A NOSOCOMIAL INFECTION is:

Also known as healthcare acquired infection Traditionally referred as hospital acquired infections Infections that develop during hospitalization One of the leading causes of death and increased morbidity for hospitalized patients Of which are mostly caused by drug resistant strains of bacteria

IV THERAPY DEVICES RELATED INFECTION

Local Infection Invasion and multiplication of microorganisms in body tissues which may be clinically unapparent or result in local cellular injury due to competitive metabolism toxins, intracellular replication or antigen antibody response

 Systemic Infection A systemic disease caused by pathogenic organisms or their toxins in the bloodstream

Definitions
Catheter Colonization: The isolation of 15 colony forming units (CFUs) of any microorganism by semiquantitative culture (roll-plate method) or 103 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 exit site, or erythema, tenderness, and swelling within 2cm of the catheter exit site. Port-pocket infection: erythema and necrosis of the skin over reservoir of totally implantable device, or purulent exudates in the subcutaneous pocket containing the reservoir. Tunnel infection: erythema, tenderness, and indurations of the tissues overlying the catheter and more than 2cm from the exit site.

Definitions
Systemic Catheter infection: isolation of the same microorganisms from catheter culture and from the blood of a patient with accompanying clinical symptoms of a BSI and no other apparent source of infection. Catheter-related bloodstream infection is the isolation of the same microbe from blood cultures that is known to be significantly colonizing the catheter of a patient Primary BSI is one that arises without apparent local infection elsewhere due to the same microbe.

Common catheters used for venous and arterial access

CATHETER TYPE Peripheral venous catheters (short)

ENTRY SITE
Usually inserted in veins of forearm or hand

LENGTH
<3 inches

COMMENTS
Phlebitis with prolonged use; rarely associated with BSI

Peripheral arterial catheters

Usually inserted in radial artery; can be placed in femoral, axillary, brachial, posterior tibial arteries Inserted via the antecubital fossa into the proximal basilic or cephalic veins; does not enter central veins, peripheral catheters

<3 inches

Low infection risk; rarely associated with BSI

Midline catheters

3 8 inches

Reported with anaphylactoid reactions on elastommeric hydrogel catheter; lower rates of phlebitis than short peripheral catheters

Common catheters used for venous and arterial access

CATHETER TYPE Nontunneled CVC

ENTRY SITE
Percutaneously inserted into central veins ( subclavian, internal jugular, or femoral) Inserted through a Teflon introducer in a central vein( subclavian, internal jugular, or femoral)

LENGTH
8 cm depending on the patient size

COMMENTS
Account for majority CRBSI

Pulmonary artery catheter

30 cm depending on the patient size

Usually heparin bonded; similar rates of BSI as CVCs; subclavian site preferred to reduce infection risk Lower rate of infection than nontunnelled CVCs

Inserted in basilic, Peripherally inserted cephalic, or brachial central venous veins and enter the catheter (PICC) superior vena cava

20 cm depending on patient size

Common catheters used for venous and arterial access

CATHETER TYPE
Tunneled central venous catheter

ENTRY SITE
Implanted into subclavian, internal jugular, or femoral veins

LENGTH
8 cm depending on the patient size

COMMENTS
Cuff inhibits migration of organisms into the catheter tract; lower rate of infection than that of the nontunneled CVC Lowest rate of CRBSI; improved patient self image; no need for local catheter site care; surgery required for catheter removal

Totally implantable

Tunnelled beneath the skin and have subcutaneous port accessed with needle; implanted in subclavian, internal jugular vein Inserted into umbilical vein or umbilical artery

8 cm depending on the patient size

Umbilical catheters

6 cm depending on the patient size

Risk for CRBSI similar with catheters placed in umbilical vein vs artery

Other Nosocomial Infection

Urinary tract infection Surgical site infection Ventilator-associated pneumonia Intravascular device-related bloodstream infection Clostridium difficile- associated diarrhea

CHAIN OF INFECTION CONTROL

Infectious Agent

Susceptible host

Reservoir

Portal of Entry

Portal of Exit Mode of Transmission

MODE OF TRANSMISSION
It is the method of transfer by which organism moves or is carried from one place to another E.g. Hands of the health care worker may carry bacteria from one person to another.

How does catheter-related infection occur?

Infection of short-term catheters is frequently been due to microbes from the skin moving along the catheter surface where the catheter enters the skin.

Date and Time IV was Inserted KARDEX

Risk Factors
Type of catheter used
The number of lumen of the catheter has

Total parenteral nutrition Duration of catheterization Catheter site insertion Expertise of the person inserting Management of catheter after insertion Guidewire exchange Use of dressing Use of triple antibiotic ointment

Common pathogens of BSI Candida albicans Staphylococcus aureus Enterobacter cloaceae Staphylococcus epidermidis Pseudomonas aeruginosa Enterococcus fecalis

Breaking the Chain of Infection Levels of Aseptic Control

How Health Care Workers Break the Chain of Infection Link Infectious or Causative Agent Reservoirs Intervention
Accurate

and rapid identification of microorganisms Early recognition of sign and symptoms of infection
Employee

health examinations and screenings Environmental sanitations Disinfection / Sterilization of instruments Standard Precautions, Medical Asepsis, Proper Hygiene Clean gowns, linens, towels, Clean wound dressing of PPE, proper waste disposal, standard precautions Handwashing, Standard Precautions, Safe food handling, isolations, use of PPE, transmission based precautions
Aseptic Handwashing, use

Portal of Exit Method or Mode of Transmission Portal of Entry

technique, medical or surgical asepsis, wound / catheter care, proper disposal, maintain skin integrity, standard precautions of Disease, Recognition of clients at risk, immunization, exercise, proper nutrition

Susceptible Host

Treatment

PRINCIPLES OF PREVENTION OF INFECTION

Consider every person (patient of staff) infectious Wash hands the most practical procedure for preventing cross contamination (person to person) Wear gloves before touching anything wet broken skin, mucous membranes, blood or other body fluids (secretions or excretions) or soiled instruments and other items Use physical barriers (protective goggles, face masks and aprons) if splashes and spills of any body fluids (secretions or excretions) are anticipated

 Use safe work practices, such as not recapping or bending needles, safely passing sharp instruments and properly disposing of medical waste Isolate patients only if secretions (airborne) or excretions (urine and feces) cannot be contained Decontaminate process instruments and other items (decontaminate, clean, high level disinfect or sterilize using Infection Prevention Practices

Prevention
Selection of a subclavian, basilic, or cephalic vein site rather than an internal jugular or femoral site Avoid use of TPN catheters for other infusion purposes Use of special team for insertion and maintenance of catheter Avoid the use of triple antibiotic ointment on central venous catheter

REVIEW INFECTION RISK FACTORS and PRACTICES

Infection is the presence and growth of a microorganisms that produces tissue death Wash your hands Routinely clean and disinfect surfaces Handle and prepare food safely Get immunized Us antibiotics appropriately Keep pets healthy Avoid contact with wild animals

PRINCIPLES OF SAFE IV CARE / PRACTICES

Use aseptic technique to avoid contamination of sterile injection equipment Do not administer medications from a syringe to multiple patients, even if the needle of cannula on the syringe is changed Use fluid infusion and administration sets for one patient only and dispose after use Use single dose vials for parenteral medications whenever possible. Use proper personal protective equipment (PPE). Adhere to safety waste protocol according to institutions policy.

VENIPUNCTURE TECHNIQUES USING VARIOUS CATHETERS AND DEVICES

The Use of Infusion Pumps

The use of needleless system

Proper use of sharp containers

Monitoring and Assessment

The use of appropriate dressing

 Health Care Worker Education and Training Surveillance for Catheter Related Infection Handwashing Barriers Precautions During Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and Replacement of Intravascular Devices

General Recommendations For Intravascular Device Use

Health Care Worker Education and Training Surveillance for Catheter Related Infection Handwashing Barriers Precautions During Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and Replacement of Intravascular Devices

 Replacement of Administration Sets and Intravenous Fluids Intravenous Injection Ports Preparation and Quality Control of Intavenous Admixtures In line Filters Intravenous Therapy Personnel Needleless Intravascular Devices Prophylactic antimicrobials

Preventing Catheter-Related Bloodstream Infections

References: Centers for Disease Control and Prevention (CDC), USA Healthcare Infection Control Practices Advisory Committee (HICPAC), USA Hospital Epidemiology and Infection Control, Mayhall 3rd ed.