Implementing Best Practice Strategies to Prevent Infection in the ICU
Section snippets
Hand hygiene and barrier precautions
Many studies have produced strong evidence that hand hygiene is still the single most important means to prevent infection. It is estimated that failure to perform proper hand hygiene during care accounts for about one third of deaths from infections [1]. Despite the long history of knowledge about the importance of hand hygiene, and incorporation of this basic information in all health care discipline education, compliance with hand hygiene by health care workers is abysmal. A number of
Preventing ventilator-associated pneumonia
Pneumonia secondary to mechanical ventilation is a major problem in the critically ill patient [22], [23]. By definition, pneumonia is associated with mechanical ventilation if it occurs after 48 hours of intubation [22], [23]. Ten to twenty percent of patients requiring mechanical ventilation will develop VAP; the risk is highest during the first 5 days of mechanical ventilation [24]. Incidences as high as 65% have been reported in the literature [25], [26], [27], [28], [29], [30], [31], [32],
Catheter-related blood stream infections
Many critically ill patients have a central venous catheters (CVCs) and other intravenous and arterial access lines for infusions and physiologic monitoring. Although the devices are lifesaving, they are associated with risks, including colonization and blood stream infections (BSIs). Approximately half of ICU patients have CVCs, which are responsible for 5.3 infections per 1000 catheter-days in the ICU, and an 18% mortality rate with 14,000 deaths per year. These infections increase hospital
Preventing surgical site infections
SSI is the second most common adverse event in hospitalized patients, with a 2%–3% overall prevalence rate [103]. Approximately 40%–60% of SSIs are preventable, and their occurrence is associated with higher mortality rate, more readmission to the hospital, longer LOS, and higher hospital costs [103], [104]. Many critically ill patients have had surgical procedures and are at higher risk for infection because of many factors, such as immunocompromised, contaminated wounds, and stress of illness.
Preventing urinary tract infections
Indwelling urinary catheters are inserted routinely into critically ill patients for ongoing monitoring of urinary output. Urinary catheter systems are often neglected as a potential contributor to infection in the ICU. Many of the recent articles related to urinary tract infections (UTIs) in critical care have focused on the problem in England and Canada. It is noted that management and prevention of UTIs in critically ill patients have not been evaluated in clinical trials, and that
Putting evidence into practice: things that work
Integration of evidence-based guidelines into practice starts with establishing a multiprofessional team, with representation from all key disciplines and areas of practice. This step is important for input and buy-in from all impacted professionals because incorporation of guidelines requires individualized organizational adaptation. This team is charged with searching the literature and available resources, evaluating current guidelines, and weighing the level of evidence and scientific merit
Summary
Critically ill patients are at high risk for infection because of many factors. Quality and regulatory groups have published guidelines regarding infection prevention in the ICU. A multifaceted, multiprofessional team approach is necessary to develop and implement strategies to prevent infections in the critically ill patient. Bundles of interventions along with daily rounds and assessment are essential program components. Ongoing surveillance and re-education and reinforcement are also part of
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Cited by (18)
Community-Acquired, Health Care-Associated, and Ventilator-Associated Pneumonia. Three Variations of a Serious Disease
2012, Critical Care Nursing Clinics of North AmericaCitation Excerpt :This includes practicing good hand hygiene and barrier precautions. Even though studies have shown that hand hygiene is the single most important method for preventing infection, hand hygiene among health care workers is poor.10 Compliance has improved somewhat over the last decade, due in large part to the introduction of alcohol-based foams and rubs.
Best Practice Models for Acute and Critical Care: Today and into the Future
2008, Critical Care Nursing Clinics of North AmericaCitation Excerpt :It is imperative that models of care be designed to minimize this growing and costly threat. Simple handwashing is powerful in preventing infection, yet compliance with handwashing by health care workers is abysmal.19 Aspects of infection control that should be integrated into models of care would include implementing system-wide organizational awareness, setting high expectations, and providing toolkits.
Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update
2022, Infection Control and Hospital EpidemiologyStrategies to enhance adoption of ventilator-associated pneumonia prevention interventions: A systematic literature review
2014, Infection Control and Hospital EpidemiologyStrategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update
2014, Infection Control and Hospital EpidemiologyEvidence-based infection control in the intensive care unit
2012, Infection Control in the Intensive Care Unit