Infection control Bundle-of-Care-Final-Ppt.pptx

Definition of bundle of care
Importance
Types and implementation

1. BUNDLE OF CARE ( Infection Prevention and Safety)

2. HEALTHCARE-ACQUIRED INFECTIONS Healthcare-Acquired Infections (HAIs), sometimes called Healthcare-Associated Infections, are infections that we get while receiving treatment at a healthcare facility, like a hospital, or from a healthcare professional, like a doctor or nurse. Official Website of the State of Rhode Island© 2024 Department of Health, Public Health Accreditation Board Certified

3. INCIDENCE OF HOSPITAL ACQUIRED INFECTION

4. WHAT IS BUNDLES OF CARE? Care “bundles” are simple sets of evidence-based practices that, when implemented collectively, improve the reliability of their delivery and improve patient outcomes. Resar R, Pronovost P, Haraden C, Simmonds T, et al. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Joint Commission Journal on Quality and Patient Safety. 2005;31(5):243-248.

5. IMPORTANCE OF CARE BUNDLE

6. IMPORTANCE OF CARE BUNDLE Benefit to the patient Shorter ICU stay Reduced financial cost Improves resource utilization Best clinical practice Clinical effectiveness

7. ELEMENTS OF BUNDLE OF CARE

8. ELEMENTS OF BUNDLE OF CARE Central Line Associated Blood S team Infection (CLABSI) Catheter Associated Urinary Tract Infections (CAUTI) Ventilator-associated Pneumonia (VAP) Surgical Site Infections (SSIs)

9. SCIENTIFIC SESSION : I

10. Central Line Associated Bloodsteam Infection (CLABSI)

11. INTRODUCTION Central Line-Associated Bloodstream Infection (CLABSI) is a type of healthcare-associated infection that occurs when bacteria or other pathogens enter the bloodstream through a central venous catheter (CVC) or central line. A central Line associated blood stream infection is a laboratory confirmed blood stream infection (BSI) in a patient who had a central line within the 48 hours period before the development of BSI, and that is not related to an infection at another site.

12. CLINICAL MANIFESTATION : The patient has at least one of the following signs and symptoms within 24 hours of a positive blood culture being collected: Fever > 100.4 °F Chills or Rigors Hypotension

13. RISK FACTORS :-

14. CLABSI RISK FACTORS : Multiple catheters and/or multiple lumens. Prolonged duration of CVC Prolonged hospital stay prior to CVC insertion Excessive manipulation of the catheter. Neutropenia Total parenteral nutrition Hematological and Immunological deficient patients

15. CARE BUNDLE TO PREVENT CLABSI INFECTION Insertion care bundle Maintenance care bundle Use single lumen unless indicated otherwise Review need for CVC on a daily basis and remove promptly if not required Use maximal sterile barrier precautions during insertion Inspect CVC site on daily basis for sign of infection Avoid femoral site; Subclavian vain is the preferred site Use aseptic technique for daily care (e.g. hand hygine before accessing the device and use of sterile single use antiseptic solution to disinfect hub) Disinfect skin with single use sterile solution of 2% Chlorhexidine gluconate in 70% isopropyl alcohol and allow to dry Use transparent dressing for 7 days

16. COMPREHENSIVE BUNDLE FOR THE PREVENTION OF CLABSI: Proper Catheter Insertion Site Selection and Dressing Catheter Maintenance Daily Catheter Assessment Hand Hygiene Antiseptic Catheter Hub Cleansing Catheter Replacement Staff Education and Training Patient and Family Education

17. CHECKLIST FOR CLABSI

18. SCIENTIFIC SESSION : II

19. Catheter Associated Urinary Tract Infections (CAUTI)

20. INTRODUCTION The centre for disease control and prevention (CDC) mentioned that, catheter associated urinary tract infections(CAUTI) were the most common health care associated infections.  CAUTI increase patients mortality, morbidity, length of hospital stays and cause an economic burden to the health care system.

21. DEFINITION CAUTI is defined as a urinary tract infection in a patient with current urinary tract catheterization or who has been catheterized in the past 48 hours. These infections are most likely caused by bacteria entering the body during catheter insertion, as a result of prolonged or unnecessary use of urinary catheters, or due to a disruption in the closed drainage system.

22. IMPACT OF CAUTI According to National health safety network every year more than 30% of hospital acquired infection are reported. Estimated more than 5,60,000 nosocomial UTIs are reported annualy . Among UTIs acquired in the hospital, approximately 75% associated with a urinary catheter. Excess length of stay 2-4 days. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay.

23. IN OUR COUNTRY CAUTI rate was 9.4 per 1000 urinary catheter days, while the overall magnitude was 14.67%. It was predominantly reported in 51-70-years age group (34%), and females (63.63%) outnumbered males (36.36%), with Escherichia coli being the commonest pathogen. The highest incidence was reported in the 3rd week of catheterization with diabetes being a predominant risk factor (17.24%). Parihar S, Sharma R, Kinimi SV, Choudhary S. An Observational Study from Northern India to Evaluate Catheter-associated Urinary Tract Infection in Medical Intensive Care Unit at a Tertiary Care Center. Indian J Crit Care Med 2023;27(9):642-646.

24. CAUSATIVE ORGANISM OF CAUTI

25. APPROPRIATE INDICATIONS FOR URINARY CATHETERS

26. RISK FACTORS FOR CAUTI Older age Female gender Prolonged catheterization>6 days Impaired immunity Disconnection drainage system Meatal colonization Catheter insertion done outside the operating room

27. SYMPTOMS Fever with temperature >38°◦C (100.4f) Suprapubic tenderness Costovertebral angle pain or tenderness Urinary urgency+ Urinary frequency+ Dysuria+

28. COMPLICATIONS OF CAUTI Urinary catheter obstruction Bladder urolithiasis Purulent urethritis Prostatitis Mechanical trauma

29. PREVENTIVE MEASURES FOR CAUTI CORE MEASURES Placement only for appropriate indications. Leave catheters in place only as long as needed. Catheter should be inserted and maintained by proper trained healthcare professional. Maintain asepsis technique during insertion. Maintain a closed drainage system. Maintain unobstructed urine flow. Perform hand hygiene and follow standard precautions.

30. SUPPLEMENTAL MEASURES TO PREVENT CAUTI Alternatives to indwelling catheterization Portable bladder ultrasound scanner Intermittent catheterization Use of antimicrobial/antiseptic catheters

31. Take home message ! Remember C.A.U.T.I. TO prevent CAUTI C= Catheter removal A= Aseptic insertion U= Use regular assessments T= Training for catheter care I= Incontinence care planning Remember: No catheter means no CAUTI!

32. SCIENTIFIC SESSION : III

33. Ventilator-associated Pneumonia (VAP)

34. Introduction Ventilator-associated pneumonia (VAP) is a serious and often life-threatening infection that occurs in patients who are on mechanical ventilation in hospitals. It is 2 nd most common nosocomial infection (15%) of all hospital acquired infections. Occurs in 25% of intubated patients.

35. DEFINITION :- Ventilator-associated pneumonia (VAP) is a type of pneumonia occurring in a patient within 48hrs or more after intubation with an endotracheal tube or tracheostomy tube and which was not present before.

36. TYPES - Early onset – Less than 96hrs of intubation - Hemophilus influenza - Streptococcus pneumoniae - Staphylococcus aureus ( methicillin sensitive ) Late onset – More than 96hrs of intubation - Pseudomonas aeruginosa - Staphylococcus aureus (methicillin resistant)

37. Clinical DIAGNOSTIC STRATEGIES OF VAP Xie X, Lyu J, Hussain T and Li M(2019) Drug Prevention and Controlof Ventilator-Associated Pneumonia.Front. Pharmacol. 10:298.

38. COMPLICATIONS :- Acute Respiratory Distress Syndrome (ARDS) Sepsis Pulmonary embolism Pulmonary edema Barotrauma Empyema

39. Prevention of Ventilator-Associated Pneumonia (VAP) Hand Hygiene Elevation of the Head of the bed ( 30 to 45 degree ) Daily sedation vacation and daily assessment of readiness for extubation. Peptic ulcer disease prophylaxis DVT prophylaxis unless contraindicated Oral care ( 2% chlorhexidine mouthwash) Aseptic suctioning according to ICU protocols Mobility and chest physiotherapy as per ICU protocols. HME filter and ventilator tubing to be changed as per protocol.

40. Hand Hygiene

41. Patient bed elevation

42. Daily sedation vacation

43. Peptic ulcer disease prophylaxis

44. (Pneumatic compression device ) (Stocking device)

45. SCIENTIFIC SESSION : IV

46. Surgical Site Infections (SSI)

47. INTRODUCTION Surgical site infections (SSIs) represent one of the most common perioperative infections worldwide. It has an incidence of 2-5%. It is the most common nosocomial infection amongst surgical patients, and the third most common nosocomial infection. There is considerable financial impact of SSIs on the healthcare system due to increased length of stay in hospital by 7-10 days, increased number of surgical interventions, increased duration of medical therapy, prolonged ICU and High Care Unit admission and increased mortality and morbidity. SSIs can lead to long term loss of function and decrease ability to return to work. It may also cause permanent disability. https://anaesthetics.ukzn.ac.za/Libraries/ICU_1/FMM_No_22_30-09-2016_Surgical_Site_Infections_-_I_Alturki.pdf

48. What is Surgical Site Infections (SSI)? SSI is an infection that occurs after surgery in the part of the body where the surgery took place. It occurs within 30 days post-surgery or up to a year in case of an implant. Drug-resistant SSIs are also becoming a significant issue in emerging countries like India, owing to congested hospital environments, irrational antibiotic prescriptions, and inadequate infection prevention and control systems. Begum PR, Rajeshkumar R, Manigandan V, et al. The Emerging Paradigm of Antimicrobial Resistance in Surgical Site Infections of the Nilgiris Region. J Pure Appl Microbiol. 2023;17(2):900-910. doi: 10.22207/JPAM.17.2.16

49. CLASSIFICATION OF SSI SSI typically occurs within 30 days after surgery. It is of 3 types. Superficial incisional SSI: -It Involves only skin and subcutaneous tissue of the incision. Deep incisional SSI: - This infection involves muscle layers and the soft tissues surrounding the muscles. Organ or space SSI: - This type of infection can be in any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. This includes a body organ or a space between organs.

50. Classification of surgical site infection according to the CDC (Center of Disease Control) Köhler F, Reese L, Kastner C,Hendricks A, Müller S, Lock JF,Germer C-T and Wiegering A (2022)Surgical Site Infection FollowingSingle-Port Appendectomy: ASystematic Review of the Literatureand Meta-Analysis.Front. Surg. 9:919744.

51. Risk factors for developing SSI Patient factor Older age Immunosuppression Obesity Diabetes mellitus Chronic inflammatory process Malnutrition Peripheral vascular disease Smoking Anaemia Radiation Steroid use

52. Local factor Poor skin preparation Contamination of instruments Inadequate antibiotic prophylaxis Prolonged procedure Local tissue necrosis Hypoxia Hypothermia

53. Symptoms include: Redness Localised Pain Erythema Discharge of pus or fluid from the wound. Fever

54. Prevention of SSI Pre-op Factors Preoperative antiseptic showering Pre-operative hair removal Patient skin preparation in the operating room Preoperative hand/forearm antisepsis Antimicrobial prophylaxis. Glycaemic control

55. Intra-operative Factors Operating room temperature – 68 ͦ- 73 ͦ, Humidity – 30% - 60% Surgical attire and wearon Aseptic surgical technique Post-operative Factors Incision care Changing Dressings

56. Bundle for the prevention of surgical site infections (SSIs) Preoperative Optimization: Preoperative screening (comorbidities such as diabetes and obesity, smoking cessation, and appropriate preoperative antimicrobial prophylaxis) Surgical Site Preparation: antiseptic solutions- chlorhexidine or iodine-based agents Hair Removal: Avoid use of razors for hair removal, Use clippers or depilatory creams help minimize the risk of skin abrasions

57.  Normothermia Maintenance: Maintaining normothermia intraoperatively through the use of warming devices, warmed intravenous fluids, and appropriate room temperature control helps optimize tissue perfusion and reduce the risk of SSIs.  Glycemic Control: Implementing strict glycemic control measures, particularly in diabetic patients , helps minimize the risk of hyperglycemia- related immunosuppression and reduces the likelihood of SSIs.  Antibiotic Prophylaxis: Administering appropriate antimicrobial prophylaxis within the appropriate timeframe before incision, adhering to recommended dosages and duration, and selecting agents based on surgical site and local resistance patterns help prevent SSIs.

58.  Surgical Technique: including gentle tissue handling, atraumatic tissue manipulation, and appropriate hemostasis, helps minimize tissue trauma and reduce the risk of contamination  Surgical Site Draping: Utilizing sterile surgical drapes and adhesive incise drapes that maintain a sterile field and minimize the risk of microbial contamination from surrounding skin surfaces helps prevent SSIs.  Postoperative Wound Care: Implementing appropriate postoperative wound care measures, including regular inspection, monitoring for signs of infection, and timely removal of surgical dressings , helps facilitate wound healing and prevent SSIs.

59. TAKE HOME MESSAGE !

60. THANK YOU