Acute severe community-acquired pneumonia: infection control in ICU · ICU Topics

ICU ward scene showing a staff member performing hand hygiene at the bedside with a WHO Five Moments poster, a patient in contact isolation with gown and gloves, and a chlorhexidine wipe-down of equipment, clinical-blue lighting — FigureInfection control in the ICU — hand hygiene (WHO Five Moments) is the single most effective, lowest-cost measure. Contact precautions, isolation of MDR colonised patients, chlorhexidine bathing and active surveillance cultures break cross-transmission.

SAQ — outbreak investigation in the ICU

SAQ — ICU outbreak: carbapenem-resistant Klebsiella (CRE) in the ICU

10 minutes · 10 marks

Over a 5-day period, three patients in your 12-bed ICU grow carbapenem-resistant Klebsiella pneumoniae (KPC-producing) from sputum and urine cultures. Two are on the ventilator and one is on a renal replacement circuit. The unit has had hand hygiene compliance of 64% on the last audit. You are asked to lead the outbreak response.

[2]

SAQ — A bundle approach to preventing device-related infections in ICU

10 minutes · 10 marks

Your ICU has reported catheter-related bloodstream infection (CRBSI) and ventilator-associated pneumonia (VAP) rates that are above the national benchmark. The medical director asks you to design a quality-improvement programme to reduce these device-associated infections.

[14]

SAQ — MDR organism isolation and hand hygiene compliance

SAQ — Newly admitted patient with suspected multidrug-resistant (MDR) organism colonisation

10 minutes · 10 marks

A 68-year-old man is transferred from a tertiary hospital overseas to your ICU for ongoing management of ventilated respiratory failure. The referral letter flags prior isolation of carbapenem-resistant Acinetobacter baumannii (CRAB) from sputum and vancomycin-resistant Enterococcus (VRE) from rectal screening. Your ICU is at 90% occupancy with no vacant single rooms for the next 6 hours. Outline your isolation and infection-control management.

[1]

SAQ — Designing a hand hygiene quality-improvement programme for the ICU

10 minutes · 10 marks

Your 16-bed ICU's most recent independent audit shows hand hygiene compliance of 58% (target ≥80%, aspirational ≥90%). The lowest-performing moment is Moment 1 (before touching a patient) at 41%. The infection prevention committee asks you to lead a multimodal improvement programme. Outline your approach and the supporting evidence.

[1]

Clinical pearls

High-yight infection control points for the CICM/FFICM exam

Hand hygiene: WHO 5 Moments — most effective infection control measure. Target >90% compliance.[1] }
Alcohol-based hand rub: preferred for routine hand hygiene (faster, better skin tolerance). BUT: NOT effective against C. diff spores — use soap and water.[1] }
C. diff: CONTACT precautions + SOAP AND WATER (alcohol gel does NOT kill spores). Sporicidal disinfectant (chlorine-based) for cleaning.[2] }
TB: AIRBORNE precautions — negative pressure room, N95/P2 respirator for staff. Door closed at all times.[2] }
Contact precautions: gown + gloves for ALL contact. Single room or cohort. Dedicated equipment.[2] }
Droplet precautions: surgical mask within 1 metre. Single room preferred. Door may remain open.[2] }
MDR organisms: contact precautions for MRSA, VRE, ESBL, CRE, MDR Pseudomonas, Acinetobacter.[2] }
Environmental cleaning: high-touch surfaces (bed rails, call button, IV poles, monitors) cleaned daily. Terminal cleaning after discharge.[2] }
Equipment: dedicated equipment for isolated patients (stethoscope, BP cuff, thermometer, glucometer). Do NOT share.[2] }
Visitors: educate on hand hygiene. Gown + gloves if providing direct care. Exclude if symptomatic (respiratory infection, diarrhoea).[2] }
Staff: ill staff should NOT come to work (especially respiratory infection, diarrhoea, skin infection). Vaccination (influenza, hepatitis B, MMR, varicella, TB screening).[2] }
Antibiotic stewardship: minimise antibiotic use → reduces C. diff, MDR selection, antibiotic-associated diarrhoea.[2] }
Audit and feedback: regular audit of hand hygiene compliance, isolation compliance, environmental cleaning. Feedback to staff → improves performance.[1] }
Infection control nurse/committee: dedicated staff for surveillance, education, outbreak investigation, policy development.[2] }

Red flags

ICU-acquired (nosocomial) infections — overview

Why ICU infection control matters

ICU patients carry roughly 5–10× the risk of a healthcare-associated infection (HAI) of ward patients because of: (1) severe illness and immune compromise; (2) multiple invasive devices (endotracheal tube, central venous catheter, urinary catheter, arterial line, surgical drains); (3) broad-spectrum antibiotic exposure that selects resistant organisms; (4) prolonged length of stay; and (5) frequent staff contact and cross-transmission. The five major device-/procedure-associated infections are CRBSI/CLABSI, VAP, CAUTI, SSI and C. difficile infection (CDI). Each is reported as a rate per 1000 device-days, is largely preventable, and is a benchmark of ICU quality. Infection control is therefore a SYSTEM — standard and transmission-based precautions, device bundles, antimicrobial stewardship, environmental hygiene and surveillance — that together target near-zero preventable infections.[1][14]

[14]

The chain of infection — what each control measure breaks

[2]

Hand hygiene — the single most effective measure

WHO Five Moments of hand hygiene educational diagram at the ICU bedside — FigureWHO Five Moments — the highest-yield, lowest-cost infection-control intervention in the ICU.

WHO 5 Moments of Hand Hygiene — the exam answer

Moment 1 — BEFORE touching a patient. Protects the patient from flora carried on your hands (e.g., after touching the bed rail you then take a pulse).[1]
Moment 2 — BEFORE a clean/aseptic procedure. Protects the patient from their own flora and yours entering a sterile site (before line insertion, before wound care, before drawing blood).[1]
Moment 3 — AFTER body-fluid exposure risk. Protects you and the unit from the patient's flora and blood-borne pathogens (after suctioning, after removing a soiled dressing, after handling a urine bag).[1]
Moment 4 — AFTER touching a patient. Protects you and the environment from the patient's flora.[1]
Moment 5 — AFTER touching patient SURROUNDINGS. Surfaces around an infected patient are as contaminated as the patient (bed rails, monitors, IV pumps). The environment is a reservoir — clean your hands after touching it even if you did not touch the patient.[1]

[1]

Hand hygiene compliance and improvement

Target compliance ≥80% (WHO); achievable >90% with a multimodal strategy. Unaided compliance is typically 20–40%, so audit and feedback are essential. Pittet's landmark Geneva study raised compliance from 48% to 66% and halved the HAI rate.[3][4]
WHO multimodal improvement strategy (5 components): (1) system change (ABHR at every point of care); (2) training and education; (3) monitoring and feedback; (4) reminders in the workplace (posters); (5) institutional safety climate (leadership and culture). This is the evidence-based bundle that actually moves compliance.[1]
Barriers to compliance: understaffing, high workload and time pressure, skin irritation, sink inaccessibility, and glove misuse ("I'm wearing gloves so I don't need to clean my hands" — false: gloves are not a substitute; perform hand hygiene on removal).[4]

Infographic of CLABSI and VAP prevention bundles with full-barrier insertion, chlorhexidine, daily line review and head-of-bed elevation — FigureDevice-infection prevention bundles — insertion asepsis, maintenance, and daily necessity review cut CLABSI and VAP rates.

[5]

[6]

Ventilator-associated pneumonia (VAP) — the prevention bundle

Catheter-associated urinary tract infection (CAUTI)

[8]

Surgical site infection (SSI)

C. difficile infection (CDI) — prevention

Multidrug-resistant (MDR) organisms

Educational compare of contact droplet and airborne precautions with example ICU pathogens and PPE engineering controls — FigureTransmission-based precautions — match contact, droplet or airborne controls to the pathogen and the route.

[2] [10]

[2]

MDR organism pearls

MRSA decolonisation options: TARGETED (screen, then mupirocin 2% nasal BD ×5 days plus chlorhexidine body washes) or UNIVERSAL (chlorhexidine bathing of all ICU patients with or without nasal mupirocin). Huang NEJM 2013 cluster-randomised trial: universal decolonisation reduced MRSA clinical isolates by 37% and MRSA bacteraemia by 44%, with no benefit from targeted screening alone.[10]
Chlorhexidine (CHG) daily bathing reduces colonisation with MRSA and VRE and, in some studies, reduces CLABSI and ICU-acquired bacteraemia. Climo 2009 multicentre trial: CHG bathing reduced MRSA acquisition by 32% and VRE acquisition by 50%.[12]
CRE screening: Carbapenem-resistant Enterobacterales are a global public-health threat — screen on admission patients with healthcare exposure in endemic regions, prior CRE colonisation, or transfer from a high-risk facility; use pre-emptive contact precautions while awaiting results.[2]
Cohorting and dedicated staff: during MDR outbreaks, cohort colonised or infected patients and, ideally, dedicate nursing staff to a cohort to prevent cross-transmission between cohorts.[2]
Donning and doffing order matters. DON (put on): gown → mask/respirator → goggles or face shield → gloves. DOFF (take off): gloves → gown → face/eye protection → mask or respirator LAST (to avoid self-contamination). Perform hand hygiene immediately after all PPE is removed.[2]

Antimicrobial stewardship in the ICU

[11] [14]

Environmental cleaning and disinfection

Surveillance cultures and active screening

[2] [14]

Key trials and evidence

Additional red flags

Prognosis and quality metrics

[14]

Final exam-ready pearls

The two questions that prevent most device infections: "Does this patient still need this device today?" and "Was the bundle used when it was inserted?" Daily device review plus bundle-driven insertion prevents the majority of CRBSI, VAP and CAUTI.[5][7][8]
Standard precautions apply to EVERY patient, EVERY time — assume every patient's blood, body fluids, secretions and non-intact skin are potentially infectious. Transmission-based precautions are ADDED on top, never instead of, standard precautions.[2]
Outbreak recognition: a cluster of the same organism (same species and sensitivities) in a unit over days–weeks, or a single case of a high-consequence pathogen (e.g., CRE, measles, TB), should trigger outbreak investigation — case-finding, cohorting, environmental cultures, and reinforcement of hand hygiene and cleaning.[13][14]
Staff vaccination and health: staff immunisation (influenza, hepatitis B, MMR, varicella, COVID-19, TB screening) and exclusion of staff with transmissible illness are part of infection control — the staff member is both a vector and a susceptible host.[2]
The WHO core components of an IPC programme (leadership, guidelines, education, surveillance, multimodal strategies, monitoring/audit, workload/staffing, built environment) are the framework an ICU's infection-control programme is judged against — exam questions on "how to improve an ICU's infection rate" map onto these.[14]

References

[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

[2]

SAQ — outbreak investigation in the ICU

SAQ — ICU outbreak: carbapenem-resistant Klebsiella (CRE) in the ICU

10 minutes · 10 marks

[2]

SAQ — A bundle approach to preventing device-related infections in ICU

10 minutes · 10 marks

[14]

SAQ — MDR organism isolation and hand hygiene compliance

SAQ — Newly admitted patient with suspected multidrug-resistant (MDR) organism colonisation

10 minutes · 10 marks

[1]

SAQ — Designing a hand hygiene quality-improvement programme for the ICU

10 minutes · 10 marks

[1]

Clinical pearls

High-yight infection control points for the CICM/FFICM exam

Hand hygiene: WHO 5 Moments — most effective infection control measure. Target >90% compliance.[1] }
Alcohol-based hand rub: preferred for routine hand hygiene (faster, better skin tolerance). BUT: NOT effective against C. diff spores — use soap and water.[1] }
C. diff: CONTACT precautions + SOAP AND WATER (alcohol gel does NOT kill spores). Sporicidal disinfectant (chlorine-based) for cleaning.[2] }
TB: AIRBORNE precautions — negative pressure room, N95/P2 respirator for staff. Door closed at all times.[2] }
Contact precautions: gown + gloves for ALL contact. Single room or cohort. Dedicated equipment.[2] }
Droplet precautions: surgical mask within 1 metre. Single room preferred. Door may remain open.[2] }
MDR organisms: contact precautions for MRSA, VRE, ESBL, CRE, MDR Pseudomonas, Acinetobacter.[2] }
Environmental cleaning: high-touch surfaces (bed rails, call button, IV poles, monitors) cleaned daily. Terminal cleaning after discharge.[2] }
Equipment: dedicated equipment for isolated patients (stethoscope, BP cuff, thermometer, glucometer). Do NOT share.[2] }
Visitors: educate on hand hygiene. Gown + gloves if providing direct care. Exclude if symptomatic (respiratory infection, diarrhoea).[2] }
Staff: ill staff should NOT come to work (especially respiratory infection, diarrhoea, skin infection). Vaccination (influenza, hepatitis B, MMR, varicella, TB screening).[2] }
Antibiotic stewardship: minimise antibiotic use → reduces C. diff, MDR selection, antibiotic-associated diarrhoea.[2] }
Audit and feedback: regular audit of hand hygiene compliance, isolation compliance, environmental cleaning. Feedback to staff → improves performance.[1] }
Infection control nurse/committee: dedicated staff for surveillance, education, outbreak investigation, policy development.[2] }

Red flags

ICU-acquired (nosocomial) infections — overview

Why ICU infection control matters

[14]

The chain of infection — what each control measure breaks

[2]

Hand hygiene — the single most effective measure

WHO 5 Moments of Hand Hygiene — the exam answer

Moment 1 — BEFORE touching a patient. Protects the patient from flora carried on your hands (e.g., after touching the bed rail you then take a pulse).[1]
Moment 2 — BEFORE a clean/aseptic procedure. Protects the patient from their own flora and yours entering a sterile site (before line insertion, before wound care, before drawing blood).[1]
Moment 3 — AFTER body-fluid exposure risk. Protects you and the unit from the patient's flora and blood-borne pathogens (after suctioning, after removing a soiled dressing, after handling a urine bag).[1]
Moment 4 — AFTER touching a patient. Protects you and the environment from the patient's flora.[1]
Moment 5 — AFTER touching patient SURROUNDINGS. Surfaces around an infected patient are as contaminated as the patient (bed rails, monitors, IV pumps). The environment is a reservoir — clean your hands after touching it even if you did not touch the patient.[1]

[1]

Hand hygiene compliance and improvement

Target compliance ≥80% (WHO); achievable >90% with a multimodal strategy. Unaided compliance is typically 20–40%, so audit and feedback are essential. Pittet's landmark Geneva study raised compliance from 48% to 66% and halved the HAI rate.[3][4]
WHO multimodal improvement strategy (5 components): (1) system change (ABHR at every point of care); (2) training and education; (3) monitoring and feedback; (4) reminders in the workplace (posters); (5) institutional safety climate (leadership and culture). This is the evidence-based bundle that actually moves compliance.[1]
Barriers to compliance: understaffing, high workload and time pressure, skin irritation, sink inaccessibility, and glove misuse ("I'm wearing gloves so I don't need to clean my hands" — false: gloves are not a substitute; perform hand hygiene on removal).[4]

[5]

[6]

Ventilator-associated pneumonia (VAP) — the prevention bundle

Catheter-associated urinary tract infection (CAUTI)

[8]

Surgical site infection (SSI)

C. difficile infection (CDI) — prevention

Multidrug-resistant (MDR) organisms

[2] [10]

[2]

MDR organism pearls

MRSA decolonisation options: TARGETED (screen, then mupirocin 2% nasal BD ×5 days plus chlorhexidine body washes) or UNIVERSAL (chlorhexidine bathing of all ICU patients with or without nasal mupirocin). Huang NEJM 2013 cluster-randomised trial: universal decolonisation reduced MRSA clinical isolates by 37% and MRSA bacteraemia by 44%, with no benefit from targeted screening alone.[10]
Chlorhexidine (CHG) daily bathing reduces colonisation with MRSA and VRE and, in some studies, reduces CLABSI and ICU-acquired bacteraemia. Climo 2009 multicentre trial: CHG bathing reduced MRSA acquisition by 32% and VRE acquisition by 50%.[12]
CRE screening: Carbapenem-resistant Enterobacterales are a global public-health threat — screen on admission patients with healthcare exposure in endemic regions, prior CRE colonisation, or transfer from a high-risk facility; use pre-emptive contact precautions while awaiting results.[2]
Cohorting and dedicated staff: during MDR outbreaks, cohort colonised or infected patients and, ideally, dedicate nursing staff to a cohort to prevent cross-transmission between cohorts.[2]
Donning and doffing order matters. DON (put on): gown → mask/respirator → goggles or face shield → gloves. DOFF (take off): gloves → gown → face/eye protection → mask or respirator LAST (to avoid self-contamination). Perform hand hygiene immediately after all PPE is removed.[2]

Antimicrobial stewardship in the ICU

[11] [14]

Environmental cleaning and disinfection

Surveillance cultures and active screening

[2] [14]

Key trials and evidence

Pronovost 2006 — Michigan Keystone (CRBSI bundle)

[5]

Huang 2013 — REDUCE MRSA (universal decolonisation)

[10]

Climo 2009 — CHG bathing to reduce MRSA and VRE acquisition

[12]

Harbarth 2008 — universal MRSA admission screening

[15]

Pittet 2000 — Geneva hand-hygiene programme

[3]

Additional red flags

Prognosis and quality metrics

[14]

Final exam-ready pearls

The two questions that prevent most device infections: "Does this patient still need this device today?" and "Was the bundle used when it was inserted?" Daily device review plus bundle-driven insertion prevents the majority of CRBSI, VAP and CAUTI.[5][7][8]
Standard precautions apply to EVERY patient, EVERY time — assume every patient's blood, body fluids, secretions and non-intact skin are potentially infectious. Transmission-based precautions are ADDED on top, never instead of, standard precautions.[2]
Outbreak recognition: a cluster of the same organism (same species and sensitivities) in a unit over days–weeks, or a single case of a high-consequence pathogen (e.g., CRE, measles, TB), should trigger outbreak investigation — case-finding, cohorting, environmental cultures, and reinforcement of hand hygiene and cleaning.[13][14]
Staff vaccination and health: staff immunisation (influenza, hepatitis B, MMR, varicella, COVID-19, TB screening) and exclusion of staff with transmissible illness are part of infection control — the staff member is both a vector and a susceptible host.[2]
The WHO core components of an IPC programme (leadership, guidelines, education, surveillance, multimodal strategies, monitoring/audit, workload/staffing, built environment) are the framework an ICU's infection-control programme is judged against — exam questions on "how to improve an ICU's infection rate" map onto these.[14]

References

[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

Your progress

SAQ — outbreak investigation in the ICU

SAQ — ICU outbreak: carbapenem-resistant Klebsiella (CRE) in the ICU

SAQ — A bundle approach to preventing device-related infections in ICU

SAQ — MDR organism isolation and hand hygiene compliance

SAQ — Newly admitted patient with suspected multidrug-resistant (MDR) organism colonisation

SAQ — Designing a hand hygiene quality-improvement programme for the ICU

Clinical pearls

Red flags

ICU-acquired (nosocomial) infections — overview

The chain of infection — what each control measure breaks

Hand hygiene — the single most effective measure

Catheter-related bloodstream infection (CRBSI / CLABSI)

Ventilator-associated pneumonia (VAP) — the prevention bundle

Catheter-associated urinary tract infection (CAUTI)

Surgical site infection (SSI)

C. difficile infection (CDI) — prevention

Multidrug-resistant (MDR) organisms

Antimicrobial stewardship in the ICU

Environmental cleaning and disinfection

Surveillance cultures and active screening

Key trials and evidence

Pronovost 2006 — Michigan Keystone (CRBSI bundle)

Huang 2013 — REDUCE MRSA (universal decolonisation)

Climo 2009 — CHG bathing to reduce MRSA and VRE acquisition

Harbarth 2008 — universal MRSA admission screening

Pittet 2000 — Geneva hand-hygiene programme

Additional red flags

Prognosis and quality metrics

References

Your progress

SAQ — outbreak investigation in the ICU

SAQ — ICU outbreak: carbapenem-resistant Klebsiella (CRE) in the ICU

SAQ — A bundle approach to preventing device-related infections in ICU

SAQ — MDR organism isolation and hand hygiene compliance

SAQ — Newly admitted patient with suspected multidrug-resistant (MDR) organism colonisation

SAQ — Designing a hand hygiene quality-improvement programme for the ICU

Clinical pearls

Red flags

ICU-acquired (nosocomial) infections — overview

The chain of infection — what each control measure breaks

Hand hygiene — the single most effective measure

Catheter-related bloodstream infection (CRBSI / CLABSI)

Ventilator-associated pneumonia (VAP) — the prevention bundle

Catheter-associated urinary tract infection (CAUTI)

Surgical site infection (SSI)

C. difficile infection (CDI) — prevention

Multidrug-resistant (MDR) organisms

Antimicrobial stewardship in the ICU

Environmental cleaning and disinfection

Surveillance cultures and active screening

Key trials and evidence

Pronovost 2006 — Michigan Keystone (CRBSI bundle)

Huang 2013 — REDUCE MRSA (universal decolonisation)

Climo 2009 — CHG bathing to reduce MRSA and VRE acquisition

Harbarth 2008 — universal MRSA admission screening

Pittet 2000 — Geneva hand-hygiene programme

Additional red flags

Prognosis and quality metrics

References