A NOSOCOMIAL INFECTION is:Also known as healthcare acquired infectionTraditionally referred as hospital acquired infectionsInfections that develop during hospitalizationOne of the leading causes of death and increased morbidity for hospitalized patientsOf which are mostly caused by drug resistant strains of bacteria

INFECTION RELATED TO IV THERAPY DEVICESLocal InfectionInvasion 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 InfectionA systemic disease caused by pathogenic organisms or their toxins in the bloodstream

DefinitionsCatheter 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.

DefinitionsSystemic 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

Common catheters used for venous and arterial access

Common catheters used for venous and arterial access

Other Nosocomial InfectionUrinary tract infection

Surgical site infection

Ventilator-associated pneumonia

Intravascular device-related bloodstream infection

Clostridium difficile- associated diarrhea

CHAIN OF INFECTION CONTROLInfectious AgentReservoirPortal of ExitSusceptible hostPortal of EntryMode of Transmission

MODE OF TRANSMISSIONIt is the method of transfer by which organism moves or is carried from one place to anotherE.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 InsertedKARDEX

Risk FactorsType of catheter usedThe number of lumen of the catheter hasTotal parenteral nutritionDuration of catheterizationCatheter site insertionExpertise of the person insertingManagement of catheter after insertionGuidewire exchangeUse of dressingUse of triple antibiotic ointment

Common pathogens of BSICandida albicansStaphylococcus aureusEnterobacter cloaceaeStaphylococcus epidermidisPseudomonas aeruginosaEnterococcus fecalis

Breaking the Chain of Infection Levels of Aseptic Control

PRINCIPLES OF PREVENTION OF INFECTIONConsider 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

PreventionSelection 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 PRACTICESInfection is the presence and growth of a microorganisms that produces tissue death

Wash your handsRoutinely clean and disinfect surfacesHandle and prepare food safelyGet immunizedUs antibiotics appropriatelyKeep pets healthyAvoid contact with wild animals

PRINCIPLES OF SAFE IV CARE / PRACTICESUse aseptic technique to avoid contamination of sterile injection equipmentDo not administer medications from a syringe to multiple patients, even if the needle of cannula on the syringe is changedUse fluid infusion and administration sets for one patient only and dispose after useUse 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 DEVICESThe 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 TrainingSurveillance for Catheter Related InfectionHandwashingBarriers Precautions During Catheter Insertion and CareCatheter InsertionCatheter Site CareSelection and Replacement of Intravascular Devices

General Recommendations For Intravascular Device UseHealth Care Worker Education and TrainingSurveillance for Catheter Related InfectionHandwashingBarriers Precautions During Catheter Insertion and CareCatheter InsertionCatheter Site CareSelection and Replacement of Intravascular Devices

Replacement of Administration Sets and Intravenous FluidsIntravenous Injection PortsPreparation and Quality Control of Intavenous AdmixturesIn line FiltersIntravenous Therapy PersonnelNeedleless Intravascular DevicesProphylactic antimicrobials

Preventing Catheter-Related Bloodstream InfectionsReferences:Centers for Disease Control and Prevention (CDC), USAHealthcare Infection Control Practices Advisory Committee (HICPAC), USAHospital Epidemiology and Infection Control, Mayhall 3rd ed.

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