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

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

4. 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.

5. 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.

6. 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.

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

8. 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

9. - 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.

10. 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.

11. 66% to 86% of these infections follow instrumentation of the urinary tract mainly urinary catheterization.

12. 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.

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

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

15. 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.

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

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

18. 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.

19. - 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.

20. - 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.

21. 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

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