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Also known as healthcare acquired in ection Traditionall! re erred as hos"ital acquired in ections In ections that de#elo" durin$ hos"itali%ation One o the leadin$ causes o death and increased &or'idit! or hos"itali%ed "atients O which are &ostl! caused '! dru$ resistant strains o 'acteria


Local In ection
In#asion and &ulti"lication o &icroor$anis&s in 'od! tissues which &a! 'e clinicall! una""arent or result in local cellular in.ur! due to co&"etiti#e &eta'olis& to/ins0 intracellular re"lication or anti$en anti'od! res"onse

S!ste&ic In ection
A s!ste&ic disease caused '! "atho$enic or$anis&s or their to/ins in the 'loodstrea&

)e initions
Catheter Colonization: The isolation of 15 colony forming units (CFUs) of any microorganism by semiquantitative culture (roll-plate method) or 1 ! 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 e$it site" or erythema" tenderness" and s%elling %ithin &cm of the catheter e$it site# Port-pocket infection: erythema and necrosis of the s'in over reservoir of totally implantable device" or purulent e$udates in the subcutaneous poc'et containing the reservoir# Tunnel infection: erythema" tenderness" and indurations of the tissues overlying the catheter and more than &cm from the e$it site#

)e initions
Systemic Catheter infection: isolation of the same microorganisms from catheter culture and from the blood of a patient %ith accompanying clinical symptoms of a ()* and no other apparent source of infection# Catheter-related bloodstream infection is the isolation of the same microbe from blood cultures that is 'no%n to be significantly coloni+ing the catheter of a patient Primary SI is one that arises %ithout apparent local infection else%here due to the same microbe#

Co&&on catheters used or #enous and arterial access

CAT+ETE( T-,E ,eri"heral #enous catheters 2short3

4suall! inserted in #eins o orear& or hand

67 inches

,hle'itis with "rolon$ed use5 rarel! associated with 9SI

,eri"heral arterial catheters

4suall! inserted in radial arter!5 can 'e "laced in e&oral0 a/illar!0 'rachial0 "osterior ti'ial arteries Inserted #ia the antecu'ital ossa into the "ro/i&al 'asilic or ce"halic #eins5 does not enter central #eins0 "eri"heral catheters

67 inches

Low in ection risk5 rarel! associated with 9SI

Midline catheters

7 8 inches

(e"orted with ana"h!lactoid reactions on elasto&&eric h!dro$el catheter5 lower rates o "hle'itis than short "eri"heral catheters

Co&&on catheters used or #enous and arterial access

CAT+ETE( T-,E Nontunneled C*C

,ercutaneousl! inserted into central #eins 2 su'cla#ian0 internal .u$ular0 or e&oral3 Inserted throu$h a Te lon; introducer in a central #ein2 su'cla#ian0 internal .u$ular0 or e&oral3 Inserted in 'asilic0 ce"halic0 or 'rachial #eins and enter the su"erior #ena ca#a

:8 c& de"endin$ on the "atient si%e

Account or &a.orit! C(9SI

,ul&onar! arter! catheter

:7< c& de"endin$ on the "atient si%e

4suall! he"arin 'onded5 si&ilar rates o 9SI as C*Cs5 su'cla#ian site "re erred to reduce in ection risk Lower rate o in ection than nontunnelled C*Cs

,eri"herall! inserted central #enous catheter 2,ICC3

:=< c& de"endin$ on "atient si%e

Co&&on catheters used or #enous and arterial access

Tunneled central #enous catheter

I&"lanted into su'cla#ian0 internal .u$ular0 or e&oral #eins

:8 c& de"endin$ on the "atient si%e

Cu inhi'its &i$ration o or$anis&s into the catheter tract5 lower rate o in ection than that o the nontunneled C*C

Totall! i&"lanta'le

Tunnelled 'eneath the skin and ha#e su'cutaneous "ort accessed with needle5 i&"lanted in su'cla#ian0 internal .u$ular #ein Inserted into u&'ilical #ein or u&'ilical arter!

:8 c& de"endin$ on the "atient si%e

Lowest rate o C(9SI5 i&"ro#ed "atient sel i&a$e5 no need or local catheter site care5 sur$er! required or catheter re&o#al

4&'ilical catheters

>? c& de"endin$ on the "atient si%e

(isk or C(9SI si&ilar with catheters "laced in u&'ilical #ein #s arter!

Other Nosoco&ial In ection

4rinar! tract in ection Sur$ical site in ection *entilator@associated "neu&onia Intra#ascular de#ice@related 'loodstrea& in ection Clostridium difficile- associated diarrhea


In ectious A$ent

Susce"ti'le host


,ortal o Entr!

,ortal o E/it Mode o Trans&ission

It is the &ethod o trans er '! which or$anis& &o#es or is carried ro& one "lace to another EA$A +ands o the health care worker &a! carr! 'acteria ro& one "erson to anotherA

+ow does catheter@related in ection occurB

In ection o short@ter& catheters is requentl! 'een due to &icro'es ro& the skin &o#in$ alon$ the catheter sur ace where the catheter enters the skinA

)ate and Ti&e I* was Inserted CA()ED

(isk Factors
T!"e o catheter used
The nu&'er o lu&en o the catheter has

Total "arenteral nutrition )uration o catheteri%ation Catheter site insertion E/"ertise o the "erson insertin$ Mana$e&ent o catheter a ter insertion 1uidewire e/chan$e 4se o dressin$ 4se o tri"le anti'iotic oint&ent

Co&&on "atho$ens o 9SI

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

9reakin$ the Chain o In ection Le#els o Ase"tic Control

+ow +ealth Care Eorkers 9reak the Chain o In ection Link In ectious or Causati#e A$ent (eser#oirs Inter#ention

and ra"id identi ication o &icroor$anis&s Earl! reco$nition o si$n and s!&"to&s o in ection

health e/a&inations and screenin$s En#iron&ental sanitations )isin ection F Sterili%ation o instru&ents Standard ,recautions0 Medical Ase"sis0 ,ro"er +!$iene Clean $owns0 linens0 towels0 Clean wound dressin$

,ortal o E/it Method or Mode o Trans&ission ,ortal o Entr!


use o ,,E0 "ro"er waste dis"osal0 standard

+andwashin$0 Standard ,recautions0 Sa e ood handlin$0 isolations0 use o ,,E0 trans&ission 'ased "recautions

technique0 &edical or sur$ical ase"sis0 wound F catheter care0 "ro"er dis"osal0 &aintain skin inte$rit!0 standard "recautions

Susce"ti'le +ost

o )isease0 (eco$nition o clients at risk0 i&&uni%ation0 e/ercise0 "ro"er nutrition

Consider e#er! "erson 2"atient o sta 3 in ectious


Eash hands the &ost "ractical "rocedure or "re#entin$ cross conta&ination 2"erson to "erson3 Eear $lo#es 'e ore touchin$ an!thin$ wet 'roken skin0 &ucous &e&'ranes0 'lood or other 'od! luids 2secretions or e/cretions3 or soiled instru&ents and other ite&s 4se "h!sical 'arriers 2"rotecti#e $o$$les0 ace &asks and a"rons3 i s"lashes and s"ills o an! 'od! luids 2secretions or e/cretions3 are antici"ated

4se sa e work "ractices0 such as not reca""in$ or 'endin$ needles0 sa el! "assin$ shar" instru&ents and "ro"erl! dis"osin$ o &edical waste Isolate "atients onl! i secretions 2air'orne3 or e/cretions 2urine and eces3 cannot 'e contained )econta&inate "rocess instru&ents and other ite&s 2deconta&inate0 clean0 hi$h le#el disin ect or sterili%e usin$ In ection ,re#ention ,ractices

Selection o a su'cla#ian0 'asilic0 or ce"halic #ein site rather than an internal .u$ular or e&oral site A#oid use o T,N catheters or other in usion "ur"oses 4se o s"ecial tea& or insertion and &aintenance o catheter A#oid the use o tri"le anti'iotic oint&ent on central #enous catheter


In ection is the "resence and $rowth o a &icroor$anis&s that "roduces tissue death
Eash !our hands (outinel! clean and disin ect sur aces +andle and "re"are ood sa el! 1et i&&uni%ed 4s anti'iotics a""ro"riatel! Cee" "ets health! A#oid contact with wild ani&als


4se ase"tic technique to a#oid conta&ination o sterile in.ection equi"&ent )o not ad&inister &edications ro& a s!rin$e to &ulti"le "atients0 e#en i the needle o cannula on the s!rin$e is chan$ed 4se luid in usion and ad&inistration sets or one "atient onl! and dis"ose a ter use 4se sin$le dose #ials or "arenteral &edications whene#er "ossi'leA 4se "ro"er "ersonal "rotecti#e equi"&ent 2,,E3A Adhere to sa et! waste "rotocol accordin$ to institutionGs "olic!A


The 4se o In usion ,u&"s

The use o needleless s!ste&

,ro"er use o shar" containers

Monitorin$ and Assess&ent

The use o a""ro"riate dressin$

+ealth Care Eorker Education and Trainin$ Sur#eillance or Catheter (elated In ection +andwashin$ 9arriers ,recautions )urin$ Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and (e"lace&ent o Intra#ascular )e#ices

+ealth Care Eorker Education and Trainin$ Sur#eillance or Catheter (elated In ection +andwashin$ 9arriers ,recautions )urin$ Catheter Insertion and Care Catheter Insertion Catheter Site Care Selection and (e"lace&ent o Intra#ascular )e#ices

,eneral -ecommendations For *ntravascular .evice Use

(e"lace&ent o Ad&inistration Sets and Intra#enous Fluids Intra#enous In.ection ,orts ,re"aration and Hualit! Control o Inta#enous Ad&i/tures In line Filters Intra#enous Thera"! ,ersonnel Needleless Intra#ascular )e#ices ,ro"h!lactic anti&icro'ials

/reventing Catheter--elated (loodstream *nfections (e erences:

Centers or )isease Control and ,re#ention 2C)C30 4SA +ealthcare In ection Control ,ractices Ad#isor! Co&&ittee 2+IC,AC30 4SA +os"ital E"ide&iolo$! and In ection Control0 Ma!hall 7rd edA