Infection Control in the ICU Environment

273 Pages·2002·5.688 MB·English

by  Juan Alonso-Echanove MD, Robert P. Gaynes MD (auth.), Robert A. Weinstein, Marc J. M. Bonten (eds.)

INFECTION CONTROL IN
THE ICU ENVIRONMENT
PERSPECTIVES ON CRITICAL CARE INFECTIOUS
DISEASES
Jordi Rella, M.D., Series Editor
t. N. Singh and J.M. Aguado (eels.): Infectious Complications in Transplant Recipients. 2000.
ISBN 0-7923-7972-1
2. P.O. Eichacker and J. Pugin (eels.): Evolving Concepts in Sepsis and Septic Shock. 200t.
ISBN 0-7923-7235-2
3. J. Rello and K. Leeper (eels.): Severe Community Acquired Pneumonia. 200t.
ISBN 0-7923-7338-3
4. R.G. Wunderink and J. Rello (eels.): Ventilator Associated Pneumonia. 200t.
ISBN 0-7923-7444-4
5. R.A. Weinstein and M. Bonten (eels.): Infection Control in the ICU Environment. 2002.
ISBN 0-7923-7415-0
INFECTION CONTROL IN
THE ICU ENVIRONMENT
Edited by
ROBERT A. WEINSTEIN
Cook County Hospital and Rush Medical College
1835 W. Harrison St.
Room 129, Durand Bldg.
Chicago, Illinois, USA 60612
MARe J.M. BONTEN
Department of Internal Medicine
Divisi~n of Infectious Diseases and Aids
University Medical Center Utrecht
Heidelberglaan 100
Utrecht
The Netherlands
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Library of Congress Cataloging-in-Publication Data
Infection control in the ICU environment / edited by Robert A. Weinstein, Marc J.M. Bonten.
p. ; cm. -- (Perspectives on critical care infectious diseases ; 5)
Inc1udes bibliographical references and index.
ISBN 978-1-4613-5236-5 ISBN 978-1-4615-0781-9 (eBook)
DOI 10.1007/978-1-4615-0781-9
1. Intensive care units. 2. Nosocomial infections--Prevention. 3. Critical care medicine.
1. Weinstein, Robert A. (Robert Alan), 1946-II. Bonten, Marc J. M. III. Series.
[DNLM: 1. Infection Control--methods. 2. Cross Infection--prevention & control. 3.
Intensive Care Units. WX 167142372002]
RA975.5.I56 1565 2002
614.4'4--dc21
2001038474
Copyright © 2002 by Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 2002
Softcover reprint ofthe hardcover Ist edition 2002
Ali rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system
or transmitted in any form or by any means, mechanical, photo-copying, recording, or otherwise,
without the prior written permission ofthe publisher, Springer Science+Business Media, LLC.
Printed an acid-free paper.
The Publisher offers discounts on this book for course use and bulk purchases.
For jurther injormation, send email [email protected].
CONTENTS
Introduction Vll
JORD! RELLO
Preface IX
1. Scope and Magnitude of Nosocomial ICU Infections
U.S. Perspective:
JUAN ALONSO-ECHANOVE AND ROBERT P. GAYNES
2. Scope xand Magnitude of Nosocomial ICU Infections 15
European Perspective:
MAAIKE M.S. IBELINGS AND HAJO A. BRUINING
3. Vancomycin-Resistant Enterococci: A Threat for the ICU? 33
U.S. Perspective:
MARY K. HAYDEN
4. Vancomycin-Resisitant Enterococci in Europe: A Changing Epidemiology? 49
European Perspective:
MARC J.M. BONTEN
5. Methicillin-Resistant Staphylococcus Aureus: Is Control Necessary? 57
U.S. Perspective:
JOHN M. BOYCE
6. Acinetobacter: Epidemiology and Control 67
U.S. Perspective:
JAMES J. RAHAL AND CARL URBAN
vi Contents
7. Acinetobacter: Epidemiology and Control 77
European Perspective:
JAVIER ARIZA AND XAVIER CORBELLA
8. Fungal Infections: The Role of Prophylactic and Empiric Antifungal
Therapy in ICU Patients 93
u.s. Perspective:
PAUL O. GUBBINS
9. Fungal Infections: The Role of Prophylaxis and Empiric Therapy in
ICU Patients 107
European Perspective:
JACQUES F.G.M. MEIS AND PAUL E. VERWEIJ
10. Newer Approaches to Preventing Vascular Catheter-Related Sepsis 115
U.S. Perspective:
RABIH o. DAROUICHE
11. Newer Approaches to Preventing Intravascular Device-Related Bloodstream
Infections 129
European Perspective:
J.A.J.W. KLUYTMANS
12. Is Prevention of Ventilator-Associated Pneumonia Cost Effective? 141
North American Perspective:
MARIN H. KOLLEF
13. Ventilator-Associated Pneumonia: Is Prevention Cost Effective? 155
European Perspective:
RICARD FERRER, TORS TEN BAUER AND ANTONI TORRES
14. Cross-Colonization in Intensive Care Units: Fact or Fiction? 169
U.S. Perspective:
MATTHEW SAMORE
15. Cross-Colonization: Fact or Fiction? 181
European Perspective:
MIGUEL SANCHEZ GARdA
16. Conventional Infection Control Measures: Value or Ritual? 195
U.S. Perspective:
JOHN P. FLAHERTY, JANIS WIENER AND ROBERT A. WEINSTEIN
17. Conventional Infection Control Measures: Value or Ritual? 213
European Perspective:
C.A.M. SCHURINK AND M.J.M. BONTEN
18. Modeling of Antibiotic Resistance in the ICU 231
U.S. Perspective:
MARC LIPSITCH AND CARL T. BERGSTROM
19. Mathematical Models in the ICU: Dynamics, Infection Control and
Antibiotic Resistance 245
European Perspective:
DAREN J. AUSTIN
Index 267
PERSPECTIVES ON CRITICAL CARE INFECTIOUS DISEASES
An Introduction to the Series
Different models of intensive care medicine have been developed worldwide, involv
ing surgeons, anesthetists, internists and critical care physicians. All intensive care
departments of hospitals have in common, the highest incidence of antibiotic con
sumption, the highest incidence of nosocomial infections and community-acquired
infections with high degrees of severity. Intensive care areas of hospitals have the
largest number of infection outbreaks and require differentiated strategies of
prevention.
The specific characteristics of the involved population require differentiated
approaches in diagnosis and therapy from those required in classical infectious prob
lems. The specific pharmacodynamic conditions of patients requiring mechanical
ventilation or continuous renal replacement, require participation of experts in
pharmacology.
The specific objective of this Series is to update therapeutic implications and
discuss controversial topics in specific infectious problems involving critically ill
patients. Each topic will be discussed by two authors representing the different man
agement perspectives for these controversial and evolving topics. The Guest Editors,
one from North America and one from Europe, have invited contributors to present
the most recent findings and the specific infectious disease problems and manage
ment techniques for critically ill patients, from their perspective.
Jordi Rello, M.D.
Series Editor
PREFACE
Infections are serious and common complications of the treatment of critically ill
patients. Intensive Care Unit (ICU) patients become more prone to develop infections
as their severity of illness, the complexity of underlying diseases, and the numbers of
interventions that breach their host defenses increase. To further complicate care, resis
tance of ICU pathogens to the newest antimicrobial therapy is emerging, despite
current prevention efforts. In such an environment, heightened infection control is of
key importance. Infection Control in the ICU Environment provides an overarching
review that details the most current and high profile infection control problems in
ICUs. Authors include noted scientists, intensivisits, and epidemiologists from the
United States and Europe and infection control experts from the U.S. Centers for
Disease Control and Prevention. The latest problem pathogens in ICUs, particularly
Acinetobacter, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant
Enterococci, are examined in detail. Cutting edge information regarding the potential
for prophylactic and/or pre-emptive therapy offungal infections in ICUs is reviewed.
The latest innovations in vascular catheter care and prevention of bloodstream infec
tions are discussed. An up-to-date review of ventilator-associated pneumonia and its
prevention is provided. Dissecting fact from fiction and value from ritual in ICU pro
cedures is thoughtfully explored. Finally, the newest innovations in use of mathemati
cal modeling to understand the epidemiology and control of infections in ICUs are
presented. The issues discussed in this book are timely, are of global importance, and
will remain on our agenda well into the next decade(s).
Marc Bonten, M.D., Ph.D.
Robert A. Weinstein, M.D.
INFECTION CONTROL IN
THE ICU ENVIRONMENT
1. SCOPE AND MAGNITUDE OF
NOSOCOMIAL ICU INFECTIONS
JUAN ALONSO-ECHANOVE, MD AND
ROBERT P. GAYNES, MD
Centers for Disease Control and Prevention, Atlanta, GA, 30333 USA
INTRODUCTION
Intensive care units (ICUs) are a primary component of modern medicine and are
currently in more than 95% of acute-care hospitals in the United States. Although
ICUs account for only 5% of hospital beds, they represent 8% to 15% of hospital
admissions. Moreover, current health care trends indicate that although the
number of beds in U. S. hospitals is decreasing, the number of intensive care beds
is increasing. More than one third of patients hospitalized in ICUs develop unex
pected complications. In particular, these patients are at high risk of developing
nosocomial infections. This is a result of the patients' severity of illness and expo
sure to life-saving invasive devices and procedures. Numerous studies have reported
high rates of infection in ICU patients accounting for >20% of nosocomial infec
tions, with increased morbidity and financial cost and a mortality exceeding 40%
(1-7).
The epidemiology of nosocomial infections in ICUs has been extensively studied.
Major sites of infection, associated pathogens, and rates vary considerably within
hospitals by type of ICU, reflecting differences in the hosts' underlying conditions,
types and frequency of invasive devices, patterns of antibiotic use and the selection
pressure, and the unique ICU environments (8-11). These observations suggest that
each type of ICU may require different control measures. In this chapter, we will
provide an overview of predisposing factors for ICU infections, current rates of
infection and the distribution by infection site and pathogens in U. S. hospitals.
R.A. Weinstein and MJM. Bonten (eds.). INFECTION CONTROL IN THE ICU ENVIRONMENT Copyright © 2001.
Kluwer Academic Publishers. Boston. All rights reserved.