Implementing Best Practice Strategies to Prevent Infection in the ICU

https://doi.org/10.1016/j.ccell.2006.08.003Get rights and content

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

First page preview

First page preview
Click to open first page preview

References (117)

  • G.P. Marelich et al.

    Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia

    Chest

    (2000)
  • C. Binkley et al.

    Survey of oral care practices in US intensive care units

    Am J Infect Control

    (2004)
  • C. Dezfulian et al.

    Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis

    Am J Med

    (2005)
  • H.M. Babcock et al.

    An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects

    Chest

    (2004)
  • R. Resar et al.

    Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia

    Jt Comm J Qual Patient Saf

    (2005)
  • P.J. Pronovost et al.

    Developing and pilot testing quality indicators in the intensive care unit

    J Crit Care

    (2003)
  • Centers for Disease Control and Prevention (CDC)

    Public health focus: effectiveness of disease and injury prevention

    MMWR

    (1992)
  • L. Kohn et al.

    To err is human: building a safer health system

    (2000)
  • S. Townsend et al.

    Implementing the surviving sepsis campaign

    (2005)
  • D.C. Angus et al.

    Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care

    Crit Care Med

    (2001)
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO). National patient safety goals for 2006....
  • Institute for Healthcare Improvement (IHI). 100K Lives Campaign. Available at: www.ihi.org/IHI/Programs/Campaign....
  • J.L. Gerberding

    Hospital-onset infections: a patient safety issue

    Ann Intern Med

    (2002)
  • Centers for Disease Control and Prevention (CDC). CDC's 7 healthcare safety challenges. Available at:...
  • Medicare Quality Improvement Community (MedQic). Surgical care improvement project. Available at: www.medqic.org....
  • J.M. Boyce et al.

    Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

    Infect Control Hosp Epidemiol

    (2002)
  • M.J. Bittner et al.

    Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit

    Infect Control Hosp Epidemiol

    (2002)
  • S. Hugonnet et al.

    Alcohol-based handrub improves compliance with hand hygiene in intensive care units

    Arch Intern Med

    (2002)
  • A. Voss et al.

    No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance?

    Infect Control Hosp Epidemiol

    (1997)
  • D. Pittet et al.

    Compliance with handwashing in a teaching hospital. Infection Control Program

    Ann Intern Med

    (1999)
  • S.M. Swoboda et al.

    Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit

    Crit Care Med

    (2004)
  • D. Pittet

    Improving adherence to hand hygiene practice: a multidisciplinary approach

    Emerg Infect Dis

    (2001)
  • D. Aragon et al.

    Outcomes of an infection prevention project focusing on hand hygiene and isolation practices

    AACN Clin Issues

    (2005)
  • Centers for Disease Control and Prevention. Hand hygiene guidelines fact sheet. Available at:...
  • O.C. Tablan et al.

    Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee

    MMWR Recomm Rep

    (2004)
  • N. Safdar et al.

    The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention

    Respir Care

    (2005)
  • J. Chastre et al.

    Ventilator-associated pneumonia

    Am J Respir Crit Care Med

    (2002)
  • C.M. Beck-Sague et al.

    Risk factors for ventilator-associated pneumonia in surgical intensive-care-unit patients

    Infect Control Hosp Epidemiol

    (1996)
  • D.E. Craven et al.

    Ventilator-associated bacterial pneumonia: challenges in diagnosis, treatment, and prevention

    New Horiz

    (1998)
  • M.H. Kollef

    The prevention of ventilator-associated pneumonia

    N Engl J Med

    (1999)
  • M.H. Kollef

    Prevention of hospital-associated pneumonia and ventilator-associated pneumonia

    Crit Care Med

    (2004)
  • J.F. Byers et al.

    Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

    Am J Crit Care

    (2000)
  • American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia

    Am J Respir Crit Care Med

    (2005)
  • National Nosocomial Infections Surveillance (NNIS)

    National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004

    Am J Infect Control

    (2004)
  • J.P. Burke

    Infection control - a problem for patient safety

    N Engl J Med

    (2003)
  • N. Bercault et al.

    Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study

    Crit Care Med

    (2001)
  • P. Fulbrook et al.

    Care bundles in critical care: a practical approach to evidence-based practice

    Nurs Crit Care

    (2003)
  • E. Crunden et al.

    An evaluation of the impact of the ventilator care bundle

    Nurs Crit Care

    (2005)
  • M.M. Levy et al.

    Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome

    Crit Care Med

    (2004)
  • H.R. Collard et al.

    Prevention of ventilator-associated pneumonia: an evidence-based systematic review

    Ann Intern Med

    (2003)
  • Cited by (18)

    View all citing articles on Scopus
    View full text