ICU PROCEDURES: Infection Control

by | Sep 13, 2024 | Nurse Article | 0 comments

ICU PROCEDURES: Infection Control

ICU Procedures: Infection Control – Nursing Management

Infection control in the ICU is critical due to the vulnerability of critically ill patients, many of whom have compromised immune systems and are at higher risk for healthcare-associated infections (HAIs). Nursing management in infection control focuses on preventing the spread of infections and implementing appropriate interventions when infections are detected.

Nursing Management of Infection Control in the ICU

1. Hand Hygiene:

  • Frequent and Proper Handwashing:
    • Nurses must follow the World Health Organization (WHO) “Five Moments for Hand Hygiene”:
      1. Before touching a patient.
      2. Before a clean or aseptic procedure.
      3. After body fluid exposure.
      4. After touching a patient.
      5. After touching patient surroundings.
  • Use of Alcohol-Based Hand Rubs (ABHR):
    • ABHR should be used if hands are not visibly soiled. When hands are visibly dirty, soap and water are required.
  • Hand Hygiene Audits:
    • Regularly participate in hand hygiene compliance audits and provide feedback.

2. Personal Protective Equipment (PPE):

  • Proper Use of PPE:
    • Depending on the situation, nurses must wear gloves, gowns, masks, eye protection, and face shields. PPE should be donned and doffed correctly to prevent self-contamination.
  • Glove Use:
    • Wear gloves when there is the potential for exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated equipment.
  • Isolation Precautions:
    • Follow appropriate isolation precautions based on the patient’s condition, including:
      • Contact Precautions: For multidrug-resistant organisms (MDROs) like MRSA, C. difficile.
      • Droplet Precautions: For infections transmitted via respiratory droplets, such as influenza.
      • Airborne Precautions: For diseases like tuberculosis (TB), requiring a negative pressure room and N95 mask.

3. Central Line-Associated Bloodstream Infections (CLABSI) Prevention:

  • Aseptic Technique for Line Insertion and Care:
    • Use sterile barriers (mask, gloves, gown, full-body drape) during central line insertion.
  • Daily Review of Line Necessity:
    • Assess the need for the central line daily, and remove it as soon as it is no longer necessary.
  • Proper Line Care:
    • Change dressings using aseptic technique, disinfect catheter hubs before access, and use antimicrobial-impregnated dressings if appropriate.
  • Chlorhexidine Bathing:
    • Implement daily bathing with chlorhexidine for patients with central lines to reduce the risk of infection.

4. Ventilator-Associated Pneumonia (VAP) Prevention:

  • Elevate the Head of the Bed:
    • Maintain the head of the bed at a 30–45 degree angle to reduce the risk of aspiration.
  • Oral Care Protocol:
    • Provide oral care with chlorhexidine every 4-6 hours to reduce oral bacterial colonization.
  • Daily Sedation Vacations and Assessment of Readiness to Extubate:
    • Minimize sedation and assess the patient’s ability to breathe spontaneously daily.
  • Subglottic Suctioning:
    • Use an endotracheal tube with a subglottic suction port to prevent the accumulation of secretions above the cuff.
  • Hand Hygiene Before and After Handling the Ventilator:
    • Prevent contamination by practicing hand hygiene before touching the ventilator or patient.

5. Catheter-Associated Urinary Tract Infections (CAUTI) Prevention:

  • Strict Aseptic Insertion Technique:
    • Ensure aseptic technique during the insertion of urinary catheters, using sterile gloves, drapes, and solutions.
  • Limit Indwelling Catheter Use:
    • Only use catheters when absolutely necessary and remove them as soon as possible.
  • Closed Drainage System:
    • Maintain a closed urinary drainage system to prevent contamination.
  • Daily Perineal Care:
    • Perform daily catheter care, cleaning the urinary meatus and catheter tubing using aseptic technique.
  • Prevent Backflow:
    • Keep the catheter bag below bladder level to prevent urine backflow.

6. Surgical Site Infection (SSI) Prevention:

  • Preoperative Care:
    • Ensure patients receive preoperative antibiotics within one hour before surgery.
    • Shave surgical areas with clippers, not razors, to avoid micro-abrasions.
  • Postoperative Wound Care:
    • Perform sterile dressing changes and regularly assess surgical wounds for signs of infection.
    • Educate patients and families on proper wound care techniques to prevent contamination.
  • Hand Hygiene Before and After Wound Care:
    • Use strict hand hygiene when handling dressings and wound sites.

7. Antibiotic Stewardship:

  • Judicious Use of Antibiotics:
    • Administer antibiotics as prescribed, ensuring the right antibiotic, dose, and duration.
  • Monitoring for Antibiotic Resistance:
    • Regularly review culture and sensitivity reports and assess for the development of MDROs.
  • Education:
    • Educate patients and healthcare staff on the importance of antibiotic stewardship and the risks of overuse.

8. Environmental Hygiene:

  • Regular Cleaning of the ICU Environment:
    • Frequently clean high-touch surfaces (bedrails, doorknobs, monitors) to reduce pathogen transmission.
  • Terminal Cleaning After Patient Discharge:
    • Perform thorough terminal cleaning of ICU rooms after patient discharge, especially for those with known infections.
  • Disinfection of Medical Equipment:
    • Ensure that all reusable equipment (e.g., ventilators, monitors, stethoscopes) is disinfected between uses.
  • Waste Disposal:
    • Dispose of all medical waste, including sharps, appropriately according to hospital protocol.

9. Multidrug-Resistant Organisms (MDRO) Management:

  • Screening and Isolation:
    • Screen patients for MDROs (e.g., MRSA, VRE) upon admission to the ICU. Place infected or colonized patients in isolation rooms.
  • Dedicated Equipment:
    • Use dedicated medical equipment for patients with MDROs to prevent cross-contamination.
  • Strict Adherence to Contact Precautions:
    • Ensure that all healthcare staff adhere to contact precautions (e.g., gloves, gowns) when entering the rooms of MDRO-positive patients.

10. Education and Training:

  • Ongoing Infection Control Education:
    • Provide regular training to ICU nurses on infection control practices, updates in protocols, and emerging pathogens.
  • Patient and Family Education:
    • Educate patients and their families on infection prevention, including hand hygiene and the importance of following isolation precautions.
  • Audit and Feedback:
    • Participate in infection control audits and review the data to improve practices. Provide constructive feedback to staff on compliance.

Nursing Considerations:

  • Patient Safety:
    • Ensure all infection control measures are adhered to, as failure to do so can result in severe infections that complicate patient recovery.
  • Documentation:
    • Document infection control practices such as hand hygiene, catheter care, and central line care accurately in the patient’s chart.
  • Interdisciplinary Collaboration:
    • Work closely with infection control specialists, physicians, and other healthcare providers to monitor infection trends and address emerging concerns promptly.

Conclusion:

Effective infection control in the ICU is paramount to preventing healthcare-associated infections. ICU nurses play a crucial role in implementing best practices, such as proper hand hygiene, the use of PPE, aseptic techniques, and patient education, to reduce the risk of infections. Ongoing training, strict adherence to protocols, and multidisciplinary collaboration are key components of successful infection control in the ICU.