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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 May;70(5):329-37


language: English

Prevention of nosocomial infection in the ICU setting

Corona A., Raimondi F.

Service of Anesthesia and Resuscitation Luigi Sacco Hospital, Milan, Italy


The aim of ­this ­review is to ­focus the epi­dem­i­ol­o­gy and pre­vent­ing meas­ures of nos­o­co­mi­al infec­tions ­that ­affect the crit­i­cal­ly ill ­patients. Most of ­them (­over 80%) are relat­ed to the ­device util­iza­tion need­ed for ­patient ­life sup­port but respon­sible for ­such com­pli­ca­tions as ven­ti­la­tor-asso­ciat­ed pneu­mo­nia (VAP), cath­e­ter-relat­ed blood­stream infec­tions (­CRBSI), sur­gi­cal ­site infec­tions (SSI) and uri­nary ­tract infec­tions (UTI). General rec­om­men­da­tions ­include ­staff edu­ca­tion and use of a sur­veil­lance pro­gram ­with a restric­tive anti­bi­o­tic pol­i­cy. Adequate ­time ­must be ­allowed for ­hand wash­ing and bar­ri­er pre­cau­tions ­must ­always be ­used dur­ing ­device manip­u­la­tion. The rou­tine chang­ing of cen­tral cath­e­ters is not nec­es­sary and increas­es ­costs; it is nec­es­sary to ­decrease the han­dling of admin­is­tra­tion ­sets, to use a ­more care­ful inser­tion tech­nique and ­less fre­quent set replace­ment. Specific meas­ures for VAP pre­ven­tion are: 1) use of mul­ti-use, ­closed-­system suc­tion cath­e­ters; 2) no rou­tine ­change of the breath­ing cir­cuit; 3) lubri­ca­tion of the the endo­tra­cheal ­tube ­cuff ­with a ­water-sol­u­ble gel; 4) main­te­nance of ­patient in ­semi-recum­bent posi­tion to ­improve ­chest phys­io­ther­a­py. Specific meas­ures for UTI pre­ven­tion ­include: 1) use of a cath­e­ter-­valve ­instead of a stan­dard drain­age ­system; 2) use of a sil­ver-­alloy, ­hydro gel-coat­ed ­latex uri­nary cath­e­ter ­instead of uncoat­ed cath­e­ters. By imple­ment­ing effec­tive pre­ven­tive meas­ures and main­tain­ing ­strict sur­veil­lance of ICU infec­tions, we ­hope to ­affect the asso­ciat­ed mor­bid­ity, mor­tal­ity, and ­cost ­that our ­patients and soci­ety ­bare. More clin­i­cal ­trials are need­ed to ver­i­fy the effi­ca­cy of pre­ven­tion meas­ures of ICU infec­tions.

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