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Hand Hygiene and

1
Prevention of

icu care
DR.T.V.RAO MD

Dr.T.V.Rao MD

Infections in

Health care Associated


Infections
Healthcare-associated

infections affect 1.4


million patients at any
time worldwide, as
estimated by the World
Health Organization. In
intensive care units, the
burden of healthcareassociated infections is
greatly increased, causing
Dr.T.V.Rao MD

Multi Drug Resistant Microbes can


be reduced with Hand hygiene

Multidrug-resistant
pathogens are
commonly involved in
such infections and
render effective
treatment challenging.
Proper hand hygiene is
the single most
important, simplest, and
least expensive means
of preventing
healthcare-associated
infections

Dr.T.V.Rao MD

CDC Says
According

to the Centers for Disease Control and


Prevention and World Health Organization
guidelines on hand hygiene in health care, alcoholbased hand rub should be used as the preferred
means for routine hand antisepsis. Alcohols have
excellent in vitro activity against Gram-positive
and Gram-negative bacteria, including multidrugresistant pathogens, such as methicillin-resistant
Staphylococcus aureus and vancomycin-resistant
enterococci

Dr.T.V.Rao MD

Our Hands are always


Contaminated with
Microbes

Dr.T.V.Rao MD

OPTIMAL HAND
HYGEINE
Correct

hand hygiene
includes washing hands
with soap and water or
using alcohol-based
hand sanitizers
(preferred). Hand
hygiene procedures
should be performed
before and after any and
all direct patient contact

Dr.T.V.Rao MD

OPTIMAL HAND HYGEINE

Direct patient contact


includes: examination of
patient, specimen collection,
and all procedures. Hands
should be cleaned before
and after contact with the
patients immediate
environment or medical
equipment. Hand hygiene
practices should be
performed before and after
eating, sneezing, coughing,
and using the restroom.

Dr.T.V.Rao MD

Every bed should have


Every

bed should have


attached alcohol
based anti-microbial
instant hand wash
solution source, which
is used before
caregiver
(doctor/Nurse/relative/
Paramedical) handles
Dr.T.V.Rao MD

Water basin
Water

basin at all
bedside has not
proven popular and
successful because
of poor compliance
by one and all and
also for reasons of
space constraints
and maintenance
issues.
Dr.T.V.Rao MD

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An operation room style sink


An operation room style
sink with Elbow or foot
operated water supply
system with running hot
and cold water supply
with antiseptic soap
solution source should
be there at a point
easily accessible and
unavoidable point,
Dr.T.V.Rao MDwhere two people can

How you enter a ICU


All

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entrants
(Irrespective of
Doctors or nurses
should don mask
and cap in ICU and
ideally an apron
which should be
replaced daily)
Dr.T.V.Rao MD

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No dirty/soiled linen
No

dirty/soiled
linen/material should
be allowed to stay in
ICU for long times for
fear of spread of bad
odour, infection and
should be disposed off
as fast as possible.
Dirty linen should be
replace regularly at

Dr.T.V.Rao MD

All surrounding to be
clean
All

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surroundings
of ICU should be
kept absolutely
clean and green
if possible for
obvious reasons

Dr.T.V.Rao MD

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Care of the Catheters


While

the epidemiology of catheter infections is


well described in western literature, data from
Indian hospitals is scarce. Though one study of
intermediate-term central catheters in children
reports rates of catheter associated
bloodstream infection of 1.3/1000 catheter
days. The definitions of catheter infections are
very variable in the published studies and need
Dr.T.V.Rao MD

Catheters as source of
Infection

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The high frequency of


fungal colonisation of
catheter tips and
candidemia (about
45%) in a paediatric
study is also unusual
and requires further
evaluation.
Dr.T.V.Rao MD

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Surveillance of Catheter associated


Infections
All

Dr.T.V.Rao MD

Institutions
and intensive care
units should
measure CABSI
rates (A) 2. For
purposes of
surveillance all
BSIs count as
CABSI

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Indication for culturing Blood

Blood cultures are to


be drawn only when
BSI is clinically
suspected (and
preferably before
antibiotics are
started) (A) Routine
cultures of vascular

Dr.T.V.Rao MD

Implementation of Standard
Operating procedures

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Standard

methodology for
blood culture,
vascular cathetertip culture and
calculation of
CABSI rates are
encouraged
Dr.T.V.Rao MD

Hand washing a great


priority

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Practical

approaches to
promote hand hygiene in
the intensive care unit
include provision of a
minimal number of hand
rub dispensers per bed,
monitoring of
compliance, and choice
of the most attractive
product. Lack of

Dr.T.V.Rao MD

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Increased use of Alcohol in


Health care Multidisciplinary

Dr.T.V.Rao MD

programs to promote
increased use of
alcoholic hand rub lead
to an increased
compliance of healthcare
workers with the
recommended hand
hygiene practices and a
reduced prevalence of
nosocomial infections.

Give everyone a
Clean Hand

Dr.T.V.Rao MD

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Program

file Created by Dr.T.V.Rao


MD for Medical and Paramedical
Professionals for improving the
health care in Intensive care Units

Dr.T.V.Rao MD

Email

doctortvrao@gmail.com