[Infection control and prevention in intensive care: environmental aspects]

Surveillance is understood as the monitoring over time of the onset of preventable infection and/or microbial colonization in patients in intensive care units (ICU), where the prevalence of nosocomial infections, particularly those caused by microorganisms multiresistant to antibiotics, is alarmingly high. Surveillance deals with: 1) pathogens responsible for infection and their patterns of antibiotic resistance; 2) epidemics; 3) endemic infections selected according to predictability; 4) frequency of use of specific invasive procedures, where the greater the use, the higher the frequency of nosocomial infections associated with them; 5) use of antibiotics. Surveillance is operated through: 1) the microbiology laboratory, which is responsible for accurate surveillance of hospital infections; 2) the active surveillance on the wards, which concerns: a) identification of infections either on admission or during hospitalization or both, b) use of invasive procedures, control of parameters, and data collection, c) type of patients treated, identification of infected patients and data analysis and interpretation. Infection prevention complementary to surveillance starts with the adoption of strategies and interventions based on the application of universal precautions and/or on the route of transmission. A crucial point is the sterilization and disinfection of medical devices. In recent years there has been a steady rise in the number of infections caused by medical devices, most likely because of the increasing use of sophisticated and complex equipment that is often difficult to decontaminate and because of the rise in the number of immunocompromised patients or those susceptible to infections.