1. Infection Control in ICU Atefkamel MD

2. Infection is a common cause of admission to intensive care units (ICUs). In addition, around 30% of patients in ICUs will acquire infection (nosocomial infection) during their admission. The resulting increase in mortality is between 20-80%

3. Causes for admission associated with infection: (predisposing factors) • trauma, • burns, • following emergency surgery (particularly intra-abdominal).

4. ICU interventions: • tracheal intubation and ventilation, • intravascular catheters, • urinary catheters, • drugs (sedatives, muscle relaxants, corticosteroids, antibiotics), • blood transfusion.

5. Patients factors: • elderly, • malnourished, • high alcohol intake, • heavy smoking, • diabetes, • neutropenia.

6. Causative organisms • Enterobacter 34%. • Staphylococcus aureus 30%, (60% MRSA) – probably now higher, with a greater proportion of MRSA. • Pseudomonas 29%. • Staphylococcus epidemidis 19%. • Candida 17%.

7. Site of infection: lower respiratory tract 65%. • Urinary tract 17%. • Blood 12%. others

8. Pyrexia and leucocytosis are unreliable indicators of infection. C reactive protein trends are not specific. Procalcitoninis a more specific and sensitive indicator of developing infection

9. Classification: In the first 3 days of hospital admission community acquired. After 5 days, infections hospital acquired. Between 3 and 5 days, both should be considered.

10. Control of infection • prevention of spread of infection between patients, • management of patients to reduce the incidence of infection.

12. Cont.