Nosocomial Infections in Intensive Care Units

Abstract

The prevalence of nosocomial infections is higher in intensive care units (ICUs) than in general hospital wards. Catheter-related bloodstream infections, ventilator-associated pneumonias, and surgical site infections cause the majority of these infections, which result in a considerable increase of morbidity, mortality, and cost. Overall length of stay, stay in the ICU, and duration of mechanical ventilation are prolonged among surviving patients. Several studies have shown that the utilization of invasive devices such as venous and urinary catheters, endotracheal tubes, and intracranial pressure monitoring devices is a major risk factor for the development of nosocomial infections in ICU patients. Thus, the incidence of such infections is expressed as number of infections per 1,000 device-utilization days. Early removal of such invasive devices will eliminate the risk of such a device-associated infection. However, the critical condition of many ICU patients often requires the continued use of these catheters, tubes, and drains. Adherence to preventive measures by ICU staff is therefore crucial for a successful risk reduction strategy. It has been shown that teaching the proper technique of catheter insertion and care results in a significant reduction in the incidence of catheter-related bloodstream infections. Implementation of evidence-based infection control measures should be the basis for all additional measures, which could be useful for the prevention of nosocomial infections in the ICU. New technologies such as the coating of catheters and tubes with antibiotics or antiseptics, the use of bacterial filters in breathing circuits, or the use of selective decontamination of the digestive tract might be applied in addition to the standard measures, but should not be used as an excuse for poor compliance with these measures. Intensive care units should receive priority attention from hospital epidemiology units. In addition to good practical advice, surveillance of nosocomial infections allows the quantification of the burden of nosocomial infections in individual units, as well as the discovery and monitoring of antibiotic resistance. This has been nicely demonstrated in two articles that appear in this issue of INFECTION [1, 2]. Continued research efforts will be needed to address the persistent, great problem of nosocomial infections in the ICU, which pose a significant threat to the health of our patients.