Veterinary Practice Management - Nosocomial Infections

An infection acquired during hospitalization

What is a nosocomial infection?

Hands of healthcare workers

**A study has shown that < 50% of small animal vets and < 20% of large animal vets wash their hands between patients

What is the primary vehicle of transmission of nosocomial infections?

• Microorganisms enter bladder during insertion or from the external aspect of the urinary catheter

• Bacteria from rectum or perineum may enter bladder (e.coli)

How is a catheter-associated urinary tract infection (CAUTI) acquired?

Bioflilm

Community of microorganisms such as bacteria that adhere to a surface and are embedded within a self-produced matrix

• Increased frequency or urgency to urinate (pollakiuria)

• Bloody urination (hematuria)

• Straining to pass urine (stranguria)

• Painful urination (dysuria)

List clinical signs of urinary tract infection

Increased frequency or urgency to urinate

What is pollakiuria?

Straining to pass urine

What is stranguria?

Painful urination

What is dysuria?

Culturing the urine via cystocentesis

How is a UTI diagnosed?

• Proper antimicrobial therapy based on culture and sensitivity

• Remove urinary catheter

How is a CAUTI treated?

• Monitor urine output in critically ill patient

• Acute anatomic or functional retention or obstruction

• Pre or post-operative use for surgical procedures

What are reasons for urinary catherization?

• Strict aseptic technique and hygiene during catheter placement

• Keep urinary collection bag below level of urinary bladder

• Consider all urine in the tubing, bag, etc. as being contaminated

• Maintain unobstructed urine flow at all times

How should a urinary catheter be maintained?

Pneumonia that develops more than 48 hours after admission with the absence of signs of infection at the time of admission

What constitutes hospital acquired pneumonia?

• Prolonged hospital stays

• 20x more likely to occur in ventilated patients

• Can occur in up to 1/3 of patients requiring mechanical ventilation

• Contaminated endotracheal tubes

• Aspiration pneumonia more common in veterinary practices

How is hospital acquired pneumonia contracted?

• Disorders such as laryngeal paralysis or megaesophagus

• Decreased mentation or recumbency from neurological disease

• Recent sedation or anesthesia

• Use of feeding tubes

What conditions can increase the risk of aspiration pneumonia in small animals?

Duration of surgery (in humans, infection rates double with every hour a patient spends in surgery)

What is the most important contribution to surgical site infections (SSI) ?

• Endocrine disease

• Diseases affecting the immune system

• Staph is the most commonly isolated organism from SSI (staphylococcus pseudointermedius in dogs)

What are the risk factors associated with surgical site infections?

• Clip fur after anesthetic induction

• Clipper blades need to cleaned and sterilized

• Shorten surgical times

• Good surgical technique must be maintained

How can SSI's be prevented?

Septicemia

Term for infection of the bloodstream

IV catheters

Septicemia is most commonly associated with

Enteric organisms such as E. coli, proteus, and enterobacter

The most common organisms cultured from IV catheters in small animal medicine are

• Remove the IV catheter

• Submit tip of catheter for culture and sensitivity

• Blood cultures if available

• Broad spectrum antibiotics

What action should be taken if an IV catheter infection is suspected?

• Aseptic placement of the IV catheter

• Clean site with chlorhexidine and alcohol or povidone iodine

What action can be taken to prevent IV catheter infections?