INTENSIVE CARE UNIT (ICU) ASSOCIATED INFECTIONS Dr.T.V.Rao MD

1. INTENSIVE CARE UNIT (ICU)
ASSOCIATED
INFECTIONS
Dr.T.V.Rao MD

2. A Patient in Intensive Care Unit is
at Risk for Many Reasons..
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Dr.T.V.Rao MD at ICU Associated
infections
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3. LIFE AT RISK WE SHOULD FIND SOME
POSSIBILITIES MAKE THINGS BETTER
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Dr.T.V.Rao MD at ICU Associated
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4. Strategies to Improve Critical
Thinking in Critical Care
• Albert Einstein
once said,
"Education is
not the learning
of facts, but the
training of the
mind to think."
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Dr.T.V.Rao MD at ICU Associated
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5. WHO SHOULD BE ADMITTED
IN INTESNIVE CARE UNITS
• ICU s are created in
order to look after the
welfare of patients that
need ventilators, blood
pressure support and
medication, cutting
edge treatments and
close monitoring by
doctors and other
healthcare staff
better nursing
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Dr.T.V.Rao MD at ICU Associated
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6. ICUs are Life saving
• It is hardly the case that
everyone admitted to the
ICU is on the verge of
losing their battle to
survive. In fact, one study
suggests that more than
half the patients admitted
to the ICU have an
exceedingly low risk of
dying during their
hospital stay.
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Dr.T.V.Rao MD at ICU Associated
infections
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7. PREVENTION IS BETTER
THAN CURE
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8. WHY ONE MAY BE IN ICU
WITH
• And why do they come to the ICU
• Ventilator support – respiratory failure –
pneumonia
• Hemodynamic support – shock
• Renal replacement therapy – renal failure,
severe acidosis
• Monitoring, Neurological dysfunction,
Haematological disorders
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Dr.T.V.Rao MD at ICU Associated
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9. THE OBVIOUS FOCUS
• Community acquired pneumonia
• Acute CNS infection
• Urinary tract infection
• Abdominal focus of infection
• Wound infection / Pus
collections
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Dr.T.V.Rao MD at ICU Associated
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10. Nosocomial Infections in
ICU patients
• Nosocomial infections
are a major cause of
avoidable morbidity,
mortality and extended
length of stay in ICU.
Prevention of these
infections is key.
Continual
surveillance,
audit and hand
hygiene are
therefore vital.
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Dr.T.V.Rao MD at ICU Associated
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11. CARE Bundles saves ICU
Patients
• The recent introduction of ‘care
bundles’ grouping best practices for care
of invasive devices have proven highly
successful for reducing the rates of
nosocomial infection in the ICU. Despite
these strategies patients in the ICU are
still twice as likely to contract a
nosocomial infection compared to the
general hospital population.
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Dr.T.V.Rao MD at ICU Associated
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12. Superbugs a great
threat
• The microbes involved tend to be more
difficult to eradicate due to increasing
microbial resistance. The most common
nosocomial infections contracted in
critical care are ventilator-associated
pneumonia, central line-associated
blood stream infection and urinary
catheter-related urinary tract infection.
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Dr.T.V.Rao MD at ICU Associated
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13. Microbiology Departments to be
competent
• Timely recognition and
management of these
conditions is key to
providing best care
within the ICU. The focus
of therapy should always
be targeted to specific
microbes with
information guided by
initial cultures and
sensitivities.
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Dr.T.V.Rao MD at ICU Associated
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14. WHY INFECTION CONTROL
ICUs
• Intensive care units (ICUs) 10
%of total beds, more than 20
percent of all nosocomial
infections are acquired in ICUs.
ICU-acquired infections account
for substantial morbidity,
mortality, and expenses.
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Dr.T.V.Rao MD at ICU Associated
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15. RISK OF INFECTIONS
IN ICU
• Contributing to the
seriousness of
nosocomial
infections, especially
in ICUs, is the
increasing incidence
of infections caused
by antibiotic
resistant pathogens
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Dr.T.V.Rao MD at ICU Associated
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16. Factors contributing in
infections
1 Compared to general patients, patients in
ICUs have more chronic comorbidities & more
severe acute physiologic derangements.
2. The high frequency of use of catheters
provide a portal of entry of organisms into
the bloodstream.
3 Multidrug-resistant pathogens
MRSA and VRE are being isolated with
increasing frequency in ICU
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Dr.T.V.Rao MD at ICU Associated
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17. The Purpose of the
Programme
• The purpose of this program
is to maintain a healthy and
safe Hospital by the
prevention and control
of health care related
infections / diseases in
particular intensive care
units. This is achieved by
surveillance and
investigation of infectious
diseases and public
education.
Dr.T.V.Rao MD at ICU Associated infections
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18. Educating our Health Care Workers
• Education programs for
employees and
volunteers are one
method to ensure
competent infection
control practices. It is a
unique challenge since
employees represent a
wide range of expertise
and educational
background.
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Dr.T.V.Rao MD at ICU Associated
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19. Why ICU patients are different
• Sickest patients (multiple diagnoses, multi-
organ failure, immunocompromised, septic
and trauma)
• Move less
• Malnourished
• More obtunded (Glasgow coma scale)
• May be associated Diabetics and Heart
failure
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Dr.T.V.Rao MD at ICU Associated
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20. ICU Care is Invasive at many
Stages
• More invasive lines and
procedures including
surgeries
• Longer length of stay
• More IV and parenteral
drugs
• More tube feeding and
Parenteral nutrition
• More ventilation
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Dr.T.V.Rao MD at ICU Associated
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21. ICU : Factors that increase
cross-infections
• Hand washing
facilities are
inadequate
• Patient close together
or sharing rooms
• Understaffing
• Preparation of IVs on
the unit
• Lack of isolation
facilities
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Dr.T.V.Rao MD at ICU Associated
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22. : Factors that increase
cross-infections
• No separation of
clean and dirty
AREAS
• Excessive antibiotic
use
• Inadequate
decontamination of
items & equipment's
• Inadequate cleaning
of environment
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Dr.T.V.Rao MD at ICU Associated
infections
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23. Some Health-Care Associated
Infections May Occur in ICU Patients
• UTI associated with Foley catheters
• Lower respiratory tract infection (post-
op and ventilator dependent)
• Skin necrosis (skin breakdown)
• Blood stream infection (and line
associated)
• Surgical-site infection
• Nutrition-related and malnutrition
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Dr.T.V.Rao MD at ICU Associated
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24. Strategy for Prevention
• Clean and decontaminate all equipment after use
• Sterilise or use high-level disinfection for all items
that come into direct or indirect contact with
mucous membranes
• Rinse and dry items that have been chemically
disinfected
• Package and store items to prevent contamination
before use
• Keep environment clean, dry and dust free
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Dr.T.V.Rao MD at ICU Associated
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25. Intensive Care Unit
Prevention of Blood stream
infections

26. Strategy for Infection
Prevention
• Strict attention to Hand hygiene
• Prudent Antibiotic use
• Aseptic technique
• Disinfection/Sterilization of items and equipment
• Education of staff infection control awareness
• Keep Environment Clean, Dry and dust free
• Surveillance of nosocomial infection to identify
problems areas & set priorities
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Dr.T.V.Rao MD at ICU Associated
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27. CHLORHEXIDINE SKIN
ANTISEPSIS
• Prepare skin with antiseptic/detergent
Chlorhexidine 2% in 70% isopropyl alcohol.
• • Pinch wings on the applicator to pop the ampule.
Hold the applicator down to allow the solution to
saturate the pad.
• • Press sponge against skin, apply chlorhexidine
solution using a back and forth friction scrub for at
least 30 seconds. Do not wipe or blot.
• • Allow antiseptic solution time to dry completely
before puncturing the site (~ 2 minutes)
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Dr.T.V.Rao MD at ICU Associated
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28. Serious Infective Complications
• Blood Stream Infections (BSI)
• Septic pulmonary emboli
• Metastasis infection
– Acute endocarditis
– Osteomyelitis
– Septic arthritis
• Shock and organ failure
• Poor outcome: Staph.aureus or Candida spp.
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Dr.T.V.Rao MD at ICU Associated
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29. Prevention Strategies: Core
Chlorhexidine Skin Cleansing
• Chlorhexidine is the
preferred agent for skin
cleansing for both CL
insertion and
maintenance
– Tincture of iodine, an
iodophor, or 70%
alcohol are alternatives
– Recommended
application methods
and contact time should
be followed for maximal
effect
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Dr.T.V.Rao MD at ICU Associated
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30. Intrinsic contamination of
infusion fluid
Connection with administration
set
Insertion site
Injection ports
Administration set connection
with IV catheter
Port for
additives
Sources of Infection
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Dr.T.V.Rao MD at ICU Associated
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31. Intralumunal Spread
Contaminated
infusate (fluid,
medication)
2. Intraluminal Spread
Contaminated infusate
(fluid, medication)
1. Extra luminal Spread
Patient’s own skin micro flora
Microorganism transferred by
the hands of Health Care
Worker
Contaminated entry port,
catheter tip prior or during
insertion
Contaminated disinfectant
solutions
Invading wound
3. Haematogenous Spread
Infection from distant
focus
Fibrin
Skin
Vein
Skin attachment
Sources of Infection
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Dr.T.V.Rao MD at ICU Associated
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32. Prevention of CR-BSI
Written Protocol
Must be performed by trained staff
according to written guidelines
Sterile procedure
Sterile gown, Sterile gloves, Sterile large
drapes
Don't shave the site
Hand disinfection
With an antiseptic solution eg
Chlorhexidine gluconate
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Dr.T.V.Rao MD at ICU Associated
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33. Prevention of CR-BSI
Skin antisepsis
• 2% Chlorhexidine gluconate has shown to
have lower BSI than 10% Povidone-iodine or
70 % Alcohol
• 2-min drying time before insertion
Maki DG et al. Lancet 1991;338:339-43
• No difference between 0.5% Chlorhexidine
gluconate or 10% Povidone-iodine
Humar A et al. Clin Infect Dis 2000;31:1001-7
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Dr.T.V.Rao MD at ICU Associated
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34. Prevention of CR-BSI
Catheters removal
• Don’t replace it routinely
• Replace it if:
– Inserted in an Emergency
– Non functioning
– Evidence of local or systemic infection
General handling
• Opening of hub: Use antiseptic-
impregnated pads eg Chlorhexidine
gluconate or povidone iodine
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Dr.T.V.Rao MD at ICU Associated
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35. Prevention of CR-BSI
Administration sets
• Replacement at 72-h intervals
• No difference in phlebitis if left
for 96 hours
• Lines for lipid emulsion:
replacement at 24-h intervals
• Lines for blood product : remove
immediately after use
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Dr.T.V.Rao MD at ICU Associated
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36. Prevention of CR-BSI
Topical antibiotic
• Prophylactic use of topical Mupirocin
(Bactroban) at insertion site or in nose is not
recommended
– Rapid development of Mupirocin resistant
– Mupirocin affect the integrity of Polyurethane
catheter
Systemic antibiotic
• Prophylactic use of antibiotic is not
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Dr.T.V.Rao MD at ICU Associated
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37. Background: Prevention Strategies
Interventions
• Michigan Keystone Project
• Decrease in CLABSI in 103 ICUs in Michigan
(66% reduction)
• Basic interventions:
– Hand hygiene
– Full barrier precautions during CL insertion
– Skin cleansing with chlorhexidine
– Avoiding femoral site
– Removing unnecessary catheters
– Use of insertion checklist
– Promotion of safety culture
Pronovost et al. NEJM 2006;355:2725-32.
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Dr.T.V.Rao MD at ICU Associated
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38. Urinary Catheterization

39. External urethral meatus &
urethra
• Pass catheter when bladder full for wash-out effect.
• Before catheterization prepare urinary meatus with
an antiseptic ( e.g. povidone iodine or 0.2%
chlorhexidine aqueous solution)
• Inject single-use sterile lubricant gel (e.g. 1-2%)
lignocaine into urethra and hold there for 3 minutes
before inserting catheter.
• Use sterile catheter.
• Use non-touch technique for insertion
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Dr.T.V.Rao MD at ICU Associated
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40. Junction between catheter &
drainage tube
• Do not disconnect catheter unless
absolutely necessary.
• For urine specimen collection disinfect
outside of catheter proximal to junction
with drainage tube by applying alcoholic
impregnated wipe and allow it to dry
completely then aspirate urine with a
sterile needle and syringe.
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Dr.T.V.Rao MD at ICU Associated
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41. Junction between drainage tube
& collection bag
• Keep bag below level of bladder. If it is
necessary to raise collection bag above
bladder level for a short period,
drainage tube must be clamped
temporarily.
• Empty bag every 8 hours or earlier if
full.
• Do not hold bag upside down when
emptying
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Dr.T.V.Rao MD at ICU Associated
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42. Tap at bottom of collection bag
• Collection bag must never touch floor.
• Always wash or disinfect hands (eg with
70% alcohol) before and after opening
tap.
• Use a separate disinfected jug to collect
urine from each bag.
• Don't put disinfectant into urinary bag.
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Dr.T.V.Rao MD at ICU Associated
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43. Intensive Care Unit
Nosocomial Pneumonia

44. • Additional morbidity
• Prolonged
hospitalization
• Long-term physical,
developmental and
neurological sequelae
• Increased cost of
hospitalization
• Death
Dr.T.V.Rao MD at ICU Associated
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Consequences of Hospital
Acquired Infections
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45. Incidence of HAI vs. Cost
Hospital acquired
Infection
Incidence Additional
cost
Urinary Tract 45% 13%
Surgical Wound 29% 42 %
Pneumonia 9 % 39%
Blood Stream 2% 4 %
Haley, 1986
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Dr.T.V.Rao MD at ICU Associated
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46. INFECTIOUS CAUSES OF
FEVER WHILST IN ICU
• Ventilator associated
pneumonia
• Catheter related blood
stream infections
• Urosepsis
• Intra-abdominal
infections
• Sinus infections
• Diarrhoea
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Dr.T.V.Rao MD at ICU Associated
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47. DEVICE RELATED
NOSOCOMIAL INFECTION
• A device-associated infection is an
infection in a patient with a device (i.e.,
central line, ventilator, or indwelling
urinary catheter) that was in use within
the 48-hour period before onset of
infection. If the interval since
discontinuation of the device is longer
than 48 hours, there must be compelling
evidence that infection was associated
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Dr.T.V.Rao MD at ICU Associated
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48. Risk factors for bacterial pneumonia
Host Factors Factors that facilitate reflux
& aspiration into the lower RT
• Elderly
• Severe Illness
• Underlying Lung Disease - Mechanical ventilation
• Depressed Mental Status - Tracheostomy
• Immunocompromising - Use of a Nasogastric Tube
Conditions or Treatments - Supine Position
• Viral Respiratory Tract Factors that impede normal
Infection Pulmonary Toilet
Colonisation - Abdominal or thoracic surgery
• Intensive Care Setting - Immobilisation
• Use of Antimicrobial Agents
• Contaminated hands
• Contaminated Equipment
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Dr.T.V.Rao MD at ICU Associated
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49. Prevention in ICU
• Turn patients to encourage
postural drainage
• Encourage to take deep
breaths and cough.
• Maintain an upright
position (elevate patient’s
head to 30º- 45º degree
angle) to reduce reflux and
aspiration of gastric
bacteria.
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Dr.T.V.Rao MD at ICU Associated
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50. Gastric Ulcer Prophylaxis
• Stomach of a healthy person : Acidic pH () &
normal peristalsis movement prevent bacterial
growth
• Alkaline pH () and loss on normal peristalsis lead
to bacterial colonisation which increases the risk of
ventilator-associated pneumonia
• Mechanical ventilation patients are at increased
risk for upper GI hemorrhage from stress ulcers.
• H2 blockers or antacids are used to prevent stress
ulcers
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Dr.T.V.Rao MD at ICU Associated
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51. Nasogastric Tube
• May erode the mucosal surface
• Block the sinus ducts
• Regurgitation of gastric contents leading to
aspiration.
• Verify placement of the feeding tube in the
stomach or small intestine by X ray
• Elevate the head of the bed 30º- 45 º degrees
Remove NG Tube if not necessary
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Dr.T.V.Rao MD at ICU Associated
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52. Ventilators
• After every patient,
clean and disinfect
(high-level) or
sterilize re-usable
components of the
breathing system or
the patient circuit
according to the
manufacturer’s
instructions.
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Dr.T.V.Rao MD at ICU Associated
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53. Suctioning mechanically
ventilated patients
• Hand washing before and after the procedure.
• Wear clean gloves to prevent cross-
contamination
• Use a sterile single-use catheter ; if it is not
possible then rinse catheter with sterile water
and store it in a dry, clean container between
uses and change the catheter every 8 - 12
hours.
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Dr.T.V.Rao MD at ICU Associated
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54. Suction Bottle
 Use single-use
disposable, if possible
 Non-disposable bottles
should be washed with
detergent and allowed
to dry. Heat disinfect in
washing machine or
send to Sterile Service
Department.
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Dr.T.V.Rao MD at ICU Associated
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55. Nebulizers
• Use sterile medications and fluids for
nebulization
• Fill with sterile water only.
• Change and reprocess device between
patients by using sterilization or a high level
disinfection or use single-use disposable
item.
• Small hand held nebulizers
– minimise unnecessary use
– between uses for the same patient
disinfect, rinse with sterile water, or air dry
and store in a clean, dry place
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Dr.T.V.Rao MD at ICU Associated
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56. Humidifiers
• Clean and sterilize
device between
patients.
• Fill with sterile water
which must be changed
every 24 hours or
sooner, if necessary.
• Single-use disposable
humidifiers are
available but they are
expensive.
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Dr.T.V.Rao MD at ICU Associated
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57. Oxygen mask
• Change oxygen
mask and
tubing
between
patients and
more
frequently if
soiled
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Dr.T.V.Rao MD at ICU Associated
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58. The Scientific study ( SENIC ) gives
guidelines
• Study of the Efficacy of Nosocomial
Infection Control (SENIC) project was
published, validating the cost-benefit of
infection control programs. Data
collected in 1970 and 1976-1977
suggested that one-third of all
nosocomial infections could be
prevented if all the following were
present: Dr.T.V.Rao MD at ICU Associated
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59. Important to consider
• One infection control professional (ICP)
for every 250 beds.
• An effective infection control physician.
• A program reporting infection rates back
to the surgeon and those clinically
involved with the infection.
• An organized hospital-wide surveillance
system.
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Dr.T.V.Rao MD at ICU Associated
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60. Antibiotics use
Must avoid widespread use
of
broad spectrum antibiotics
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61. Diagnosis Problem-
Detection of Infection
in the ICU’s

62. Sepsis – Leading cause of
• Bacterial infections and sepsis are responsible
for significant morbidity and mortality in
patients admitted to the intensive care unit
and their management is further complicated
by the increase in the global burden of
antimicrobial resistance. Inthis setting, new
diagnostic methods able to overcome the
limits of traditional microbiology in terms of
turn-around time and
• accuracy are highly warranted
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63. Current Diagnostic Methods
• Current diagnostic methods in patients
presenting with sepis is largely rely on
the culture of micro-organisms from
blood to detect bacteraemia. However,
not only is this approachrelatively slow
and laborious, culture-based systems
sufferfrom a number of pre-analytical
limitations that may affect performance,
such as inadequate blood volume
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64. Blood culture systems
• Currently, automated BC
systems are the gold
standardfor bloodstream
infection detection Many
automated BC
• systems exist (e.g.
BACTECTMFX,BacT/ALERT®)
whichapply different
methods to detect
organism growth (i.e. differ
binding agents) and their
performance has been
compared
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65. Delayed Laboratory results
Impacts Patients
• when an organism is cultured, definitive
identification and susceptibility testing may
be delayed for few days. Contamination is a
frequent problem that may occurat blood
culture (BC) collection and may drive
inappropriateantibiotic use, misdirect clinical
diagnosis and expose patientto unnecessary
toxicities . There are also many fastidious
pathogens, which can be challenging to
culture in standard automated systems
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66. Examples of difficult to detect infections:
Uncultivable organisms
Viruses are under appreciated as causes
of nosocomial infections. Except in cases
of high morbidity viral cultures are not
done in resource scarce settings. Impact
food-borne, respiratory, water borne
illnesses.
We don’t know the spectrum of anti-
microbial activity of most preservatives
and cleaners for many viruses.
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Dr.T.V.Rao MD at ICU Associated
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67. Cooperation Between Laboratory
and Clinician saves many lives
• This, combined with
regular liaison with
local microbiology
colleagues, will
ensure the best
treatment with the
least risk of causing
selective pressures
and further multi
drug resistance.
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68. FUNGI TOO INFECTIVE IN
ICU PATIENTS

69. RISK FACTORS FOR
ASPERGILLOSIS
• Neutropenia
steroids
• • Environmental
exposure
• • Building work
• • Compost heaps
• • Marijuana
smoking
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70. Covid 19
Mucormycosis
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71. INVASIVE ASPERGILLOSIS
• Incidence increasing
commonest cause of
infectious death in
many transplant units
• • commonest cause
of death in
childhood
leukaemia
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72. Examples from the NNIS
Manual
• Symptomatic Urinary Tract Infection:
– Patient must have one of the two criteria:
• Fever >38 C OR urgency OR frequency OR
dysuria OR suprapubic tenderness without
other cause
OR
• Urine culture with at least 105 organisms per
ml or no more than two species of organisms
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Dr.T.V.Rao MD at ICU Associated
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73. Surveillance of
Intensive care Units

74. Alert organism for surveillance
and barrier precautions
• Gram-positive pathogens
• Methicillin-resistant Staphylococcus
aureus
• Glycopeptide-intermediate/resistant S.
aureus
• Glycopeptide-resistant enterococci
• High-level aminoglycoside-resistant
enterococci
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Dr.T.V.Rao MD at ICU Associated
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75. Alert organism for surveillance
and barrier precautions
• Gram-negative pathogens
• Aminoglycoside-resistant Enterobacteriaceae
• Carbapenem-resistant
Enterobacteriaceae/Acinetobacter spp.
• 4GCa
• -resistant Enterobacteriaceae
• Burkholderia cepaciae
• Acinetobacter spp. resistant to three drug classesb
• Pseudomonas spp. or other no
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76. Rationalistic Antibiotic use
• With the increasing problem of
antibiotic resistance, there is an urgent
need to improve ou ruse of antibiotics
by better de¢ning the nature of
infection inthe ICU. By
the adoption of such good clinical
practice, carewithin the ICU can be
made safer
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Dr.T.V.Rao MD at ICU Associated
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77. ANTIBIOTIC POLICIES
• While efforts are made to ensure prompt and
optimal treatment of infection, antibiotics
should be reviewed frequently,ideally every
day, with a view to streamlining to
simpler,sometimes even oral, therapy at the
earliest opportunity and tostopping
treatment at the earliest appropriate
moment. Theuse of automatic stop orders
may be appropriate with regard toselected
drugs for speci¢c indications.
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78. Prior to starting any surveillance
• Agree upon a
written case
definition that is
practical given the
laboratory
facilities and
patient work load
in your facility.
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79. SURVEILLANCE
• Cornerstone of all successful hospital infection
control programs.
• Surveillance is only the starting point and
benchmark for assessing the need for intervention
strategies.
Effective surveillance involves counting cases
and then calculating rates of various
infections, analyzing these data, reporting the
data in an appropriate way to personnel
involved in patient care
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80. PROBLEMS WITH AIR SAMPLING
HAS LIMITATIONS ??
• Incubation period of IPA unknown
• Estimates vary from 48 hours -3
monthsvariation in spore counts
andpredominant species
• Variable efficiency of different air samplers
• May not take account of
surfacecontamination
• • Settle plates, contact plates, honey jars
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81. Our plan for future should include
• Unlike scheduled activities, occasional clusters of
patients who are colonized or infected will trigger
further investigation including a case-control study.
New laboratory methods developed and refined
within the last decade can now determine how
related the strain is at the molecular level.
The QI/IC plan should include special problem-
focused studies that describe personnel or
environmental sampling, including what
circumstances and who has the authority to order
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82. Hand washing
• Single most effective action to prevent HAI -
resident/transient bacteria
• Correct method - ensuring all surfaces are cleaned -
more important than agent used or length of time
taken
• No recommended frequency - should be determined
by intended/completed actions
• Research indicates:
– poor techniques - not all surfaces cleaned
– frequency diminishes with workload/distance
– poor compliance with guidelines/training
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84. Research indicates:
• Research
indicates:poor
techniques - not all
surfaces cleaned
requency diminishes
with
workload/distancepoor
compliance with
guidelines/training
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85. Why we are not washing hands ???
• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
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86. The Hospitals and Microbiology Departments should
create
documentation on
• central line-associated bloodstream infections
• (CLABSI),
• catheter-associated urinary tract infections
(CAUTI),
• surgical site infections (SSI),
• hospital-onset Clostridium difficile infections (C
difficile), and
• hospital-onset methicillin-resistant Staphylococcus
aureus
• •(MRSA) bacteremia (bloodstream infections
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87. Who will pay for better care
???
• The problem of
resources for
proving better ICU
care in
Developing
countries
continues to be
real problem,
need additional
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88. EPIDEMIOLOGY
• A multicenter, prospective cohort surveillance
study of 46 hospitals in Central and South
America, India, Morocco, and Turkey.
• Rates of device-associated infection were
determined between 2002 and 2005; an overall rate
of 14.7 percent or 22.5 infections per 1000 ICU days
was found.
• Specific devices:
– Ventilator associated pneumonia (VAP); 24.1 cases/1000
ventilator days (range 10.0-52.7)
– CVC-related bloodstream infections; 12.5/1000 catheter
days (7.8-18.5)
– Catheter-associated urinary tract infections; 8.9/1000
catheter days (1.7-12.8)
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89. Our Vision to Future
• Infection control
programs must
maintain training
records of employees.
The minimum training
required is annual
OSHA blood borne
pathogen, tuberculosis
prevention and control
and new employee
orientation.
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90. Why we need better ICU’s
• For an incidence as well as for a
prevalence population of critically ill
patients, there is a window of critical
opportunity for admission into the ICU,
much like the golden our for the
trauma patient.
• Efforts should be made to avail ICU facilities to as
many recently deteriorated patients as possible,
especially those who could be transferred into the
ICU very early after deterioration, such as
patients on hospital wards.
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91. Staff training a great Priority
• All staff in the ICU should be taught sound
infection control practice. There should be
e¡ective links with the hospitalepidemiologist
and infection control team nurses. Adequate
isolation facilities and handwashing facilities
should be available, and there should be
some single rooms with reversible
airexchange for either positive or negative
pressure isolation
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92. Critical care in India
Growing very fast
• Critical care in India has
evolved very rapidly
and significantly in the
last two decades of its
existence. Not only has
the number of ICUs and
the number of properly
equipped beds
increased, but the
trained manpower has
increased leaps and
bounds.
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93. CONCLUSIONS :
STRATEGY FOR INFECTION PREVENTION
• Strict attention to Hand hygiene
• • Prudent Antibiotic use
• • Aseptic technique
• • Disinfection/Sterilization of items and
equipment
• • Education of staff infection control
awareness
• • Keep Environment Clean, Dry and dust free
• • Surveillance of nosocomial infection to
identify problems areas & set priorities
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94. UNSOLVED ISSUES ON
right to live or die
• Published data on EOL decisions in Indian
ICUs is lacking. What is needed is a
prospective determination of which patients
will benefit from aggressive management
and life-support. A consensus regarding the
concept of Medical Futility is necessary to
give impetus to further discussion on more
advanced policies including ideas such as
Managed Care to restrict unnecessary health
care costs, euthanasia,
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95. Do remember the Reasons for Infections
are Many but solutions are few …
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96. DO NOT FORGET ONE DAY MANY
OF US AND EVEN NEAR AND DEAR
NEED ICU CARE
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97. Yet No Substitute for Hand Washing
Are You Washing ?
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98. Let us support our Hospitals with
clean hands
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99. Follow me for more articles of
Interest on Infections on …
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