30. Infection Control

Infection control measures must be undertaken to decrease the risk of nosocomial infection and to prevent transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) from patients to ICU staff and vice versa.

Universal precautions apply to all patients, regardless of underlying diseases

Barrier precautions are required when there is potential for contact with blood and other bodily secretions and fluids, as these may harbor infectious agents.

Barriers include gloves, protective eye-wear or face shields, and gowns.

Special precautions including contact, airborne, and droplet precautions

They are used to limit the transmission of antibiotic-resistant bacteria from patients to health-care workers and other patients, to limit the spread of viruses and bacteria present in respiratory secretions, and to protect immunocompromised hosts from infection (reverse isolation).

Contact precautions are used for patients colonized or infected with antibiotic-resistant bacteria such as vancomycin-resistant enterococcus (VRE), and require that gloves be worn when entering the room, and gowns be worn when there is direct contact with the patient, or equipment or surfaces in the patient’s room.

Airborne and droplet precautions limit the spread of pathogens in respiratory secretions.

Airborne precautions are used to limit spread of Mycobacterium tuberculosis, varicella-zoster virus (VZV), rubeola, and multiple other viruses.

A private negative pressure isolation room is required for patients with airborne precautions.

Droplet precautions are used to limit spread of infectious agents such as Neisseria meningitidis, Haemophilus influenzae, Mycoplasma pneumoniae, adenovirus, and rubella virus.

Personnel and visitors that come in close proximity to patients on droplet precautions must wear a surgical mask.

A private room is preferred, but a negative pressure isolation room is not required.

To decrease transmission of blood-borne pathogens (HIV, HBV, HCV) it is recommended to immediately discard used needles without recapping into special puncture-proof receptacles.

Limiting the use of antibiotics

The frequent use of broad-spectrum antibiotics in the ICU has resulted in emergence of microorganisms that are resistant to multiple antibiotics.

The recent emergence of VRE is very concerning, particularly because it suggests that other more virulent Gram-positives, such as methicillin-resistant Staphylococcus aureus (MRSA), may also become resistant to vancomycin.

To decrease the likelihood of selecting for antibiotic-resistant organisms, the narrowest spectrum of antibiotics should be chosen.

When broad empiric antibiotic therapy is required, the regimen should be rapidly narrowed based on results of cultures.

Prophylactic perioperative antibiotics should not be routinely administered for all surgeries, and should be limited to the immediate perioperative period (24 hours).

Many institutions have policies that limit the use of various antibiotics, require justification for use of certain agents, and have guidelines for routine perioperative antibiotic prophylaxis.