Infection Control

in ICUs:
To Be or Not To Be in Ukraine?

Yuri I. Nalapko
Medical University, Lugansk, Ukraine
Background
Leading Cause of Mortality of Patients
in ICUs Are Nosocomial Complications,
And On the First Place Are –

INFECTIONS
University of London
19 colleges, 12 institutes:

-King’s College London

-London School of Economics
-Imperial College London
-Queen Mary
-London Business School…

3 Monarchs, 33 Presidents and Prime-Ministers,

54 Noble Prize Winners, 2 Olympic Champions
Medical Faculty
5 hospitals:

-St. Mary
-Charing Cross
-Hammersmith
-Chelsea and Westminster
-South Kensington
If the problem seems to be
unsolved, try to see
by the new look
IMPERIAL COLLEGE LONDON
ACADEMIC ANESTHETICS

Dr M Maze and colleagues

CHELSEA AND WESTMENISTER
ITU

Dr N Soni Dr N Fauvel
ST THOMAS’ HOSPITAL CHARING CROSS
ITU, NEUROLOGY HOSPITAL, ITU

Dr G Plant Dr M Palazzo
THE ROYAL SOCIETY
OF MEDICINE
Infection Control =

To Control –

- To Check

- To Manage
Infection Control –

Organization System of Patients’ and

Personnel’ Infection Safety.

IC Coordinator
IC Expert Group
IC Team
Departments Personnel
Laboratory
Key Strategies
of Infection Control in ICUs

ƒ Prevent Infections
ƒ Diagnose & Treat Effectively
ƒ Use Antimicrobials Wisely

ƒ Prevent Transmission
Modern Technologies
of Infection Control in ICU

Prevent Infections
1. Get the catheters out!

Diagnose & Treat Effectively

2. Target the pathogen
3. Expert Approach

Use Antimicrobials Wisely

4. Treat infection, not contamination
5. Know when to say “no” to vanco

Prevent Transmission
6. Practice hand hygiene
 Prevent Infections

1.Get the catheters out!

Fact:
Catheters and other invasive devices are
the # 1 exogenous cause of hospital-onset
infections.

NNIS Online at CDC

Biofilm on Intravenous Catheter
24 hours after Insertion

Electron Micrograph
 Prevent Infections

1.Get the catheters out!

Fact: Catheters and other invasive devices are the # 1 exogenous
cause of hospital-onset infections.

Actions:
use catheters only when essential
use the correct catheter
use proper insertion & catheter-care protocols
remove catheters when not essential

NNIS Online at CDC

 Diagnose & Treat Effectively

2. Target the pathogen

Fact:

Appropriate antimicrobial therapy

(correct regimen, timing, dosage, route,
and duration) saves lives.

NNIS Online at CDC

 Diagnose & Treat Effectively

2. Target the pathogen

Fact: Appropriate antimicrobial therapy saves lives.

Actions:
culture the patient
target empiric therapy to likely pathogens and local antibiogram
target definitive therapy to known pathogens and antimicrobial
susceptibility test results

NNIS Online at CDC

 Diagnose & Treat Effectively

3. Expert Approach

Fact:

Infectious diseases expert input improves

the outcome of serious infections.
Infectious Diseases Experts

Infectious Diseases
Specialists
Healthcare Infection Control
Epidemiologists Professionals

Clinical Optimal
Pharmacists Patient Care
Clinical
Clinical Pharmacologists
Microbiologists
Surgical Infection
Experts
 Diagnose & Treat Effectively

3. Expert Approach

Fact
Infectious diseases expert input improves the outcome of serious
infections.

Action
consult infectious diseases experts about patients with serious
infections

NNIS Online at CDC

 Use Antimicrobials Wisely

4. Treat infection,
not contamination
Fact

A major cause of antimicrobial overuse

is “treatment” of contaminated
cultures.
 Use Antimicrobials Wisely

4. Treat infection, not contamination

Fact
A major cause of antimicrobial overuse is treatment
of contamination or colonization.

Actions
Treat pneumonia, not the tracheal aspirate
Treat bacteremia, not the catheter tip
Treat urinary infection, not the indwelling urinary catheter

¾ Link to: IDSA guideline for evaluating fever in critically ill adults
 Use Antimicrobials Wisely

5. Know when to say

“no” to vanco

Fact

Vancomycin overuse promotes

of resistant pathogens.
Vancomycin Utilization in Hospitals
in the USA
(defined daily doses per 1000 patient-days)
120
100
80
60
40
20
0
Non-ICU Heme-Onc Med ICU Med-Surg Surg ICU Ped ICU
ICU

Source: National Nosocomial Infections Surveillance (NNIS) System

Evolution of Drug Resistance in S. aureus
Penicillin Methicillin
Penicillin-resistant Methicillin-resistant
S. aureus
[1950s] S. aureus [1970s] S. aureus (MRSA)

Vancomycin
[1997]

[1990s]

Vancomycin- Vancomycin Vancomycin-resistant

resistant [ 2002 ]
intermediate- enterococci (VRE)
S. aureus resistant
S. aureus
(VISA)

¾ CDC Facts about VISA ¾ MMWR on VRSA ¾ CDC Facts about VRE
 Use Antimicrobials Wisely

5. Know when to say “no” to vanco

Fact:
Vancomycin overuse promotes emergence, selection, and spread of
resistant pathogens.
Actions:
Fever in a patient with an intravenous catheter is not a routine
indication for vancomycin
Consider 1st generation cephalosporins or maxipime instead of
vancomycin

¾ IDSA guideline for evaluating fever in critically ill adults

 Prevent Transmission

6. Practice hand hygiene

Fact:

Hand hygiene is the single most important

infection control measure for preventing the
spread of antimicrobial resistant organisms.
Improved Patient Outcomes associated with
Proper Hand Hygiene

Ignaz Philipp Semmelweis

(1818 - 1865)
Chlorinated lime hand antisepsis
Wash your hands with plain soap
or antibacterial soap:
your hands are visibly soiled (dirty)
hands are contaminated with blood or body fluids
before eating
after using the restroom

Wash your hands with use an alcohol-based

handrub:
before having direct contact with patients
after having direct contact with a patient’s skin
after having contact with body fluids and wounds
after touching equipment near the patient
after removing gloves
 Prevent Transmission

6. Practice hand hygiene

Fact
Hand hygiene is the single most important infection control
measure for preventing the spread of antimicrobial resistant
organisms.

Actions:
Wash your hands by plain soap and use alcohol-based / alchohol-
free handrub
Set an example!
 Infection Control Committees
in Ukraine:

• Registration and Discovering if NIs

• Elaborating of Microbial Passport of ICU
• Personnel Education
• Protocols of Manipulations
• Estimation of Effectiveness
Working together for a safer… life!