INFECTIONS IN INTENSIVE CARE UNITS Detection, Caring Prevention By Dr.T.V.Rao MD

1. INFECTIONS IN
INTENSIVE CARE UNITS
Detection, Caring Prevention
Dr.T.V.Rao MD
10/6/2020 Dr.T.V.Rao MD 1

2. Ignaz Semmelweis
(1818-1865)
• Obstetrician,
practised in Vienna
• Studied puerperal
(childbed) fever
• Established that high
maternal mortality
was due to failure of
doctors to wash hands
after post-mortems
• Reduced maternal
mortality by 90%
• Ignored and
ridiculed by
colleagues
A tribute to Ignaz Semmelweiss
(1818-1865)
. . . . .
Dr.T.V.Rao MD 2

3. What is a Intensive Care Unit
• An intensive care unit (ICU) is
defined as a specially staffed,
specialty equipped, separate section
of a hospital dedicated to the
observation, care, and treatment of
patients with life threatening
illnesses, injuries, or complications
from which recovery is possible
10/6/2020 Dr.T.V.Rao MD 3

4. A Patient in Intensive Care Unit is at
Risk for Many Reasons..
10/6/2020 Dr.T.V.Rao MD 4

5. The Purpose of the Programme
• It provides special
expertise and facilities
for the support of
vital function and
utilizes the skill of
medical nursing and
other staff
experienced in the
management of these
problems10/6/2020
Dr.T.V.Rao MD5

6. Infection in ICU are
•More in Prevention
•Little in Treatment
10/6/2020 Dr.T.V.Rao MD 6

7. Educating our Health Care
Workers
• Education programs for
employees and volunteers are one
method to ensure competent
infection control practices. The ICP
must become knowledgeable and
techniques that will motivate and
sustain behavioral change.
10/6/2020 Dr.T.V.Rao MD 7

8. Why ICU patients are different
• Many times very sick patients (multiple
diagnoses, multi-organ failure,)
immunocompromised, septic and
trauma)
• Move less
• Malnourished
• More obtunded (Glasgow coma scale)
• May be associated Diabetics and Heart
failure
10/6/2020 Dr.T.V.Rao MD 8

9. 9
ICU patients are rapidly colonized with
pathogenic bacteria
• Skin colonized in hours to days
– Staph. aureus, Proteus mirabilis, Klebsiella spp.
present @ 100-106 CFU /cm2 skin
• Perineal/inguinal > axilla > trunk > upper
extremities and hands
• Dialysis/CRF, diabetes, dermatitis, broad
spectrum Abx increase risk
• Patients shed 106 squames/day -> widespread
contamination of the room
Reviewed in Pittet et al Lancet Infect Dis
2006

10. EPIDEMIOLOGY
• Contributing factors
–The high frequency of indwelling
catheters among ICU patients
–The use and maintenance of these
catheters necessitate frequent contact
with health care workers, which
predispose patients to colonization
and infection with nosocomial
pathogens.
10/6/2020 Dr.T.V.Rao MD 10

11. Drug Resistant Bacteria a threat to Life
• Multidrug-resistant pathogens
such as methicillin-resistant
Staphylococcus aureus (MRSA)
and Vancomycin-resistant
enterococci (VRE) are being
isolated with increasing
frequency in ICUs
10/6/2020 Dr.T.V.Rao MD 11

12. Health Condition
(disorder/disease)
WHO ICF
Environmental
Factors
Personal
Factors
Body function&structure
(Impairment)
Activities
(Limitation)
Participation
(Restriction)

13. ICU Care is Invasive at many
Stages
• More invasive lines and
procedures including
surgeries
• Longer length of stay
• More IV and parenteral
drugs
• More tube feeding and
Parenteral nutrition
• More ventilation
10/6/2020 Dr.T.V.Rao MD 13

14. ICU : Factors that increase
cross-infections
• Hand washing facilities are inadequate
• Patient close together or sharing rooms
• Understaffing
• Lack of isolation facilities
• No separation of clean and dirty AREAS
• Excessive antibiotic use
• Inadequate decontamination of
items & equipment's
10/6/2020 Dr.T.V.Rao MD 14

15. Some Health-Care Associated Infections
May Occur in ICU Patients
• UTI associated with Foley catheters
• Lower respiratory tract infection (post-op
and ventilator dependent)
• Skin necrosis (skin breakdown)
• Blood stream infection (and line
associated)
• Surgical-site infection
• Nutrition-related and malnutrition10/6/2020 Dr.T.V.Rao MD 15

16. Strategy for Prevention
• Hand washing
• Use gloves to prevent contamination of the
hands when handling respiratory secretions
• Wear gloves and gowns (contact precautions)
during all contact with patients and fomites
potentially contaminated with respiratory
secretions
• Use aseptic techniques
10/6/2020 Dr.T.V.Rao MD 16

17. Strategy for Prevention
• Clean and decontaminate all equipment after use
• Sterilise or use high-level disinfection for all items
that come into direct or indirect contact with
mucous membranes
• Rinse and dry items that have been chemically
disinfected
• Package and store items to prevent contamination
before use
• Keep environment clean, dry and dust free
10/6/2020 Dr.T.V.Rao MD 17

18. Strategy for Infection
Prevention
• Strict attention to Hand hygiene
• Prudent Antibiotic use
• Aseptic technique
• Disinfection/Sterilization of items and equipment
• Education of staff infection control awareness
• Keep Environment Clean, Dry and dust free
• Surveillance of nosocomial infection to identify
problems areas & set priorities
10/6/2020 Dr.T.V.Rao MD 18

19. Intensive Care Unit
Prevention of Blood stream
infections
10/6/2020 Dr.T.V.Rao MD 19

20. Central Venous Catheters
Indications
• IV fluids and drugs
• Blood and blood products
• Total Parenteral Nutrition (TPN)
• Hemodialysis
• Hemodynamic monitoring
10/6/2020 Dr.T.V.Rao MD 20

21. Serious Infective Complications
• Blood Stream Infections (BSI)
• Septic pulmonary emboli
• Metastasis infections
– Acute endocarditis
– Osteomyelitis
– Septic arthritis
• Shock and organ failure
• Poor outcome: Staph.aureus or Candida spp.
10/6/2020 Dr.T.V.Rao MD 21

22. Incidence of CR-BSI
• Type of catheter
Teflon or Polyurethane ( < infections) vs Polyvinyl
chloride
• Site of insertion
Subclavian (< infections) vs Internal Jugular &
Femoral (high risk of colonization & deep venous
thrombosis)
• No. of Lumen
Single-lumen catheter (< infections) vs
Multi-lumen catheter
10/6/2020 Dr.T.V.Rao MD 22

23. Intrinsic contamination of
infusion fluid
Connection with administration
set
Insertion site
Injection ports
Administration set connection
with IV catheter
Port for
additives
Sources of Infection
10/6/2020 Dr.T.V.Rao MD 23

24. Intralumunal Spread
Contaminated
infusate (fluid,
medication)
2. Intraluminal Spread
Contaminated infusate
(fluid, medication)
1. Extra luminal Spread
Patient’s own skin micro flora
Microorganism transferred by
the hands of Health Care
Worker
Contaminated entry port,
catheter tip prior or during
insertion
Contaminated disinfectant
solutions
Invading wound
3. Haematogenous Spread
Infection from distant
focus
Fibrin
Skin
Vein
Skin attachment
Sources of Infection
10/6/2020 Dr.T.V.Rao MD 24

25. Prevention Strategies: Core
Proper Insertion Practices
• Ensure utilization of insertion bundle:
– Chlorhexidine for skin antisepsis
– Maximal sterile barrier precautions (e.g., mask, cap [i.e., similar to
those worn in the O.R.], gown, sterile gloves, and large sterile
drape)
– Hand hygiene
• Many CLs in patients on non-ICU hospital wards are placed
outside those wards (Emergency room, ICU, Operating
room, or Pre-operative areas)
• In one study, 49% of CLs were present on admission to the
ward. Rates of BSI in this study were higher in CLs placed
in Emergency Room
• Define where placement occurs and review technique in
those areas
10/6/2020 Dr.T.V.Rao MD 25
Trick et al. Am J Infect Control 2006;34:636-41.

26. Prevention Strategies: Core
Chlorhexidine Skin Cleansing
• Chlorhexidine is the preferred agent for skin
cleansing for both CL insertion and maintenance
– Tincture of iodine, an iodophor, or 70% alcohol are
alternatives
– Recommended application methods and contact time
shouldbe followed for maximal effect
• Prior to use should ensure agent is
compatible with catheter
– Alcohol may interact with some polyurethane
catheters
– Some iodine-based compounds may interact
with silicone catheters
10/6/2020 Dr.T.V.Rao MD 26

27. Prevention of CR-BSI
Written Protocol
Must be performed by trained staff
according to written guidelines
Sterile procedure
Sterile gown, Sterile gloves, Sterile large
drapes
Don't shave the site
Hand disinfection
With an antiseptic solution eg
Chlorhexidine gluconate
10/6/2020 Dr.T.V.Rao MD 27

28. Prevention of CR-BSI
Skin antisepsis
• 2% Chlorhexidine gluconate has shown to
have lower BSI than 10% Povidone-iodine or
70 % Alcohol
• 2-min drying time before insertion
Maki DG et al. Lancet 1991;338:339-43
• No difference between 0.5% Chlorhexidine
gluconate or 10% Povidone-iodine
Humar A et al. Clin Infect Dis 2000;31:1001-7
10/6/2020 Dr.T.V.Rao MD 28

29. Prevention of CR-BSI
Dressing
• Gauze dressings every 2
days
• Transparent dressing
every 7 days on short
term catheter
• Replace dressing when
catheter is replaced or
dressing becomes damp
or loose.
Grady NPet al, HICPAC draft guidelines: 2002
10/6/2020 Dr.T.V.Rao MD 29

30. Prevention of CR-BSI
Catheters removal
• Don’t replace it routinely
• Replace it if:
– Inserted in an Emergency
– Non functioning
– Evidence of local or systemic infection
General handling
• Opening of hub: Use antiseptic-
impregnated pads eg Chlorhexidine
gluconate or povidone iodine
10/6/2020 Dr.T.V.Rao MD 30

31. Prevention of CR-BSI
Administration sets
• Replacement at 72-h intervals
• No difference in phlebitis if left for 96
hours
• Lines for lipid emulsion: replacement
at 24-h intervals
• Lines for blood product : remove
immediately after use
10/6/2020 Dr.T.V.Rao MD 31

32. Prevention of CR-BSI
Topical antibiotic
• Prophylactic use of topical Mupirocin (Bactroban) at
insertion site or in nose is not recommended
– Rapid developmentof Mupirocin resistant
– Mupirocinaffect the integrity of Polyurethane catheter
Systemic antibiotic
• Prophylactic use of antibiotic is not recommended at
the time of catheter insertion
10/6/2020 Dr.T.V.Rao MD 32

33. Background: Prevention Strategies
Interventions
• Michigan Keystone Project
• Decrease in CLABSI in 103 ICUs in Michigan (66%
reduction)
• Basic interventions:
– Hand hygiene
– Full barrier precautions during CL insertion
– Skin cleansing with chlorhexidine
– Avoiding femoral site
– Removing unnecessary catheters
– Use of insertion checklist
– Promotionof safety culture
10/6/2020 Dr.T.V.Rao MD 33
Pronovostet al. NEJM 2006;355:2725-32.

34. Urinary Catheterization
10/6/2020 Dr.T.V.Rao MD 34

35. External urethral meatus &
urethra
• Pass catheter when bladder is full for wash-
out effect.
• Before catheterization prepare urinary meatus with
an antiseptic ( e.g. povidone iodine or 0.2%
chlorhexidine aqueous solution)
• Inject single-use sterile lubricant gel (e.g. 1-2%)
lignocaine into urethra and hold there for 3 minutes
before inserting catheter.
• Use sterile catheter.
• Use non-touch technique for insertion
10/6/2020 Dr.T.V.Rao MD 35

36. Junction between catheter & drainage
tube
• Do not disconnect catheter unless
absolutely necessary.
• For urine specimen collection disinfect
outside of catheter proximal to junction
with drainage tube by applying alcoholic
impregnated wipe and allow it to dry
completely then aspirate urine with a
sterile needle and syringe.
10/6/2020 Dr.T.V.Rao MD 36

37. Junction between drainage tube
& collection bag
• Keep bag below level of bladder. If it is
necessary to raise collection bag above
bladder level for a short period, drainage
tube must be clamped temporarily.
• Empty bag every 8 hours or earlier if full.
• Do not hold bag upside down when
emptying
10/6/2020 Dr.T.V.Rao MD 37

38. Tap at bottom of collection bag
• Collection bag must never touch floor.
• Always wash or disinfect hands (eg with
70% alcohol) before and after opening
tap.
• Use a separate disinfected jug to collect
urine from each bag.
• Don't put disinfectant into urinary bag.
10/6/2020 Dr.T.V.Rao MD 38

39. Strategies for Prevention of CAUTI
Avoid unnecessary placement of indwelling urinary
catheters
+++
Remove catheters as quickly as possible +++
Alternative condom catheter, intermittent bladder
catheterization
+++
Aseptic technique in catheter insertion +++
Appropriate catheter maintenance ++
Antimicrobial therapy -
Different catheter composition +10/6/2020 Dr.T.V.Rao MD 39

40. Intensive Care Unit
Nosocomial Pneumonia
10/6/2020 Dr.T.V.Rao MD 40

41. Incidence of HAI vs. Cost
Hospital acquired
Infection
Incidence Additional
cost
Urinary Tract 45% 13%
Surgical Wound 29% 42 %
Pneumonia 9 % 39%
Blood Stream 2% 4 %
Haley, 198610/6/2020 Dr.T.V.Rao MD 41

42. Risk factors for bacterial pneumonia
Host Factors Factors that facilitate reflux
& aspiration into the lower RT
• Elderly
• Severe Illness
• Underlying Lung Disease - Mechanical ventilation
• Depressed Mental Status - Tracheostomy
• Immunocompromising - Use of a Nasogastric Tube
Conditions or Treatments - Supine Position
• Viral Respiratory Tract Factors that impede normal
Infection Pulmonary Toilet
Colonisation - Abdominal or thoracic surgery
• Intensive Care Setting - Immobilisation
• Use of Antimicrobial Agents
• Contaminated hands
• Contaminated Equipment
10/6/2020 Dr.T.V.Rao MD 42

43. Prevention in ICU
• Turn patients to
encouragepostural
drainage
• Encourageto take deep
breathsand cough.
• Maintainan upright
position(elevatepatient’s
head to 30º- 45º degree
angle) to reduce reflux
and aspirationof gastric
bacteria.
10/6/2020 Dr.T.V.Rao MD 43

44. Gastric Ulcer Prophylaxis
• Stomach of a healthy person : Acidic pH () &
normal peristalsis movement prevent bacterial
growth
• Alkaline pH () and loss on normal peristalsis lead to
bacterial colonisation which increases the risk of
ventilator-associatedpneumonia
• Mechanical ventilation patients are at increased risk
for upper GI hemorrhage from stress ulcers.
• H2 blockers or antacids are used to prevent stress
ulcers
10/6/2020 Dr.T.V.Rao MD 44

45. Nasogastric Tube
• May erode the mucosal surface
• Block the sinus ducts
• Regurgitation of gastric contents leading to
aspiration.
• Verify placement of the feeding tube in the
stomach or small intestine by X ray
• Elevate the head of the bed 30º- 45 º degrees
Remove NG Tube if not necessary
10/6/2020 Dr.T.V.Rao MD 45

46. Ventilators
• After every patient,
clean and disinfect
(high-level) or
sterilize re-usable
components of the
breathing system or
the patient circuit
according to the
manufacturer’s
instructions.
10/6/2020 Dr.T.V.Rao MD 46

47. Suctioning mechanically
ventilated patients
• Hand washing before and after the procedure.
• Wear clean gloves to prevent cross-
contamination
• Use a sterile single-use catheter ; if it is not
possible then rinse catheter with sterile water
and store it in a dry, clean container between
uses and change the catheter every 8 - 12
hours.
10/6/2020 Dr.T.V.Rao MD 47

48. Suction Bottle
 Use single-use
disposable, if possible
 Non-disposable bottles
should be washed with
detergent and allowed
to dry. Heat disinfect in
washing machine or
send to Sterile Service
Department.
10/6/2020 Dr.T.V.Rao MD 48

49. Nebulizers
• Use sterile medications and fluids for nebulization
• Fill with sterile water only.
• Change and reprocess device between patients by
using sterilization or a high level disinfection or use
single-use disposable item.
• Small hand held nebulizers
– minimise unnecessary use
– between uses for the same patient disinfect, rinse
with sterile water, or air dry and store in a clean,
dry place
• Reprocess nebulizers daily
10/6/2020 Dr.T.V.Rao MD 49

50. Humidifiers
• Clean and sterilize
device between
patients.
• Fill with sterile water
which must be changed
every 24 hours or
sooner, if necessary.
• Single-use disposable
humidifiers are
available but they are
expensive.
10/6/2020 Dr.T.V.Rao MD 50

51. Oxygen mask
• Change oxygen
mask and tubing
between
patients and
more frequently
if soiled
10/6/2020 Dr.T.V.Rao MD 51

52. Too many Wash basins are Hazardous
• It is not necessary to have an individual hand
wash basins for every bed space as there us a
risk of Legionella and other infections
associated with infrequently used water
outlet.
• All water outlets must run daily to minimize
the potential for legionella within the pipeline
10/6/2020 Dr.T.V.Rao MD 52

53. The Scientific study ( SENIC )
gives guidelines
• Study of the Efficacy of Nosocomial Infection Control (SENIC)
project was published, validating the cost-benefit of infection
controlprograms. Data collected in 1970 and 1976-1977
suggestedthat one-third of all nosocomial infections could be
preventedif all the following were present:
• One infection control professional (ICP) for every 250 beds.
• An effective infection control physician.
• A program reporting infection rates back to the surgeon and
those clinically involvedwith the infection.
• An organized hospital-wide surveillance system.
10/6/2020 Dr.T.V.Rao MD 53

54. • Methicillin-resistant
S. aureus (MRSA) is
resistant to several
antibiotics. Another
form of S. aureus,
vancomycin-resistant
S. aureus (VRSA), is
resistant to one of the
most powerful, last
line of defence
antibiotics,
vancomycin
Concerns with staphylococcus
Dr.T.V.Rao MD 54

55. RESISTANT GRAM NEGATIVE ORGANISMS
• Resistance to multiple antibiotics
Organisms:
E .coli
Proteus
Enterobacter
Acinetobacter
• Stenotrophomnonas
Pseudomonas aeruginosa
10/6/2020 Dr.T.V.Rao MD 55

56. • Escherichiacoli (E.
coli) has gradually
become resistant to
different types of
antibiotics. In 2003,
the overall resistance
of E. coli to common
amino penicillin
antibiotics reached
47% across Europe
E.Coli and emerging resistance
Dr.T.V.Rao MD 56

57. SURVEILLANCE
Dr.T.V.Rao MD 57
• Important means of monitoring HAI
Early detection of trends outbreaks
• Laboratory Based
Microbiology Laboratory lists +ve organisms
ICN reviews ‘Alert organisms’ reported
• 2. Ward Based
Ward staff monitor patients
ICN reviews ICN visits wards

58. Universal precautions
• Hand washing
• Personal protective equipment [PPE]
• Preventing/managing sharps injuries
• Aseptic technique
• Isolation
• Staff health
• Linen handling and disposal
• Waste disposal
• Spillages of body fluids
• Environmental cleaning
• Risk management/assessment
Dr.T.V.Rao MD 58

59. Antibiotics use
Must avoid widespread
use of
broad spectrum antibiotics
10/6/2020 Dr.T.V.Rao MD 59

60. Problem-Detection of
Infection in the ICU’s
10/6/2020 Dr.T.V.Rao MD 60

61. Examples of difficult to detect infections:
Uncultivable organisms
Viruses are under appreciated as causes of
nosocomial infections. Except in cases of high
morbidity viral cultures are not done in
resource scarce settings. Impact food-borne,
respiratory, water borne illnesses.
We don’t know the spectrum of anti-microbial
activity of most preservatives and cleaners for
many viruses.
10/6/2020 Dr.T.V.Rao MD 61

62. Examples from the NNIS
Manual
• Symptomatic Urinary Tract Infection:
– Patient must have one of the two criteria:
• Fever >38 C OR urgency OR frequency OR
dysuria OR suprapubic tenderness without
other cause
OR
• Urine culture with at least 105 organisms per
ml or no more than two species of organisms
10/6/2020 Dr.T.V.Rao MD 62

63. Definition of surgical site infection
(no implant)
• Occurs within 30
days of surgery
AND has one of the
following:
Purulent drainage
from drain OR
Organism isolated
from aseptically
obtained fluid in the
organ space
10/6/2020 Dr.T.V.Rao MD 63

64. Prior to starting any surveillance
• Agree upon a
written case
definition that is
practical given the
laboratory
facilities and
patient work load
in your facility.
10/6/2020 Dr.T.V.Rao MD 64

65. Our plan for future should include
• Unlike scheduled activities, occasional clusters of
patients who are colonized or infected will trigger
further investigation including a case-control study.
New laboratory methods developed and refined
within the last decade can now determine how
related the strain is at the molecular level. The QI/IC
plan should include special problem-focused studies
that describe personnel or environmental sampling,
including what circumstances and who has the
authority to order
10/6/2020 Dr.T.V.Rao MD 65

66. Hand washing
• Single most effective action to prevent HAI -
resident/transient bacteria
• Correct method - ensuring all surfaces are cleaned -
more important than agent used or length of time taken
• No recommended frequency - should be determined by
intended/completed actions
• Research indicates:
– poor techniques - not all surfaces cleaned
– frequency diminishes with workload/distance
– poor compliance with guidelines/training
10/6/2020 Dr.T.V.Rao MD 66

67. Why we are not washing hands ???
• Working in high-risk areas
• Lack of hand hygiene promotion
• Lack of role model
• Lack of institutional priority
• Lack of sanction of non-compliers
10/6/2020 Dr.T.V.Rao MD 67

68. EPIDEMIOLOGY
• A multicenter, prospective cohort surveillance study of 46
hospitals in Central and South America, India, Morocco,
and Turkey.
• Rates of device-associated infection were determined
between 2002 and 2005; an overall rate of 14.7 percent or
22.5 infections per 1000 ICU days was found.
• Specific devices:
– Ventilator associated pneumonia (VAP); 24.1 cases/1000
ventilator days (range 10.0-52.7)
– CVC-related bloodstream infections; 12.5/1000 catheter days
(7.8-18.5)
– Catheter-associatedurinary tract infections; 8.9/1000 catheter
days (1.7-12.8)
10/6/2020 Dr.T.V.Rao MD 68

69. Cockroaches (Ectobius vittiventris) in
an Intensive Care Unit, Switzerland1
• Cockroaches are capable of harboring Escherichia coli
Enterobacterspp. Klebsiellaspp. , Pseudomonas
aeruginosa, Acinetobacter baumannii , other
nonfermentativebacteria Serratia marcescens Shigella
spp. Staphylococcus aureus group A streptococci ,
Enterococcusspp. , Bacillus spp. , various fungi , and
parasites and their cysts . An outbreak of extended-
spectrum β-lactamase–producing Klebsiella
pneumoniaein a neonatal unit was attributed to
cockroaches
• Emerging Infectious Diseases March 2009
10/6/2020 Dr.T.V.Rao MD 69

70. Rapid and Newer method of
Contamination with
• ATP testing works because Adenosine
Triphosphate is present in all types of organic
material (i.e. food, bacteria, bodily fluids,
unique proteins, allergens and even skin), and
the ability to detect it through an ATP
bioluminometer indicates the amount of
microbial and non-microbial contamination in
a given test area. This is accomplished by a
luminescent chemical reaction,
10/6/2020 Dr.T.V.Rao MD 70

71. Our Vision to Future
• Infection control
programs must
maintain training
records of employees.
The minimum training
required is annual OSHA
blood borne pathogen,
tuberculosis prevention
and control and new
employee orientation.
10/6/2020 Dr.T.V.Rao MD 71

72. Why we need better ICU’s
• For an incidence as well as for a
prevalence population of critically ill
patients, there is a window of critical
opportunity for admission into the ICU,
much like the golden our for the
trauma patient.
• Efforts should be made to avail ICU facilities to as
many recently deteriorated patients as possible,
especially those who could be transferred into the
ICU very early after deterioration, such as
patients on hospital wards.
10/6/2020 Dr.T.V.Rao MD 72

73. WHONET - Documentation
• Establishing WHONET
Documentationmakes
the Antibiograms
assessments easy by
Microbiologistsand
Consultantsat any
Hospital.
• We are fully functional
to the advantages of
the WHONET
documentation,
Dr.T.V.Rao MD 73

74. Do remember the Reasons for Infections are
Many but solutions are few …
10/6/2020 Dr.T.V.Rao MD 74

75. Consequences of hospital infections
???
Hospital Pathogen Unhappy
patients
Unhappy
director
Hospital Surveillance Happy
Patients
Happy
directorDr.T.V.Rao MD 75

76. How successful are our Programmes
• Accreditationfrom competentgovernment
agency; training of ICU nurses and Intensivecare
physicians;technologysharing with developed
countries,fundingprograms in collaborationwith
WHO, ICMR, DBT, NGOs; use of information
technologyfor patient care, training and
research.Setting up acute care units in
emergencydepartmentsgreatly reduces the door
to interventiontime and has the potentialto
revolutionizethe management of diverse
emergenciesboth infectiousand non-infectious.
10/6/2020 Dr.T.V.Rao MD 76

77. Can We completely eliminate
ICU related Infections
• As noted in the EPIC II report (JAMA), these
measureswill not completely eliminate the risk
of infection or antibiotic resistance. Limiting the
use of antibiotics in patients with evidence of
infection rather than colonisation, and
discontinuing antibiotic use when their benefits
have been obtained as well as utilising
biomarkersin decision-making and in response
to the increasing number of antibiotic-resistant
pathogens, new drugs are urgently needed.
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78. Let us support our Hospitals with
clean hands
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79. 10/6/2020 Dr.T.V.Rao MD 79

80. • Program File Created by
Dr.T.V.Rao MD for benefit of Health
care workers Nurses and
Paramedical professionals
• Email
• doctortvrao@gmail.com
10/6/2020 Dr.T.V.Rao MD 80