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Symposium on intensive care: 2. Infection control in the surgical intensive care unit
Abstract:
Control of infection in the surgical intensive care unit demands unfailing attention to three distinct areas: a) The bacteria responsible may be endogenous or exogenous. The effects of the former can be limited by careful surgical techniques and judicious use of antibiotics, of the latter by the practice of asepsis and antisepsis, essentially of scrupulous cleanliness. b) The environment of infection concerns the support of natural barriers to infection (notably the integrity of the skin and the adequate drainage of the pulmonary system), and the sterility and appropriate care and use of the many invasive devices currently available. c) The patient's natural defence mechanisms show considerable variation, and those at increased risk can be detected by skin-testing with a number of antigens as well as by recognized clinical features. It is in these patients with anergy and abnormal natural defences that total parenteral nutrition can be of the greatest value.
Insights
Effective surgical intensive care unit infection control requires managing bacteria, maintaining patient barriers, and supporting natural defenses. Identifying at-risk patients with impaired immunity is crucial for interventions like total parenteral nutrition.
Area of Science:
- Infection Control
- Surgical Intensive Care
- Immunology
Background:
- Surgical site infections (SSIs) are a significant concern in intensive care units (ICUs).
- Infection control strategies must address endogenous and exogenous bacterial sources.
- Maintaining patient's natural defenses and environmental sterility are critical.
Purpose of the Study:
- To outline key areas for controlling infection in surgical ICUs.
- To highlight the importance of patient's immune status in infection risk.
- To identify specific patient populations that may benefit from nutritional support.
Main Methods:
- Review of infection control principles in surgical ICUs.
- Categorization of infection control into bacterial sources, environmental factors, and host defenses.
- Identification of methods for detecting patients at increased risk of infection.
Main Results:
- Infection control involves managing endogenous/exogenous bacteria via surgical techniques, antibiotics, asepsis, and antisepsis.
- Environmental control includes maintaining skin integrity, pulmonary drainage, and device sterility.
- Patient risk stratification can be achieved through skin testing and clinical assessment.
Conclusions:
- Vigilance in managing bacterial sources, environmental factors, and host defenses is paramount for infection control.
- Patients with anergy and compromised natural defenses are at higher risk.
- Total parenteral nutrition (TPN) can be a valuable intervention for high-risk patients with impaired immunity.