الفهرس 
Review of literature
Prevention of Catheter associated Urinary Tract InfectionsOnly 14 pages are availabe for public view
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Abstract
The prevention of Healthcare associated infections (HCAI) in Critical care unit
demands knowledge of the infection rates, sources and the pathogens involved as well
as the common risk factors for infection. The incidence of HCAI varies according to
the type of hospital or ICU and the patient population.
Standard precautions are the basic level of infection control that should be used in
the care of all patients all of the time. Standard Precautions are based on the principle
that all blood, body fluids, secretions, excretions except sweat, non-intact skin, and
mucous membranes may contain transmission-based infectious agents. These include:
hand hygiene; use of gloves, gown, mask, eye protection, or face shield, and safe
injection practices. Also, equipment or items in the patient environment likely to have
been contaminated with infectious body fluids must be handled in a manner to prevent
transmission of infectious agents (e.g., wear gloves for direct contact, properly clean
and disinfect or sterilize reusable equipment before use to another patient).
Although there are many risk factors for various type of HCAI in various groups
of patients, more commonly identified risk factors can be divided into four groups: (a)
Those related to underlying health impairment; (b) those related to the acute disease
process; (c) those related to use of invasive procedures and (d) those related to other
treatment modalities.
There are many techniques used for sterilization as steam sterilization, ethylene
oxide, plasma gas, Per-acetic acidic, vaporized formaldehyde. There are many levels
for disinfection practice that includes followings: High level disinfectants: these
inactivate all forms of microorganisms, including all types of viruses and fungi. They
can also destroy some bacterial spores if the exposition time is long enough (7-10
hours). Intermediate level disinfectants: these eliminate all forms of vegetative
bacteria: Mycobacterium tuberculosis as well as most viruses and fungi, but they do
not ensure destruction of bacterial spores. Low level disinfectants: these eliminate
most vegetative bacterial forms and some viruses and fungi, but do not guarantee
destruction of Mycobacterium tuberculosis, non-lipid viruses or bacterial spores.
There are major determinants of infection risk with intravascular catheters: the
type of catheter, the location of catheter placement, and the duration of catheter
placement. These parameters should be taken in mind to prevent vascular catheter
associated infections. CLABSI prevention includes hand hygiene plus aseptic
technique, maximal sterilization barrier precautions, skin preparation, catheter site
dressing regimens as using transparent dressing plus chlorhexidine gluconate–
impregnated sponge, and catheter care precautions as using sutureless securement
device.
According to catheter associated UTI, the most important aspects of infection
control and prevention are avoidance of unnecessary catheterization, use of sterile
technique when placing the catheter, and removal of the catheter as soon as possible.
The choice of catheter depends upon clinical indication and expected duration of
catheterization. The best alternative to an indwelling urethral catheter should be
considered. The source of microorganisms causing CAUTI can be endogenous, typically via
meatal, rectal, or vaginal colonization, or exogenous, such as via contaminated hands of
healthcare personnel or equipment. The most frequent pathogens associated with CAUTI
were Escherichia coli and Candida spp., followed by Enterococcus spp., Pseudomonas
aeruginosa, Klebsiella pneumoniae, and Enterobacter spp. A smaller proportion was caused
by other gram-negative bacteria and Staphylococcus spp. The choice of catheter depends
upon clinical indication and expected duration of catheterization. Guidelines for CAUTI
prevention includes appropriate urinary catheter use, consider using alternatives to indwelling
urethral catheterization in selected patients when appropriate, proper techniques for urinary
catheter insertion or maintenance.
Surgical site infections (SSIs) are a common cause of healthcare-associated
infection. The United States Centers for Disease Control and Prevention (CDC) have
developed criteria that define SSI as infection related to an operative procedure that
occurs at or near the surgical incision within 30 days of the procedure, or within 90
days if prosthetic material is implanted at surgery. There are three different types of
SSIs defined by CDC: superficial infections, deep incision infections, and infections
involving organs or body spaces. The degree of surgical site contamination at the time
of surgery influences the probability of SSI. Whether an SSI occurs depends upon a
complex interaction between numerous factors, including the nature and number of organisms
contaminating the surgical site, antimicrobial prophylaxis, the health of the patient, and the
technique of the surgeon. Other risk factors for SSI are associated with impaired wound
healing (e.g. cigarette smoking, older age, obesity, malnutrition, diabetes, immunosuppressive
therapy). SSI control includes tracheostomy stoma care in critical care unit.
Hospital-acquired (or nosocomial) pneumonia (HAP) is pneumonia that occurs
48 hours or more after admission and did not appear to be incubating at the time of
admission. Ventilator-associated pneumonia (VAP) is a type of pneumonia that
develops more than 48 to 72 hours after endotracheal intubation. Aspiration is a major
predisposing mechanism for both hospital-acquired pneumonia (HAP) and VAP.
Appropriate patient positioning and subglottic drainage in ventilated patients are two
important modalities for the prevention of aspiration. Prevention of VAP includes
ventilation reducing risk by avoid intubation if possible: use non-invasive positive
pressure ventilation whenever possible, minimize sedation: manage ventilated patients
without sedatives whenever possible; interrupt sedation once a day for patients
without contraindications, and maintain and improve physical condition: provide early
exercise and mobilization, accompying measures as education, measuring
performance, providing feedback, improvement in the overall safety culture in
healthcare, and public reporting, and finally preventive measures as change of the
ventilator circuit only if visibly soiled or malfunctioning, selective oral or digestive
decontamination, endotracheal tube with subglottic drainage of secretions, regular
oral care with chlorehexidine, prophylactic probiotics, and elevate the head of the bed
to 30-45o - ultrathin polyurethane ET cuffs - automated of ET cuff pressure - saline
irrigation before traceal suctioning - mechanical tooth brushing.
Multi-drug resistant organisms (MDROs) are defined as microorganisms,
predominantly bacteria, that are resistant to one or more antimicrobial agents, and are
usually resistant to all but one or two commercially available antimicrobial agents.
Multidrug resistance occurs against gram-negative bacilli, which are an important
cause of HAP and VAP, is variably defined as resistance to at least two, three, four, or
eight of the antibiotics typically used to treat infections with these organisms. Pan
resistance refers to those gram-negative organisms with diminished susceptibility to
all of the antibiotics recommended for the empiric treatment of VAP. Prevention of
MDROs includes antimicrobial stewardship by making analyse antimicrobial use,
horizontal precautions by making early identification of MDROs, and assess need for
universal decolonization of ICU patients.
Prevention of occupational transmission of infections in ICU includes personal
health and safety education about standard precautions as hand washing and personnel
protective equipments, modes of transmission of infection and importance of
transmission-isolation precautions, importance of reporting certain illnesses (whether
work related or acquired outside the hospital), importance of reporting exposure to
blood and body fluids to prevent transmission of bloodborne pathogens, importance of
cooperating with infection control personnel during outbreak investigations, and
importance of HCW screening and immunization programs and management of job
related illness and postexposure of the infection like hepatitis B, hepatitis C, HIV,
viral respiratory infections, and TB.