Presentation9 Types Nosocom

7/28/2019 Presentation9 Types Nosocom

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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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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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- 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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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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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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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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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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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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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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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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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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# 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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Presentation9 Types Nosocom

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