Infection control protocols in intensive care units

Mr. ANILKUMAR B R M.sc Nursing
LECTURER
MEDICAL- SURGICAL NURSING

 Hospital acquired infections (HAIs) are common
in intensive care unit (ICU) patient and are
associated with increased morbidity and
mortality.
 The main reason being severity of illness,
interruption of normal defense mechanism (e.g.
mechanical ventilation), malnutrition & inability
to ambulate make it more susceptible to multi
drug resistant organism (MDRO).

The most frequent mode of
transmission is Contact transmission,
this may be direct or indirect other
modes include droplet transmission,
airborne transmission, common
vehicle such as ventilator etc.

Age more than 70 years
Shock
Major trauma
Acute renal failure
Coma
Prior antibiotics

Mechanical ventilation
Drugs affecting the immune system
(steroids, chemotherapy)
Indwelling catheters
Prolonged ICU stay (>3 days).
 Protein-energy malnutrition

 Hand hygiene
 Hands are the most common vehicle for
transmission of organisms and “hand hygiene” is
the single most effective means of preventing the
horizontal transmission of infections among
hospital patients and health care personnel

 Sterile gloves should be
worn after hand hygiene
procedure while
touching mucous
membrane and non-
intact skin and
performing sterile
procedures e.g. arterial,
central line and Foley
catheter insertion

 Wear a gown to prevent
soiling of clothing and
skin during procedures
that are likely to
generate splashes of
blood, body fluids,
secretions or excretions.

 The sterile gown is
required only for aseptic
procedures and for the
rest, a clean, non-sterile
gown is sufficient.
 Remove the soiled gown
as soon as possible, with
care to avoid
contamination.

 Used patient-care
equipment soiled with
blood, body fluids,
secretions, or excretions
should be handled
carefully to prevent skin
and mucous membrane
exposures, contamination
of clothing and transfer
of microorganisms to
other patients or the
environment.

 Ensure that reusable
equipment is not used
for the care of another
patient until it has been
cleaned and sterilized
appropriately.
 Ensure that single use
items and sharps are
discarded properly.

 VAP is most common infection
acquired in ICU.
 VAP as defined by CDC is a
pneumonia which occurs in a
patient who was intubated &
mechanically ventilated at the
time of onset of pneumonia or
within 48 hours before onset of
pneumonia.

1. Awareness & Training Shorten the
duration of intubation and invasive
ventilation.
2. Consider use of noninvasive
ventilation.
3. Avoid continues use of paralytics as
far as possible.

1. Promote adequate oral hygiene with s 0.12%
Aq. Chlorhexidine
2. Ensure appropriate dosages of sedation or
narcotics
3. Consider use of sedation scale to avoid over-
sedation.
4. Wean patient off invasive ventilation as soon as
possible.
5. Prevent unplanned extubation e.g. patient self
extubation.

1. Practice of standard precaution should be
observed Perform tracheal suction
properly with aseptic precaution & avoid
routine saline instillation during
suctioning.
2. Ensure appropriate disinfection,
sterilization, and maintenance of
respiratory equipment.
3. Place the ventilated patient in semi-
upright position around 45 degrees.

Urinary tract infections (UTIs) are
the most common type of
nosocomial infections, accounting
for 40% of all infections in hospital
per year.
Almost 80% of these infections are
due to instrumentation or
catheterization.

1. Female gender
2. Postpartum status.
3. Older age
4. Severe underlying illness an
5. High blood creatinine level.
6. The wrong reason for catheterization.
7. Contamination during insertion Errors in
catheter care
8. Use of broad spectrum antibiotics.

 Insert catheters only for appropriate
indications.
Follow aseptic insertion of the urinary
catheter.
Maintain a closed drainage system.
Remove the catheter as soon as
possible.
 Use strict aseptic technique
 Maintain strict catheter care

 Replace bags with new or clean containers
when needed.
 Avoid irrigation, if frequent irrigation is
required, the catheter should be changed.
 Caution the patient against pulling on the
catheter.
 Avoid raising the collection bag above the
level of the patient’s bladder.
 Remove the catheter when it is no
longer needed

 Central venous catheters (CVCs) are
widely used in modern medicine.
However, placing a catheter poses
infectious and mechanical risks to
patients due to complications that
can be fatal.

 Insertion date should be put on all vascular
access devices.
 Use 2% chlorhexidine wash daily for skin
cleansing to reduce.
 Use maximal sterile barrier precautions
(cap, mask, sterile gown and sterile
gloves).

 Strict aseptic precaution while
cannulation.
 Daily inspection & changing CVC if signs
of local infections appear.

 Surgical site infection (SSI) is the
second most common health care
associated infection.
 Surgical site infection accounts for
14% to 16% of hospital-acquired
infections.

 Give antibiotic prophylaxis according to
guidelines.
 Don’t use razors to remove hair at the
operative site.
 Control blood glucose in patients
scheduled for cardiac surgery.
 Strict aseptic technique when hanling
surgical site.
 Educate patients and families about their
role in SSI prevention.

 Work with hospital administration for
better patient to nurse ratio in the ICU.
 Policies for controlling traffic flow to
and from the unit to reduce sources of
contamination from visitors, staff and
equipment .
 Waste and sharp disposal policy.

 Education and training for ICU staff about
prevention of nosocomial infections .
 ICU protocols for prevention of nosocomial
infections .
 Audit and surveillance of infections and
infection control practices .
 Infection control team (multidisciplinary
approach)
 Vaccination of health care personnel .

Infection control protocols in intensive care units

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