Prevention of nosocomial infections in ICU. What is really effective?

In South East of France, about 20% of the ICU patients with a length of stay > or = 2 days will develop a nosocomial infection (NI) related to an invasive device. This elevated rates of NI (the most elevated in the hospital) are related to the usual severity of patients, the use of invasive devices such as indwelling arterial catheter, central venous catheter, intubation and bladder catheter. These two characteristics are associated with an important antimicrobial consumption and a subsequent selection of resistant bacteria. The techniques which could be used in the prevention of NI have now proved to be effective. They are hand disinfection, non sterile gloves utilization and a rationale use of mask, gowns. The application of these measures are known as Standard Precautions, recommended by the CDC. The specificity of prevention in ICU is questionable, since many measures can be applied in ICU, anesthesia or surgery. In the prevention of NI in ICU, without any doubt, the most important (but the most difficult to achieve) is the strict respect of standard precautions. To achieve this goal, the best investment is alcoholic hand rub. Among the specific measures, maximum barrier precaution for CVC insertion, reduction of indication and duration of invasive device exposure. The real challenge is to apply few effective measures, but accepted, associated with behavioural changes and whose compliance is measured.