INFECTIONS IN INTENSIVE CARE UNITS -NEED FOR ACTIVE SURVEILLANCE
Dr.T.V.Rao MD
Post graduate question in Clinical Microbiology in European Union Today many of the Hospitals are equipped to deal the critically patients in Intensive care units, yet we have no standard guidelines to bring IN Nationally accredited protocols, many evolving hospitals are guided by decisions of Infection control committee as we are aware Healthcare-associated infections (HAIs) are major patient safety problems in hospitals, especially in intensive care units (ICUs). Patients in ICUs are prone to HAIs due to reduced host defense mechanisms, low compliance with infection prevention and control (IPC) measures due to lack of education and training, and heavy workload and low staffing levels, leading to cross-transmission of microorganisms from patient to patient Impact Health care associated Infections, Patients with HAIs have prolonged hospital stays, and have high morbidity and mortality, thus adding economic burden on the healthcare system. For various reasons, in low-to-middle income countries (LMICs), as Happening in India and many developing countries the scale of the problem is huge; each year, many people die from HAIs
What is a ICU associated Infection - An infection is considered as ICU-acquired if it occurs in the ICU after more than 48 hours? In practice, all infections with onset from day 3 onwards in the ICU should be reported. (The day of admission to the ICU is counted as day
ROLE OF DIAGNOSTIC MICROBIOLOGY – It is true there are no better methods than improving the quality of diagnostic microbiology services certainly we need qualified Medical microbiologists with interest in clinical Microbiology
Device-associated HAI
A device-associated, healthcare-associated infection is an HAI in a patient with a (relevant) device that was used within the 48-hour period before onset of infection (even if it was used only intermittently). The term ‘device associated ‘is only used for pneumonia, bloodstream infections, and urinary tract infections. ‘Relevant devices ‘refers to intubation, central vascular catheters, and urinary catheters. If the interval is longer than 48 hours, there must be compelling evidence that the infection was associated with device use. For catheter-associated UTI, an indwelling urinary catheter must have been in place seven days before positive laboratory results or signs and symptoms meeting the criteria for UTI were evident
Data collection for surveillance - surveillance of Blood Stream Infections (BSI), Central Venous Catheter Related Infections (CVC RI) and Ventilator Associated Pneumonia (VAP). This is a targeted surveillance program, the methodology of which permits risk-adjusted rates for comparison of infection rates between ICUs, hospitals and countries (bench marking). Risk factors are collected for every patient staying in the ICU, whether infected or not e.g. it is patient-based surveillance.
Need Feedback from microbiologists
Criteria for diagnosing Pneumonia
All microbiologists reported that non-quantitative endotracheal aspirates were carried out most frequently to identify pneumonia infections; laboratories in Scotland do not carry out this diagnostic procedure.
Criteria for diagnosing BSIs
All sites carry out the microbiology analysis required to diagnose BSI according to the Definitions standard operative procedures documented in the laboratory Infection details data There appeared to be some lack of clarity as to when infections should be recorded and what constituted an episode. Thus, duplicate reporting of infections was noted, this in part reflected a lack of clarity as to when infections should be reported, and difficulties in determining whether new episodes had occurred and duplicate reporting of an infection when new microbiology data became available. The antibiotic use data generated from the ICUs demonstrates the variation in antibiotic usage between hospitals. This is likely to reflect local policies and the resistance/sensitivity past organisms causing infections in individual hospitals or units.
Ref 1 Surveillance of Intensive Care Unit Associated Infections Pilot Report Funded by: Scottish Executive Health Department Health protection Scotland
2 European surveillance of healthcare-associated infections in intensive care units Hai-Net ICU protocol version 1.02
Dr.T.V.Rao M D Freelance reporter in Clinical Microbiologist
Dr.T.V.Rao MD
Post graduate question in Clinical Microbiology in European Union Today many of the Hospitals are equipped to deal the critically patients in Intensive care units, yet we have no standard guidelines to bring IN Nationally accredited protocols, many evolving hospitals are guided by decisions of Infection control committee as we are aware Healthcare-associated infections (HAIs) are major patient safety problems in hospitals, especially in intensive care units (ICUs). Patients in ICUs are prone to HAIs due to reduced host defense mechanisms, low compliance with infection prevention and control (IPC) measures due to lack of education and training, and heavy workload and low staffing levels, leading to cross-transmission of microorganisms from patient to patient Impact Health care associated Infections, Patients with HAIs have prolonged hospital stays, and have high morbidity and mortality, thus adding economic burden on the healthcare system. For various reasons, in low-to-middle income countries (LMICs), as Happening in India and many developing countries the scale of the problem is huge; each year, many people die from HAIs
What is a ICU associated Infection - An infection is considered as ICU-acquired if it occurs in the ICU after more than 48 hours? In practice, all infections with onset from day 3 onwards in the ICU should be reported. (The day of admission to the ICU is counted as day
ROLE OF DIAGNOSTIC MICROBIOLOGY – It is true there are no better methods than improving the quality of diagnostic microbiology services certainly we need qualified Medical microbiologists with interest in clinical Microbiology
Device-associated HAI
A device-associated, healthcare-associated infection is an HAI in a patient with a (relevant) device that was used within the 48-hour period before onset of infection (even if it was used only intermittently). The term ‘device associated ‘is only used for pneumonia, bloodstream infections, and urinary tract infections. ‘Relevant devices ‘refers to intubation, central vascular catheters, and urinary catheters. If the interval is longer than 48 hours, there must be compelling evidence that the infection was associated with device use. For catheter-associated UTI, an indwelling urinary catheter must have been in place seven days before positive laboratory results or signs and symptoms meeting the criteria for UTI were evident
Data collection for surveillance - surveillance of Blood Stream Infections (BSI), Central Venous Catheter Related Infections (CVC RI) and Ventilator Associated Pneumonia (VAP). This is a targeted surveillance program, the methodology of which permits risk-adjusted rates for comparison of infection rates between ICUs, hospitals and countries (bench marking). Risk factors are collected for every patient staying in the ICU, whether infected or not e.g. it is patient-based surveillance.
Need Feedback from microbiologists
Criteria for diagnosing Pneumonia
All microbiologists reported that non-quantitative endotracheal aspirates were carried out most frequently to identify pneumonia infections; laboratories in Scotland do not carry out this diagnostic procedure.
Criteria for diagnosing BSIs
All sites carry out the microbiology analysis required to diagnose BSI according to the Definitions standard operative procedures documented in the laboratory Infection details data There appeared to be some lack of clarity as to when infections should be recorded and what constituted an episode. Thus, duplicate reporting of infections was noted, this in part reflected a lack of clarity as to when infections should be reported, and difficulties in determining whether new episodes had occurred and duplicate reporting of an infection when new microbiology data became available. The antibiotic use data generated from the ICUs demonstrates the variation in antibiotic usage between hospitals. This is likely to reflect local policies and the resistance/sensitivity past organisms causing infections in individual hospitals or units.
Ref 1 Surveillance of Intensive Care Unit Associated Infections Pilot Report Funded by: Scottish Executive Health Department Health protection Scotland
2 European surveillance of healthcare-associated infections in intensive care units Hai-Net ICU protocol version 1.02
Dr.T.V.Rao M D Freelance reporter in Clinical Microbiologist
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