Page 203 - policy and procedure infection control

Policies and Procedures on Infection Control

• Isolation of Candida from any sterile site should be considered a significant finding in
an ICU patient. Heavy colonization places patients at risk for infection and should be
used in the decision to treat
• Precise mycologic diagnosis to the species level is helpful in treating patients.
Susceptibility testing of candidal isolates may be helpful, although specific drug
levels are not usually needed (with the exception, perhaps, of flucytosine).

13.7.3 Aspergillous infection
• Aspergillus spp. are ubiquitous, commonly occurring in soil, water and decaying
vegetation and can be cultured from the hospital environment (unfiltered air, ventilation
systems, dust dislodged during hospital construction, carpeting, food and ornamental
plants).
• In healthcare settings it contaminates wet reservoirs e.g. indwelling catheters and
can cause serious bloodstream infections.
• Route of acquisition includes inhalation of fungal conidia, ingestion of contaminated
food, contamination of adhesive tape or gauze used with intravascular catheters and
contamination of patient care items.
• Aspergillus species has become a common cause of nosocomial infection in highly
immunocompromised patients such as those with hematologic malignancy
undergoing bone marrow or solid organ transplantation or corticosteroid therapy.
Outbreaks of nosocomial aspergillosis occur mainly among neutropenic patients ( <
500granulocytes per mm ).
3
• Contaminated air or ventilation systems have been associated with outbreaks of
nosocomial aspergillosis.

13.7.4 Infection Control General Precautions
• Proper use of antibiotics and strict protocol for invasive procedures.
• Standard and expanded precautions i.e hand hygiene before and after patient contact.
Gown, gloves, and mask are indicated for suspected or proven infections for which
Transmission-Based Precautions are recommended.
• Antifungal therapy must be based on yeast identification.

• Remove existing intravascular catheter in patient with candidemia or acute
hematogenously disseminated candidiasis. All infected devices should be removed.
(refer to catheter related sepsis)
• Tunneled CVCs or implantable devices should be removed as soon as possible in
the presence of documented catheter – related fungemia.
• Bone marrow recipients should received anti fungal prophylaxis

192 Ministry of Health Malaysia