The multitude of devices at high risk for colonization and potential development of infection include urinary catheters, prosthetic surgical implants (heart-valves, orthopedic implants), intravascular catheters, and even surgical meshes, explains Cherry. any area that requires contact from caregivers for use on/with/for patients, particularly invasive procedures and equipment, such as ventilators or other respiratory support, intravenous sites and ports, other catheters, agrees Katie Calabrese, MSN, NNP, CNS, product manager/market management for Baxa Corporation.ĭevice-related infections have plenty of opportunities in the ICU. In the ICU, there are so many clinical personnel involved in patient care, this increases direct contact, thus increasing risk of organism transfer, says Thomas Cherry, RN, BSN, clinical product manager of the critical care division of Cook Inc., a medical device manufacturer. In busy, high-acuity ICUs, pressure situations tend to decrease compliance of hand hygiene and other infection control preventative practices. Some of the areas in the ICU where I see potential problem are stethoscopes, handling patient charts, even clothing of clinicians (especially neckties). Any one of these transmission routes can be a significant problem for any facility. Contact transmission can occur a few ways via direct secretion contact with the patient, contact with a contaminated surface/piece of equipment, and healthcare workers hands. These patients can then become a reservoir in a unit that can put other patients at risk as well as staff. This potentially sets them up to have a resistant organism as the cause of their infection. They are sick by the time that they get into an acute care facility and more than likely have been treated for something prior to their admission. In any healthcare setting, in particular, critical care areas such as an ICU, you are dealing with a compromised patient, explains Karen Williams, manager for infection control at Morristown Memorial Hospital in New Jersey. Some of the main sources of contact transfer may be virtually invisible, because they are so ubiquitous in the healthcare setting. Surface cleaning will be addressed in a companion article (see page 32) the remaining three factors are explored below. Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care.įour distinct areas stand out as particular areas of concentration: preventing contact transfer, improving surface cleaning, preventing device-related infections, and altering hand hygiene compliance. Recent data strongly confirm that these strategies may only be effective over prolonged periods if they can be integrated into the behavior of all staff members who are involved in patient care. The principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside, write Eggimann and Pittet. Is it a matter of distributing the information more widely? Is it that healthcare workers disdain change and simply stick to the old routines while ignoring new recommendations? Whatever the cause, there is clearly a need for change. Bundling packages to prevent ventilator-associated pneumonia (VAP) have proven quite successful, as well as packages to avoid intravascular device-related infections. Means of preventing these causes are now widely published, and yet, the infections continue. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. Nosocomial infections now concern 5 percent to 15 percent of hospitalized patients and can lead to complications in 25 to 33 percent of those patients admitted to ICUs, they write. Philippe Eggimann, MD, and Didier Pittet, MD, MS, intensive care and infection control specialists, respectively, authored a paper five years ago that is still relevant today. Healthcare workers treating these patients literally hold life and death in their hands. Even with great advances in medical technology, these patients continue to be at the greatest risk for infection infections that are often avoidable by taking a few simple precautions. The intensive care unit (ICU) of the hospital has always been where the most vulnerable patients are kept, so they can be closely monitored and treated, often with a one-to-one ratio of nurse to patient, for the most scrupulous of care.
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