Transcript Infection from Invasive procedures

Infection from Invasive
procedures
Prepared by : Rasha Musleh
2008
Neonatal babies in NICU departments are at
high risk of infection, as those neonates came
from sterile environment with low immunity to
any pathogens.
All
health care personnel who participate
in invasive procedures should always use
appropriate sterile barrier precautions to
prevent transmitting infection to neonates.
By:
 proper
hand washing
 Sterile
gloves &Surgical masks
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Sterile Gowns and other protective
apparel
Health-care institutions purchase millions of
intravascular catheters each year.
Intravascular catheters provide necessary
vascular access; their use puts neonates at
risk for local and systemic infectious
complications
. Blood-stream infection related to
the catheter is the most serious type of
catheter infection.
Definition: isolation of the same micro-organism
from culture of a catheter segment or blood
drawn from the catheter and from blood
preferably drawn from a peripheral vein of a
patient with accompanying clinical symptoms
of BSI and no other apparent source of
infection
The incidence of BSI varies
considerably by
 type of catheter
 frequency of catheter
manipulation,
 and patient-related factors
(e.g., underlying disease and
acuity of illness)
Other catheter related
infections
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Colonized catheter
Exit –site infection : erythema tenderness,
induration or purulence within 2 cm of the
skin at the exit site of catheter.
Tunnel infection : erythema tenderness and
induration in the tissues overlying the
catheter and > than 2 cm from the exit site
Infusate blood stream infection.
Catheter related blood stream
infections
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Catheter related blood stream infection
[CR-BSI] are associated with:
Increased morbidity
Increased mortality
Prolonged hospitalization.
Increased medical cost
Peripheral venous catheters are the
devices most frequently used for
vascular access.
 Although the incidence of (BSIs) is
rarely associated with these
catheters but serious infectious
complications may occur.
 In general complications occurred;
up to one-fourth of catheters that
can result in serious morbidity &
mortality.
PCVCs Catheters:
These catheters are the
commonest cause of
hospital-acquired
bloodstream infection.
Peripheral Arterial Catheters:
Peripheral arterial catheters are usually
inserted into the radial ,or femoral
artery and permit continuous blood
pressure monitoring and blood gas
measurements.
Umbilical venous
catheter:
In neonatal practice an
umbilical venous
catheter can be used to
deliver parenteral
nutrition, particularly
during the first week of
life.
To reduce the risk of
infection maximum
sterile precautions
should be used during
the insertion.
Catheters can become infected in several
different ways:
1.
through infection at the insertion site which
migrates along the catheter surface
2. via contamination of the catheter ports with
subsequent colonization of the lumen of the
catheter
3. or through hematogenous spread of
infection arriving at the catheter from
pathogens entering the bloodstream from
other sources.
4. Administration of contaminated infusate
S
o:
A number of guidelines
including skin prep should be
reviewed and implemented as
part of a comprehensive
program to reduce infection.
Each unit should have a written
policy on the procedures
governing the use of these
catheters
General recommendations for IV
device use ( AAP)
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Health care workers education and training
Surveillance for catheter related infection
Proper hand washing
Barrier precautions during catheter insertion
and care
Selection and replacement of intravascular
device
Replacement of administration sets and
intravenous fluids.
Preparation and quality control of intravenous
admixture.
The first step that used to reduce coetaneous
colonization of the skin & to reduce infection
especially those extremely low birth weight
infants ( less than 1000 gm) are particularly at
risk. includes:
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1- disinfecting the site prior to insertion
2-preventing colonization from other areas
getting near the insertion site
3- and care of the site after insertion.
Barrier precautions
--(Appropriate washing
To Alter the
infection )
The current standard is
the use of alcohol
based solution with
ethanol 60-85 %
[Manugel] in addition
to hand washing.
--Patient skin
preparation
Cleans the skin with an
appropriate antiseptic
that include 70%
alcohol, or 10%
Povidone-iodine or
alcohol based solution
to chlorhexidine.
Do not palpate the insertion site after
the skin has been cleaned.
 Use sterile gauze for cleaning
 Avoid contaminating catheter
 Use transparent dressing
 Better to wear mask even when applying
a peripheral venous catheter.
 It is often necessary to remove the
catheter in order to clear the
infection).
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Surveillance for catheter related
infection
Conduct studies in your unit concerning
incidence of CR-BSI .
( The reported incidences of catheterrelated sepsis in the NICU vary from)
5% to nearly 40%
 Palpate the catheter insertion site daily
through intact dressing.
 Visually inspect catheter site [better
than to inspect it every hour]
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 Redness or swelling if seen at any time
stop the infusion and establish a new IV
line in a different vein or artery & apply
sterile gauze to prevent infection
 Record the date & time of catheter
insertion in an obvious location near the
catheter insertion site and on patient’s
record
Replacement of administration
set and intravenous fluids
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Change the IV infusion fluid bag
every 24 hours; even if the bag still
contains IV fluid (they can be a major
source of infection
Replace IV tubings including
stopcocks & extension tubes using
sterile technique no more frequently
than 72 hours intervals unless
clinically indicated .(Stopcock
contamination occurring in 45% - 50%
They are a potential portal for entry
of microorganisms
Replace tubing used for lipid within 24
hours & Complete infusions of lipid
containing parenteral nutrition within 24
hours also.
these products have been identified as
independent risk factors for BSI.
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Infusion of blood products should be
completed within 4 hours of hanging the
product.
Preparation and quality control of
intravenous admixture
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Admix all parenteral fluids in a laminar
flow hood using aseptic technique.
Check all containers of parenteral fluid
for visible therapy, leaks, cracks, and the
manufacturer’s expiration date before
use.
Use single dose vials for parenteral
additives or medications whenever
possible.
If multi-dose vials are used
- Refrigerate multidose vial after they are opened, if
recommended by the manufacturer.
- Clean the rubber diaphragm with alcohol before use.
- Use a sterile device each time a multidose vial is
accessed, and avoid touch contamination of the device
before penetrating the rubber diaphragm.
- Discard multi-dose vials when empty, when suspected
or visible contamination occurs, or when the
manufacturer’s stated expiration date is reached
Additional specific risk factors include prolonged use of
parenteral nutrition [ lipid emulsion] (Mathieu 2006).
Preparation of parenteral
nutrition under laminar flow at
HFH
Conclusion
So it is very important to handle the
invasive procedures in sterile way and
to adopt a special guidelines in
performing any invasive procedure
(sterile way in care, giving any
medication, IV fluids administrations)
PCVC insertion at
HFH
References:
-Exposure to invasive procedures in neonatal intensive care unit
admissions, DP Barker and N Ruttera ,archives of Disease in
Childhood - Fetal and Neonatal edition, Vol 72, November 1, 2006;
91(6): F448 - F453, www.http://fn.bmj.com/PDF.
- Journal of Research in Nursing, Mathieu, September 1, 2006; 330 – 353,
www .http://fn.bmj.com/.
-Do WE STII hurt Newborn babies, Mangureten, S.H. Scott and C.E.
Guzetta et al ,2003,F54-F55, www.http://archpedi.ama-assn.org/.pdf
-Neonatal Sepsis, (Adapted from Schrag S, Gorwitz R, Fultz-Butts K,
Schuchat A) November 2005 ,http://www.merck.com/.html
-Infection Control Program Moderator , October , 2006, http://www.apic.org/
source/.
-Infection control program, sepsis, AAP, http: /www.apic.com