Chapter 125. Health Care– Associated Infections (Part 3) pptx

Health Care– Associated Infections Part 3 Nosocomial and Device-Related Infections The fact that 25–50% or more of nosocomial infections are due to the combined effect of the patient'

Chapter 125 Health Care– Associated Infections

(Part 3)

Nosocomial and Device-Related Infections

The fact that 25–50% or more of nosocomial infections are due to the combined effect of the patient's own flora and invasive devices highlights the importance of improvements in the use and design of such devices Intensive education and "bundling" of evidence-based interventions (Table 125-2) can reduce infection rates through improved asepsis in handling and earlier removal of invasive devices, but the maintenance of such gains requires ongoing efforts It is especially noteworthy that turnover or shortages of trained personnel jeopardize safe and effective patient care and have been associated with increased infection rates

Table 125-2 Examples of "Bundled Interventions" to Prevent Common Health Care–Associated Infections and Other Adverse Events

Prevention of Central Venous Catheter Infections

Educate personnel about catheter insertion and care

Use chlorhexidine to prepare the insertion site

Use maximum barrier precautions during catheter insertion

Ask daily: Is the catheter needed?

Prevention of Ventilator-Associated Pneumonia and Complications

Elevate head of bed to 30–45 degrees

Give "sedation vacation" and assess readiness to extubate daily

Use peptic ulcer disease prophylaxis

Use deep-vein thrombosis prophylaxis (unless contraindicated)

Prevention of Surgical-Site Infections

Administer prophylactic antibiotics within 1 h before surgery; discontinue within 24 h

Limit any hair removal to the time of surgery; use clippers or do not remove hair at all

Maintain normal perioperative glucose levels (cardiac surgery patients).a

Maintain perioperative normothermia (colorectal surgery patients).a

Prevention of Urinary Tract Infections

Place bladder catheters only when absolutely needed (e.g., to relieve obstruction), not solely for the provider's convenience

Use aseptic technique for catheter insertion and urinary tract instrumentation

Minimize manipulation or opening of drainage systems

Remove bladder catheters as soon as is feasible

a

These components of care are supported by clinical trials and experimental evidence in the specified populations; they may prove valuable for other surgical patients as well

Source: Adapted from information presented at the following websites:

www.cdc.gov/ncidod/dhqp/gl_intravascular.html;

www.cdc.gov/ncidod/dhqp/gl_hcpneumonia.html;

www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html;

www.medqic.org/scip