NOSOCOMIAL INFECTION : NURSES ROLE IN MINIMIZING TRANSMISSION DR AHMAD SHALTUT OTHMAN JAB ANESTESIOLOGI & RAWATAN RAPI HOSP SULTANAH BAHIYAH ALOR SETAR, KEDAH
Nosocomial infection Nosocomial or hospital acquired infections result from delivery of health services in a healthcare facility
ICU Environment ICU harbor a high population of microorganisms that may become resistant to antibiotics.
Why ICU? Many potential environmental reservoirs Many opportunities for cross contamination
ICU Patients Predisposing factors.. Poor Nutritional status Suppressed immune system Disease process ICU PATIENTS Lower resistance to microorganisms Invasive devices Open wound Treatment
Protecting Patients From Harm Need basic understanding of Epidemiology of infection caused by common micro-organisms Practices, procedures and treatments that prevent these infections Nurses pivotal role that reduce patients susceptibility to infection
Chain of Infection
Infectious agent Infectious agent microorganisms (bacteria, viruses) Resident normally reside on the skin in stable numbers Transient attach loosely to the skin by contact with another easily removed by hand washing
Reservoirs source of pathogen place in which an infectious agent can survive but may or may not multiply
Portal of exit From the reservoir, exit through the skin, respiratory tract, blood. Site where microorganism leaves
Mode of transmission The mechanism for transfer of an infectious agent from a reservoir to a susceptible host Means of spread: Airborne Droplet Contact Direct Indirect (Objects)
Portal of Entry (to the host) The path by which an infectious agent enters the susceptible host Respiratory tract Skin/mucous membrane Gastrointestinal tract Genitourinary tract Parenteral (percutaneous, via blood)
Host susceptibility A patient usually lacking of effective resistance to a particular pathogenic agent. Host must be susceptible to the strength and numbers of the microorganisms. To reduce susceptibility provide adequate nutrition, promote body defenses against infection & provide immunization.
Nosocomial infection in ICU Ventilator associated pneumonia(vap) Catheter related blood stream infections(crbsi) Urinary tract infections from urinary catheters (CAUTI). Surgical-site infections (SSI) Fungal infections
Breaking the Chain of Infection is the responsibility of each healthcare providers make sure that ports of entry are not subjected to pathogens (nose, mouth, eyes, urinary tract, open wounds, etc)
Breaking the Chain of Infection Pathogen Identification identification of infectious agent and appropriate treatment Asepsis and Hygiene potential hosts and carriers must practice asepsis & maintain proper personal hygiene Control Portals of Exit practice standard precautions (Control body secretions and wash hands according to protocol)
Breaking the Chain of Infection Prevent a Route of Transmission prevent direct or indirect contact : proper handwashing, disinfection and sterilization techniques, isolation of infected patients.. Protect Portal of Entry make sure that ports of entry are not subjected to pathogens (nose, mouth, eyes, urinary tract, open wounds, etc.) Recognition of Susceptible Host must recognize and protect high-risk patients
NURSES AS ROLL ROLE MODELS in minimizing nosocomial infection
QUOTES..
Nurse an essential member of the healthcare team provide a safe environment for patients identify patients who are at high risk of infection prompts the physician by reporting patient response and improvement
The nurse leads healthcare members in practicing prevention strategies to protect the patient from infection
Nurses Role Responsibility Knowledge Skills Creator : to create & provide a safe environment for patients
Role as Infection Control Personnel Protect patients and ourselves
What important practices which can minimise the likelihood of harm occurring
Infection Control Focus Established programme of control and prevention Standard principles : Universal precautions Environmental hygiene Hand hygiene Use of personal protective equipment Safe use and disposal of sharps
Key action areas in preventing infection Practice Target Detail Hand hygiene All patients Using soap and water or alcohol-based hand rub at the right time and in the right way Standard (universal) precautions: -Hand hygiene -Use of personal protective equipment -Safe use and disposal of sharps All patients Ensures personal protection and the prevention of crossinfection if protective clothing is worn and changed appropriately
Key action areas in preventing infection Practice Target Detail Care of invasive devices: -Urinary catheters -Peripheral catheter care -CVC care -ETT -Enteral feeds Identify those patients with devices in situ Principles of asepsis and appropriate and timely removal Bundle strategies Wound care Identify those patients with breached skin integrity Depends on nature of wound: acute versus chronic care may differ. Principles of asepsis for surgical wounds
Superbugs MRSA MRSA methicillin resistant staphylococcus aureus common nosocomial infection in hospitals & long term care facilities. MRSA is easily transmitted by health care workers because it frequently colonizes on the skin VERY IMPORTANT TO WASH YOUR HANDS.
THE HANDS GIVE IT AWAY New England Journal of Medicine Volume 360:e3 January 15, 2009 Number 3
Acinetobacter MRO opportunistic bacterial pathogen contrasts it behaviour to other gram-ve bacteria (which usually do not survive dry conditions) ability to survive drying enables the organism to survive and persist in the ward environment outbreaks
Acinetobacter MRO Humans moist, warm areas axilla, groin, between toes Hospitals moist environments humidifiers, tap water, sinks, ventilator equipment, computer keypad IS A TRANSIENT ORGANISM easily carried & easily removed
An outbreak of multidrug-resistant Acinetobacter baumannii Outbreak : controlled by emphasizing the control of environmental reservoirs (reduced environmental contamination)
Common bacteriological cultures in VAP 2007 2012 60 Percentage of organism isolated 50 40 30 20 10 Acinetobacter spp. Pseudomonas spp. Klebsiella spp. MRSA MSSA Fungi 0 2007 2008 2009 2010 2011 2012 Year
WHO
Adherence to Bundle Care Ventilator Care Bundle CVC Care Bundle CAUTI Bundle ICU management Guidelines and Protocols
Ventilator Care Bundle COMPONENT Head of bed 30-45 DVT prophylaxis PU prophylaxis Sedation holds DEFINITION patients nursed with the head of bed at least 30-45 patients receiving prophylaxis within 24hrs of admission patients receiving PU prophylaxis within 24hrs of admission patients who have had their sedation held within the last 24hrs
VCB compliance and VAP 2007 2011 100 90 82.4 88.3 90.6 93.8 96 18 16 VCB compliance % 80 70 60 50 40 30 20 15.4 13.5 11.6 10.1 6.8 14 12 10 8 6 4 VAP per 1000 ventilator days 10 2 0 2007 2008 2009 2010 2011 0 VCB compliance % VAP per 1000 ventilator days
CVC Care Bundle 1 Hand hygiene 2 Maximal barrier precautions before insertion 3 Chlorhexidine skin antisepsis 4 Optimal Catheter site selection - with Subclavian vein as preferred site 5 Daily review of CVC necessity with prompt removal of unnecessary lines
Protective/Barrier isolation physical protection negative psychological impact on the patient (feeling of loneliness) provide emotional and psychological support
MailOnline Eyeshadow a breeding ground for bacteria? Women keep make-up for six YEARS after expiry date leaving them at risk of infection Culprits for spreading infection
Nurse burnout increases likelihood of infection AJIC: American Journal of Infection Control Volume 40, Issue 6, 486-490, August 2012 nurse burnout remained significantly associated with UTI (0.82; P =.03) and SSI infection (1.56; P <.01) Reducing burnout in RN is a promising strategy to help control infections in acute care facilities FIT FOR DUTY
Evolution of a nurse Once upon a time New generation
Supposed to be..
Take Home Message Nurses play a pivotal role in preventing nosocomial infections They create and provide safe environment Universal precautions are the cornerstones of the principle Implementation of appropriate care bundles is of key importance in infection prevention
THANK YOU FOR YOUR ATTENTION