approaching infection outbreak in picu
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An infection control nurse informed the PICU consultant that two patients have been found to have MDR Acinetobacter infections. This may constitute an Acinetobacter outbreak. The consultant should confirm it is an outbreak by investigating patients and the environment, calculating the attack rate, and comparing it to the background rate. If confirmed, treatment and prevention measures should be implemented, including isolation, cohorting, strict sterilization and disinfection procedures.
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approaching infection outbreak in picu
- 1. How do I approach Infection Outbreak in PICU? Dr Farhan Shaikh Consultant Pediatric Intensivist Internal assessor for Quality Standards Rainbow Children’s Hospital Hyderabad
- 11. The Action Plan
- 17. http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf © World Health Organization 2009. All rights reserved., and the 'How to Handrub', URL: http://www.who.int/gpsc/5may/How_To_HandRub_Poster.pdf © World Health Organization 2009. All rights reserved.'
- 18. http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf © World Health Organization 2009. All rights reserved., and the 'How to Handrub', URL: http://www.who.int/gpsc/5may/How_To_HandRub_Poster.pdf © World Health Organization 2009. All rights reserved.'
- 28. Sheet No: Bundle Criteria Use a single column for each Ventilated patient. Mark the appropriate response in the box. Optimal answer Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Prevention of aspiration of contaminated secretions Elevate head of bed 30-45 degrees Ventilator circuit drained before repositioning patient Prevention of bacterial colonization of oropharynx, stomach & sinuses Hand hygiene performed before & after contact with ventilator circuit. Yes/No Condensate from ventilator circuit drained every 2-4 hours Oral suction devices rinsed after every use & stored in plastic covers Unit mouth care policy followed every 2-4 hrs
- 29. Reason if ventilator circuit condensate not drained D 1: Busy schedule D 2: Did not remember D 3: Bed non-functional Gowns worn before providing care to the patient whenever soiling from respiratory secretions observed Ventilator circuits & in-line suction catheters changed only if visibly soiled Did the patient develop VAP today as per the defined criteria? Yes/No Reason if Head end not elevated N 1: Pt unstable N 4: Other (Add comment) N 2: Surgical restriction N 3: Raised ICT
- 30. Environmental and Infection Control Supports
- 32. Spaulding categorized the process as.. Critical items: Items entering body or vascular system Must be sterilized by steam under pressure, dry heat , Or for heat sensitive items ETO Semicritical : Items in contact with mucosa or non-intact skin. Disinfection by a high level disinfectant (e.g. Gluteraldehyde) Spaulding EH. Chemical disinfection of medical and surgical materials. In: Lawrence C, Block SS, eds. Disinfection, sterilization, and preservation. Philadelphia: Lea & Febiger, 1968:517-31.
- 53. Scenario
- 57. THUS COMPLETING AUDIT CYCLE Audit: How to do in practice? BMJ 2008;336:1241-5
- 60. THANK YOU
Notes de l'éditeur
- E.g. During outbreak of Surgical Site Infection (SSIs) caused by MRSA, a patient who is growing MSSA will be excluded
- One of the first task of the investigative team is to develop a working case definition based on the known facts of the outbreak.
- Any outbreak investigation must include close inspection of the environment mainly the inanimate objects.
- With adequate nursing staff, it is more likely that infection control practices will be given appropriate attention and applied correctly and consistently
- More than 30 years ago, Earle H. Spaulding devised a rational approach to disinfection and sterilization of patient-care items and equipment.14 This classification scheme is so clear and logical that it has been retained, refined, and successfully used by infection control professionals and others when planning methods for disinfection or sterilization. 1, 13, 15, 17, 19, 20
- Intact skin acts as an effective barrier to most microorganisms; therefore, the sterility of items coming in contact with intact skin is "not critical."
- patients should be moved for essential purposes only. If transportation is required, use precautions to minimize the risk of transmission.
- MRSA: Cultures of the nares identify most patients with MRSA and peri-rectal and wound cultures can identify additional carriers MDRO-GNB: peri-rectal or rectal swabs alone or in combination with oro-pharyngeal, endotracheal, inguinal, or wound cultures.
- Decolonization regimens are not sufficiently effective to warrant routine use. Therefore, most healthcare facilities have limited the use of decolonization to MRSA outbreaks, or other high prevalence situations, especially those affecting special-care units. Several factors limit the utility of this control measure on a widespread basis: 1) identification of candidates for decolonization requires surveillance cultures; 2) candidates receiving decolonization treatment must receive follow-up cultures to ensure eradication; and 3) recolonization with the same strain, initial colonization with a mupirocin-resistant strain, and emergence of resistance to mupirocin during treatment can occur(289, 303, 308-310). HCP implicated in transmission of MRSA are candidates for decolonization and should be treated and culture negative before returning to direct patient care. In contrast, HCP who are colonized with MRSA, but are asymptomatic, and have not been linked epidemiologically to transmission, do not require decolonization.