Bloodstream Infections - Research Paper Example

? TOPIC: BLOOD INFECTIONS Blood infections are serious infections that are acquired by hospitalization patients who require intensive care (Ibrahim, 2000).Among the blood infections ,vancomycin resistant Enterococcus, ORSA and coagulase negative Staphylococcus are due to inadequate administration of antibiotics (Ibrahim, 2000).They are a major cause of morbidity and mortality in immune compromised cases and patients who have hematologic malignancies because they receive intensive cytotoxic therapies (Apostolopoulou, 2010).The use of medical device also has a consequence of introducing systemic infections consequently causing device related blood infections (Kojic, 2004) .Examples of these devices includes, ventricular assist device, cardiovascular devices, urinary catheter and penile implants .Other causes blood infections includes use of unscreened blood products, and contact between patients. For central line associated bloodstream infections, they are actually associated with increased length of hospitalization (Guerin, 2010). In USA, it has been reported that increased risk of developing blood stream infections (BSI) is associated with the increased use of central venous catheters (CVSs) in ICU patients especially when the skin catheter site is colonized by bacteria and fungi. This is a major risk factor for CVC infection. Other predisposing factors to infection includes; exposure to mechanical ventilations (Jerome, 2000). Patients receiving TPN are also at risk as they are associated with growth of other microorganisms such as Candida spp and coagulase negative Staphylococcus. Factors affecting the infection rates and impacts of infection rates on nursing The infection rate of bloodstream infections is determined by factors such as nutrition, length of hospitalization, dose of inoculants, age, inadequate administration of antimicrobial agents, immunity levels of the patient and whether the he/she had been exposed to the pathogens previously, surgery and chemotherapy received by the patient before the infection, exposure to invasive procedures, co-morbidities, hospital services and severity of infection at administration and use of steroids (Guerin, 2010).The impacts of these factors on nursing is that, the nursing working environment can be compromised, there is more exposure to different infectious agents, the hospital is forced to put more stuff for surveillance, prevention and control and this means extra cost. The nurses will also have a lot of work loads if there is under stuffing and more injuries such as needle stick (Stone, 2004). Nursing interventions that impact percentages of blood stream infection. Line management It may consist of daily inspection of catheters insertion sites, taking care of the site by changing the dressing if wet or soiled, time to time documentation of ongoing catheter, ensuring of proper application of CHG impregnated sponge on the insertion site, hand hygiene, using chlordexine during dressing of the site, appropriate flushing procedures, tubing replacement and increasing time allocated for CVC management. Other intervention that impact on the percentages of blood stream infections includes, educating of the stuff so as to make the nurses aware of evidence based infection control guidelines for inserting and also for maintaining of CVCs. This will help in prevention of nosocomial infections and empower them to stop catheter insertion if guidelines have not been followed. Putting in place a checklist will be important in ensuring that the nurses adhere to evidence based guidelines of preventing infections. Creation of a catheter insertion carts will be critical in ensuring that nurses obtain all the materials needed to follow the CDC guidelines for sterile CVV insertions (Guerin, 2010). Aseptic techniques. Aseptic techniques should be used during insertion and caring of intravascular catheters. Clean gloves are recommended for peripheral catheters while sterile gloves are good for arterial and central catheters. Aseptic techniques includes the use of mask, sterile gloves, sterile gowns, guide wise exchange, use chlordexine and other disinfectants in skin preparations.(Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts.). Frequent hand washing is a basic control measure but its compliance varies from 20 to 40 % although it can be high for motivated nurses and other medical stuff (Jerome, 2000).It should be done either by using antiseptic soaps or water alcohol gels/ foams. It must be done before and after palpating catheter insertion sites, before and after inserting, accessing, dressing, repairing and replacing. The use of gloves should be used together with hand washing. The significance of hand hygiene is that it reduces the risks of cross transmission ((Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts.). Proper techniques and compliance with procedure guidelines is also an important intervention. Compliance with evidence based infection control practices and use of proper guidelines during catheter insertions will help in reducing bloodstream infections. Creating a catheter insertion cart will also improve compliance by reducing the number of steps involved and by ensuring collection of all materials that comply with CDC guidelines. Materials that impact percentage of bloodstream infections The type of dressing used can influence the percentages of bloodstream infections. Examples of these dressing types includes; gauze dressing, intact dressing and vascular access dressing. Dressing types which get soiled or damped easily should be changed more often to avoid infections. However for TSM dressing it should be changed at least once in a week (Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts.). The type of cleansing agents used is also an important factor influencing the percentages of bloodstream infections .Disinfectants such as alcohol, betadine, povidone iodine and chlordexine can be used and according to manufactures instructions. However, for povidone iodine it should not be used for Allergic or hypersensitivity patients. The use of water as a cleansing agent should be avoided as this is likely to introduce microorganism to catheters not unless precautions have been put in place to prevent infections. Those disinfectants with short contact and high residual ability are considered the best eg alcohol. Other factors which should be considered as they may determine whether a person will have bloodstream infections or not. Location of the catheter/ site of insertion Catheters can be located in various parts of the body such as subclavian, jugular, femoral among other body parts. According to (Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts.), subclavian site other than jugular or femoral site in adults patients reduces infection risk for non tunneled CVC placements. More blood infections are likely to occur in indwelling catheters particularly the tunneled catheters than in untunneled catheters (Kojic, 2004). Length of stay The length of stay before admission and after hospitalization should also be taken into consideration. For instance, in catheter related infections they are associated with patients who have central venous catheters and who have been staying in the hospital for at least 48 hours (Kojic, 2004). Nosocomial bloodstream infections are also related to long stay in the hospital. Hospital service Good hospital practices in which there is proper adherence to guidelines and aseptic procedures will reduce the risk of developing bloodstream infections. Duration of catheter replacement Duration of catheter replacement will also determine whether a person will be infected or not. For example, hemodialysis catheters should not be replaced routinely so as to prevent infections while for peripheral venous catheters they should be removed at least 72 to 96 hours in adults to prevent infections such as Phlebitis (Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts.). Type of catheter In USA, more than 5 million venous central catheters are inserted annually and it has been estimated that 2 to 12 % of all CVCs leads to sepsis. The national nosocomial infection surveillance data has shown that 70 to 87 % of all primary bloodstream infections do occur in patients who have central catheters lines. More infections are also likely to occur for tunneled catheters than in untunneled ones (Kojic, 2004). Acuity of illness Severity of illness is a risk factor to infection. Other predisposing factors to infections are; immunocomprimised state, iatrogenic factors such as use of antibiotics, diabetes mellitus, surgery, hyperalimentation fluids, parenteral nutrition, hematologic malignancies, burns, gastrointestinal diseases and Candidemia. All these factors can make a patient to be more susceptible to infectious microorganisms such as Candida spp, which are commensal. For instance, Candida grabrata is related to azole prophylaxis, urinary or vascular catheters while C.tropica is related to bone marrow transplantation and neutropenia (Kojic, 2004). Antibiotic therapy if inadequately administered can lead to infections especially those that are related to antibiotic resistance (Ibrahim, 2000).However it has been shown to be a beneficial approach in preventing bacterial infections and those caused by Candida spp. This therapy is carried out by exposing the catheter lumen to pharmacological concentrations of antibiotic for either hours or days (Kojic, 2004).To reduce emergence of resistant strains, various approaches can be used. These includes; selection of the most effective antibiotic agents, cycling antibiotics, careful assessment of the prevailing resistant levels and use of combination therapies (Jerome, 2000). Among the interventions used so far to control bloodstream infections, there are some which have been shown to have great impacts and they include; educating of staff to empower them , use of checklists and careful observation of catheter insertions by link nurses so as to ensure compliance, effective use of aseptic techniques, using disinfectants which have short time conduct and those that have longer residual effects, stabilization of catheter sites, ensuring skin preparations by scrubbing with regular bathing soaps and tap water, increasing time allocated for CVC management (Tsuchida & Makimoto, 2007) References Apostolopoulou, E. V. (2010). Infection probability score,APPACHE 11 and KARNOFSKY scoring systems as prediction of bloodstream infection onset in hematology-oncology patient. BMC infectious disease , 10, 135-. Guerin, K. j. (2010). Reduction in central line associated bloodstream infections by implimentation of a postinsertion care bundle. Am.J infect control , 38 (6), 430-3. Ibrahim, E. G. (2000). The influence of inadequate antimicrobial treatment of bloodstream infection on patients in the ICU setting. Chest , 146-155. Jerome, R. S. (2000). The influence of the composition of the nursing staff on primary blood stream infections on surgical intensive care unit. Infection and Hospital epidemiology , 21 (1), 12-17. Kojic, E. A. (2004). Candida infectionof medical devices. Clinical microbiology reviews , 17 (2), 255-267. Prevention of bloodstrream infectionjs:In prevention and control of health care associated infections in Masachutts. (n.d.). Retrieved Nov. 6, 2011, from Stone, P. S. (2004). International confrence on women andinfectious diseases.Nurse's working conditions. Emerging infectious diseases , 10 (11), n.p. Tsuchida, T., & Makimoto, K. T. (2007). The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison. International Journal Of Nursing Studies [Int J Nurs Stud] , 44 (8), 13224-33. Read More