INFECTION CONTROL IN CRITICAL CARE UNIT

Introduction

• The term infection refers to a state in which parasitic organisms attach themselves to the body, or to the inside of the body, of another organism, causing contamination and disease in the host organism.

Nosocomial / Hospital Acquired Infections

• "Any clinically recognizable disease that affects, the patients as a consequence of hospital admission, or hospital staff as a consequence of their work whether or not the symptoms appear during hospital stay."
• Nosocomial infections are infections which are a result of treatment in a hospital or a healthcare service unit, but secondary to the patient's original condition.
• Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge.

Incidence Pattern

• 10 to 30% of patients admitted to hospitals and nursing homes in India, acquire Nosocomial infection as against an impressive five per cent in the West.
• Average Incidence - 5% to 10%, but may be up to 28% in ICU
• Urinary Tract Infection - usually catheter related -28%
• Surgical Site Infection or wound infection -19%
• Pneumonia -17%
• Blood Stream infection - 7% to 16%

Types of HAI

• Cross infection
• Environmental and
• Self-commensal - to-opportunistic

Factors associated with HAI

• Low resistance to infection
• Contact with infectious person
• Drug resistance among endemic microbes
• Contaminated environmental sites

Consequences

• Prolongation of hospital stay: Varies by site, greatest with pneumonias and wound infections
• Additional morbidity
• Mortality increases - in order - LRI, BSI, and UTI
• Surgical Site Infection or wound infection -19%
• Pneumonia -17%
• Long-term physical & neurological consequences
• Direct patient costs increased-Escalation of the cost of care

Main Routes Of Transmission

Contact Transmission:

• Direct-contact transmission- Involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person.
• Indirect- contact transmission- It Involves contact of a susceptible host with a contaminated intermediate object. Such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients.

Droplet transmissions:

• It occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance bronchoscopy of certain procedures such as

Airborne transmission:

• It occurs by dissemination of either airborne droplet nuclei (small-particle residue 5 µm or smaller in size. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host.

Common vehicle transmission:

• Applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.

Vector borne transmission:

• It occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Infection Control Measures In ICU

• General Measures:
  • Frequent Hand Washing
  • Physical Barriers (Gloves, Aprons, Mask, cap)
• Consultation with infection control team
• Invasive Procedures:
  • Aseptic techniques
  • Use of sterile gloves
  • Frequent change of catheters or intravenous lines
• Vascular Cannulation
  • Hands must be washed
  • Protective gloves should be worn
  • Appropriate skin disinfection
• Apparatus / equipment
  • Sterilization, disinfection
  • decontamination
• Disposable Items:
  • Disinfected and discarded
  • Not be reused or recycled
• Reusable Items:
  • Decontaminated and disinfect/ sterilize before each use
• Ventilator circuits:
  • Ventilator/breathing circuit must be regularly sterilized, or decontaminated and disinfected
  • Disposable circuits may be necessary for patients with infectious diseases
• Supplies:
  • Storage Area :- Clean and sterile items should not be stored in the same area where decontamination procedures take place
  • Sterile Items: -All sterilized items must be stored in a clean, dry area. Stock supply must be rotated so that the oldest is used first
  • Linen: - Linen is stored in a clean, dry area and kept covered to prevent airborne contamination.
• Isolation of patient with contagious disease/ infection
• Hygiene: Patients Hygiene, bath, hand washing, change of dressing.
• Personnel:
  • A clean uniform
  • Avoid wearing Jewelry (a potential breeding area for colonization of bacteria)
  • Exposure to a communicable disease must be reported to his/her immediate supervisor
  • Infection Control Measures In ICU
• Housekeeping:
  • Frequent Cleaning of the patient care area.
  • No brooming
  • Only wet mopping/ vacuum cleaning
• Visitors:
  • Limit number
  • Limit visit hours
  • Do not allow flowers, eatables from outside
• Limited Access: Only authorized personnel are allowed access
• Waste disposal:
  • Disinfection and disposal of sharps
  • Avoid re-sheathing of needles.
  • Segregation
  • Storage in color coded containers as per nature of waste
• Education:
  • On infection control and safety
  • Orientation regarding infection control
  • Practicing universal precautions within the critical care area

Prevention of Nosocomial Infections

(Reducing Person To Person Transmission)

Hand Washing:

• The importance of hands in the transmission of hospital infections has been well demonstrated and can be minimized with appropriate hand hygiene.

Personal Hygiene:

• All staff should maintain good personal hygiene. Nails must be clean and kept short. False nails should not be worn. Hair must be worn short or pinned up. Beard and moustaches must be kept trimmed short and clean.

Clothing

• Working clothes: -Staff can normally wear a personal uniform or street clothes covered by white coat. In specific area such as ICU, uniform trousers and a short sleeved gown are required for men and women.
• Shoes: In aseptic unit staff must wear dedicated shoes, which must be easy to clean.
• Caps: In aseptic unit staff must wear caps or hoods which completely cover the hair.
• Masks: Masks of cotton wool, gauze, or paper are ineffective.
• Gloves: Staff should wear sterile gloves for surgery, care for immune-compromised patients, invasive procedures. And non-sterile gloves should be worn for all patient contacts were hands are likely to be contaminated.

Safe injection practices:

• To prevent transmission of infections between patients with injections:
• Eliminate unnecessary injections
• Use sterile needle and syringe
• Use disposable needle and syringes, if possible
• Prevent contamination of medications
• Follow safe sharps disposal practices

Preventing transmission from the environment

• To minimize the transmission of microorganisms from equipment and the environment, adequate methods for cleaning, disinfecting and sterilizing must be in place. Written policies and procedures which are updated on a regular basis must be developed for each facility.

Surveillance of Nosocomial infections

• "Ongoing, systematic collection, analysis and interpretation of health data essential to planning, implementation and evaluation of public health services; closely integrated with timely dissemination of the data to those who need to know about it".

Nosocomial/Hospital Infection Control

• Steps are following -
  • Isolation of patients with communicable disease
  • Hand washing & Hand disinfection
  • Infection control policies and procedures
  • Education of Medical staff
  • Ensuring employee health
  • Medical waste management

Role of Nurses In Infection Control

• Participating in the Infection Control Committee
• Promoting the development and improvement of nursing techniques, and ongoing review of aseptic nursing policies, with approval by the infection Control Committee
• Developing training programmes for members of the nursing staff
• Supervising the implementation of techniques for the prevention of infections in specialized areas such as the operating suite, the intensive care unit, the maternity unit and newborns
• Monitoring of nursing adherence to policies
• Identifying Nosocomial infections
• Investigation of the type of infection and infecting organism.
• Participating in training of personnel
• Surveillance of hospital infections
• Participating in outbreak investigation
• Development of infection control policy and review and approval of patient care policies relevant of infection control.
• Ensuring compliance with local and national regulations
• Liaison with public health and with other facilities where appropriate
• Providing expert consultative advice to staff health and other appropriate hospital programmes in matters relating to transmission of infection.