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Infection control in patients undergoing mechanical ventilation: traditional approach versus a new
K Meijer1, H K van Saene, J C Hill
1University of California Davis Medical Center, Sacramento 95817.
Abstract:
Nosocomial infections are major causes of morbidity and mortality in critically ill patients. Traditional infection control practices focus on preventing infection by controlling patient exposure to microorganisms within the patient's environment. We discuss these practices, along with the factors and organisms responsible for nosocomial infection in the patient undergoing mechanical ventilation. Despite traditional infection control measures, nosocomial infection continues to be a major problem. In recent years evidence has accumulated that points to bacterial colonization of the oropharynx and gastrointestinal tract as a major source of infection. A new technique, selective decontamination of the digestive tract, is being studied extensively for its ability to control colonization of the oral cavity and the gastrointestinal tract. In the technique nonabsorbable topical antibiotics are applied to the oropharynx and instilled into the stomach, and a short course of an intravenous cephalosporin is included. The technique appears a worthwhile addition to traditional infection control measures.
Insights
Selective decontamination of the digestive tract may help prevent nosocomial infections in mechanically ventilated patients. This approach targets bacterial colonization, offering a potential addition to traditional infection control methods.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Nosocomial infections significantly increase morbidity and mortality in critically ill patients.
- Traditional infection control focuses on environmental microbial exposure, but remains insufficient.
- Bacterial colonization of the oropharynx and GI tract is a key source of these infections.
Purpose of the Study:
- To review traditional infection control practices for mechanically ventilated patients.
- To explore the role of bacterial colonization in nosocomial infections.
- To evaluate the potential of selective decontamination of the digestive tract (SDD).
Main Methods:
- Discussion of traditional infection control strategies.
- Analysis of factors and organisms causing nosocomial infections in ventilated patients.
- Review of studies on SDD, involving topical antibiotics and IV cephalosporin.
Main Results:
- Traditional methods alone are insufficient to control nosocomial infections.
- SDD aims to reduce bacterial colonization in the oropharynx and GI tract.
- SDD shows promise in controlling colonization.
Conclusions:
- Nosocomial infections remain a critical challenge in intensive care.
- Selective decontamination of the digestive tract is a promising strategy.
- SDD may complement traditional infection control for ventilated patients.