NOSOCOMIAL RESPIRATORY INFECTION

Compiled by R

RISKS FACTORS

Extremes of age Severe underlying disease Immunosuppression Depressed sensorium Cardiopulmonary disease Post thoraco-abdominal surgery Mechanically ventilated – ventilated

associated pneumonia

PREVENT OF PERSON-TO-PERSON TRANSMISSION OF BACTERIA

Wear gloves Mucous membranes, Handling respiratory secretions or objects contaminated with respiratory secretionsHand hygiene after removal of glove

Change gloves and decontaminate hands

In between contacts with different patients

Change Gloves Between contacts with a contaminated body site and the respiratory tract or respiratory device on the same patient

Wear mask and apron or gwon

When anticipate soiling of respiratory secretions from a patient (e.g. intubation, tracheal suctioning, tracheostomy, bronchoscopy) Change after procedure and before providing care to another patient

PREVENT OF PERSON-TO-PERSON TRANSMISSION OF BACTERIA

Use a sterile, single-use catheter, if open-method suction system is employed.

Use only sterile fluid to remove secretions from suction catheter if the catheter is to be used for re-entry into the patient’s lower respiratory tract

PRECAUTIONS FOR PREVENTION OF ASPIRATION

The use of devices eg. end tracheal, tracheostomy, oro/ nasogastric tubes

Remove from patients as soon as they are not indicated

Method of intubation Use orotracheal rather than nasotracheal unless indicated

Drainage of tracheal secretions When feasible, use an endotracheal tube with subglottic suctioning to allow drainage of tracheal secretions that accumulate in the subglottic area

Removal of endotracheal tube Ensure that secretions are cleared from above the endotracheal tube cuff before deflating the cuff in preparation for tube removal or before moving the tube

PRECAUTIONS FOR PREVENTION OF ASPIRATION

Patient on mechanical ventilation or at high risk for aspiration (e.g. on oro or nasoenteral tube)

Elevate the head of the bed 30 – 45 degrees

Proper placement of feeding tube Routinely verify appropriate placement of the feeding tube

Feeding tolerance Routinely assess the patient’s feeding tolerance by measuring residual gastric volume and adjust the rate and volume of enteral feeding to avoid regurgitation.

PREVENTION OF POSTOPERATIVE PNEUMONIA IN HIGH RISK GROUP

Age ≥ 60 years History of chronic lung disease or

smoking On steroids for chronic conditions History of chronic alcohol consumption Impaired sensorium History of cerebrovascular accident

with residual neurologic deficit

PREVENTION OF POSTOPERATIVE PNEUMONIA IN HIGH RISK GROUP

General anesthesia Upper abdominal or thoracic surgery Emergency surgery Obesity

ASSIST PATIENT IN BREATHING EXERCISE

Deep breathing exercises and use of incentive spirometry

Provide instructions of deep breathing exercises and use of incentive spirometryduring pre and post-operation During post-operation, encourage to take deep breaths and ambulate them as soon as possible unless medically contraindicated

Post-operative analgesia Provide adequate postoperative analgesia to facilitate effective coughing and deep breathing

STERILIZATION OR DISINFECTION AND MAINTENANCE OF RESPIRATORY EQUIPMENT AND DEVICES

Refer policy and procedure of nosocomial infection in GICU

Non routine sterilization and disinfection of Internal machinery of mechanical

ventilators Change more frequently than every 48

hours an HME that is in use on a patient. Change when it malfunctions mechanically

or becomes visibly soiled

CONT

Change of ventilator breathing circuit when visibly soiled

Change the oxygen delivery system (tubing, nasal prongs or mask) that is in use on one patient when it malfunctions or becomes visibly contaminated or between uses on different patients

Drain and discard periodically any condensate in the circuit. Take precautions not to allow the condensate to drain towards the patient

CONT

Use sterile water to fill bubble-through humidifiers

Clean, disinfect, rinse with sterile water and dry nebulizers between treatments on the same patient. Replace nebulizers with those that have undergone sterilization or high-level disinfection between uses on different patients

CONT

Use only sterile fluid for nebulization, and dispense the fluid into the nebulizer aseptically. Use aerosolized medications in single dose vial whenever possible.

Change the mouthpiece of a peak flow mrter or the mouthpiece and filter of a spirometer between uses on different patients

Change entire length of suction-collection tubing and canisters between uses on different patients

CONT

Between uses on different patients, clean reusable components of the anesthetic breathing system, inspiratory and expiratory breathing tubing, y-piece, reservoir bag, humidifier, and tubing, and then sterilize or subject them to high-level liquid chemical disinfection or pasteurization in accordance with the device manufacturers’ instructions.

CONT

A bacterial-viral filter placed between the y-piece and the mask or endotracheal tube serves to protect the pateint and the anaesthesia delivery system from contamination.

CONCLUSION IN CARE OF EQUIPMENTS Equipmentso Individualizeo Bacteria filtero If reusable for other patient, disinfection

properly otherwise use once onlyo Clean if visibly soiled or contaminatedo Dry after clean Rinsing / nebulizationo Sterile water