Introduction
ICUs comprise fewer than 10 percent of all hospital beds but account for more than 20 percent of nosocomial infections. ICU-acquired infections significantly cause morbidity, mortality, and hospital expenditures. The primary causes of fatalities in ICUs are infections and sepsis, representing 40 percent of all ICU expenses. The percentage of ICU infections is projected to rise along with the number of ICU beds, adding pressure to the expense of healthcare. Nosocomial infections are more likely to affect patients in critical care settings. ICU patients generally have greater severity of abrupt physiological abnormalities and more chronic associated diseases than other hospital patients.
What Are the General Infection Control Measures in Critical Care?
Improvement of Nutritional Status:
It is generally known that a poor diet causes immune system dysfunction and vulnerability to infection. The sole risk factor for infections at the surgical site is nutritional deficiencies. Patients undergoing heart surgery with low serum albumin levels are at higher risk for postoperative infection problems. Patients in medical ICUs who are not receiving enough calories are far more likely to get nosocomial bloodstream infections. Enteral feeding of critically ill adult patients considerably reduces the risk of total infections compared to parenteral feeding. Early enteral feeding, when achievable, is associated with a reduced risk of sepsis or septic shock and improved ICU survival.
Glucose Regulation:
Critically ill patients frequently have hyperglycemia ( and insulin resistance, which are linked to poor outcomes in diabetics and are even more common in those who have hyperglycemia brought on by stress. Patients with diabetes undergoing cardiovascular surgery experience more significant postoperative wound infections than those without diabetes. Hyperglycemia among trauma patients hospitalized in the intensive care unit increases their risk of infection, particularly bloodstream and respiratory infections. It is still unknown what the ideal blood glucose level should be, and further research is required to establish it.
The Environment of an Intensive Care Unit:
Patients are frequently exposed to different harmful organisms in the ICU setting. These microorganisms can be found anywhere, increasing the risk of contracting illnesses. They can be discovered on caregivers' hands, lab coats, doorknobs, keyboards, or the room's architecture and atmosphere.
Much research is being done on ways to reduce germs' environmental burden and ultimately lessen hospital-acquired infection rates. Nevertheless, future efforts to lower colonization pressure may benefit from experimental methods of cleaning the environment, such as hydrogen peroxide vapor decontamination devices and UV light sterilizing lamps. The environmental and hand contamination rates can be significantly reduced through the combination of environmental cleaning alongside a hand hygiene education program.
Screening Patients:
Newly admitted ICU patients exposed to multidrug-resistant microorganisms are a continuing source of infection and transmission. Many hospitals have adopted surveillance cultures to find Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococci (VRE), with notable success in reducing the rate of inoculation and colonization with these microorganisms.
What Are the Various Device-Related Infections and Ways to Control Them in Critical Care?
Various devices are highly susceptible to colonization and the emergence of infections, including urine catheters, intravascular catheters, surgical meshes, and prosthetic surgical implants (heart valves, orthopedic implants). According to the Centers for Disease Control and Prevention (CDC), the most effective prevention strategy is to avoid using them when unnecessary. Additionally, the ongoing requirement for such devices must be assessed every day. Clinicians must use extreme caution while introducing and maintaining such intrusive devices.
Hand washing before and after interacting with each patient is the first step. Second, proper skin antiseptic solutions, such as two percent chlorhexidine, and strict sterile barrier procedures must be followed when inserting these devices. Finally, many modern devices feature surface-modified antimicrobial coatings shown in studies to stop microorganisms from colonizing catheter surfaces, helping to stop biofilm formation. The most researched include central venous and ventricular catheters coated with Minocycline or Rifampin, chlorhexidine or silver sulfadiazine, and silver-coated catheters. Even though these technologies already exist, their acceptance has been limited because of the initial higher investment requirements without considering the long-term financial benefits of preventing infections.
ICU patients frequently develop urinary tract infections (UTIs), catheter-related bloodstream infections (CRBIs), and ventilator-associated pneumonia (VAP). The most important thing is to keep the device in place as little as possible. Unfortunately, it may not always be possible to stop using this equipment, so physicians sometimes have to choose items that provide additional protection against infections, like silver- or antimicrobial-coated catheters and things like BioPatch, an antimicrobial dressing that can be applied to the skin encircling an intravascular catheter to lessen the growth of bacteria near the insertion site.
Why Is Hand Hygiene Important in Critical Care?
Routine hand washing (before and after treating a patient) is crucial in preventing infections. Throughout the hospital environment, hand hygiene adherence should be excellent. However, it is essential in the intensive care unit (ICU), where patients are highly susceptible and may already be at risk for several infections due to comorbid conditions or traumas. Influencing behavior to increase hand hygiene compliance, which is still one of the most effective ways to lower the pathogen population and the risk of cross-contamination, and managing colonization pressure are the two main challenges that infection management in the ICU often faces.
Additionally, selecting materials suited for the environment is a crucial factor. The best hand hygiene products balance antibacterial effectiveness and moisturization to preserve skin conditions and promote hand hygiene compliance. To ensure efficacy, active components for hand wash, lotion, and alcohol hand rub formulations must also be suitable. Instead of making individual product judgments that can lead to incompatible items, staff should use a continuum or routine approach when choosing products. Recently available alcohol-based gels have been demonstrated to promote hand hygiene compliance and efficiency, especially when placed in every patient's room or passageway before entry.
Conclusion
There have been significant improvements in the treatment of seriously unwell people. However, any new technical development may increase the chance of nosocomial infection spreading. The rise of antibiotic-resistant germs, frequent or prolonged use of invasive instruments, and host variables increase the risk of infection. In every ICU, control and preventative strategies are crucial. These techniques include isolating patients, hand washing, using protective gear, cleaning and sanitizing equipment, sanitizing the environment, and offering instruction and training. One of the most crucial steps for reducing cross-contamination is washing one's hands before and after handling each ICU patient.
