| Abstract: |
Nosocomial pneumonia is defined as pneumonia that appears 48 hours or more after hospitalization. In this definition, it is assumed that the patient was not incubating the causative microorganism when admitted to the hospital. Patients with HAP may be managed in a ward or, when the illness is severe, in ICU. Most cases of HAP occur outside ICUs. However, patients on mechanical ventilation carry the highest risk of HAP and it is in these patients that the entity has been best studied. Ventilator-Associated Pneumonia (VAP) refers to pneumonia that begins and develops after endotracheal intubation. However, a patient who has just undergone tracheotomy and is not yet on a ventilator is similarly susceptible to VAP. Thus, a more appropriate term would be “endotracheal-tube-associated pneumonia”. Device-related or foreign-body-related infection is a complication of medical progress, which has progressively increased over the past three decades and will continue to rise for the foreseeable future. As technological advances in medicine continue to progress, there will be new and innovative devices implanted in patients to prolong and improve the quality of life, and with these new techniques it is predictable that there will be novel infections associated with their implantation. There are numerous devices inserted in the human body for various conditions. Devices that are most prone to infections are usually meant for temporary use but have become long term or permanent due to special needs. These usually involve catheters communicating with a normally sterile site with the surface of the body i.e. urethral catheters and intravascular catheters. It is estimated that 45-50% of all nosocomial infections are related to devices. Devices predispose to infections by breaking or invading the cutaneous or mucosal barriers and by supporting growth of microorganisms. Presence of foreign material impairs the host defense mechanisms locally, and infection or colonization result in chronic infection or tissue necrosis. The extent of the problem can be appreciated with the knowledge that more than 30% of hospitalized patients have one or more vascular catheters inserted; more than 10% of hospitalized patients have indwelling urinary catheters; total hip replacement worldwide exceeds one million a year, and knee replacement more than 250,000. The numbers and diversity of IVDs used for vascular access have dramatically increased over the past 30 years in modern health care centers across the world. The utilization of short-term CVCs of different types are now standard in most modern ICUs. The tremendous increase of utilization of these various IVDs have been accompanied over the years with substantial rise in infectious complications, particularly Bloodstream Infections (BSI). Intravascular devices are now the single most important cause of health care associated bacteremia or BSI. Analysis of the risk of BSIs per 100 devices would clearly show greater risk of infection for longer-term catheters, with very low risk for peripheral intravenous catheters which would normally last for 3-5 days. In more recent years, it has been widely recommended for calculating and reporting infectious rates as BSIs per 1000 catheter days.Objectives: The present essay aim to update the concepts of Nosocomial Infections In The ICU; including its incidence, risk factors, and prophylaxis.
|
|
|