2021_Book_TextbookOfPatientSafetyAndClin

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Table 17.16 Common risk factors increasing the risk of
HAIs [122, 123]
Patient-related
Treatment-related
Environmentrelated
Age >70 years
Shock
Major trauma
Acute renal failure
Coma
Prior and/or prolonged antibiotic
therapy
Mechanical ventilation
Drugs affecting the immune
system (steroids, chemotherapy)
Indwelling catheters
Prolonged intensive care unit stay
(>3 days)
(3) after body fluid exposure; (4) after touching
the patient; and (5) after touching the patient’s
surrounding (these three latter moments are
intended to protect the personnel and the environment
from the patient’s germs) and two methods,
with water and soap or alcohol-based solutions
[122].
In addition, standard precautions include preventive
measures that should always be used,
irrespective of a patient’s infection status. Sterile
gloves should be worn after hand hygiene in case
of sterile procedures or exposition to body fluids.
It is important not to wear the same gloves when
caring for more patients, remove them and wash
hands after caring for a single patient. Wearing
gown, mask, and eye protection/face shield is
very important to avoid soiling clothing and skin
during procedures potentially delivering body
fluids [122].
In patients known or suspected to have airborne,
contact or droplet infections (M. tuberculosis,
H. influenzae, varicella zoster virus, herpes
virus among others), additional precautions
should be followed.
For airborne infections, isolation with
negative- pressure ventilation is preferable.
Additionally, all people entering the room,
including visitors, must wear respiratory protections
(such as the disposable N-95 respirator
mask).
For contact infections, single use patient-care
equipment is recommended. If unavoidable, adequate
cleaning and disinfection before using to
another patient is mandatory. As well, the movements
of the patients across different wards
should be limited.
In droplet infections, the patient should be isolated
and his/her movements limited, while
respiratory protections must be worn when entering
the isolation room. Additional specific strategies
to prevent specific nosocomial infections
have been reported by Mehta et al. [123].
Finally, environmental factors cannot be
neglected. Adequate cleaning and disinfection
are important, especially when considering the
patient’s closest surfaces, such as bedrails, bedside
tables, doorknobs, and equipment. The frequency
of cleaning should be as follows: surface
cleaning twice weekly, floor cleaning 2–3 times/
day, and terminal cleaning after discharge or
death. Central air-conditioning systems should
ensure that air recirculates through appropriate
filters (air should be filtered to 99% efficiency
down to 5 μm). Isolation facility should include
both negative- and positive-pressure ventilations.
Alcohol gel dispensers should be positioned at
the entry of every rooms and near entrance/exit
for health operators, patients, and visitors.
17.3.3 Prevention of Venous
Thromboembolism
M. L. Regina et al.
The hospitalization for an acute condition is
responsible for an eight-fold increase in the
thrombotic risk and accounts for nearly 25% of all
thromboembolic events [124]. However, risk
stratification of patients admitted to IM is often
complicated by their high heterogeneity [125,
126]. For this purpose, the Padua Prediction Score
has been implemented and validated by Prandoni
et al. [126]. It includes 11 thrombotic risk factors
and identifies patients at high or low risk for
venous thromboembolism (VTE) (Table 17.17).
Patients with a score