Infection control

ICU departments rife with infection: study

TORONTO – A single-day snapshot of thousands of patients in hospital intensive care units in more than 75 countries suggests more than half had infections.

On May 8, 2007, 51% of the more than 14,000 patients were classified as infected, and 71% were receiving antibiotics, according to the study, which was published in a recent issue of the Journal of the American Medical Association.

“The principal finding was that infection in intensive care units is even more common than we had thought it was,” said Dr. John Marshall of the University of Toronto and St. Michael’s Hospital, one of the authors of the study.

Of the 7,087 ICU patients with infections, lungs were the most common site of infection, accounting for 64%, followed by the abdomen at 20% and the urinary tract at 15%.

Patients who became infected tended to be sicker either because they had chronic conditions before they were admitted to the ICU or because their acute problem left them more vulnerable to infection, Marshall said.

Infections and related sepsis or blood poisoning was the leading cause of death in non-cardiac intensive care units. Patients in ICUs who developed infections were twice as likely to die, 25% versus 11% among non-infected patients, the researchers found.

The risk went up over the first week in the ICU and increased progressively the longer the patient was there, Marshall said.

Marshall said the results show that providing adequate numbers of nurses and properly designed ICU wards can lower the risk of infection and save lives.

Patients who end up in intensive care are often sicker, and may be on ventilators and have intravenous lines that involve being stuck with needles and tubes, which increase the risk of infection, said Dr. Chris Hayes of the Canadian Patient Safety Institute in Toronto.

“Coming into hospital does carry a risk of infection,” said Dr. Hayes, who is also medical director for quality and patient safety at St. Mike’s. “Patients and families need to be vigilant and need to be responsible and make sure their healthcare providers are washing their hands.”

For healthcare workers, prevention strategies for infection control mean more than hand washing. It also includes taking extra care when doing anything with very sick patients, a practice that is being adopted in Canada, he added.

Other measures Hayes suggested include:

• Preparing the skin with a proper antiseptic agent.

• Putting a large drape on the patient.

• Covering yourself with a gown, gloves, cap and mask as if the procedure was an operation.

Despite the study results, Hayes said there are signs of progress. In recent years, Canadian hospitals have instituted tougher overall infection control programs that are showing positive results.

In an editorial that accompanies the study, Dr. Steven Opal of the Warren Alpert Medical School at Brown University, in Providence, R.I., and Dr. Thierry Calandra of Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland, gave suggestions on antibiotic use in ICUs.

“Development of novel classes of antimicrobial agents is sadly lacking and needs to be a major research priority. New drugs are needed to replace the increasingly obsolete classes of antibiotics that currently exist.

“A ‘post-antibiotic era’ is difficult to contemplate but might become a reality unless the threat of progressive antibiotic resistance is taken seriously,” the pair wrote.

Posted Dec.10, 2009