Nosocomial Infection in an Intensive-Care Unit Identification of Risk Factors

Abstract

The important preventive measures derived from our results are that underlying conditions suffered by the patient at the ICU admission should be corrected promptly, the depression of the patient's level of consciousness with sedatives should be monitored carefully, and the horizontal position of the head of the bed should be avoided totally. Patients with a high risk of infection can be the target of special preventive measures.

Nursing considerations to complement the Surviving Sepsis Campaign guidelines

“…Aspiration of upper airway secretions is a common event even in normal healthy adults (33). Semi-recumbent position in mechanically ventilated patients has been associated with lower levels of aspiration into the lower airways (34-36) and lower VAP incidence than the supine position (37)(38)(39). In patients receiving enteral nutrition, head-of-bed elevation is especially effective in reducing the risk of VAP (37).…”

Evidence on measures for the prevention of ventilator-associated pneumonia

“…Some studies have found the semirecumbent position to be associated with lower levels of aspiration into the lower airways [131][132][133] and lower VAP incidence than the supine position [134][135][136]. A recent study by VAN NIEUWENHOVEN et al [137] questioned the efficacy of this measure and its feasibility for daily practice.…”

“…The influence of sedation as a risk factor for VAP has been documented in some studies [11,135,187]. In the study by KRESS et al [187], in which 128 adult patients receiving mechanical ventilation were randomised either to daily interruption of sedative drug infusions until they were awake or were interrupted only at the discretion of the clinician, the daily interruption group had shorter duration of mechanical ventilation (p,0.01) and length of intensive care unit stay (p50.02) than the latter group.…”

Inflammatory Proteins, Genetic Variation, and Environmental Influences on Health Care Associated Infection Development in Sepsis

“…90,91 The relationship of severity of illness and health care associated infections has been described. 10 McCluster et al similarly report that patients who developed HAI had higher APACHE III scores than those who did not develop HAI but the relationship was not statistically significant. 9 Kinasewitz et al analyzed multiple biomarkers from the PROWESS data set (n = 1,690), a randomized controlled trial of recombinant human activated protein C in severe patients with sepsis.…”

“…[2][3][4][5] The mechanism for development of all HAI is unclear; although, predisposing factors such as invasive devices [6][7][8] may be responsible for approximately half of all HAI 9 and severity of illness is a predisposing factor. 9,10 Although the central role of the inflammatory response is to control infections, an exaggerated response may also play a role in the development of HAI.…”