Infection control and prevention strategies in the ICU

Abstract

Although only 5–10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and the incidence of nosocomial infections in ICUs is 5–10 times higher than that observed in general hospital wards. Systemic and respiratory infections are far more common than in general wards, and most epidemics originate, in ICUs. Nosocomial infections are the primary focus of most infection control programmes because they are the cause of high mortality rates in ICUs. Effective programmes are usually based on the cooperation of the intensive care physician, the infectious disease specialist, the microbiologist and the clinical epidemiologist. The infectious disease specialist develops specific guidelines for the antimicrobial therapy of typical infections which minimize the selective pressure for microorganisms within the ICU. The microbiologist provides rapid and accurate diagnosis of the pathogens involved. The clinical epidemiologist identifies epidemics at early stages, using epidemiological tools and molecular typing methods, as well as summarizing trends of antimicrobial susceptibility patterns and setting standards for isolation practices. A simple and inexpensive way to reduce nosocomial infections in ICUs is to ensure that staff disinfect their hands after dealing with a patient. Intravascular devices, mechanical ventilation and urinary catheterization are major risk factors for nosocomial infections, and their use should be evaluated daily and discontinued as soon as clinically possible. Selective decontamination of the digestive tract and the use of standard immunoglobulin for prophylaxis are still controversial and need further investigation. The use of monoclonal antibodies, such as anti-endotoxin antibodies, has failed to improve the prognosis in the critically ill septic patient. Today, the major infectious threat to ICU patients is the increase in multiply-resistant microor-ganisms: methicillin-resistantStaphylococcus aureus, enterococci andCandida spp. in particular.