INFECTION CONTROL

IN THE

I C U

MARY JEAN N. FAJARDO, R.N.

PAST PRESIDENT and ADVISER

Cardinal Santos Medical Center

INTENSIVE CARE UNIT

• ICU Patients are a subgroup of all hospitalized patients, accounting for 25% of all hospitalized infections.

• The prevalence of ICU-acquired infections is significantly higher in developing countries than in industrial countries, varying from 4.4% and 88.9%

• Major problems associated with increased Healthcare AssociatedInfections (HAI’s) in these countries are low compliance of handhygiene, excessive number of patients and workload, inadequatePPE, and late establishment of IC program

• Consequently, ICU acquired infections have been associated withsignificant morbidity, mortality and rising healthcare costs withlimited resources

Increased risk of infection in ICU Patients is associated with:

• Severity of illness

• Underlying conditions

• Exposure to multiple invasive devices and procedures (ET intubation, Urinary catheters, etc.)

• Increased patient contact with Healthcare Personnel (HCP)

Risk factors of infection in Developed & Developing Countries:

• Age

• Co-morbid Diseases

• Mechanical ventilation

• Duration of hospitalization

• Length of ICU stay

• Immune suppresion and greater severity

According to European Prevalence of Infection in ICU,

most common site of infection:

• Respiratory system (64%)

• Abdomen (20%)

• Bloodstream (15%)

• genitourinary (14%)

The Causative Agents:

• 47% Gram-positive pathogens ( Staphylococcus aureus – 20%)

• 62% Gram-negative pathogens ( Pseudomonas species - 20% & E coli –

16% )

• 19% Fungal pathogens

* Patients hospitalized in ICUs are 5 to 10

times more likely to acquire HAI than other

hospital patients.

• The frequency of infections at different anatomic

sites and the risk of infection vary by the type of

ICU, and the frequency of specific pathogens varies by infection site.

* Contributing to the seriousness of HAI, is the increasing incidence of infections caused by antibiotic-resistant pathogens.

THE INANIMATE ENVIRONMENT IS A RESERVOIR OF PATHOGENS

SOURCES OF CROSS-INFECTION IN THE ICU:

Hands of Staff & other HCP (via 2 bowl handwashing,

communal towels, or no handwashing)

Assisted ventilation equipment

Suction and drainage bottles

IV lines – central and peripheral

Urinary catheters

Dressing trolleys

Disinfectant containers

Wounds and wound dressings

Lack of Hand washing facilities

Patient close together or sharing rooms

Understaffing

Preparation of IV’s on the unit

Lack of Isolation Facilities

No separation of clean & dirty areas

Excessive antibiotic use

Inadequate decontamination of items & equipments

Inadequate cleaning of environment

5 ESSENTIAL STEPS FOR CROSS

CONTAMINATION

1. Organisms are present on the patient’s skin or have been shed into

inanimate objects immediately surrounding the patient.

2. Organisms must be transferred to the hands of Health-care workers (HCP).

3. Organisms must be capable of surviving for at least several minutes on HCP

worker’s hands.

4. Handwashing or hand antisepsis by the HCP must be inadequate or omitted

entirely, or the agent used for hand hygiene is inappropriate.

5. The contaminated hand(s) of the caregiver must come into direct contact

with another patient or with an inanimate object that will come into direct

contact with the patient.

Transmission to Hands from Skin and Environment

More Contamination with More Care

Sickest patients (multiple diagnosis, multi-organ failure, immunocompromised, septic and trauma)

Move Less

Malnourished

More obtunded (Glasgow coma scale)

Diabetes and Heart Failure

PAY MORE ATTENTION

Hand Washing

Use gloves to prevent contamination of thehands when handling respiratory secretions

Wear gloves and gowns (contact precautions)during all contact with patients and fomitespotentially contaminated with respiratorysecretions

Use aseptic technique

Clean and decontaminate all equipment afteruse

Sterilize or use high-level disinfection for allitems that come into direct or indirect contactwith mucous membranes

Rinse and dry items that have beenchemically disinfected

Package and store items to preventcontamination before use

Keep environment clean, dry and dust free

Identify reservoir, colonized and infectedpatients, environmental contamination;common sources

Halt transmission among patient

Improve hand washing and asepsis, Barrierprecautions (gloves, gown) for colonized andinfected patients, eliminate any commonsource: disinfect environment, separatesusceptible patients, close unit to newadmissions if necessary

Halt progression from colonization toinfection. Discontinue compromising factorswhen possible (e.g. extubate, remove NGT,discontinue bladder catheters, as clinicallyindicated; rotate IV catheter sites; properventilator and pulmonary care)

Modify host factors, treat underlying diseaseand complications

Control antibiotic use (rotate, restrict, orcease)

Communication Campaign

Conclusions

Nosocomial transmission of pathogenic bacteria creates a major health burden

Multifaceted interventions are needed for high level control: proper hand hygiene is the cornerstone of prevention efforts

Isolation of patients may place them at risk for errors of omission

Thank You!!!