Adapt or perish--a relentless fight for survival: designing superbugs out of the intensive care unit

Lethal microorganisms have terrorized man since the beginning of time, killing more human beings than anything else in history. The most infamous epidemic, the Black Death, wiped out almost half the population of Europe. To quote H.G. Wells, "adapt or perish, now as ever, is nature's inexorable imperative." Superbugs are nature's revenge on humans for their ingenuity. For decades antibiotics, which work by honing in on particular bacteria, have been the chief line of defense against infection. There is growing urgency for the judicious assessment of both conventional and innovative strategies with regard to antibiotic use, infection control, molecular detection of pathogens and adequate treatment of multidrug-resistant organisms in hospitals, especially critical care units. Financial restraints, changing demographics, an aging population and the limited introduction of new antibiotics have established an imperative for utilization of goal directed strategies in infection prevention and control. Research and development of both clinical and environmental weapons to combat these adversaries is essential if man is to adapt, not perish, in this fight for survival. This article will provide a snapshot of advances in infection prevention and control, including evidence based design, as they relate to the critical care environment.