Infection Control Precautions for Ventilated Tracheitis Patient with Klebsiella and Pseudomonas History
A ventilated adult patient with tracheitis and a history of Klebsiella and Pseudomonas infections requires Standard Precautions with strict adherence to hand hygiene and respiratory secretion management protocols. 1
Standard Precautions Required
Hand Hygiene Protocol
- Decontaminate hands before and after contact with the patient, the tracheostomy tube, or any respiratory device using either antimicrobial soap and water or alcohol-based waterless antiseptic agent (if hands are not visibly soiled). 1
- Hand hygiene is mandatory before and after contact with mucous membranes, respiratory secretions, or objects contaminated with respiratory secretions, regardless of whether gloves are worn. 1
Gloving Requirements
- Wear gloves for handling respiratory secretions or objects contaminated with respiratory secretions. 1
- Change gloves and decontaminate hands between contacts with different patients, after handling respiratory secretions, and between contacts with a contaminated body site and the respiratory tract or respiratory device on the same patient. 1
Gown Use
- Wear a gown when soiling with respiratory secretions is anticipated, and change it after soiling occurs before providing care to another patient. 1
Tracheostomy-Specific Precautions
Tracheostomy Care
- When changing a tracheostomy tube, wear a gown, use aseptic technique, and replace the tube with one that has undergone sterilization or high-level disinfection. 1
- Perform all tracheostomy care under aseptic conditions. 1
Suctioning Precautions
- If using open-system suction, use a sterile, single-use catheter for each suctioning episode. 1
- Use only sterile fluid to remove secretions from the suction catheter if the catheter is to be used for re-entry. 1
- Wear gloves during endotracheal suctioning procedures. 1
Ventilator Circuit Management
Equipment Handling
- Prevent inadvertently flushing condensate collecting in the ventilator circuit into the lower airway when the patient turns or the bedrail is raised. 1
- Vigilance is needed as condensate can become contaminated from patient secretions. 1
- Maintain endotracheal cuff pressure at greater than 20 cm H₂O to reduce the likelihood of aspiration of oropharyngeal bacteria around the endotracheal tube cuff. 1
Patient Positioning
- Manage intubated patients in a semirecumbent position (45° head elevation), particularly during feeding, to reduce aspiration risk. 1
- Supine positioning facilitates aspiration and increases the risk of healthcare-associated pneumonia. 1
Isolation Considerations
No Additional Isolation Required
Standard Precautions are sufficient for this patient scenario. 1 Contact Precautions would only be added if the patient had active infection with a multidrug-resistant organism requiring contact isolation per institutional policy, but the question indicates a history of these organisms rather than current active infection with resistant strains.
Common Pitfalls to Avoid
- Failing to perform hand hygiene before AND after each patient contact is the most common breach leading to transmission of healthcare-associated pathogens. 1
- Reusing suction catheters in open-system suctioning increases the risk of introducing bacteria into the lower respiratory tract. 1
- Allowing ventilator circuit condensate to drain back into the patient's airway can introduce high concentrations of bacteria directly into the lungs. 1
- Placing patients flat during enteral feeding significantly increases aspiration risk and subsequent pneumonia development. 1
Monitoring for Progression
Given this patient's history of Klebsiella and Pseudomonas colonization, monitor closely for progression from tracheitis to ventilator-associated pneumonia, which occurs in 10-30% of patients with ventilator-associated tracheobronchitis. 2 The risk of infection increases with duration of mechanical ventilation, with the highest risk occurring in the first two weeks of intubation. 3