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Focused surveillance for hospital-acquired infections is the cornerstone of infection prevention activities in the ICU.
Commonly used invasive devices in the ICU such as endotracheal tubes and central venous and urinary catheters are significant risk factors for health care–associated infection (HAI). Evidence-based ICU policies and procedures and staff education can reduce the risk of device-related infections.
Rates of antibiotic resistance are improving, and its containment and prevention require a multifactorial approach, including adequate hand hygiene, surveillance for resistant pathogens, enforced infection control precautions, and prudent use of antibiotics.
Standard infection control precautions should be applied to all ICU patients. Precautions for contagious or epidemiologically significant pathogens are based on modes of transmission.
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Health care–associated infections (HAIs) result in significant morbidity and mortality. Hospital-acquired infections affect approximately 1 in 25 to 30 hospitalized patients in the United States at any point1 with 68,700 patients dying in 2015, at an estimated cost of $9 billion.2 Prevention of HAI would result in US$ 25 to 30 billion saving in medical care cost.3 Intensive Care Units (ICU) beds, while accounting for less than 10% of all hospital beds, are responsible for more than 20% of the nosocomial infections.4 Patients admitted to the ICU have been shown to be at particular risk for HAIs given the immunocompromised state and the multitude of invasive procedures and devices. This has put a strain on health care resources in the United States and other countries. Multiple national initiatives have successfully decreased the prevalence of HAI, but important work remains to be done.5 Prevention of nosocomial infections in the ICU should be an important goal of any critical care clinician.
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A likely explanation to account for the observation that ICU patients are more vulnerable to acquiring an HAI compared with other hospitalized patients is that critically ill patients frequently require invasive medical devices, such as urinary catheters, central venous and arterial catheters, and endotracheal tubes with frequent manipulation for prolonged periods of time. Data show that both central vein catheters (CVCs) and arterial catheters are common especially in surgical ICU patients.6 Thirty-nine percent of critically ill patients have arterial catheters in place although these are not associated with improved survival in patients requiring mechanical ventilation.6 More so both CVCs and arterial catheters result in infection by compromising the normal skin and mucosal barriers and serving as a nidus for the development of biofilms, which provide a protected environment for bacteria and fungi. In a survey of cases of ICU-acquired primary bacteremia, 47% were catheter-related.7 While the increased severity of illness of ICU patients makes intuitive sense as a potential risk factor for health care–associated infection, few studies have shown a consistent relationship.8 This may be explained, however, by the fact that scoring systems were developed primarily to predict mortality and may not adequately capture markers for health care–associated ...