A8. Infection and infection control on the ICU

Although intensive care units (ICUs) account for fewer than 10% of total beds in most hospitals, more than 20% of all nosocomial infections are acquired in ICUs. ICU-acquired infections account for substantial morbidity, mortality, and expense. Most bacterial infections that occur on the ICU have some sort of anti-microbial resistance.

Most common infections:

• Catheter-associated UTI
  • E. coli
• Ventilator-associated pneumonia (VAP) – occurs > 48 hours after initiation of invasive ventilation
  • Gram-negatives (pseudomonas, E. coli)
  • S. aureus
• Central line-associated blood stream infection (CLABSI)
  • Staphylococci

Most problematic pathogens:

• Vancomycin-resistant enterococci (VRE)
• MRSA
• Pseudomonas aeruginosa
• Multidrug-resistant gram-negative bacteria

Risk factors:

• Patients in poor condition
• Invasive interventions and devices
• Older age
• Comorbidities
• Long duration of hospitalization
• Antibiotic use

Prevention:

• Proper hygienic measures
• Ensure sterility during procedures
• Avoid invasive procedures when possible
• Discontinue indwelling sources of infection when possible
• Education of staff
• Etc.