The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices

Introduction. Health care-associated infections (HAIs) are a major threat to patient safety. The spread of HAIs cases in intensive care units (ICUs) and in surgical units is influenced by the severity of the patients' condition, as well as the number of invasive procedures and the environment of the units. The immune systems of critically ill patients are in a severe state which increases the probability of beneficial conditions for a colonisation by pathogenic microorganisms due to invasive procedures. Furthermore, the action of inserting an invasive device (urinary catheter, peripheral vein catheter) disrupts the natural defence mechanisms by itself. Aim of the study. To determine risk factors of HAIs during invasive procedures: peripheral vein catheter and urinary catheter insertion and care at the time. Materials and methods. The research was performed in the ICUs and in the surgical units of Latvia's regional multi-profile hospitals (n=3), using the quantitative research method: questionnaire (n=188), and qualitative research methods: clinically structured empiric research (n=45) and microbiological tests (n=86): a) with a Count-Tact applicator and a special culture medium, b) with a swab, and c) with catheter sedimentation method. Results. The study results showed that surgical nurses take care of 18 to 40 patients per day, while intensive care nurses take care of 2 to 3 patients per day. A common problem identified in ICUs and in surgical units related to the lack of unified nursing protocols on performing invasive procedures in all cases (100%; 45/45). Microbiological investigations showed a high level of bio-contamination during invasive procedures: the amount of microorganisms on the nurses' hands considerably exceeded the acceptable levels in all cases (100%; 4/4), and medium to high levels of bio-contamination were discovered on patient's changed bed sheets (100%; 2/2) as well as in nurses' hair (85.7%; 48/56) and their work wear (78.5%; 44/56). In 25% of the observed cases Staphylococcus aureus was discovered in the sterile zone of the peripheral vein catheter 72 hours and 96 hours after the catheter's insertion. 72 hours after the catheter's insertion, as well as 7 days after the insertion of a urinary catheter, 100% of the cases revealed the presence of at least one and in some cases several of the following pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli , β haemolytic Streptococcus and fungi, such as Candida albicans and Candida tropicalis. Conclusions. The main risk factors of HAIs in patients' care using invasive devices are: the lack of unified nursing protocols, aseptic and antiseptic mistakes and excessive workload, as well as a high level of bio-contamination in the ICUs and in surgical units.