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Also known as healthcare acquired infection Traditionally referred as hospital acquired infections Infections that develop during hospitalization One of the leading causes of death and increased morbidity for hospitalized patients Of which are mostly caused by drug resistant strains of bacteria
Systemic Infection A systemic disease caused by pathogenic organisms or their toxins in the bloodstream
Definitions
Catheter 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.
Definitions
Systemic 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.
ENTRY SITE
Usually inserted in veins of forearm or hand
LENGTH
<3 inches
COMMENTS
Phlebitis with prolonged use; rarely associated with BSI
Usually inserted in radial artery; can be placed in femoral, axillary, brachial, posterior tibial arteries Inserted via the antecubital fossa into the proximal basilic or cephalic veins; does not enter central veins, peripheral catheters
<3 inches
Midline catheters
3 8 inches
Reported with anaphylactoid reactions on elastommeric hydrogel catheter; lower rates of phlebitis than short peripheral catheters
ENTRY SITE
Percutaneously inserted into central veins ( subclavian, internal jugular, or femoral) Inserted through a Teflon introducer in a central vein( subclavian, internal jugular, or femoral)
LENGTH
8 cm depending on the patient size
COMMENTS
Account for majority CRBSI
Usually heparin bonded; similar rates of BSI as CVCs; subclavian site preferred to reduce infection risk Lower rate of infection than nontunnelled CVCs
Inserted in basilic, Peripherally inserted cephalic, or brachial central venous veins and enter the catheter (PICC) superior vena cava
ENTRY SITE
Implanted into subclavian, internal jugular, or femoral veins
LENGTH
8 cm depending on the patient size
COMMENTS
Cuff inhibits migration of organisms into the catheter tract; lower rate of infection than that of the nontunneled CVC Lowest rate of CRBSI; improved patient self image; no need for local catheter site care; surgery required for catheter removal
Totally implantable
Tunnelled beneath the skin and have subcutaneous port accessed with needle; implanted in subclavian, internal jugular vein Inserted into umbilical vein or umbilical artery
Umbilical catheters
Risk for CRBSI similar with catheters placed in umbilical vein vs artery
Susceptible host
Reservoir
Portal of Entry
MODE OF TRANSMISSION
It is the method of transfer by which organism moves or is carried from one place to another E.g. Hands of the health care worker may carry bacteria from one person to another.
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.
Risk Factors
Type of catheter used
The number of lumen of the catheter has
Total parenteral nutrition Duration of catheterization Catheter site insertion Expertise of the person inserting Management of catheter after insertion Guidewire exchange Use of dressing Use of triple antibiotic ointment
Common pathogens of BSI Candida albicans Staphylococcus aureus Enterobacter cloaceae Staphylococcus epidermidis Pseudomonas aeruginosa Enterococcus fecalis
and rapid identification of microorganisms Early recognition of sign and symptoms of infection
Employee
health examinations and screenings Environmental sanitations Disinfection / Sterilization of instruments Standard Precautions, Medical Asepsis, Proper Hygiene Clean gowns, linens, towels, Clean wound dressing of PPE, proper waste disposal, standard precautions Handwashing, Standard Precautions, Safe food handling, isolations, use of PPE, transmission based precautions
Aseptic Handwashing, use
technique, medical or surgical asepsis, wound / catheter care, proper disposal, maintain skin integrity, standard precautions of Disease, Recognition of clients at risk, immunization, exercise, proper nutrition
Susceptible Host
Treatment
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
Prevention
Selection 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
Health Care Worker Education and Training Surveillance for Catheter Related Infection Handwashing Barriers Precautions During Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and Replacement of Intravascular Devices
Replacement of Administration Sets and Intravenous Fluids Intravenous Injection Ports Preparation and Quality Control of Intavenous Admixtures In line Filters Intravenous Therapy Personnel Needleless Intravascular Devices Prophylactic antimicrobials