- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Part 13.1 Diagnosis and surveillance
- Part 13.2 Nosocomial infection
- Chapter 283 Definition, epidemiology, and general management of nosocomial infection
- Chapter 284 Healthcare worker screening for nosocomial pathogens
- Chapter 285 Environmental decontamination and isolation strategies in the ICU
- Chapter 286 Antimicrobial selection policies in the ICU
- Chapter 287 Oral, nasopharyngeal, and gut decontamination in the ICU
- Chapter 288 Diagnosis, prevention, and treatment of device-related infection in the ICU
- Chapter 289 Antibiotic resistance in the ICU
- Part 13.3 Infection in the immunocompromised
- Part 13.4 Tropical diseases
- Part 13.5 Sepsis
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 1351) Nosocomial infection
Nosocomial infection or ‘healthcare-associated infection’ (HAI), is one of the most common medical complications affecting patients in intensive care units (ICUs). The prevalence of HAI generally exceeds 25% in ICUs worldwide and ICU-acquired HAI accounts for more than 20% of all HAI in general. HAI depends on the patient’s underlying disease, the presence of invasive devices, use of antimicrobial therapy, type of ICU, and workload and training of healthcare workers. Surveillance has a major impact on the incidence of infections. HAI rates are used to assess patient safety and healthcare systems’ effectiveness, but adjustment for case-mix and standardization of surveillance method are needed. Prevention must be guided by the measurement of indicators, such as HAI rates, structure indicators, process indicators, and audits using checklists to assess if correct procedures and equipment are in place. Routine hand hygiene is the most important feature of infection control. Although the optimal approach to reducing HAI in critically-ill patients remains unclear, recent studies and large quality improvement initiatives have shown that education-based strategies with multimodal interventions, including some bundle approaches, can decrease HAI rates in ICUs.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Part 13.1 Diagnosis and surveillance
- Part 13.2 Nosocomial infection
- Chapter 283 Definition, epidemiology, and general management of nosocomial infection
- Chapter 284 Healthcare worker screening for nosocomial pathogens
- Chapter 285 Environmental decontamination and isolation strategies in the ICU
- Chapter 286 Antimicrobial selection policies in the ICU
- Chapter 287 Oral, nasopharyngeal, and gut decontamination in the ICU
- Chapter 288 Diagnosis, prevention, and treatment of device-related infection in the ICU
- Chapter 289 Antibiotic resistance in the ICU
- Part 13.3 Infection in the immunocompromised
- Part 13.4 Tropical diseases
- Part 13.5 Sepsis
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care