NOSOCOMIAL INFECTION IN ICU AND PRINCIPLES FOR PREVENTION

Abstract

Between 5 to10% of patients who are admitted to ICUs acquire an infection during their admission.Data collected from 112 European medical ICUs between 1992 and 1997 indicated that NIs developed in 7.8% of hospitalized patients of 181,993 patients. UTIs (31%) were the most common, with 95% occurring in catheterized patients. Pneumonia, which was ventilator-associated in 86% of cases, represented 27% of all NIs, and bloodstream infections represented 19% of which 87% were found to be catheter-related. The length of ICU stay is the predominant risk factor for nosocomial infection followed by the use of medical devices. Other risk factors include the patient's underlying illness, selected medications, and the type of health care facility. In the EPIC study seven risk factors were determined for ICU-acquired infection: increased length of stay (more than 48 hours), mechanical ventilation, diagnosis of trauma, central venous catheterization, pulmonary artery catheterization, urinary catheterization, and stress ulcer prophylaxis. The colonization of the host by potentially pathogenic may occur from exogenous or endogenous sources. The most common pathogens responsible for ICU infections are gram-positive organisms; coagulase-negative staphylococci (CoNS) were responsible for 42.9% of bloodstream infections, whereas S aureus was implicated in 27.8% of pneumonia cases. Methicillin-resistant S aureus (MRSA) and vancomycin-resistant enterococci have shown substantial increases in prevalence in both ICU and non-ICU hospital settings. gram-negative pathogen was P aeruginosa, which was associated with 18.1% of pneumonia cases ,also K pneumoniae, Enterobacter spp. associated with occurrence of pneumonia in the ICU between 1986 and 2003 .E coli isolates are urine samples (32.1%).