INFECTION CONTROL IN ICU

Содержание

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Patients in the ICU are at

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Patients in the ICU
an increased
risk of developing nosocomial infection:
The severity of the patient’s illness and
underlying conditions
The length of exposure to invasive devices and
procedures
The increased contact with health-care
personnel
The length of the ICU stay
The special environmental characteristics of
the unit such as space limitations

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

The most frequently encountered problems facing

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين The most frequently encountered
patients and HCWs in
the ICU:
Nosocomial pneumonia
Urinary tract infection
Intravascular related infections
Surgical site infection
Antibiotic resistance

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Host Characteristics
1. Alterations may be present

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Host Characteristics 1. Alterations
in the host
Defenses
Genetic
Acquired
Secondary to underlying disease
2. Susceptibility to infection is influenced
by the severity of underlying illness

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Host characteristics (cont.)
3. ICU patients become

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Host characteristics (cont.) 3.
more easily colonized with hospital flora :
Patients in the ICU are frequently colonized
with hospital flora, which are more likely to
be resistant to antibiotics
Patients may be exposed to increased numbers of microorganisms from the frequent use and long duration of invasive devices.

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Interventions
Support host defenses by use

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Interventions Support host defenses
of appropriate
therapy, aseptic technique, and nursing care of
the immobilized patient
Treat underlying disease process
Adhere to aseptic techniques, especially hand
washing
Strictly adhere to recommended protocols for
invasive procedures
Use contact isolation precautions for patients
colonized or infected with antibiotic-resistant
micro-organisms

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Therapeutic Measures
1-Medical devices
Intravascular devices and lines
Respiratory

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Therapeutic Measures 1-Medical devices
support and devices
Urinary Catheters

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Intravascular devices and lines
Risk
multiple invasive

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Intravascular devices and lines
lines
new portals of entry.
performed in a concentrated time period and/or under emergency conditions
lipid emulsions are excellent media for the growth of microorganisms.

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Recommendations for Placement of Intravascular Catheters

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Recommendations for Placement of
Health-care worker education and
training
Aseptic technique during catheter
insertion and care

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Do proper hand Hygiene
Wearing Gloves

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Do proper hand Hygiene
Select insertion site with the lowest risk
Do not routinely use arterial or venous cut down procedures as a method to insert catheters
Disinfect clean skin with an appropriate antiseptic
Allow the antiseptic to remain on the insertion site and to air dry before catheter insertion.

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Use either sterile gauze or sterile,

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Use either sterile gauze
transparent, semi permeable dressing to cover the catheter site.
Record the operator, date, and time of catheter insertion
Monitor the catheter sites visually or by palpation

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Recommendations (cont.)
Selection and replacement of intravascular

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Recommendations (cont.) Selection and
catheters:
Remove any intravascular catheter that is no longer essential
Replace peripheral venous catheters . every 72--96
hours in adults to prevent phlebitis
When adherence to aseptic technique cannot be ensured (i.e., during a medical emergency), replace all catheters as soon as possible and after no longer
than 24 hours Replace all CVCs if CRBSI is suspected.

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Recommendations (cont.)
Replacement of administration sets, and

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Recommendations (cont.) Replacement of
parenteral fluids
Replace administration sets no more frequently than at 72-hour intervals, unless catheter-related infection is suspected or documented
Replace tubing used to administer blood, blood products, or lipid emulsions within 24 hours of initiating the infusion
Complete the infusion of lipid-containing solutions within 24 hours , lipid emulsions within 12 hours, blood & blood products within 4 hours of hanging the blood

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Preparation and quality control of IV

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Preparation and quality control
admixtures
Administer all parenteral fluids using aseptic technique.
Do not use any container of parenteral fluid that has visible turbidity, leaks, cracks, or particulate matter or if the manufacturer's expiration date has passed.
Use single-dose vials for parenteral additives or medications when possible.

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If multidose vials are used
Refrigerate multidose

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين If multidose vials are
vials after they are opened if recommended by the manufacturer.
Cleanse the access diaphragm of multidose vials with 70% alcohol before inserting a device into the vial.
Use sterile syringe and needle every time to access a multidose vial and avoid touch contamination of the device before penetrating
the access diaphragm.

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Respiratory Support and Devices Risks
Mechanical ventilation

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Respiratory Support and Devices
bypasses the respiratory tract host defenses
Contaminated equipment or solutions provide a mechanism for transfer of microorganisms to a susceptible patient
Aerosolization of microorganisms may pose a risk to other patients and Personnel

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Interventions
Prevention of aspiration place patient in

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Interventions Prevention of aspiration
semi-recumbent position.
Preservation of gastric acidity use non alkalinizing gastric cyto protective agent on patients at risk for stress bleeding.
Nasal prongs or mask:
Change between patients.
If masks are reusable, wash thoroughly, dry and
wipe with 70% alcohol.

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4.Nasogastric-tube :
Routinely verify appropriate tube

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين 4.Nasogastric-tube : Routinely verify
placement.
Place patient in semirecumbent position.
5.Endotracheal tubes:
They may be recycled after through cleaning and
autoclaving.
Disposable ones are available but are more expensive.
6.Humidifiers and Nebulizers :
Use only sterile water and fluids and dispense them aseptically.
If multi-dose medication vials are used, then handle, dispense and store correctly
Between treatment on the same patient, disinfect, rinse with sterile water and air dry medication nebulizers.

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7.Ventilator circuits:
Disposable tubes don not

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين 7.Ventilator circuits: Disposable tubes
routinely need to be
changed for a single patient unless it becomes
contaminated or malfunctions.
Multiple-use tubes must be heat disinfected for at least 76oC for 30 min., or sterilized between patient.
A ventilated patient may use the same circuit for 4-5 days before reprocessing

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8.Endotracheal suction catheters:
Disposable suction catheters

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين 8.Endotracheal suction catheters: Disposable
may be used for up to 24 hours on the same patient, provided that it is stored properly and does not become contaminated.
The water used for flushing the catheter after each suction must be sterile and changed every time.
9.Suction and drainage bottles:
Non disposable bottles must be changed every 24 hours (or sooner if full).
The contents are emptied down the toilet and it must be washed and sterilized.
The recyclable connector tubing should be cleaned thoroughly and sterilized.

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10.Ambu-bags:
They are extremely difficult to disinfect

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين 10.Ambu-bags: They are extremely
and become contaminated very quickly
Heat is the most reliable method of disinfection.
Glutaraldehyde can also be used but the bag must be rinsed thoroughly in sterile water.

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Protection of staff and patients by

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Protection of staff and
use of appropriate:
Isolation precautions
Personal protective equipment.

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين
Irrigation Solutions
Risks
Opened bottles of water or

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Irrigation Solutions Risks Opened
other solutions that may be used for irrigation or to fill reservoirs of respiratory therapy equipment remain at the bedside, these opened bottles may become contaminated and serve as a reservoir of microorganisms.
Interventions
Date all bottles of solutions; discard unused fluid at least every 24 hours.

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مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين

Guideline for Prevention of atheterassociated Urinary

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Guideline for Prevention of
Tract Infections
Educate personnel in correct techniques
of catheter insertion and care.
Catheterize only when necessary.
Emphasize hand-washing and aseptic
technique
Secure catheter properly.
Maintain closed sterile drainage.
Obtain urine samples aseptically.
Maintain unobstructed urine flow.

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Wash hands.
Don clean gloves.

* مشرف تطوير الجودة ومكافحة العدوى/ بسام شاهين Wash hands. Don clean
Cleanse perineum with washcloth if needed.
Remove gloves and perform antiseptic hand
washing after perineal cleansing.
Don sterile gloves.
Drape the patient
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