Host defense mechanisms and compromises in the trauma patient

Infection in multiple trauma patients remains the number one complication and the second leading cause of death in this population. Because each type of injury has its own intrinsic infection risks and the treatment of the injury necessitates the use of invasive therapy, the prevention of infection may not be possible. The most effective infection control measures may be continual nursing assessment of the patient, including observing for subtle changes that would indicate the presence of an infection. It is the early distinction of infection as the underlying mechanism of inflammatory responses and fever that best facilitates an expedient and appropriate course of therapy. Classic recommendations of infection control practices such as hand washing and meticulous aseptic technique during all procedures, plus an awareness of the many ways that microorganisms can contaminate and innoculate the patient are the best strategies for nursing care. Nursing actions must be guided by a clear understanding of the patient's host defense mechanisms and how they are jeopardized by both the injury and the therapy. This understanding facilitates the implementation of specific nursing care measures to promote the restoration of normal host defense mechanisms and to prevent further compromise of the trauma patient while in the ICU.