Prevention of Cross Infection in Hospital setting

3. Also known as Nosocomial infection whose
development is favored by a hospital
environment, such as one acquired by a patient
during a hospital visit or one developing among
hospital staff.

4. Why focus on infection prevention
and control ?
 More than 20 percent of all nosocomial infections are
acquired in ICUs
 ICU-acquired infections account for substantial
morbidity, mortality, and expense.
 Improving infection prevention and control in critical
care acts as a catalyst for improvement in the rest of
the hospital.

5. Sources of Infection
Endogenous sources: 50%
Pt’s own flora, such as skin, nose, mouth, GI tract,
or genitals ( greatest source of danger)
Exogenous sources are: 15%
Environment ( Air 5%,Instrument 10%)
Cross Infection : 35%
patient care personnel, visitors and other patients

6. EPIDEMIOLOGY
 Culture results
from ICU-acquired
infections at
Vidant Medical
Center
 UTI – Urinary tract
infection;
 HCAP – Healthcare-
associated
pneumonia;
 CABSI – Catheter-
associated
bloodstream
infection

7. Epidemiology of HAI

8.  more chronic comorbidities & more severe
acute physiologic derangements.
 the high frequency of use of catheters provide
a portal of entry of organisms into the
bloodstream.
 Multidrug-resistant pathogens MRSA and VRE
are being isolated with increasing frequency
in ICUs

9. Risk Factors :
 Presence of underlying comorbidities such as:
 diabetes, renal failure, malignancies predispose patients to colonization
and infection with multidrug-resistant bacteria
 Presence of indwelling devices, central venous catheters and endotracheal
tubes which bypass natural host defense mechanisms and serve as portals
of entry for pathogens.
 Frequent manipulations and contact with HCWs usually concurrently
caring for multiple ICU patients
 Hands are the vehicles for transfer of pathogens from patient to patient.
 Long hospital courses prior to the ICU admission more Antibiotic Exposure
,…..

10. 1. MRSA ( Methicillin Resistant Staphylococcus Aureus)
Resistant to flucloxacillin
May cause: wound infection, bacteremia, skin/soft tissue infection,
UTI, Pneumonia
Colonization common: nose, axilla, perineum, wound/lession
Spread by: hands, fomites, aerosols
Control: eradication of carriage, barrier nursing, screening of other
patients

11. 2. Tuberculosis – open pulmonary TB and sputum smear positive
for Acid fast bacilli.
3. Viral Infection - chicken pox, Hepatitis B, HIV
4. Gram Negative Organism – resistant to multiple antibiotics.
Organism such as: E coli, Proteus, Enterobacter, Acinetobacter,
Pseudomonas Aeruginosa
Causes: Bacteremia, UTI, Pneumonia, Wound infection
Control: Anti-biotic policy
Adherence of infection control guidelines
prevention of cross infection

12. an application of
scientific and
epidemiological
principles for
infection prevention
and reduction in rates
of nosocomial
infections.

13. If known or suspected on admission to hospital, or
detected following admission:
Standard Precaution and Transmission Based
Precaution
Isolation (barrier precautions)
Inform Infection Control team
Treatment - if appropriate
Regular surveillance

17. Hand washing
is frequently called the single most important
measure to reduce the risks of
transmitting skin microorganisms from one
person to another or from one site to another
on the same patient. Washing hands as
promptly and thoroughly as possible between
patient contacts and after contact
with blood, body
fluids, secretions, excretions, and equipment
or articles contaminated by them is an
important component of infection control and
isolation precautions.

18. Steps of proper Hand Washing

20. Alcohol Hand Rub
An easy way to use because
of faster application
compared to correct hand
washing

22. Regular Surveillance
 Monitor the incidence of
epidemiologically-important organisms
and targeted HAIs that have substantial
impact on outcome and for which
effective preventive interventions are
available;
 use information collected through
surveillance of high-risk populations,
procedures, devices and highly
transmissible infectious agents to detect
transmission of infectious

23. Top CDC Recommendations to Prevent Healthcare-
Associated Infections
To Prevent Catheter-Associated Urinary Tract Infections
(CAUTIs:)
 Insert catheters only for appropriate indications
 Leave catheters in place only as long as needed
 Ensure that only properly trained persons insert and maintain catheters
 Insert catheters using aseptic technique and sterile equipment (acute
care setting)
 Follow aseptic insertion, maintain a closed drainage system
 Maintain unobstructed urine flow
 Comply with CDC hand hygiene recommendations and Standard
Precautions
 Also consider:
 Alternatives to indwelling urinary catheterization
 Use of portable ultrasound devices for assessing urine volume to reduce
unnecessary catheterizations
 Use of antimicrobial/antiseptic-impregnated catheters

24. To Prevent Surgical Site Infections
Before surgery
 Administer antimicrobial prophylaxis in accordance with evidence-based
standards and guidelines
 Treat remote infections-whenever possible before elective operations
 Avoid hair removal at the operative site unless it will interfere with the
operation; do not use razors
 Use appropriate antiseptic agent and technique for skin preparation
During Surgery
 Keep OR doors closed during surgery except as needed for passage of
equipment, personnel, and the patient
After Surgery
 Maintain immediate postoperative normothermia
 Protect primary closure incisions with sterile dressing
 Control blood glucose level during the immediate post-operative period
(cardiac)
 Discontinue antibiotics according to evidence-based standards and
guidelines

25. Central Line-Associated Bloodstream Infections
(CLABSIs) Outside ICUs:
 Remove unnecessary central lines
 Follow proper insertion practices
 Facilitate proper insertion practices
 Comply with CDC hand hygiene recommendations
 Use appropriate agent for skin antisepsis
 Choose proper central line insertion sites
 Perform adequate hub/access port disinfection
 Provide staff education on central line maintenance and insertion
Also consider:
 Chlorhexidine bathing
 Antimicrobial-impregnated catheters
 Chlorhexidine-impregnated dressings

26. Clostridium difficile Infections
 Contact Precautions for duration of diarrhea
 Comply with CDC hand hygiene recommendations
 Adequate cleaning and disinfection of equipment and environment
 Laboratory-based alert system for immediate notification of positive test
results
 Educate about C. diff infection: healthcare personnel, housekeeping,
administration, patients, families
Also consider:
 Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48
hours)
 Presumptive isolation for symptomatic patients pending confirmation
of C. diffinfection
 Evaluate and optimize testing for C. diff infection
 Implement soap and water for hand hygiene before exiting room of a
patient with C. diff infection
 Implement universal glove use on units with high C. diff infection rates
 Use EPA-registered disinfectants with sporicidal claim (e.g., bleach) or
sterilants for environmental disinfection
 Implement an antimicrobial stewardship program

27. To Prevent MRSA Infections
 Comply with CDC hand hygiene recommendations
 Implement Contact Precautions for MRSA colonized and infected
patients
 Recognize previously MRSA colonized and infected patients
 Rapidly report MRSA lab results
 Provide MRSA education for healthcare providers
Also consider:
 Active surveillance testing – screening of patients to detect
colonization even if no evidence of infection
 Other novel strategies
 Decolonization
 Chlorhexidine bathing

28. Conclusion
 Although the ICU environment cannot be made microbe
free, aggressive measures should be made to reduce
HAIs and their associated increased morbidity, mortality,
length of stay and financial burden. The majority of
these infections are preventable with adequate
preventative measures. Healthcare workers are
mandated to implement infection control measures in
their daily practice. As patients in the ICU are critically
ill, infection control measures to avoid complications is
a priority and integral part of care. ICU providers must
be familiar with their institution’s infection control
guidelines for the prevention and management of
invasive devices/catheters, endotracheal tubes and
tracheostomies.