Infection Surveillance in Intensive Care
Post on 11-May-2015
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Infection surveillance in Intensive care
Dr C ClarkeConsultant in Intensive Care Medicine & Anaesthesia
Craigavon Area Hospital
Surveillance
The systematic collection and analysis of data on nosocomial infection occurrences
Incidence of nosocomial infection
ID patterns and potential solutions
Outcome objectives (IHI)
Surveillance
Requires cooperation between infection control and ICU
Agree the aims and goals
Ensure quality of ICU care
Surveillance
Expensive and labour intensive
Accuracy- over and under diagnosis eg miss outbreak/cluster
Benchmarking-eg comparing a cancer hospital with Burns Unit
Potential for data to be hidden
Those that do worst at finding infection-”look the best”
Surveillance
Well established CDC (USA-centre for disease control)
KISS - Krankenhaus Infektions Surveillance Systems
Tend to underestimate
Benchmark infection rates and establish standards of preventative care
Confidential, Voluntary, Methodologically sound
Outcomes
CVC infection rates 2.1-1,5 Bloodstream infections per 1000 CVC days (29% reduction
Neonatal Unit –No change in infection rates over 10 years
Overall the evidence supports this approach
Key points
A surveillance program should be in place to monitor the incidence and features of local nosocomial infection and to help develop strategies to decrease the incidence of infection in the ICU
Handwashing and specific isolation protocols key factors
CVCs, indwelling catheters and ventilation-discontinue ASAP
Quality Indicators-according to ICS
20 indicators in order of importance 3 hand hygiene 6 unit acquired bacteraemias 7 unit acquired MRSA infection 8 catheter related blood stream infection 9 unit acquired C. Difficle 12 Appropriate infection isolation
Colonisation v infection
Clinical indicators of infection
Colonisation common of respiratory and urinary tracts in ICU
SIRS often present due to non-infective causes
CRP PCT
Quantitative culture (eg >106 cfu/ml of resp secretion)
Immunocompromised?
ICS
CDC Definitions
a nosocomial infection as a localized or systemic condition 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s) and 2) that was not present or incubating at the time of admission to the hospital (7, and NNIS Manual, Section XIII, May 1994, unpublished). For most bacterial nosocomial infections, this means that the infection usually becomes evident 48 hours (i.e., the typical incubation period) or more after admission.
A central line associated blood stream infection is a laboratory-confirmed bloodstream infection (BSI) in a patient who had a central line within the 48 hour period before the development of the BSI and that is not related to an infection at another site.
The CLABSI must meet one of the following criteria:
Criterion 1Patient has a recognised pathogen cultured from one or more blood culturesandOrganism cultured from blood is not related to an infection at another site.
Criterion 2Patient has at least one of the following signs or symptoms: fever (>38°C), chills, or hypotensionandsigns and symptoms and positive laboratory results are not related to an infection at another siteandCommon skin contaminant is cultured from two or more blood cultures drawn on separate occasions
Criterion 3Patient < 1 year of age has at least one of the following signs or symptoms: fever (>38°C core) hypothermia (<36°C core), apnoea, or bradycardiaand Signs and symptoms and positive laboratory results are not related to an infection at another siteand Common skin contaminant is cultured from two or more blood cultures drawn on separate occasions.
Summary
Surveillance is an integral of Intensive Care
Dependent of data collection
Definitions are complex
Microbiology must always be interpreted with clinical information.
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