Recently published papers: A review of novel strategies in the prevention of hospital-acquired infections, the ability of intensivists to perform echocardiography, and the benefit of polymyxin B haemoperfusion in abdominal sepsis

James Hayward,Richard Venn

doi:10.1186/cc7992

Abstract

Chlorhexidine bed baths seem to reduce the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus detected by surveillance cultures. There is also some evidence on the benefit of chlorhexidine mouthwashes in the prevention of ventilator-associated pneumonias. Acid-suppressing drugs increase the incidence of hospital-acquired pneumonias in non-intensive care unit patients, although this association has not been shown in the intensive care setting. Intensivists can be trained to perform basic echocardiography in a short period of time, but their errors could lead to incorrect changes in management. Polymyxin B haemoperfusion was shown in interim analysis to improve patients with abdominal sepsis to such an extent that the EUPHAS randomised controlled trial was halted on ethical grounds, although other authors have criticised this decision.

Highlights

Prevention of hospital-acquired infections and ventilatorassociated pneumonias is a key concern in the reduction of mortality in both the critical care and general ward patient populations
Owing to the low rate of methicillin-resistant S. aureus bacteremia prior to the change in practice, Climo and colleagues were unable to show a significant reduction in methicillin-resistant S. aureus bloodstream infections, they suggest that with sufficiently powered studies this may be shown to be the case
Two other studies have found that oral decontamination with either chlorhexidine or a chlorhexidine/ collistin mixture did significantly reduce the incidence of ventilator-associated pneumonias [3,4]

Summary

Introduction

Prevention of hospital-acquired infections and ventilatorassociated pneumonias is a key concern in the reduction of mortality in both the critical care and general ward patient populations. Owing to the low rate of methicillin-resistant S. aureus bacteremia prior to the change in practice, Climo and colleagues were unable to show a significant reduction in methicillin-resistant S. aureus bloodstream infections, they suggest that with sufficiently powered studies this may be shown to be the case. Panchabhai and colleagues compared oropharyngeal cleansing using 0.2% chlorhexidine with the study intensive care unit (ICU) policy of twice-daily 0.01% potassium permanganate in a randomised controlled trial [2].

Results

Conclusion