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VOLUME 18 , ISSUE 3 ( March, 2014 ) > List of Articles

GUIDELINES

Guidelines for prevention of hospital acquired infections

Vijaya Patil, Subhash Todi, S. N. Myatra, D. P. Samaddar

Keywords : Hospital Acquired Infection prevention, Standard Precautions, Burns, Monitoring Surveillance, Antibiotic Stewardship

Citation Information : Patil V, Todi S, Myatra SN, Samaddar DP. Guidelines for prevention of hospital acquired infections. Indian J Crit Care Med 2014; 18 (3):149-163.

DOI: 10.4103/0972-5229.128705

License: CC BY-ND 3.0

Published Online: 01-03-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

These guidelines, written for clinicians, contains evidence-based recommendations for the prevention of hospital acquired infections Hospital acquired infections are a major cause of mortality and morbidity and provide challenge to clinicians. Measures of infection control include identifying patients at risk of nosocomial infections, observing hand hygiene, following standard precautions to reduce transmission and strategies to reduce VAP, CR-BSI, CAUTI. Environmental factors and architectural lay out also need to be emphasized upon. Infection prevention in special subsets of patients - burns patients, include identifying sources of organism, identification of organisms, isolation if required, antibiotic prophylaxis to be used selectively, early removal of necrotic tissue, prevention of tetanus, early nutrition and surveillance. Immunodeficient and Transplant recipients are at a higher risk of opportunistic infections. The post tranplant timetable is divided into three time periods for determining risk of infections. Room ventilation, cleaning and decontamination, protective clothing with care regarding food requires special consideration. Monitoring and Surveillance are prioritized depending upon the needs. Designated infection control teams should supervise the process and help in collection and compilation of data. Antibiotic Stewardship Recommendations include constituting a team, close coordination between teams, audit, formulary restriction, de-escalation, optimizing dosing, active use of information technology among other measure. The recommendations in these guidelines are intended to support, and not replace, good clinical judgment. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments.


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  1. Plowman R; Graves N; Griffin M; Roberts JA; Swan AV; Cookson B; Taylor L. The socioeconomic burden of hospital acquired infection. London Public health laboratory service and the London school of hygiene and tropical Medicine, 1999.
  2. Wenzel RP. The Lowbury Lecture. The economics of nosocomial infections. J Hosp Infect 1995;31:79-87.
  3. Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. Available from: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. March 10, 2014
  4. WHO guidelines on hand hygiene in health care: A summary. Available from: http://www.whqlibdoc.who.int/hq/2009/WHO_IER_PSP_2009.07_eng.pdf. March 10, 2014
  5. Maselli DJ, Restrepo MI. Strategies in the prevention of ventilator-associated pneumonia. Ther Adv Respir Dis 2011;5:131-41.
  6. Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S31-40.
  7. Lorente L, Blot S, Rello J. Evidence on measures for the prevention of ventilator-associated pneumonia. Eur Respir J 2007;30:1193-207.
  8. Guidelines for the prevention of intravascular catheter-related infections. Available from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
  9. Guidelines for prevention of catheter-associated urinary tract infections. Available from http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf.
  10. Circulation for disinfection and sterilization in healthcare facilities, 2008. Available from: http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf.
  11. Guidelines for environmental infection control in health care facilities. Available from: http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf.
  12. Wysocki AB. Evaluating and managing open skin wounds: Colonization versus infection. AACN Clin Issues 2002;13:382-97.
  13. Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak M. Changes of microbial flora and wound colonization in burned patients. Burns 2004;30:357-61.
  14. LeVoyer T, Cioffi WG Jr, Pratt L, Shippee R, McManus WF, Mason AD Jr, et al. Alterations in intestinal permeability after thermal injury. Arch Surg 1992;127:26-9.
  15. Wurtz R, Karajovic M, Dacumos E, Jovanovic B, Hanumadass M. Nosocomial infections in a burn intensive care unit. Burns 1995;21:181-4.
  16. Goldmann DA, Pier GB. Pathogenesis of infections related to intravascular catheterization. Clin Microbiol Rev 1993;6:176-92.
  17. Becker WK, Cioffi WG Jr, McManus AT, Kim SH, McManus WF, Mason AD, et al. Fungal burn wound infection. A 10-year experience. Arch Surg 1991;126:44-8.
  18. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182-205.
  19. Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1714-21.
  20. Burke JF, Quinby WC, Bondoc CC, Sheehy EM, Moreno HC. The contribution of a bacterially isolated environment to the prevention of infection in seriously burned patients. Ann Surg 1977;186:377-87.
  21. McManus AT, McManus WF, Mason AD Jr, Aitcheson AR, Pruitt BA Jr. Microbial colonization in a new intensive care burn unit. A prospective cohort study. Arch Surg 1985;120:217-23.
  22. Kates SG, McGinley KJ, Larson EL, Leyden JJ. Indigenous multiresistant bacteria from flowers in hospital and nonhospital environments. Am J Infect Control 1991;19:156-61.
  23. Monafo WW, West MA. Current treatment recommendations for topical burn therapy. Drugs 1990;40:364-73.
  24. Mozingo DW, McManus AT, Kim SH, Pruitt BA Jr. Incidence of bacteremia after burn wound manipulation in the early postburn period. J Trauma 1997;42:1006-10.
  25. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev 2006;19:403-34.
  26. Hart DW, Wolf SE, Chinkes DL, Beauford RB, Mlcak RP, Heggers JP, et al. Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 2003;54:755-61.
  27. Edlich RF, Hill LG, Mahler CA, Cox MJ, Becker DG, Horowitz JH, et al. Management and prevention of tetanus. J Long Term Eff Med Implants 2003;13:139-54.
  28. Lesseva M. Central venous catheter-related bacteraemia in burn patients. Scand J Infect Dis 1998;30:585-9.
  29. Sheridan RL, Kacmarek RM, McEttrick MM, Weber JM, Ryan CM, Doody DP, et al. Permissive hypercapnia as a ventilatory strategy in burned children: Effect on barotrauma, pneumonia, and mortality. J Trauma 1995;39:854-9.
  30. Linden PK. Approach to the immunocompromised host with infection in the intensive care unit. Infect Dis Clin North Am 2009;23:535-56.
  31. Fishman JA, Issa NC. Infection in organ transplantation: Risk factors and evolving patterns of infection. Infect Dis Clin North Am 2010;24:273-83.
  32. Dykewicz DA, Jaffe H, Spira T, et al. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR Morb Mortal Wkly Rep 2000;49:1-128. Last accessed date March 10, 2014
  33. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. Available at http://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf Last accessed date March 10, 2014
  34. Nishimura S, Kagehira M, Kono F, Nishimura M, Taenaka N. Handwashing before entering the intensive care unit: What we learned from continuous video-camera surveillance. Am J Infect Control 1999;27:367-9. Last accessed date March 10, 2014
  35. Pittet D. Hand hygiene: Improved standards and practice for hospital care. Curr Opin Infect Dis 2003;16:327-35.
  36. French GL, Otter JA, Shannon KP, Adams NM, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): A comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31-7.
  37. Guidelines for intensive care unit design. Guidelines/Practice Parameters Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1995;23:582-8.
  38. Ferdinande P. Recommendations on minimal requirements for Intensive Care Departments. Members of the Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 1997;23:226-32.
  39. Centers for Disease Control and Prevention, Infectious Disease Society of America, American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000;49:1-125, CE1.
  40. Green M, Avery R, Preiksaitis J. Guidelines for the prevention and management of infectious complications of solid organ transplantation. Am J Transplant 2004;4 Suppl 10:10-7, 57-109, 160-3.
  41. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50:1-43.
  42. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2010. Ann Intern Med 2010;152:36-9.
  43. Centers for Disease Control and Prevention. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. [2009 Apr 10].
  44. UTIs in renal insufficiency, transplant recipients, diabetes mellitus and immunosuppression. In: Grabe M, Bishop MC, Bjerklund-Johansen TE, Botto H, Çek M, Lobel B, Naber KG, Palou J, Tenke P, Wagenlehner F. Guidelines on urological infections. Arnhem, The Netherlands: European Association of Urology (EAU); 2009 Mar. p. 52-63. Available at : http://www.guideline.gov/content.aspx?id=14806
  45. Yokoe, DS, Mermel LA, Deverick AJ, Kathleen AM, Burstin H, David CP, et al. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. Infection Control and Hospital Epidemiology 2008;29:S12-S21
  46. Starling B. Postnote July 2005 Number 247 Infection control in healthcare settings. Available from: http://www.parliament.uk/parliamentary_offices/post/pubs2005.cfm. Last accessed date March 10, 2014
  47. Chastre J, Luyt CE. Ventilator-associated pneumonia. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray& Nadel′s Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 33.
  48. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbid Mortal Wkly Rep. 2002;51:1-45
  49. Mody L, McNeil SA, Sun R, Bradley SE, Kauffman CA. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control Hosp Epidemiol 2003;24:165-71.
  50. Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting, 2008. Australian Government Department of Health and ageing. Available from: http://www.health.gov.au/internet/main/./icg-guidelines-index.htm. Last accessed date March 10, 2014
  51. Perz JF, Thompson ND, Schaefer MK, Patel PR. US outbreak investigations highlight the need for safe injection practices and basic infection control. Clin Liver Dis 2010;14:137-51. Last accessed date March 10, 2014
  52. Centers for Disease Control and Prevention (CDC). Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities - Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. MMWR Morb Mortal Wkly Rep 2005;54:220-3.
  53. Mody L. Infection control issues in older adults. Clin Geriatr Med 2007;23:499-514, vi.
  54. Edmond MB, Wenzel RP. Organization for infection control. In: Mandel GL, Bennet JE, Dolin R. Principles and practice of infectious diseases. 5th ed. Philadelphia; Churchill Livingston. 2009; 2988-2995.
  55. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O′Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1-45.
  56. Review of outcomes data analysis HLTIN403B-Implement and monitor infection control policies and procedures. Available from: http://www.riskresponse.com. au/training/units-of-competency/hlt07-health/hltin403b-imple ment-and-monitor-infection-control-policies-and -procedures.
  57. Hargreaves, S. UK team adopts unique approach to hospital infection control. The Lancet. 2008; 8(12): 747
  58. 58. 58. Infection control program quality monitoring indicators. Vs 2. NSW Department of Health 2005. Available at www0.health.nsw.gov.au/pubs/2005/pdf/infection_ctrl_manual.pdf
  59. ICNA Audit Tools for Monitoring ICNA Audit Tools for Monitoring Infection Control Guidelines within the Community Setting 2005 pp1-48. Department of Health U.K Available at : http://www.ips.uk.net/icna/Admin/uploads/AuditTools2005.pdf
  60. Do AN, Ray BJ, Banerjee SN, Illian AF, Barnett BJ, Pham MH, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis 1999;179:442-8.
  61. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805.
  62. Boughton B. Computerized infection monitoring and rapid control measures benefit patients and hospitals. From Medscape Medical News. Available from: http://www.medscape.com/viewarticle/725013.
  63. Pittet D, Allegranzi B, Sax H, Bertinato L, Concia E, Cookson B, et al. Considerations for a WHO European strategy on health-care-associated infection, surveillance, and control. Lancet Infect Dis 2005;5:242-50.
  64. Centers for Disease Control and Prevention (CDC). Monitoring hospital-acquired infections to promote patient safety - United States, 1990-1999. MMWR Morb Mortal Wkly Rep 2000;49:149-53.
  65. Coffin SE, Zaoutis TE. Infection control, hospital epidemiology, and patient safety. Infect Dis Clin North Am 2005;19:647-65.
  66. B. Ray, D. P. Samaddar, S. K. Todi, N. Ramakrishnan, George John, and Suresh Ramasubban. Quality indicators for ICU: ISCCM guidelines for ICUs in India. Indian J Crit Care Med. 2009 Oct-Dec; 13(4): 173-206.
  67. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362-86.
  68. Lautenbach E. Expanding the universe of methicillin-resistant staphylococcus aureus prevention. Ann Intern Med 2008;148:474-6.
  69. Fishman N. Antimicrobial stewardship. Am J Med 2006;119 6 Suppl 1:S53-61.
  70. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159-77.
  71. Drew RH. Antimicrobial stewardship programs: How to start and steer a successful program. J Manag Care Pharm 2009;15:S18-23.
  72. Shah RC, Shah P. Antimicrobial stewardship in institutions and office practices. Indian J Pediatr 2008;75:815-20.
  73. Raghunath D. Emerging antibiotic resistance in bacteria with special reference to India. J Biosci 2008;33:593-603.
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