Page 202 - policy and procedure infection control

Policies and Procedures on Infection Control

13.7
13.7 Fungal InfectionsFungal Infections

13.7.1 Introduction
• The incidence of fungal infections has increase in recent years as the
immunocompromised population increases.
• Candida infections are currently the fourth most common cause of bloodstream
infections in ICUs and have led to the highest crude mortality rates for patients with
bloodstream infections.
• Data from Europe showed that 17% of microbiologically documented infections in
ICUs were due to fungi, representing the fourth most common cause of nosocomial
bloodstream infections.
• The rate of candidemia in ICU patients has been estimated at 1/1000 patient days,
less than half of such infections were caused by Candida albicans, and slightly
more than half were due to non-albicans Candida species.
• Hospital construction and renovation have been associated with an increased risk
for nosocomial fungal infection, particularly aspergillosis, among severy immune-
compromised patient.
• The nonpathogenic fungi such as Trichosporon, Paeilomyces, acromium species,
Mucormycosis agents and Dematiaceous are increasingly being identified as
nosocomial pathogens.

13.7.2 Candida Infection
• Risk factors for systemic fungal infections, particularly Candida infections, in ICU
patients include neutropenia, long-term central venous catheter access, colonization
by Candida, exposure to broad-spectrum antibiotics, all forms of vascular
catheterization, mechanical ventilation, blood transfusions, hemodialysis, diabetes
mellitus, steroid use, immunosuppression, parenteral feeding, and presence of urinary
catheters.
• Independent risk factors for Candida nosocomial infection in ICU patients include
length of previous broad spectrum antibiotic treatment, severity of underlying illness
(as measured by APACHE II score), and intensity of Candida colonization (as
measured by the number of body sites colonized).
• Candida infections including candidemia can be transmitted via the hands of healthcare
workers, the evidence for cross infections particularly in the ICU’s has increased in
the literature.
• There is a strong relationship between candida infections and hyperalimentation
using intravascular devices.
• Candiduria is especially common in patients receiving prolonged urinary catheterization
and broad spectrum antimicrobial agents.

Ministry of Health Malaysia 191