CURRENT Essentials of Critical Care.pdf

152 Current Essentials of Critical Care■■Prevention of Nosocomial InfectionEssential Concepts• Infection acquired in hospital (not present or incubating at thetime of admission); onset at least 2–4 days after hospitalizationdepending on site and pathogen identified• Manifestations specific for site and source• Occurs in 5–35% of ICU patients; most common urinary tractinfection, pneumonia, surgical site infection, bloodstream• Sources: bacterial flora colonizing patients, with pathogens increasinglyresistant to antibiotics, and patient’s endogenous floraEssentials of Management• Prevent cross-contamination using universal precautions (handwashing; gloves, masks, gowns when necessary; special carewith patient soiled linen and removed devices); appropriate isolationof patients with easily transmissible pathogens (C difficile,M tuberculosis) or highly resistant pathogens (methicillinresistantS aureus, vancomycin-resistant enterococcus)• Appropriate use of antimicrobial agents to limit selection of resistantpathogens• Ventilator-associated pneumonia: use semirecumbent ratherthan supine positioning, sucralfate rather than antacid therapyfor prevention of stress gastritis (controversial), continuous subglotticaspiration, noninvasive ventilation when possible• Nosocomial sinusitis: limit duration of nasogastric or nasolaryngealtubes; oral hygiene• Bloodstream infection: use careful sterile technique in insertionand handling of devices; use “tunneled” catheters for long-termintravenous use; minimize use of femoral venous catheters; consideruse of antimicrobial impregnated catheters in selected patients• Urinary tract infection: use indwelling urinary catheter onlywhen necessary; reassess need daily, discontinue if possible• Surgical site infections: stress optimal sterile surgical techniques;antimicrobial prophylaxis when and only if appropriate■ PearlHand washing is the single most effective method to avoid nosocomialtransmission of pathogens.ReferenceEggimann P: Infection control in the ICU. Chest 2001;120:2059. [PMID:11742943]