2. SURGICAL SITE INFECTION (SSI):- The incidence of post-operative infection is higher in elderly patients.Most wound infections manifest within a week of surgery.Causative agents:-E.coli,Proteus,Enterococci and coagulase negative staphylococci.Sign and symptoms:-• Pain /Tenderness• Localized swelling• Redness• Purulent discharge from the incisionMeasures to prevent infection:-• Use aseptic techniques while changing the dressing.• Daily change the dressing of surgical site.• Check the surgical site for any redness,swelling and purulent discharge.• Use sterile gauze for dressing.• Wash hands.• 3. BLOOD STREAM INFECTION (BSI)catheter related:- Infection that is caused by intravenous cannulation or central line catheter is known as blood stream infection.Causative agents:-Gram negative bacilli are the common pathogens.Sign and symptoms:-• Fever• Chills• Positive blood culture test for agent• Redness• Swelling• Pain• HypotensionMeasures to prevent BSI:-• Wash hands before and after the procedure.• Daily review of line for redness and swelling.• Promptly removal of unnecessary lines.• Use barrier precautions.4. VENTILATOR ASSOCIATED PNEUMONIA (VAP):- The patient should be on mechanical ventilation (either through an endo-tracheal tube or through tracheostomy) in an ICU for more than 48 hours to be considered to be a case under consideration for VAP. Causative agents:-Streptococcus pneumonia,Haemophilus influenza, Pseudomons Sign and Symptoms:-• Fever• Hypoxemia• Rales and dullness to percussion• New onset of purulent sputum or change in character of sputum• Same organism isolated from blood culture as from respiratory tract with no other source of infection.Measures to prevent infection:-• Hand washing• Elevation of head end of bed• Maintain oral hygiene• Management of or-pharyngeal and tracheal secretions• Changing in placement of feeding tube• Usage of antiseptic mouthwashROLE OF NURSE IN PREVENTION OF NOSOCOMIAL INFECTION:-1. Prevent patient to patient spread of infection.2. Provide isolation according to guidelines.3. Perform hand hygiene.4. Use gloves when handling any body fluids.5. Avoid wearing artificial finger nails.6. Use protection in isolation.7. Get vaccination done against infections.8. Avoid risk of airborne disease by vaccination e.g. Influenza.9. Prevent patient exposure to contaminated medical equipment by sterilization,disinfection.10. Follow guidelines for routine removal and replacement of IV lines.11. Remove urinary catheter at earliest time possible.12. Remove endo-tracheal and NG tubes as soon as possible.PREVENTION AND SAFETY MEASURES:-UNIVERSAL PRECAUTIONS (BARRIER NURSING)HAND HYGIENE:-Purpose: – To remove transient microorganisms from the skin of the hands.Technique:-• Hand washing (40-60 sec): wet hands and apply soap rub all surfaces,rinse hands and dry thoroughly with a single use towel,use towel to turn off facet.• Hand rubbing(20-30 sec): apply enough product to cover all areas of the hands,rub hands until dry.STEP OF HAND WASHING Wash palms and fingers Wash back of hand Wash fingers and knuckles Wash thumbs. Wash fingertips Wash wristsPERSONAL PROTECTIVE EQUIPMENT:- • Masks• Gloves• Gowns & Aprons• Eye protective ware(goggle)• Boots or overshoes• ASEPTIC TECHNIQUES Minimize the risk of introduction pathogenic microorganisms into susceptible sites. Prevent the transfer of potential pathogens from the contaminated site to other sites, patient or staff. Thus, aseptic technique are those used whenever there is a break in skin integrity, as in a surgical wound dressing or when natural defence mechanisms are bypassed as in intravascular cannulation and endotracheal suction. Aseptic techniques involve the use of sterile equipment including sterile gloves if the susceptible site is to be manipulated. For e.g. surgery. When a non-touch technique is used and the risks related to contamination of the operators hands only, non sterile gloves may be adequate. Invasion procedure provides a major opportunity for entry of pathogens into the body. For e.g. intravascular devices have been shown to increase the risk of infection. Adequate disinfection of skin mucosal surfaces and hands must be undertaken prior to invasive procedures to reduce the number of potential pathogens at the site.