PART II CATHETER RELATED BLOOD STREAM INFECTION (CR-BSI) CATHETER RELATED URINARY TRACT INFECTIN (CR-UTI)

MAHA NAGA NURSING SPECIALIST ALEXANDRIA UNIVERSITY STUDENT HOSPITAL Dr. MOUSTAFA ARAFA ASSOSIATE PROF. OF EPIDEMIOLOGY HIGH INSTITUTE OF PUBLIC HEALTH ALEXANDRIA UNIVERSITY

CVC RELATED BLOOD STREAM INFECTION Blood stream infection is associated with the use of intravascular catheters. Catheter related blood stream infection (CR-BSIs), are associated with increased morbidity, mortality rate of 10% to 20 %, prolonged hospitalization (mean of 7 days ) and increased medical costs.

RISK FACTORS - The site at which the catheter is placed. - The type of barrier precautions used during catheter insertion. - The skill of the person inserting the catheter. - The use of a guide wire to replace an existing catheter.

CRITERIA FOR DIAGNOSIS -Fever. -Signs of cutaneous involvement ( erythema, induration, tenderness, or purulent drainage ) at the insertion site of catheter. -Positive blood or tip of catheter culture.

MICROBIOLOGY Blood stream infections are caused by: Coagulase-negative staphylococci, particularly Staphylococcus epidermidis. Candida species. Enterococci. Staphylococcus aureus.

PREVENTION AND CONTROL MEASURES - Health care worker education and training - Surveillance for catheter-related infection - Hand washing - Barrier precautions during catheter insertion and care - Catheter site care - Selection and replacement of intravascular devices

- Replacement of administration sets and intravenous fluids - Clean injection parts with 70% alcohol or povidone-iodine before accessing the system - Do not use filters routinely for infection control purposes - Do not administer anti-microbials routinely before insertion or during use of an intravascular device to prevent catheter colonization or bloodstream infection.

CATHERTER RELATED UTI The urinary tract accounting for more than 40% of the total number reported by acute-care hospitals ( 40 – 45 % of nosocomial infections ) and affecting an estimated 600,000 patients per year, they contribute only 10 to 15 percent to prolongation of hospital stay and to extra costs.

66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization.

RISK FACTORS Acquiring a urinary tract infection depend on the following: -the method and duration of catheterization. -the quality of catheter care. - and host susceptibility.

Host factors which appear to increase the risk of acquiring catheter-associated urinary tract infections include : advanced age, debilitation, and the postpartum state

CRITERIA FOR DIAGNOSIS Symptoms that may occur include - dysuria. - urinary frequency. - incontinence of recent onset. - flank pain. - and fever.

Bacteriologic diagnosis : - For complicated, recurrent UTIs, asymptomatic bacteriuria is defined as > 10 5 CFU/mL in a midstream urine sample after > 4 hours of bladder incubation. - For women with uncomplicated symptomatic cystitis bacteriuria is defined as > 10 2 CFU/mL with pyuria.

MICROBIOLOGY Catheter-associated urinary tract infections are caused by a variety of pathogens, including : - Escherichia coli - Klebsiella - Proteus - Enterococcus

Other causative micro-organisms: - Pseudomonas - Enterobacter - Serratia - Candida.

PREVENTION AND CONTROL MEASURES - Educate personnel in correct techniques of catheter insertion and care. - Catheterize only when necessary. - Emphasize hand washing. - Insert catheter using aseptic technique and sterile equipment. - Secure catheter properly. - Maintain closed sterile drainage.

- Obtain urine samples aseptically. - Maintain unobstructed urine flow. - Periodically re-educate personnel in catheter care. - Use smallest suitable bore catheter. - Avoid irrigation unless needed to prevent or relieve obstruction. - Do not change catheters at arbitrary fixed intervals.

- Consider alternative techniques of urinary drainage before using an indwelling urethral catheter. - Spatially separate infected and uninfected patients with indwelling catheters. - Avoid routine bacteriologic monitoring.

SUGGESTED FURTHER READINGS GUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONSGUIDELINE FOR PREVENTION OF INTRAVASCULAR DEVICE-RELATED INFECTIONS The Impact of Hospital-Acquired Bloodstream InfectionsThe Impact of Hospital-Acquired Bloodstream Infections

- Guideline for Prevention of Catheter-associated infections - urinary tract infection Guideline for Prevention of Catheter-associated infectionsurinary tract infection