Healthcare-associated Infections Katerina Kaziani,1
Infection Control in the Intensive Care Unit Garyphalia Poulakou,2
Maria Lerikou,3 Elias Perros4
and George Dimopoulos5
1. Intensivist, Department of Critical Care Medicine; 2. Senior Registrar on Internal Medicine, 4th Department of Internal Medicine; 3. Pulmonologist, Department of Critical Care Medicine, University Hospital ATTIKON, Athens; 4. Pulmonologist-intensivist, Department of Pulmonary Medicine, General Hospital of Piraeus; 5. Assistant Professor, Critical Care Medicine, Department of Critical Care Medicine, University Hospital ATTIKON, Athens
Abstract
Intensive care unit (ICU)-acquired infections are a major cause of morbidity and mortality associated with a number of risk factors including prolonged ICU stay, different interventions and devices placement, prolonged mechanical ventilation and colonisation with micro-organisms coming from ICU environment. Because of the increased rate of emerging multi-drug-resistant pathogens, multidisciplinary infection control programmes have become a necessity in order to suppress antibiotic resistance and to improve the outcome of critically ill patients. Infection control in the ICU is based on general control measures, transmission-based (isolation) precautions, antibiotic utilisation policies, surveillance and decolonisation of the patients. Hand disinfection remains the cornerstone of the bundle of actions, which, apart from general infection control measures and transmission-based precautions, must have an antibiotic utilisation restriction policy as a priority. In parallel, specific infection’s prevention strategies should be implemented, emphasising on ventilation-associated pneumonia and blood stream infections. Systematic surveillance reflects a tool with which the infection rates and the effectiveness of different measures could be evaluated. This information is objective of communication with administration authorities. Infection control committees are responsible for the education and adherence of nursing and medical staff to the methods of infection prevention.
Keywords Hospital-acquired infections, surveillance, antimicrobial resistance, infection control, hand disinfection
Disclosure: George Dimopoulos has received grants, honorarium and unrestrictive grants from Pfizer, Gilead UK, MERK, Virogates, Novartis and Baxter. The remaining authors have no conflicts of interest to declare. Received: 10 August 2011 Accepted: 22 August 2011 Citation: European Infectious Disease, 2011;5(2):121–4 Correspondence: George Dimopoulos, Assistant Professor, Critical Care Medicine, ATTIKON University Hospital, Medical School, University of Athens, 1 Rimini st, 12462, Xaidari, Athens, Greece. E:
gdimop@med.uoa.gr
Hospital-acquired infections (HAI) affect millions of patients, costing enormously in terms of mortality, morbidity and financial expenses. As has been shown by various studies, the incidence of HAI in intensive care units (ICUs) is higher than in clinical wards or other departments because of the severity of the illness, the high incidence of chronic co-morbidities in critically ill patients, the frequent presence of indwelling devices, the performance of mechanical ventilation and the prominence of multidrug-resistant (MDR) pathogens, factors that are also related to poor outcome.1–4
A remarkable rise in the incidence of MDR bacterial pathogens has been noticed during the last few years in the ICUs, while it is estimated that a significant percentage of infections can be prevented by infection control strategies.5
The recognition of high-risk patients and
the better understanding of the pathophysiology of those infections contribute to the improvement of the effectiveness of infection control programmes. Micro-organisms involved in HAI have, in almost all cases previously, colonised the host, coming from an exogenous or an endogenous source. In the first case, transmission from an exogenous source usually takes place via direct contact or airborne droplets transmission, while in the second case, is commonly associated with a normal barrier derangement.6–9
© TOUCH BRIEFINGS 2011 Hand Hygiene
Hand hygiene is considered the most important measure for the avoidance of microbial transmission in the hospital setting among patients, HCW and different surfaces. Hand disinfection should take place before and after every contact with a patient or his/her surrounding, whether there is a body fluid exposure or not. The alcohol-based products are the cornerstone for hand washing as they are more effective than antimicrobial liquids or plain soap and
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The infection control programmes in the ICU are based on general infection control measures for the prevention of microbial transmission among patients and healthcare workers (HCW), transmission-based precautions and antimicrobial policy – surveillance methods for the restriction of the emergence of MDR pathogens and their source control.
General Control Measures for Infections Prevention
The purpose of general control measures is the prevention of infectious agents’ transmission among patients and HCW. They are applied uniformly to all patients, regardless of the micro-organisms by which they are colonised or infected, including mainly hand hygiene and barrier precautions (gloves, masks and gowns).10,11
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