Infection Control in ICUAtef kamelMD

Infection is a common cause of admission to intensive care units (ICUs). In addition, around 30% of patients in ICUs will acquire infection (nosocomial infection) during their admission. The resulting increase in mortality is between 20-80%

Causes for admission associated with infection: (predisposing factors)

• trauma,• burns, • following emergency surgery

(particularly intra-abdominal).

ICU interventions:

• tracheal intubation and ventilation,

• intravascular catheters,• urinary catheters,• drugs (sedatives, muscle

relaxants, corticosteroids, antibiotics),

• blood transfusion.

Patients factors:

• elderly,• malnourished,• high alcohol intake,• heavy smoking,• diabetes,• neutropenia.

Causative organisms

• Enterobacter 34%.• Staphylococcus aureus 30%,

(60% MRSA) – probably now higher, with a greater

proportion of MRSA.• Pseudomonas 29%.• Staphylococcus epidemidis 19%.• Candida 17%.

Site of infection:lower respiratory tract 65%.• Urinary tract 17%.• Blood 12%.others

Pyrexia and leucocytosis are

unreliable indicators of infection.

C reactive protein trends are not

specific.

Procalcitonin is a more specific

and sensitive indicator of

developing infection

Classification:In the first 3 days of hospital

admission community acquired.After 5 days, infections

hospital acquired. Between 3 and 5 days, both should be considered.

Control of infection

• prevention of spread of infection between patients,

• management of patients to reduce the incidence of infection.

Cont.