Infection control in critical care units

INFECTION CONTROL PROTOCOLS BY Mrs.Keerthi Samuel

1. INFECTION CONTROL IN CRITICAL CARE UNIT Mrs. Keerthi Samuel Asst.Professor Vijay Marie CON

2. INTRODUCTION The intensive care unit (ICU) of the hospital has always been where the most vulnerable patients are kept, so they can be closely monitored and treated, often with a one-to-one ratio of nurse to patient, for the most scrupulous of care. Nosocomial infection comes from Greek work “ nosus ” meaning disease and “ komeion ” meaning “to take care” also called as “hospital acquired infection”.

3. DEFINITION An infection that occurs in a patient as a result of care at any type of health care facility and was not present at the time of arrival to the hospital. Infections are considered nosocomial if they first appear 48hrs or more after hospital admission or within 30 days after discharge.

4. Nosocomial infections accounts for 7% in developed and 10% in developing countries.Hospital waste serves as potential source of pathogens and about 20%–25% of hospital waste is termed as hazardous. The nosocomial infection was seen more in the 40-60 year of age. The male were more prone to nosocomial infections than the female. Infection rate is upto 5% to 10% but may be up to 28% in ICU UTI - 28%,Surgical site infection – 19%,Pneumonia – 17%,Blood steam infection – 7% to 10% INCIDENCE

5. Endogenous Patient own flora may invade patient tissue during some surgical operation or instrument manipulation Normal commensalism of the skin respiratory , urinary track Exogenous From another patient , staff members environment in the hospital Environmental sources are air, water, food Cross infection SOURCES OF INFECTION

6. CAUSATIVE ORGANISMS OF INFECTION

7. RISK FACTORS

8. Ventilator-associated pneumonia Staphylococcus aureus Methicillin resistant Staphylococcus aureus Candida albicans Pseudomonas aeruginosa Acinetobacter baumannii Stenotrophomonas maltophilia Clostridium difficile COMMON NOSOCHOMIAL INFECTIONS Tuberculosis Urinary tract infection Hospital-acquired pneumonia Gastroenteritis Vancomycin-resistant Enterococcus Legionnaires’ disease.

9. MAJOR HAI’S

10. Contact : Hand or clothing (staphylococcus aureus, streptococcus ) Instrument : endoscope, bronchoscope, (pseudomonas aeruginosa) Airborne : droplets of respiratory infection transmitted by inhalation, dust beding , floors, wound exudates & skin (pseudomonas aeruginosa, staphylococcus aureus) Aerosols : nebulizers humidifers & AC ( pneumophilia) MODE OF TRANSMISSION

11. Oral route : Hospital food may contain antibiotic resistant bacteria may colonize intestine can cause infection Parenteral route: Disposal syringes & needles , blood transfusion ( hepatitis B, HIV) MODE OF TRANSMISSION

12. Avoid surgical site infection An isolation unit for a patient infected by an infectious disease Sterilization of medical equipment Validation and cleaning of hospitals environment PREVENTION

13. PPE used in healthcare includes gloves, aprons, long sleeved gowns, goggles, fluid-repellant surgical masks, face visors and respirator masks. PPE

14. Prevention and implementation of infection control policies Supervision of state of professional care with regard to infections Surveillance of nosocomial infection Analyze, interpret and disseminate data arising out of surveillance and to recommend remedial measures and ensure follow up action Develop an antibiotic policy, To discuss infection control related audit findings and identify solutions to issues INFECTION CONTROL PROGRAMME

15. Formulate policies & protocols on the methods of sterilization and disinfection Employee health program Conduct in house orientation program Guidelines for segregation and disposal of hospital waste Conduct meeting every month (2 nd Wednesday of every month) INFECTION CONTROL PROGRAMME

16. Follow hand washing protocol Follow biomedical waste management Attend HICC related class Follow aseptic techniques while doing procedures Follow care bundle protocols to prevent nosocomial infections ROLE OF A NURSE

17. HAND WASHING

18. CAUTI BUNDLE

19. CLABSI BUNDLE

20. 7’S SSI PREVENTION BUNDLE

21. VAP

22. SURVEILLANCE FOR NOSOCOMIAL INFECTION Definition :The collection tabulation interpretation and dissemination of data on the occurrence of nosocomial infection or other untoward event for the purpose of their prevention and control Purposes: Establish baseline rate Evaluate polices and procedures Evaluate control measures Our break control Licensing

23. HOSPITAL INFECTION CONTROL COMMITTEE Every hospital must have an effective Hospital-acquired Infection Control Committee.Responsible for the control of HAIs The membership of the hospital ICC should reflect the spectrum of clinical services and administrative arrangements of the health care facility.

24. 1 .Chief executive, or hospital administrator or Medical superintendent (Chairperson). 2. Clinical microbiologist (Infection control officer). 3. Infection Control Nurse (ICN). 4. Infectious Diseases Physician (if available) 5. Chief of nursing services. 6. Medical record officer (if available). 7. Representative from the major clinical specialties. 8. Additionally representatives of any other department ( pharmacy,maintenance , housekeeping, etc) may be invited as necessary HOSPITAL INFECTION CONTROL COMMITTEE

25. To formulate & update policies on matters related to hospital infections Review and approve surveillance and infection prevention program, emergence of drug resistance Use of different antimicrobial agents Proper sterilization & disinfection procedures To assess and promote improved practice at all levels of health facility. To obtain and manage critical bacteriological data and information, including surveillance data FUNTIONS

26. To ensure appropriate staff training Safety management Development of policies for the prevention and control of infection To develop its own infection control manual Monitor and evaluate the performance of program To recognize and investigating outbreaks of infections in the hospital and community FUNTIONS

27. Promotion of hand hygiene Make best use of aseptic techniques Universal precautionary practices Patient’s education and Cleaning and disinfection practices. ROLE OF A NURSE

28. CDC guidelines for infection control in hospital personnel. American Journal of Infection Control, 2015, 26:289–354 Prevention of Hospital-Acquired Infections: A Practical Guide. 2nd Edition. World Health Organization; http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf Guideline for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention, Respir Care 2014; 39:1191. Eggimann P and Pittet D. Infection Control in the ICU. Chest . 2001;120:2059-2093. REFERENCES