Description
Health care workers must understand the serious consequences of infections acquired in the intensive care unit (ICU). The financial, medical, and social costs to hospitals and patients are enormous. Implementing and enforcing strict infection control measures is necessary to reduce the rate of ICU-acquired infections. It is imperative to use a multimodal approach that includes ongoing staff education programs, daily reassessments-intervention bundles, antimicrobial stewardship programs, infection prevention committees, and risk factor identification and minimization. A developing field of study in critical care is infection control in the intensive care unit.
Summary Listen
- Hospital-acquired infections (HAIs) are infections that develop in a hospital setting, appearing at least 48 hours after admission or within 30 days of discharge. Infections present upon arrival at the hospital are not considered HAIs. The sources of infection can be endogenous, originating from the patient's own flora on the skin, respiratory or urinary tract, or exogenous, coming from the hospital environment.
- Endogenous infections occur when normal bacteria from the skin, respiratory tract, or urinary tract invade tissues due to breaks in the skin or other breaches. Urinary tract infections, for example, can arise after catheterization, introducing bacteria from the urinary tract into the bladder.
- Exogenous infections originate from the environment and enter the patient's body through air, contact, or contaminated food and water. Air conditioning filters, contaminated medical oxygen, and especially caregiver hands are sources of exogenous infections. Patient environment such as unclean beds or shared toilets also contribute.
- Risk factors for HAIs can be patient-related or hospital-related. Patient-related factors include immunocompromised status, immunosuppression due to medications, comorbidities like diabetes, poor physiological reserve in elderly or nutritionally deficient patients, and physical wounds. Hospital-related factors include poor hand hygiene, patient crowding, inadequate disinfection, lack of isolation, and poor staffing levels.
- The main types of HAIs in intensive care settings include surgical site infections (SSIs), ventilator-associated pneumonia (VAP), catheter-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). Prevention strategies include thorough hand hygiene, barrier nursing, reverse barrier nursing, and the implementation of care bundles for VAP, CAUTI, CLABSI, and SSIs.
- Hand hygiene, involving either soap and water or alcohol-based hand rub, is paramount to prevent the spread of infection. There are five key moments for hand hygiene: before patient contact, before aseptic procedures, after body fluid exposure risk, after patient contact, and after contact with patient surroundings. Hands should be scrubbed for at least 20 seconds, following eight specific steps.
- Ventilator-associated pneumonia (VAP) can be prevented with a VAP bundle: head-of-bed elevation, sedation breaks, oral care, and regular suctioning. Catheter-associated bloodstream infections (CLABSI) can be prevented by strict protocols during central line insertion and maintenance, including hand hygiene, maximal barrier precautions, chlorhexidine skin preparation, catheter site dressing changes, wiping ports with alcohol, and regular flushing.
- For catheter-associated urinary tract infections (CAUTI), strategies include avoiding unnecessary catheterization, aseptic insertion, regular perineal care, securement of the catheter, maintaining a closed system, frequent drainage, and monitoring urine characteristics. Surgical site infections (SSI) prevention involves pre-operative bathing with antiseptic solution, avoiding shaving, prophylactic antibiotics, proper skin preparation, and maintaining sterility during surgery.
- Antimicrobial stewardship programs are crucial to combat multi-drug resistant organisms. Antibiotic choices should be based on local pathogen prevalence and resistance patterns. Infections should be treated following hospital’s defined protocol and avoid simultaneous use of multiple antibiotics to slow resistance.
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