Hanyang Med Rev.  2011 Aug;31(3):153-158. 10.7599/hmr.2011.31.3.153.

Nosocomial Infections in Intensive Care Unit: Epidemiology and Control Strategy

• Pai H

• KMID: 2168192
• DOI: http://doi.org/10.7599/hmr.2011.31.3.153

Abstract

Nosocomial infections are known cause of increased mortality and morbidity and are an important factor in prolonging the length of hospital stay. The intensive care unit (ICU) is highly vulnerable to nosocomial infections largely due to disease severity and consequent lowered resistance to infection as well as the frequency of invasive interventions for the patients. This manuscript will briefly review the epidemiology, risk factors and control measures for nosocomial infections focused on patients in the ICU. Furthermore, recent strategies to control device-associated infections such as catheter-associated urinary tract infections, catheter-associated blood- stream infections and ventilator-associated pneumonias will be described.

Keyword

Intensive Care Units; Cross Infection; Epidemiology; Infection Control

MeSH Terms

Cross Infection
Humans
Infection Control
Intensive Care Units
Length of Stay
Pneumonia, Ventilator-Associated
Risk Factors
Rivers
Urinary Tract Infections
Critical Care

Reference

1. Barsanti MC, Woeltje KF. Infection prevention in the intensive care unit. Infect Dis Clin North Am. 2009. 23:703–725.

2. Beyersmann J, Gastmeier P, Grundmann H, Barwolff S, Geffers C, Behnke M, et al. Use of multistate models to assess prolongation of intensive care unit stay due to nosocomial infection. Infect Control Hosp Epidemiol. 2006. 27:493–499.

3. Lee SO, Kim ES, Kim HY, Park ES, Jin HY, Ki HK, et al. Korean nosocomial infections surveillance system, intensive care unit module report: data summary from July 2007 through June 2008. Korean J Nosocomial Infect Control. 2008. 13:69–82.

4. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009. 37:783–805.

5. Dempsey DT, Mullen JL, Buzby GP. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr. 1988. 47:352–356.

6. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004. 20:843–848.

7. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006. 354:449–461.

8. Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA. 1999. 281:1310–1317.

9. Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med. 2007. 35:76–81.

10. Larson EL, Aiello AE, Bastyr J, Lyle C, Stahl J, Cronquist A, et al. Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med. 2001. 29:944–951.

11. Carling PC, Parry MF, Von Beheren SM. Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infect Control Hosp Epidemiol. 2008. 29:1–7.

12. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007. 35:S65–S164.

13. Srinivasan A, Song X, Ross T, Merz W, Brower R, Perl TM. A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infect Control Hosp Epidemiol. 2002. 23:424–428.

14. American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. 1996. 153:1711–1725.

15. Craven DE, Chroneou A. Mandell GL, Douglas RG, Bennett JE, editors. Nosocomial pneumonia. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 2010. 7th ed. Philadelphia: Churchill Livingstone;3717–3725.

16. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999. 340:627–634.

17. Fleming CA, Balaguera HU, Craven DE. Risk factors for nosocomial pneumonia. Focus on prophylaxis. Med Clin North Am. 2001. 85:1545–1563.

18. Gastmeier P. Evidence-based infection control in the ICU (except catheters). Curr Opin Crit Care. 2007. 13:557–562.

19. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011. 39:S1–S34.

20. Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis. 2001. 32:1249–1272.

21. Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007. 7:645–657.

22. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections [Internet]. c2011. cited 2011 May 20. Atlanta(US): Centers for Disease Control and Prevention;Available from: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.

23. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010. 31:319–326.

24. Rebmann T, Greene LR. Preventing catheter-associated urinary tract infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control. 2010. 38:644–646.

25. Lee MS. Korean Society for Nosocomical Infection Control. Intensive care unit. Infection control and prevention in healthcare facilities. 2011. 4th ed. Seoul: Hanmibook;273–282.