ICU · Antimicrobial Stewardship
Acute severe community-acquired pneumonia: infection control in ICU
Also known as Infection control in ICU · Nosocomial infection prevention · ICU hygiene · Isolation precautions
Infection control in ICU prevents transmission of pathogens between patients, staff, and the environment. Core components: (1) Hand hygiene (WHO 5 Moments — single most effective measure). (2) Standard precautions (for ALL patients — gloves, gown, eye protection when exposure risk). (3) Transmission-based precautions: contact (MRSA, VRE, C. diff, MDR), droplet (influenza, RSV, pertussis), airborne (TB, measles, chickenpox). (4) Environmental cleaning (high-touch surfaces, terminal cleaning). (5) Equipment cleaning/disinfection (dedicated equipment for isolated patients). (6) Surveillance (MDR screening cultures, infection rates). (7) Staff education and audit. (8) Antimicrobial stewardship. ICU infection rate is a quality metric — lower is better.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Hand hygiene compliance <70% = significant infection risk — audit, feedback, education
- C. diff: contact precautions + soap and water (NOT alcohol gel — spores survive alcohol)
- TB: airborne isolation — NEGATIVE PRESSURE room, N95/P2 respirator
Meet the patient
A 68-year-old man is transferred from an overseas ICU, ventilated for respiratory failure, with a referral letter that flags carbapenem-resistant Acinetobacter in his sputum and vancomycin-resistant Enterococcus on a rectal screen. Your unit is full and there is no single room for six hours. The two questions that decide his first hour are the two that decide every ICU infection-control problem: which precautions protect the unit, and which device can come out today.[2]
References19ShowHide
- [1]Pittet D, Allegranzi B, Boyce J, et al. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infection Control and Hospital Epidemiology, 2009.PMID 19508124
- [2]Siegel JD, Rhinehart E, Jackson M, Chiarello L, HICPAC. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American Journal of Infection Control, 2007.PMID 18068815
- [3]Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 2000.PMID 11073019
- [4]Lotfinejad N, Peters A, Tartari E, et al. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infectious Diseases, 2021.PMID 34331890
- [5]Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 2006.PMID 17192537
- [6]O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 2011.PMID 21460264
- [7]Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection control and hospital epidemiology, 2014.PMID 25376073
- [8]Lo E, Nicolle LE, Coffin SE, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 2014.PMID 25376068
- [9]Dubberke ER, Carling P, Carrico R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 2014.PMID 25376069
- [10]Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. New England Journal of Medicine, 2013.PMID 23718152
- [11]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 2021.PMID 34605781
- [12]Climo MW, Sepkowitz KA, Zuccotti G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Critical Care Medicine, 2009.PMID 19384220
- [13]Dancer SJ. Mopping up hospital infection. Journal of Hospital Infection, 1999.PMID 10549308
- [14]Storr J, Twyman A, Zingg W, et al. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrobial Resistance and Infection Control, 2017.PMID 28078082
- [15]Harbarth S, Fankhauser C, Schrenzel J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA, 2008.PMID 18334690
- [16]Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery, 2017.PMID 28467526
- [17]Allegranzi B, Bischoff P, de Jonge S, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infectious Diseases, 2016.PMID 27816413
- [18]Allegranzi B, Zayed B, Bischoff P, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infectious Diseases, 2016.PMID 27816414
- [19]Anderson DJ, Chen LF, Weber DJ, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet, 2017.PMID 28104287