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Also known as healthcare acquired in ection Traditionall! re erred as hos"ital acquired in ections In ections that de#elo" durin$ hos"itali%ation One o the leadin$ causes o death and increased &or'idit! or hos"itali%ed "atients O which are &ostl! caused '! dru$ resistant strains o 'acteria
S!ste&ic In ection
A s!ste&ic disease caused '! "atho$enic or$anis&s or their to/ins in the 'loodstrea&
)e initions
Catheter Colonization: The isolation of 15 colony forming units (CFUs) of any microorganism by semiquantitative culture (roll-plate method) or 1 ! CFUs by quantitative culture (sonication technique)" from a catheter tip or subcutaneous segment in the absence of simultaneous clinical symptoms#
Local catheter-related infection: Exit site Infection: purulent drainage from the catheter e$it site" or erythema" tenderness" and s%elling %ithin &cm of the catheter e$it site# Port-pocket infection: erythema and necrosis of the s'in over reservoir of totally implantable device" or purulent e$udates in the subcutaneous poc'et containing the reservoir# Tunnel infection: erythema" tenderness" and indurations of the tissues overlying the catheter and more than &cm from the e$it site#
)e initions
Systemic Catheter infection: isolation of the same microorganisms from catheter culture and from the blood of a patient %ith accompanying clinical symptoms of a ()* and no other apparent source of infection# Catheter-related bloodstream infection is the isolation of the same microbe from blood cultures that is 'no%n to be significantly coloni+ing the catheter of a patient Primary SI is one that arises %ithout apparent local infection else%here due to the same microbe#
ENT(- SITE
4suall! inserted in #eins o orear& or hand
LEN1T+
67 inches
COMMENTS
,hle'itis with "rolon$ed use5 rarel! associated with 9SI
4suall! inserted in radial arter!5 can 'e "laced in e&oral0 a/illar!0 'rachial0 "osterior ti'ial arteries Inserted #ia the antecu'ital ossa into the "ro/i&al 'asilic or ce"halic #eins5 does not enter central #eins0 "eri"heral catheters
67 inches
Midline catheters
7 8 inches
(e"orted with ana"h!lactoid reactions on elasto&&eric h!dro$el catheter5 lower rates o "hle'itis than short "eri"heral catheters
ENT(- SITE
,ercutaneousl! inserted into central #eins 2 su'cla#ian0 internal .u$ular0 or e&oral3 Inserted throu$h a Te lon; introducer in a central #ein2 su'cla#ian0 internal .u$ular0 or e&oral3 Inserted in 'asilic0 ce"halic0 or 'rachial #eins and enter the su"erior #ena ca#a
LEN1T+
:8 c& de"endin$ on the "atient si%e
COMMENTS
Account or &a.orit! C(9SI
4suall! he"arin 'onded5 si&ilar rates o 9SI as C*Cs5 su'cla#ian site "re erred to reduce in ection risk Lower rate o in ection than nontunnelled C*Cs
ENT(- SITE
I&"lanted into su'cla#ian0 internal .u$ular0 or e&oral #eins
LEN1T+
:8 c& de"endin$ on the "atient si%e
COMMENTS
Cu inhi'its &i$ration o or$anis&s into the catheter tract5 lower rate o in ection than that o the nontunneled C*C
Totall! i&"lanta'le
Tunnelled 'eneath the skin and ha#e su'cutaneous "ort accessed with needle5 i&"lanted in su'cla#ian0 internal .u$ular #ein Inserted into u&'ilical #ein or u&'ilical arter!
Lowest rate o C(9SI5 i&"ro#ed "atient sel i&a$e5 no need or local catheter site care5 sur$er! required or catheter re&o#al
4&'ilical catheters
Susce"ti'le host
(eser#oir
,ortal o Entr!
MO)E OF T(ANSMISSION
It is the ðod o trans er '! which or$anis& &o#es or is carried ro& one "lace to another EA$A +ands o the health care worker &a! carr! 'acteria ro& one "erson to anotherA
(isk Factors
T!"e o catheter used
The nu&'er o lu&en o the catheter has
Total "arenteral nutrition )uration o catheteri%ation Catheter site insertion E/"ertise o the "erson insertin$ Mana$e&ent o catheter a ter insertion 1uidewire e/chan$e 4se o dressin$ 4se o tri"le anti'iotic oint&ent
and ra"id identi ication o &icroor$anis&s Earl! reco$nition o si$n and s!&"to&s o in ection
E&"lo!ee
health e/a&inations and screenin$s En#iron&ental sanitations )isin ection F Sterili%ation o instru&ents Standard ,recautions0 Medical Ase"sis0 ,ro"er +!$iene Clean $owns0 linens0 towels0 Clean wound dressin$
+andwashin$0
"recautions
+andwashin$0 Standard ,recautions0 Sa e ood handlin$0 isolations0 use o ,,E0 trans&ission 'ased "recautions
Ase"tic
technique0 &edical or sur$ical ase"sis0 wound F catheter care0 "ro"er dis"osal0 &aintain skin inte$rit!0 standard "recautions
Treat&ent
Susce"ti'le +ost
Eash hands the &ost "ractical "rocedure or "re#entin$ cross conta&ination 2"erson to "erson3 Eear $lo#es 'e ore touchin$ an!thin$ wet 'roken skin0 &ucous &e&'ranes0 'lood or other 'od! luids 2secretions or e/cretions3 or soiled instru&ents and other ite&s 4se "h!sical 'arriers 2"rotecti#e $o$$les0 ace &asks and a"rons3 i s"lashes and s"ills o an! 'od! luids 2secretions or e/cretions3 are antici"ated
4se sa e work "ractices0 such as not reca""in$ or 'endin$ needles0 sa el! "assin$ shar" instru&ents and "ro"erl! dis"osin$ o &edical waste Isolate "atients onl! i secretions 2air'orne3 or e/cretions 2urine and eces3 cannot 'e contained )econta&inate "rocess instru&ents and other ite&s 2deconta&inate0 clean0 hi$h le#el disin ect or sterili%e usin$ In ection ,re#ention ,ractices
,re#ention
Selection o a su'cla#ian0 'asilic0 or ce"halic #ein site rather than an internal .u$ular or e&oral site A#oid use o T,N catheters or other in usion "ur"oses 4se o s"ecial tea& or insertion and &aintenance o catheter A#oid the use o tri"le anti'iotic oint&ent on central #enous catheter
+ealth Care Eorker Education and Trainin$ Sur#eillance or Catheter (elated In ection +andwashin$ 9arriers ,recautions )urin$ Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and (e"lace&ent o Intra#ascular )e#ices
+ealth Care Eorker Education and Trainin$ Sur#eillance or Catheter (elated In ection +andwashin$ 9arriers ,recautions )urin$ Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and (e"lace&ent o Intra#ascular )e#ices
(e"lace&ent o Ad&inistration Sets and Intra#enous Fluids Intra#enous In.ection ,orts ,re"aration and Hualit! Control o Inta#enous Ad&i/tures In line Filters Intra#enous Thera"! ,ersonnel Needleless Intra#ascular )e#ices ,ro"h!lactic anti&icro'ials