Prevention of infection in the intensive care unit

To review tactics used to prevent intensive care unit infections, particularly ventilator-associated pneumonia and catheter-related bloodstream infections.

Health-care-associated infections in the intensive care unit are associated with elevated mortality, morbidity, and hospital costs, and increasing antibiotic resistance. The US Centers for Disease Control and Prevention recently published guidelines for the prevention of ventilator-associated pneumonia and catheter-related bloodstream infections. Though not generally recommended, selective decontamination of the digestive tract, an antibiotic prophylaxis strategy, consistently demonstrates reduction in ventilator-associated pneumonia rates and mortality but its broader use is limited by concerns of increasing resistance. The continued positive results from selective decontamination of the digestive tract require that this strategy receive significant attention in future studies. Regarding catheter-related bloodstream infections, the recommendations suggest education should be used to reduce infection rates, but it is likely that the impact of these directives is undervalued. The data demonstrate marked reduction in catheter-related bloodstream infections in both Latin America and the USA by employing a very low-tech intervention of education, performance feedback, and initiating process controls.

By preventing infections in the intensive care unit, not only is the expected effect to reduce injury related to the disease process, but the long-term effect is to also reduce resistance by decreasing the need for antibiotics.