A NOSOCOMIAL INFECTION

is:

Also known as healthcare acquired infection

Traditionally referred as hospital acquired
infections
Infections that develop during hospitalization
One of the leading causes of death and
increased morbidity for hospitalized patients
Of which are mostly caused by drug resistant
strains of bacteria

INFECTION RELATED TO IV
THERAPY DEVICES
Local Infection

Invasion and multiplication of microorganisms in

body tissues which may be clinically unapparent
or result in local cellular injury due to competitive
metabolism toxins, intracellular replication or
antigen antibody response

 Systemic Infection

A systemic disease caused by pathogenic

organisms or their toxins in the bloodstream

Definitions

Catheter Colonization: The isolation of 15

colony forming units (CFUs) of any
microorganism by semiquantitative culture
(roll-plate method) or 103 CFUs by quantitative
culture (sonication technique), from a catheter
tip or subcutaneous segment in the absence
of simultaneous clinical symptoms.

Local catheter-related infection:

Exit site Infection: purulent drainage from the
catheter exit site, or erythema, tenderness, and
swelling within 2cm of the catheter exit site.

Port-pocket infection: erythema and necrosis of

the skin over reservoir of totally implantable
device, or purulent exudates in the subcutaneous
pocket containing the reservoir.
Tunnel infection: erythema, tenderness, and
indurations of the tissues overlying the catheter
and more than 2cm from the exit site.

Definitions

Systemic Catheter infection: isolation of the same

microorganisms from catheter culture and from the
blood of a patient with accompanying clinical
symptoms of a BSI and no other apparent source of
infection.

Catheter-related bloodstream infection is the isolation

of the same microbe from blood cultures that is
known to be significantly colonizing the catheter of a
patient

Primary BSI is one that arises without apparent local

infection elsewhere due to the same microbe.

Common catheters used for venous and arterial access

CATHETER TYPE

ENTRY SITE

Peripheral venous
catheters (short)

Usually inserted in
veins of forearm or
hand

<3 inches

Phlebitis with prolonged

use; rarely associated
with BSI

Peripheral arterial
catheters

Usually inserted in
radial artery; can be
placed in femoral,
axillary, brachial,
posterior tibial arteries

<3 inches

Low infection risk; rarely

associated with BSI

Midline catheters

Inserted via the

antecubital fossa into
the proximal basilic or
cephalic veins; does
not enter central veins,
peripheral catheters

LENGTH

3 8 inches

COMMENTS

Reported with
anaphylactoid reactions
on elastommeric
hydrogel catheter; lower
rates of phlebitis than
short peripheral
catheters

Common catheters used for venous and arterial access

ENTRY SITE

LENGTH

Nontunneled CVC

Percutaneously
inserted into central
veins ( subclavian,
internal jugular, or
femoral)

8 cm depending on
the patient size

Account for majority

CRBSI

Pulmonary artery
catheter

Inserted through a
Teflon introducer in
a central
vein( subclavian,
internal jugular, or
femoral)

30 cm depending
on the patient size

Usually heparin
bonded; similar rates
of BSI as CVCs;
subclavian site
preferred to reduce
infection risk

Peripherally inserted Inserted in basilic,

central venous
cephalic, or brachial
catheter (PICC)
veins and enter the
superior vena cava

20 cm depending
on patient size

Lower rate of
infection than
nontunnelled CVCs

CATHETER TYPE

COMMENTS

Common catheters used for venous and arterial access

CATHETER TYPE

ENTRY SITE

LENGTH

COMMENTS

Tunneled central
venous catheter

Implanted into
subclavian, internal
jugular, or femoral
veins

8 cm depending on
the patient size

Cuff inhibits migration

of organisms into the
catheter tract; lower
rate of infection than
that of the nontunneled
CVC

Totally implantable

Tunnelled beneath the

skin and have
subcutaneous port
accessed with needle;
implanted in
subclavian, internal
jugular vein

8 cm depending on
the patient size

Lowest rate of CRBSI;

improved patient self
image; no need for
local catheter site care;
surgery required for
catheter removal

Inserted into umbilical

vein or umbilical artery

6 cm depending on
the patient size

Umbilical catheters

Risk for CRBSI similar

with catheters placed in
umbilical vein vs artery

Other Nosocomial Infection

Urinary tract infection

Surgical site infection

Ventilator-associated pneumonia

Intravascular device-related bloodstream infection

Clostridium difficile- associated diarrhea

CHAIN OF INFECTION
CONTROL
Infectious Agent

Reservoir

Susceptible host

Portal of Entry

Portal of Exit
Mode of Transmission

MODE OF TRANSMISSION
It is the method of transfer by which

organism moves or is carried from one

place to another
E.g. Hands of the health care worker may
carry bacteria from one person to another.

How does catheter-related infection

occur?
Infection of short-term catheters is
frequently been due to microbes from the
skin moving along the catheter surface
where the catheter enters the skin.

Date and Time IV

was Inserted
KARDEX

Risk Factors

Type of catheter used

The number of lumen of the catheter has

Total parenteral nutrition

Duration of catheterization
Catheter site insertion
Expertise of the person inserting
Management of catheter after insertion
Guidewire exchange
Use of dressing
Use of triple antibiotic ointment

Common pathogens of BSI

Candida albicans
Staphylococcus aureus
Enterobacter cloaceae
Staphylococcus epidermidis
Pseudomonas aeruginosa
Enterococcus fecalis

Breaking the Chain of Infection

Levels of Aseptic Control

How Health Care Workers Break the Chain of Infection

Link

Intervention

Infectious or Causative
Agent

Accurate and rapid identification of microorganisms

Reservoirs

Employee health examinations and screenings

Early recognition of sign and symptoms of infection

Environmental sanitations
Disinfection / Sterilization of instruments
Standard Precautions, Medical Asepsis, Proper Hygiene
Clean gowns, linens, towels, Clean wound dressing

Portal of Exit

Handwashing, use of PPE, proper waste disposal, standard

Method or Mode of
Transmission

Handwashing, Standard Precautions, Safe food handling,

isolations, use of PPE, transmission based precautions

Portal of Entry

Aseptic technique, medical or surgical asepsis, wound /

Susceptible Host

Treatment of Disease, Recognition of clients at risk,

precautions

catheter care, proper disposal, maintain skin integrity, standard

precautions
immunization, exercise, proper nutrition

PRINCIPLES OF PREVENTION
OF INFECTION

Consider every person (patient of staff) infectious

Wash hands the most practical procedure for

preventing cross contamination (person to person)

Wear gloves before touching anything wet broken skin,

mucous membranes, blood or other body fluids
(secretions or excretions) or soiled instruments and other
items

Use physical barriers (protective goggles, face masks

and aprons) if splashes and spills of any body fluids
(secretions or excretions) are anticipated

Use safe work practices, such as not recapping

or bending needles, safely passing sharp
instruments and properly disposing of medical
waste

Isolate patients only if secretions (airborne) or

excretions (urine and feces) cannot be contained

Decontaminate process instruments and other

items (decontaminate, clean, high level
disinfect or sterilize using Infection Prevention
Practices

Prevention

Selection of a subclavian, basilic, or cephalic vein

site rather than an internal jugular or femoral site

Avoid use of TPN catheters for other infusion

purposes

Use of special team for insertion and maintenance

of catheter

Avoid the use of triple antibiotic ointment on central

venous catheter

REVIEW INFECTION RISK

FACTORS AND PRACTICES

Infection is the presence and growth of a

microorganisms that produces tissue death

Wash your hands

Routinely clean and disinfect surfaces
Handle and prepare food safely
Get immunized
Us antibiotics appropriately
Keep pets healthy
Avoid contact with wild animals

PRINCIPLES OF SAFE IV CARE /

PRACTICES

Use aseptic technique to avoid contamination of sterile

injection equipment
Do not administer medications from a syringe to multiple
patients, even if the needle of cannula on the syringe is
changed
Use fluid infusion and administration sets for one patient
only and dispose after use
Use single dose vials for parenteral medications
whenever possible.
Use proper personal protective equipment (PPE).
Adhere to safety waste protocol according to institutions
policy.

VENIPUNCTURE TECHNIQUES
USING VARIOUS CATHETERS
AND DEVICES

The Use of Infusion Pumps

The use of needleless system

Proper use of sharp containers

Monitoring and Assessment

The use of appropriate dressing

Health Care Worker Education and Training

Surveillance for Catheter Related Infection
Handwashing
Barriers Precautions During Catheter Insertion
and Care
Catheter Insertion
Catheter Site Care
Selection and Replacement of Intravascular
Devices

General Recommendations For

Intravascular Device Use

Health Care Worker Education and Training

Surveillance for Catheter Related Infection
Handwashing
Barriers Precautions During Catheter Insertion
and Care
Catheter Insertion
Catheter Site Care
Selection and Replacement of Intravascular
Devices

Replacement of Administration Sets and

Intravenous Fluids
Intravenous Injection Ports
Preparation and Quality Control of Intavenous
Admixtures
In line Filters
Intravenous Therapy Personnel
Needleless Intravascular Devices
Prophylactic antimicrobials

Preventing Catheter-Related
Bloodstream Infections
References:

Centers for Disease Control and Prevention

(CDC), USA
Healthcare Infection Control Practices Advisory
Committee (HICPAC), USA
Hospital Epidemiology and Infection Control,
Mayhall 3rd ed.

Good Day!