Professional Documents
Culture Documents
INFECTIONS – PREVENTIVE
MEASURES
Asja Jaklič
University Medical Centre Ljubljana
Department of Infectious diseases and Febrile
Ilnesses
Intensive care unit
SLOVENIJA
INTRODUCTION
After admission to a hospital patient expects to get better
45%
40% UTI
35%
SSI
30%
25% PNEUMONIA
20%
15% BACTEREMIA
AND SEPSIS
10%
OTHER
5%
0%
WAYS OF TRANSMISSION
Contact
– direct; most frequently - hand to hand
contamination from medical staff
- Indirect; through medical equipment
Airborne (droplets or aerogen)
Bloodborne at transfusion or needlestick
injuries
Common carrier: food, water, drugs
HAI PREVENTION
HAND HYGIENE (DISINFECTION, hand
washing, using gloves)
Isolation – following strict protocols
Sterilization and disinfection
Infection control – epidemiologists
Medical staff education
UTI PREVENTION AND URINARY
CATHETERS
UTI include sympthomatic UTI,
asympthomatic bacteriurias and others
1. Catheter insertion
2. Catheter /
drain tube connection 1
3
2
3. Drain tube /
bag connection
4. Drain spout
CRITRICAL SITES IN A
DRAINAGE SYSTEM
Catheter insertion
Catheter and bag connection
Sampling port
Drain spout
Urine reflux
CATHETERISATION METHODS
AND UTI RISKS
Single catheterisation – bacteriuria incidence in
1-5 % after a procedure
Intermitent catheterisation – less risk for
infection compared to inserted catheters
Short term catheterisation – up to 72 hrs,
incidence of bacteriuria at 10 – 20 % of patients
Long term catheterisation – over 72 hrs, risk for
bacteriuria is 5-10 % per catheterisation day
MEASURES FOR UTI
PREVENTION
General measures ( medical staff skills,
education, use of protocols, hand hygiene)
Catheters insertion only when indicated
Material choice – depends on indication and
estimated lenght of catheterisation
Postopki dela ( insertion and catheter
replacement, urine bag drainage and
replacement, closed drainage system use,
unobstructed urine flow, sampling, urine catheter
flushing, documentation)
URINARY CATHETERS –
material choice
PVC – intermitent catheterisation
Short term catheterisation – siliconised
latex or latex
Long term catheterisation (over 1month) –
100% silicone or teflon
Hydrogel Catheter for longer period 2-3
months
Silver or antibiotic coated catheters??
Centre for Disease Control
Recommendations
CATHETER CHOICE
1. Best type of catheterization
intermittent as associated with lower risk of infection and
keeps bladder working
2. Indwelling catheters
Preferably SPC
0-5 days - coated latex - encrustation/irritation
0-5 days or more - 100% silicone
- inert material
- better patient compliance
Size 10-12Fr No larger than 18Fr
URINARY DRAINAGE BAG
Closed system
Dry irreversable chamber or antireflux
valve
Urine sampling port ( needleless)
Drain spout at the bottom
Bag replacement – according to
hospital/institutional standard
Urinary bag drainage when 2/3 full
MINIMAL REQUIREMENTS FOR
UTI PREVENTION
Catheter insertion only if necessary
Education about insertion and catheter care
Sterile urinary catheter and sterile urinary drainage bag
Hand hygiene – disinfection
Aseptic technique
Urinary bag placed below the bladder level
Closed drainage system
Catheter fixation
Unobstructed urine flow
Ventilator Associated Pneumonia (VAP)
and Preventive Measures
Male gender
Age
COPD
Urgent surgery
Admission after trauma
VAP - Risk Factors for developing VAP
Mouth / oropharynx
Colonisation/Contamination of
equipment & accessories
Gastric bacterial overgrowth
Aspiration of oral and/or
gastric contents
Impaired mucociliary
clearance
Colonisation of tracheal tube
biofilm
Enteral tube
Transmission by staff
“Aspiration of oral and/or gastric secretions Previous pulmonary disease
Education of staff
Tracing VAP
Prevention of cross-contamination of microbes
Affecting Risk factors for VAP
Preventing legionella disease
Preventing transfer of aspergilus
Preventing virus transfer accordingly to transport
manners
Affecting patient’s response
Diagnosing and controlling epidemics
Non-Invasive Mechanical
Ventilation (NIV)
Indication: patients with acute respiratory failure, COPD
with acute exacerbation and cardiac insufficiency,
weaning from MV and less frequent for long-term NIV
Complications:
mask leak, skin
iritation/breakaga (nose or
face decubitus), eye
irritation, mucosa humidity
loss, uncomfortable, gastric
insuflation feeling
Handling and Changing
Equipment
Change if needed
Intubation and replacement done aseptically
Suctioning of secretion above the cuff (subglottic
suctioning)
Silver coated ET tubes
Sealing of the cuff
Solution: EVAC tube with
subglottic suctioning
Solution: EVAC tube with
subglottic suctioning
New ET tubes: cuff, design
Tracheal Cuff
Wall Creases
Polyurethane cuffed endotracheal
The Journal of Thoracic and
tubes to prevent early postoperative Cardiovascular Surgery: April 2008
pneumonia after cardiac surgery: a
pilot study.
Van de Velde, Gent, Belgium n = 164
Main Results: VAP was found in 31 of 140 (22.1%) patients in the ETT-C group
and 11 of 140 (7.9%) in the ETT-PUC-SSD group (p=0.001). Cox regression
analysis showed:
- ETT-C as risk factor for global VAP (Hazard Ratio=3.3; 95% confidence interval =
1.66-6.67; p=0.001),
- early-onset VAP (Hazard Ratio=3.3; 95% confidence interval = 1.19-9.09; p=0.02)
- late-onset VAP (Hazard Ratio=3.5; 95% confidence interval = 1.34-9.01; p=0.01).
Conclusion: The use of an endotracheal tube with polyurethane cuff and
subglottic secretion drainage helps prevent early and late-onset VAP.
Open suction:
Each suctioning new suction catheter,
collecting chamber
Replace connecting tube and Y-piece every 24 hours
solution)
Complications and risks of disconnections
Closed Suction:
Single patient use
medical staff
Minimizes contamination of patients’ environment
Spreading of micro-organisms
with open suctioning
R. Distler / Prof. Dr. B. Wille
Results on nursing staff 7 CFUs = ca. 2 %
22 CFUs
30 CFUs = 8 %
=6%
(right) (left)
Spreading of micro-organisms
with open suctioning R. Distler / Prof. Dr. B. Wille
Institute for Hospital Hygiene and Infection Control
Results on patients Gießen (Germany)
1 CFU
1 CFU
=5%
=5%
1 CFU 16 CFUs
=6% = 84 %
Blank test:
1-2 CFUs*/25 l air
With open
suctioning:
Average 126
CFUs /25 l air
(right) (left)
Patient Positioning
Follow protocols
Too late or incorrect antibiotic treatment increases
mortality
Use of wide-spectrum antibiotic and after 48-72 hours
evaluate antibiotic effect
Implementation of microbiologic cultures’ results
Medical Staff