Infection control and prevention - Essay Example

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Insertion of central venous catheters has become commonplace in the peri-operative and intensive care setting.Over the years,they have played a reliable role in patient care for haemodynamic management,patent intravenous access in patients suffering from chronic illnesses and administration of parenteral nutrition…
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Download file to see previous pages Insertion of central venous catheters (CVCs) has become commonplace in the peri-operative and intensive care setting. Over the years, they have played a reliable role in patient care for haemodynamic management, patent intravenous access in patients suffering from chronic illnesses and administration of parenteral nutrition and other chemotherapeutic agents. The three sites that are utilized for central venous catheter insertion are internal jugular, subclavian and femoral. Although, like any other medical intervention, these catheters have their own share of complications, it is the risk of infection, which has the most serious clinical and economic repercussions for the patient, physician and health care facility with high morbidity and mortality.One survey determined that central lines are associated with more than 40% of blood stream infections in England. Thus, it is imperative that strict infection control measures are enforced during the care of CVCs. Risk of infection in peri-operative setting would depend upon whether the CVC is kept in situ for a long time or it is removed post surgery. Otherwise, rest of the discussion about CRBSI is applicable to ICU as well as peri-operative setting. Definition and diagnosis of CRBSI Catheter related blood stream infection (CRBSI) is a type of hospital acquired infection which is clinically defined as fungemia or bacteremia in a patient with CVC in situ, as shown by positive blood culture from a peripheral vein, along with clinical signs of infection, but no other apparent source for positive blood culture. ...
, or, blood sample from a peripheral vein and sample drawn from the catheter hub (IDSA 2012)) Risk of CRBSI in perioperative and ICU setting Many factors have been investigated for the role that they are likely to play in the development of these infections. The factors which have been most commonly scrutinized for their role in causation of CRBSI are: Selection of the type of catheter: single lumen catheters have a lower incidence of CRBSI than multiple lumen, antimicrobial impregnated catheters preferred in centres with high rates of CRBSI or prolonged requirement of CVC (reference no.23), role of peripherally inserted central catheters (PICCs) the site of CVC insertion: Subclavian most preferred, femoral least preferred hand hygiene: technique should be accurately followed aseptic precautions and skin preparation followed during insertion: use of gloves and barrier precautions, skin preparation with chlorhexidine in alcoholic solution nature and material of the dressing applied over the insertion site antibiotic ointment systemic antibiotic prophylaxis antimicrobial flush and lock solutions anticoagulant flush replacement of CVCs Replacement of IV administration sets handling of the CVC port by nursing and other health care staff USG guidance at the time of insertion Various studies and clinical trials support or contradict these factors. Also, there are evidence based practices and interventions based on these related factors and derived from the existing knowledge about infection control, which, when diligently followed in ICUs and other health care settings, have demonstrated a decrease in the rate of development of CRBSI (National Institute for Clinical Excellence 2003, Healthcare Infection Control Practices Advisory Committee 2011). Pathogenesis of Catheter ...Download file to see next pagesRead More
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