Prevention and control of infections in intensive care

Small intensive care units (ICUs) functioning within their capacity and caring mainly for post-operative patients have fewer problems with infection control than larger ICUs with a varied case mix, sub-optimal staffing levels, and high levels of antibiotic consumption. Under these circumstances chronic cross colonisation and infection are inevitable and outbreaks may occur. Little can be done to reduce the risks of infection which arise as a direct result of the patient's clinical condition and prior colonisation status. However, selection pressure from antibiotic usage can be modified, as can environmental hygiene, ventilation and architectural design. One of the simplest measures for reducing cross infection remains one of the most intractable: compliance by staff with protocols and standards for maintaining hand hygiene. Simplification of procedures by the ready availability of alcohol hand rub preparations with or without chlorhexidine may improve matters.