Post on 03-Apr-2018
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Nosocomial InfectionsDr. A. A. Wegdan
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1- Surgical site infection (SSI) Classification
A - Superficial incision SSI. Infection occurs within 30 days.
It involves skin or SC tissue.
B - Deep incision SSI. Infection occurs 30 days after the operation, or 1 year with implant.
It involves deep soft tissues.
C - Organ/Space SSI. Infection occurs 30 days after the operation, or 1 year with implant.
Infection involves organs/spaces component.
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1- Surgical site infection (SSI)
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1- Surgical site infection (SSI)
Manifestations and Diagnosis
- Superficial incision SSI.1- Purulent drainage, with or without laboratory confirmation.
2- Organisms isolated.
3- At least one of: pain or tenderness, swelling, redness, or heat and incision
opened by surgeon.
4- Clinical diagnosis.
- Deep incision SSI.
1- Purulent drainage from the deep incision, not from the organ/ space.2- Spontaneous dehisces or open & the patient has at least one of: fever,
pain, tenderness.
3- An abscess.
4- Surgeon confirmation.
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1- Surgical site infection (SSI)
- Organ/Space SSI.1- Purulent drainage.
2- Organisms isolated.
3- An abscess or other evidence of infection.
4- Diagnosis by surgeon or attending physician.
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2. Urinary tract infections (UTI)
Classification and manifestations
- Asymptomatic bacteriuria. Patient has no symptoms (No fever or dysuria or frequency).
- Symptomatic UTI: (with or without history of
catheterization).
Patient has one of the following symptoms:
- Fever > 38 C.
- Urgency.
- Dysuria or supra pubic pain.
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2. Urinary tract infections (UTI)
Diagnosis
- Asymptomatic bacteriuria.
Patient has history of urinary catheter (7 days) and a positive urine
culture of >105 microorganism/ml
Or he has two positive urine cultures of > 105 microorganism/ml of
the same organisms.
- Symptomatic UTI (with or without history of
catheterization).
Patient has positive urine culture(>105 microorganism/ml, with nomore than two isolated microorganism).
Or he has Positive urine culture > 103 microorganism/ml and positive
leucocyturia of > 104 l /ml.
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3. Respiratory tract infection (RTI)
Classification
- Upper respiratory infections (nose, throat, ear).
- Lower respiratory infections (pneumonia).
Manifestation and Diagnosis- Lower respiratory infections (pneumonia).
a. Clinical (Signs/symptoms):
i. Patient has at least one of the following:
1. Recent fever >38.5oC with no other cause.
2. Leucopenia or leucocytosis.
3. Patient is >70 years old, has altered mental status with no other
cause.
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3. Respiratory tract infection (RTI)
Manifestation and Diagnosis
- Lower respiratory infections (pneumonia).
ii. And with at least 2 of the following:-
1. New onset of purulent sputum or change in character or
respiratory secretions.
2. New onset or worth of cough or dyspnea or tacpnea.
3. Worse gas exchange.
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3. Respiratory tract infection (RTI)
b. Diagnostic radiology:
Patient shows in two or more serial X-ray at least one of :
1. New or progressive and persistent Infiltrate.
2. Consolidation.
3. Cavitations.
4. Pneumatocele (infants < 1 year).
c. Laboratory evidence:
1. Positive growth in blood culture (with x-ray and clinical).
2. Positive growth in expectorate with an organism never commensal:
Legionel la, As pergi l lus.
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4. Intravascular catheter related
infections Classification
# Local
- Catheter colonization.
- Phlebitis.
- Exit site infection (within 2 cm).
# Blood stream infection (Bacteremia)
Primary.
Secodary (CRI): In patient with I.V.C.
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4. Intravascular catheter related
infections Manifestation and Diagnosis
# Local
Induration and/or erythema along S.C. tract of catheter.
Signs of inflammation.
Exudation/Purulent fluid at catheter site exit.
By culture of catheter tip.
# Blood stream infection (Bacteremia)
Fever > 38C.
Chills.
Hypotension.
One positive blood culture from peripheral blood culture.
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4. Intravascular catheter related
infections Prevention
a. Peripheral catheter:
- Minimize patient exposure to peripheral catheterization.
- That could be through:
Insertion only if necessary.
Early removal if not used.
Maximum duration for an adult is< 96 h.
Daily inspection of the insertion site and immediateremoval if infection is suspected.
Hand disinfection before insertion.
Skin disinfection before insertion.
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4. Intravascular catheter related
infections
b. Central Venous Catheter:
A written protocol for using CVC.
The indications of insertion/duration of CVC be limited.
Continuous education of health-care workers.
The protocol should contain information about:
- Precautions for insertion:
Surgical conditions (sterile mask, cap, gowns and gloves), large sterile
drapes
Skin disinfection
Limit the use of the venous line
Insertion sites
- subclavian (if more than 5-7 days), jugular, femoral.
- tunneling of CVC for jugular or femoral site.
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4. Intravascular catheter related
infections- Type of catheter:
Polyurethane, silicone (better than Teflon or PVC)
Mono-lumen = multi-lumen
Coated catheters
- With silver chlorhexidine-sulfadiazine: possible.- With heparin: less thrombosis.
- Use in aseptic conditions
Daily clinical surveillance.
No scheduled systematic replacement.
Wound dressing- Date placement, date refection.
- Occlusive dressing (replaced every 72 h).
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4. Intravascular catheter related
infections
- Replacement of the lines Optimum 2 to 3 days.
Except if blood transfusion or lipid perfusion (change/day)
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5. Gastrointestinal infection
Classification
# Gastroentritis/Food poisoning.
- Acute onset of diarrhea with / without vomiting.
# Hepatitis
- Jaundice.
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5. Gastrointestinal infection
Manifestation and Diagnosis
# Gastroentritis/Food poisoning: Two of:
Nausea and vomiting.
Ab dominal pain.
Headache.
Any laboratory evidence of enteric pathogens.
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5. Gastrointestinal infection
# Hepatitis: Two of: Fever > 38.
Anorexia.
Nausea.
Vomiting.
Abdominal pain.
Jaundice.
Or history of transfusion (3 months).
Laboratory confirmation: Positive laboratory tests for hepatitis viruses.
Abnormal liver function tests.
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6. Systemic infections Viral etiology.
Many organs are involved.
Diagnosed only clinically.
Examples: Mumps, rubella, varicella.
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