NURSING MANANGEMENT

AND ADMINISTRATION
ASSIGNMENT
ON
STANDARD PROTOCOL OF THE
UNIT

Submitted to: Submitted by:

Mrs. Susan Johnson Ms. Nishalin Mawlot
Lecturer MSc. Nursing 2nd Year
Bel-Air College Bel- Air College
Of Nursing Of Nursing

Submitted on:
Remarks:
INFECTION CONTROL IN INTENSIVE CARE UNIT
Standard precautions are meant to reduce the risk of transmission of blood borne and other
pathogens from both recognized and unrecognized sources. They are the basic level of
infection control precautions which are to be used, as a minimum, in the care of all patients.

Hospital acquired infections (HAIs) are common in intensive care unit (ICU) patient and are
associated with increased morbidity and mortality. The main reason being severity of illness,
interruption of normal defence mechanism (e.g. mechanical ventilation), malnutrition &
inability to ambulate make it more susceptible to multi drug resistant organism (MDRO).

MODES OF TRANSMISSION

The most frequent mode of transmission is contact transmission, this may be direct or indirect
other modes include droplet transmission, airborne transmission, common vehicle such as
ventilator etc.

FACTORS CONTRIBUTING TO INFECTION IN ICU

 Age more than 70 years

 Shock
 Major trauma
 Acute renal failure
 Coma
 Prior antibiotics
 Mechanical ventilation
 Drugs affecting the immune system (steroids, chemotherapy)
 Indwelling catheters
 Prolonged ICU stay (>3 days).
 Protein-energy malnutrition

PREVENTION OF INFECTION IN INTENSIVE CARE UNIT

Hand hygiene

Hands are the most common vehicle for transmission of organisms and “hand hygiene” is the
single most effective means of preventing the horizontal transmission of infections among
hospital patients and health care personnel.
Gloves

Sterile gloves should be worn after hand hygiene procedure while touching mucous
membrane and non- intact skin and performing sterile procedures e.g. arterial, central line and
Foley catheter insertion.

Gown

 Wear a gown to prevent soiling of clothing and skin during procedures that are likely to
generate splashes of blood, body fluids, secretions or excretions.
 The sterile gown is required only for aseptic procedures and for the rest, a clean, non-
sterile gown is sufficient.
 Remove the soiled gown as soon as possible, with care to avoid contamination.

Handling patient care equipment

 Used patient-care equipment soiled with blood, body fluids, secretions, or excretions
should be handled carefully to prevent skin and mucous membrane exposures,
contamination of clothing and transfer of microorganisms to other patients or the
environment.
 Ensure that reusable equipment is not used for the care of another patient until it has been
cleaned and sterilized appropriately.
 Ensure that single use items and sharps are discarded properly.

Prevention of Ventilator Associated Pneumonia (VAP)

VAP is most common infection acquired in ICU.VAP as defined by CDC is a pneumonia

which occurs in a patient who was intubated & mechanically ventilated at the time of onset of
pneumonia or within 48 hours before onset of pneumonia.

Prevention strategy

1. Awareness & Training Shorten the duration of intubation and invasive ventilation.
2. Consider use of non-invasive ventilation.
3. Avoid continues use of paralytics as far as possible.
4. Promote adequate oral hygiene with s 0.12% Aq. Chlorhexidine.
5. Ensure appropriate dosages of sedation or narcotics.
6. Consider use of sedation scale to avoid over- sedation.
7. Wean patient off invasive ventilation as soon as possible.
8. Prevent unplanned extubation e.g. patient self extubation.
9. Practice of standard precaution should be observed.
10. Perform tracheal suction properly with aseptic precaution & avoid routine saline
instillation during suctioning.
11. Ensure appropriate disinfection, sterilization, and maintenance of respiratory equipment.
12. Place the ventilated patient in semi- upright position around 45 degrees.

Prevention of urinary tract infection

 Urinary tract infections (UTIs) are the most common type of nosocomial infections,
accounting for 40% of all infections in hospital per year.
 Almost 80% of these infections are due to instrumentation or catheterization.

Factors affecting UTI in ICU/CCU

1. Female gender
2. Postpartum status.
3. Older age
4. Severe underlying illness
5. High blood creatinine level.
6. The wrong reason for catheterization.
7. Contamination during insertion Errors in catheter care.
8. Use of broad spectrum antibiotics.

Prevention of UTI

1. Insert catheters only for appropriate indications.

2. Follow aseptic insertion of the urinary catheter.
3. Maintain a closed drainage system.
4. Remove the catheter as soon as possible.
5. Use strict aseptic technique.
6. Maintain strict catheter care.
7. Replace bags with new or clean containers when needed.
8. Avoid irrigation, if frequent irrigation is required, the catheter should be changed.
9. Caution the patient against pulling on the catheter.
10. Avoid raising the collection bag above the level of the patient’s bladder.
11. Remove the catheter when it is no longer needed.
Prevention of central venous catheter infection

Central venous catheters (CVCs) are widely used in modern medicine. However, placing a
catheter poses infectious and mechanical risks to patients due to complications that can be
fatal.

Prevention

1. Insertion date should be put on all vascular access devices.

2. Use 2% chlorhexidine wash daily for skin cleansing to reduce.
3. Use maximal sterile barrier precautions (cap, mask, sterile gown and sterile gloves).
4. Strict aseptic precaution while cannulation.
5. Daily inspection & changing CVC if signs of local infections appear.

Prevention of surgical site infection

1. Surgical site infection (SSI) is the second most common health care associated infection.
2. Surgical site infection accounts for 14% to 16% of hospital-acquired infections.
3. Give antibiotic prophylaxis according to guidelines.
4. Don’t use razors to remove hair at the operative site.
5. Control blood glucose in patients scheduled for cardiac surgery.
6. Strict aseptic technique when handling surgical site.
7. Educate patients and families about their role in SSI prevention.

Other infection control measures in ICU/CCU

1. Work with hospital administration for better patient to nurse ratio in the ICU.
2. Policies for controlling traffic flow to and from the unit to reduce sources of
contamination from visitors, staff and equipment.
3. Waste and sharp disposal policy.
4. Education and training for ICU staff about prevention of nosocomial infections.
5. ICU protocols for prevention of nosocomial infections.
6. Audit and surveillance of infections and infection control practices.
7. Infection control team (multidisciplinary approach).
8. Vaccination of health care personnel.
Conclusion

In addition to practices carried out by health workers when providing care, all individuals
(including patients and visitors) should comply with infection control practices in health-care
settings. The control of spread of pathogens from the source is key to avoid transmission.
Among source control measures, respiratory hygiene/cough etiquette, developed during the
severe acute respiratory syndrome (SARS) outbreak, is now considered as part of standard
precautions. Worldwide escalation of the use of standard precautions reduce unnecessary
risks associated with health care. Promotion of an institutional safety climate helps to
improve conformity with recommended measures and thus subsequent risk reduction.
Provision of adequate staff and supplies, together with leadership and education of health
workers, patients, and visitors, is critical for an enhanced safety climate in health-care
settings.
BIBLIOGRAPHY

1. https://blog.bunzlchs.com/save-lives-clean-your-hands-a-closer-look-at-
hand-hygiene/
2. Chandrokar A.G. Hospital administration and planning.2nd edition.
Published by Paras medical publisher. 2009. Hyderabad. Page No: 117
3. Vati Jogindra. Nursing Management and administration. 2nd edition.
Published by Jaypee Brothers. 2013.New Delhi.
4. https://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Bro
chure.pdf
5. https://www.who.int/publications/i/item/9789241597906