Guidelines for prevention of hospital acquired infections

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.

[1]  R. Drew Antimicrobial Stewardship Programs: How to Start and Steer a Successful Program , 2009, Journal of managed care pharmacy : JMCP.

[2]  D. Pittet Hand hygiene: improved standards and practice for hospital care , 2003, Current opinion in infectious diseases.

[3]  J. Preiksaitis,et al.  Guidelines for the prevention and management of infectious complications of solid organ transplantation , 2004 .

[4]  E. Lautenbach Expanding the Universe of Methicillin-Resistant Staphylococcus aureus Prevention , 2008, Annals of Internal Medicine.

[5]  P. Patel,et al.  US outbreak investigations highlight the need for safe injection practices and basic infection control. , 2010, Clinics in liver disease.

[6]  Steven E Wolf,et al.  Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. , 2003, The Journal of trauma.

[7]  B. Allegranzi,et al.  Considerations for a WHO European strategy on health-care-associated infection, surveillance, and control , 2005, The Lancet Infectious Diseases.

[8]  L. Mody Infection control issues in older adults. , 2007, Clinics in geriatric medicine.

[9]  S. Coffin,et al.  Infection control, hospital epidemiology, and patient safety. , 2005, Infectious disease clinics of North America.

[10]  John T Brooks,et al.  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, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[11]  B. Jovanovic,et al.  Nosocomial infections in a burn intensive care unit. , 1995, Burns : journal of the International Society for Burn Injuries.

[12]  J. Burke,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 , 2007 .

[13]  B. Pruitt,et al.  Incidence of bacteremia after burn wound manipulation in the early postburn period. , 1997, The Journal of trauma.

[14]  R. Wenzel The Lowbury Lecture. The economics of nosocomial infections. , 1995, The Journal of hospital infection.

[15]  C. Ryan,et al.  Permissive hypercapnia as a ventilatory strategy in burned children: effect on barotrauma, pneumonia, and mortality. , 1995, The Journal of trauma.

[16]  D Watling,et al.  Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. , 2004, The Journal of hospital infection.

[17]  N Taenaka,et al.  Handwashing before entering the intensive care unit: what we learned from continuous video-camera surveillance. , 1999, American journal of infection control.

[18]  D. Raghunath Emerging antibiotic resistance in bacteria with special reference to India , 2008, Journal of Biosciences.

[19]  L. Mody,et al.  Introduction of a Waterless Alcohol-Based Hand Rub in a Long-Term–Care Facility , 2003, Infection Control & Hospital Epidemiology.

[20]  Guidelines for intensive care unit design. Guidelines/Practice Parameters Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine. , 1995, Critical care medicine.

[21]  P. Ferdinande Recommendations on minimal requirements for Intensive Care Departments , 1997, Intensive Care Medicine.

[22]  Didier Pittet,et al.  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 , 2002 .

[23]  Helen Burstin,et al.  Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals , 2008, Infection Control & Hospital Epidemiology.

[24]  M. Pham,et al.  Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. , 1999, The Journal of infectious diseases.

[25]  憲 大久保 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007 , 2008 .

[26]  R. Haley,et al.  The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. , 1985, American journal of epidemiology.

[27]  R. Edlich,et al.  Management and prevention of tetanus. , 2003, Journal of long-term effects of medical implants.

[28]  Jean-Yves Fagon,et al.  Ventilator-associated pneumonia. , 2002, American journal of respiratory and critical care medicine.

[29]  S. Saint,et al.  Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals , 2008, Infection Control & Hospital Epidemiology.

[30]  M. Lesseva Central venous catheter-related bacteraemia in burn patients. , 1998, Scandinavian journal of infectious diseases.

[31]  Jerome I. Tokars,et al.  Recommendations for preventing transmission of infections among chronic hemodialysis patients , 2001 .

[32]  J. Edwards,et al.  National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. , 2007, American journal of infection control.

[33]  R. Plowman,et al.  The socioeconomic burden of hospital acquired infection. , 2000, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[34]  R. Shah,et al.  Antimicrobial stewardship in institutions and office practices , 2008, Indian journal of pediatrics.

[35]  M. Restrepo,et al.  Strategies in the prevention of ventilator-associated pneumonia , 2011, Therapeutic advances in respiratory disease.

[36]  S. Todi,et al.  Quality indicators for ICU: ISCCM guidelines for ICUs in India , 2009, Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine.

[37]  A. Wysocki Evaluating and managing open skin wounds: colonization versus infection. , 2002, AACN clinical issues.

[38]  E. Larson,et al.  Indigenous multiresistant bacteria from flowers in hospital and nonhospital environments. , 1991, American journal of infection control.

[39]  D. Goldmann,et al.  Pathogenesis of infections related to intravascular catheterization , 1993, Clinical Microbiology Reviews.

[40]  Kelly D Peterson,et al.  National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. , 2008, American journal of infection control.

[41]  Didier Pittet,et al.  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 Dis , 2002, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[42]  J. Rello,et al.  Evidence on measures for the prevention of ventilator-associated pneumonia , 2007, European Respiratory Journal.

[43]  M. West,et al.  Current Treatment Recommendations for Topical Burn Therapy , 1990, Drugs.

[44]  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. , 2001, Cytotherapy.

[45]  A. Mason,et al.  Microbial colonization in a new intensive care burn unit. A prospective cohort study. , 1985, Archives of surgery.

[46]  Carlene A. Muto,et al.  SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus , 2003, Infection Control & Hospital Epidemiology.

[47]  R. Wenzel,et al.  Organization for Infection Control , 2010 .

[48]  J. Fishman,et al.  Infection in organ transplantation: risk factors and evolving patterns of infection. , 2010, Infectious disease clinics of North America.

[49]  J. Koplan Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. , 2000, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[50]  D. Warren,et al.  Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[51]  M. Akçay,et al.  Changes of microbial flora and wound colonization in burned patients. , 2004, Burns : journal of the International Society for Burn Injuries.

[52]  P. Linden Approach to the immunocompromised host with infection in the intensive care unit. , 2009, Infectious disease clinics of North America.

[53]  A. Mason,et al.  Alterations in intestinal permeability after thermal injury. , 1992, Archives of surgery.

[54]  N. Fishman,et al.  Healthcare Infection Control Practices Advisory Committee , 2012 .

[55]  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. , 2005, MMWR. Morbidity and mortality weekly report.

[56]  Sanjay Saint,et al.  Guidelines for the prevention of intravascular catheter-related infections. , 2002, American journal of infection control.

[57]  A. Mason,et al.  Fungal burn wound infection. A 10-year experience. , 1991, Archives of surgery.

[58]  D. Church,et al.  Burn Wound Infections , 2006, Clinical Microbiology Reviews.