Infection Prevention and Control

Video Transcript
IPC in Critical Care Settings
IPC in Critical Care Settings
Healthcare-associated infections are a persistent problem in critical care units. Patients in these
areas are usually non-ambulatory, malnourished, immunocompromised, or severely ill. Additionally,
critical care settings have a high prevalence of multi-drug resistant organisms (MDROs). Hence
infection prevention and control in these areas are of utmost importance.
ICU-acquired infection was not present in the patient or incubating at the time of admission into the
ICU but acquired during the stay in the ICU. An actual ICU-acquired infection usually manifests 48
hours after the entry of the patient into the ICU.
The common HAIs that are usually encountered include:
• Respiratory infections
• Device-related infections
• MDRO infections
Infection prevention and control in critical care settings should primarily focus on the following:
• Hand hygiene
• Personal protective equipment
• Isolation precautions
• Precise environmental cleaning
• Prevention of device-associated infections
• Antimicrobial stewardship
• Prevention of transmission-based infections
Hand Hygiene
Hand Hygiene
• Hand hygiene is the most important, simple, convenient, and least expensive infection control
measure. Alcohol-based hand rubs are effective against gram-negative, gram-positive, and also
multi-drug resistant pathogens. Alcohol-based hand rubs are usually effective against
Methicillin-resistant Staphylococcus aureus (MRSA), Mycobacterium tuberculosis, vancomycin-
resistant enterococci, most viruses, and some fungi. However, alcohol-based hand rubs are
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ineffective in the presence of dirt, soil, and Clostridium difficile. In such situations, handwashing
with soap and water is more effective.
• ICUs must have a sufficient number of washbasins accessible and alcohol-based hand rubs
available at one per ICU bed. Hand hygiene compliance audits, training sessions and feedback
must be provided to all ICU staff. Staff involved in procedures and direct patient care must not
wear any jewelry. Shirts and uniforms must have short sleeves (bare below the elbow).
Personal Protective Equipment
Personal Protective Equipment
Personal Protective Equipment or PPE must be easily accessible and provided in sufficient numbers
to the intensive care unit or ICU staff. The staff involved in patient care must wear PPE appropriate to
the patient care or procedure risk. Gloves provide adequate barrier protection against infectious
agents. Discard gloves after a single use. Perform hand hygiene after glove removal. Disposal aprons
or gowns must be used depending on the risk of exposure. If gross contamination by splashing is
present, full cover gowns and eye/face shields must be worn.
Isolation Procedure
Isolation Procedure
Patients in ICU usually require intensive care and close supervision. Hence, complete isolation of such
patients might not be feasible. Private rooms in ICUs may be used if a patient requires isolation.
Patients with the same condition can be grouped as cohorts. Isolation precautions may be carried out
for patients with vancomycin-resistant enterococci, Clostridium difficile (C. difficile), respiratory
syncytial virus, Methicillin-resistant Staphylococcus aureus (M.R.S.A.), chickenpox. Appropriate PPE
must be used in isolation rooms and removed before leaving the patient's room.
Device Associated Infections
Device Associated Infections
• Device-associated infections like ventilator-associated pneumonia, CLABSI, Catheter-
associated urinary tract infections are commonly encountered in ICUs. Comprehensive
prevention bundle programs have to be implemented along with standard precautions for the
prevention of these infections.
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• Only trained personnel must be involved in the insertion, handling, and removal of the devices.
If used for insertion, ultrasound probes must be cleaned with quaternary ammonium
compounds to remove MRSA and other bacteria. Instruments used for patients suspected of
being infected with Clostridium difficile must be disinfected with bleach.
• Patient-care equipment is implicated in healthcare-associated infections, especially when they
are shared between individuals. These items can be categorized depending on the risk of
infection associated as critical, semi-critical, and non-critical items.
Precise Environmental Cleaning
Precise Environmental Cleaning
• Environmental cleaning in a hospital setup is important in the prevention of HAIs.
Environmental surfaces like bed railings and tabletops in an ICU can harbor pathogens like
MRSA and vancomycin-resistant enterococci, transmitted to patients. Cleaning and disinfection
of an ICU have to be done regularly and whenever a hazardous event like a blood spill has
happened. Adequate spacing must be maintained between beds. Furniture, curtains, and other
fixtures must be of a material that can be easily cleaned. Appropriate disinfectants like
quaternary ammonia compounds, sodium hypochlorite, phenolics, and so on can be used for
routine cleaning and disinfection. Novel technologies include ultraviolet light, hydrogen
peroxide vapor/mist systems, and ultra-microfibers. Monitoring of environmental disinfection
must be conducted at regular intervals. Various techniques used include agar plate cultures,
swab cultures, and ATP systems.
Antimicrobial Stewardship
Antibiotic Stewardship
• Antibiotic resistance is a major issue in ICUs. Implementation of antimicrobial stewardship
programs is mandatory to prevent unnecessary or indiscriminate use of antibiotics. Antibiotic
usage in an ICU must meet the therapeutic goals, have minimal toxicity, and side effects, and
prevent the emergence of resistant agents. The antibiotic therapy chosen must preserve the
normal flora. Regulation of the use of broad-spectrum antimicrobials is a must.
• Moreover, use antimicrobials with the lowest resistance potential. Antimicrobials like
ciprofloxacin, ceftazidime, and imipenem gave rise to resistant strains even during clinical
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trials. The use of these antibiotics is associated with the emergence of resistant strains. These
must be replaced with those with low resistance potentials like cefotaxime, amikacin, and
meropenem. When patients are infected with antibiotic-susceptible pathogens, treatment with
first-line antibiotics must be encouraged even in the critical care unit.
Prevention of Transmission-based Infections
Prevention of Transmission-based infections

• Transmission-based precautions include contact, droplet, and airborne. These precautions are
most often used in respiratory infections. Patients with tuberculosis and respiratory infections
must be educated about sneeze and cough etiquette. Ventilation and air handling units
minimize the risk of airborne diseases.
We have reached the end of this session. We will discuss IPC in Emergency Room in the next session.