Infection in the intensive care unit: prevention strategies

Nosocomial infections remain among the most common treatment complications, particularly in intensive care unit patients. In many countries antibiotic resistance is increasingly hampering treatment of these infections. Preventive strategies have therefore become more important and have been directed both against the development of specific infections and against the spread of antibiotic-resistant pathogens. The present review addresses recent data on the latter issue. In particular, we discuss the first approaches to use mathematical modelling as a tool to analyse and guide strategies to prevent infection, and the effects of antibiotic cycling.

Several mathematical models to address the dynamics of pathogen transmission in hospital settings have been developed. One of the models may allow quantification of the effects of different strategies to prevent infection in intensive care units, and another may be used to determine the relative importance of different colonization routes, without the need for expensive genotyping methods. The results of the first prospective studies on antibiotic cycling are inconclusive, and again mathematical modelling may help to provide testable hypotheses for such interventions. Finally, recent studies have shown that alcohol-based hand rubs are better than hand washing with soap and water for most hand disinfection purposes.

The first results of use of mathematical modelling to guide infection control strategies should be subjected to prospective, empirical testing in order to determine their clinical usefulness. More rigorously designed studies are needed to determine the benefits of antibiotic cycling strategies. Hands should be disinfected with alcohol-based hand rubs, which should be available at each bedside.