppressive medication

Presence of co-morbidity

Severity of illness

Normal flora

Contaminated health care facility

Health care worker related factor

Invasive device

Factors determining HCAI

Host factors

Old age

Debilitation

Immunosuppression

Microorganism

Multidrug resistant

Virulence factor 

Procedures

Diagnostic

Therapy

Care

Rehabilitation

Hospital setting

Space

Ventilation

Cleanliness

Impact of HCAI

Increase :

Hospital stay

Financial burden

Antimicrobial resistant

Morbidity

Mortality

Effect quality of life

Types of HCAI

CLABSI- central line associated blood stream infection

CAUTI- catheter associated urinary tract infection (most common)

VAP- ventilator associated pneumonia

SSI- surgical site infection

CAUTI

Catheter associated urinary tract infection

Definition

CAUTI is an infection, involving any part of the urinary system, including urethra, urinary bladder, ureters, kidney.

Most common type of HCAI.

Pathogenesis

The route of infection in CAUTI is ascending.

Extraluminal- before insertion, Intraluminal.

Contamination of the junction b/w foley’s catheter and drainage bag.

Catheterization

Contamination

Adherence of microorganism

Bio film

CAUTI

Direct effect of urinary catheter on bladder

Mechanical trauma

Local inflammation

Increase risk of infection

 CAUTI

Risk factor

Prolonged use.

Criteria

48 hrs.

Patient has at least one of the sign and symptoms:

fever> 38℃

Suprapubic tenderness

Costovertebral angle pain or tenderness

Urinary urgency

Urinary frequency

Dysuria

Patient has urine culture with no more than two species of organisms.

Care preventive measures

Hand hygiene and standard precautions.

Use the indwelling urinary catheter only when it is indicated.

During insertion follow strict aseptic technique.

Routine catheter care and maintenance.

Make sure the unobstructed flow of urine.

Nurses/health care worker handling the patient with catheter must be trained and skilled.

Assess the need for removal.

Latex foley catheter used for 14 days.

Silicon foley catheter used for 12 weeks/90 days.

SSI

Surgical site infection

Definition

Infection that occurs after surgery in the part of body, where the surgery took place.

Classification

Based on Etiology

Primary: acquired from endogenous source.

Secondary: acquired from OT or ward.

Based on depth of wound

Superficial SSI up to skin and subcutaneous tissue.

Deep incision SSI up to fascia and muscle.

Organ SSI up to organ.

Based on severity

MINOR: may discharge pus or infected serous fluid but should not be associated with excessive discomfort, systemic sign.

MAJOR: need a secondary procedure to drain pus.

Risk factors

Patient factor

Old age

Immunosuppression

Diabetes, renal failure

Malnutrition

Smoking

Anemia

Steroid use

Operative factor

Pre-operative shaving/poor part preparation

Length of operation

Foreign material in surgical site

Poor wound closure

Breech in sterility

Sources of SSI

Exogenous source- contaminated hands, instruments or implants.

Endogenous source- bacteria released into wound, patient’s own skin flora.

Common microorganism for SSI

Staphylococcus

Streptococcus

Pseudomonas

E.coli

Preventive measures

Pre-operative:

Pre-operative bathing

Bowl and bladder preparation

Part preparation

Follow aseptic technique

Glucose level

Intra operative:

Painting of the surgical part

Use of sterile draping and properly draping

Antibiotic prophylaxis

Ensure patient should be normothermic

Blood glucose <200mg/dl

Post operative:

Target glucose<200mg/dl

Normothermic

IV fluid administration

Nutrition support

Follow strict aseptic technique

SSI care bundle

Bath

Part preparation

Blood sugar

Temperature

Antibiotic prophylaxis

VAP

Ventilator associated pneumonia

Definition

It is pneumonia that develops 48 hours or longer after mechanical ventilation is given by an ET tube. VAP results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms.

Risk factors

Host related factors

Underlying medical condition

Old age

Immunosuppression

Malnutrition

Body position

Sedation  

Device related factors

ETT/TT intubation

NPA/OPA

Prolonged intubation

No. of intubation

Health care worker related

Poor hand hygiene

Not using appropriate PPE

Fails to follow basic standard precautions 

Common microorganism

Pseudomonas

Pathogenesis

Bacteria enter the lower respiratory tract via-

Aspiration of organisms from the oropharynx & GI.

Direct inoculation.

Inhalation of bacteria.

Preventive measures

Hand hygiene

Oral care

Elevated head of bed

Suctioning

Feeding

Daily sedation vacation and daily assessment of readiness to wean

  • CLABSI

Central line associated blood stream infection

Introduction

It is a laboratory confirmed bloodstream infection(BSI) in a patient who had a central line within 48 hrs period before the development of BSI and that is not related to an infection at another site.

Risk factors

Patient/host related-

Increasing severity of illness.

Compromised integrity of skin.

Presence of distant infection.

Catheter related-

Risk of BSI increase with increasing lumen no.

For non-tunneled catheter risk of BSI varies by anatomical sites- max. for groin insertion, intermediate for neck insertion and lowest for chest or upper extremity insertion.

Healthcare worker related-

Risk increases after breaks in aseptic technique during placement and maintenance.

Pathogenesis

Invasion of skin organism at the insertion site into catheter tract.

Direct contamination of catheter or catheter hub.

Hematogenous spread of infection from another focus.

Common microorganism

Coagulase –ve staphylococcus

Preventive measures

Hand hygiene

Need for the line

Dressing

Site cleaning- 2% chlorhexidine

Hub decontamination – 70% isopropyl alcohol