The work done at the intensive care unit is only getting more complicated by the day. The steady evolution of medicine and the increasing lifespans of people around the world have made the work of intensivists more trying them ever.
The birth of ICUs can be attributed to the outbreak of polio epidemics in Copenhagen in 1950’s. It was a masterpiece when it came to organizing and optimizing the healthcare processes. The sheer management and attention to detail is what made this process stand out from every other. Multidisciplinary teams were employed, along with the logistics required for such proliferation. Finally, and most importantly, there was stringent quality checking at every level to ensure the highest standards of care.
The learnings from Copenhagen were incorporate across the world. ICUs became a norm in hospitals and verily became the cornerstone of intensive treatment. The understanding remains that it is only in the intensive care unit that a patient with serious ailment will get any succor.
Having said that, the ICU, too, is not immune to its own share of problems. Infections are one of the biggest issues that plague an ICU. Let’s take a look at infections and their role in the ICU.
ICU Patients are Vulnerable to Infections
The keyword in every ICU around the world is vigilance. There are a number of issues of infections that can be countered through a simple adherence to rules and technology. Using gloves, sharp covers, air exchanges etc. can ensure that infections don’t spread. But to use this all, there needs to be constant vigilance.
Another thing that also plays a major role in contracting infections in the ICU is the time spent by the patient there. The more time a patient spends in the ICU the more they are vulnerable to the contracting an infection. Among hospitals around the world, the practice of constant surveillance of ICU patients has become common.
Patients in ICUs are often bedridden and have a number of devices attached to them at all times. All of which vastly increases their risk of exposure to diseases. The presence of invasive devices exponentially increases the risk of infection since they provide a direct means of entry for bacteria. But these devices are lifesavers and the cost-benefit analysis always comes out in their favour. The only way then, that remains to avoid infection, is to be constantly monitoring the patient and their status.
Common ICU Infections
There are some common and widespread infections that haunt ICUs around the world. While preventive measures can keep them controlled, they are still around.
Ventilator-Associated Pneumonia: This disease usually occurs 48 hours after the mechanical ventilation is given to the patient. This ventilation could be done through the means of an endotracheal tube or tracheostomy. Invasion of microorganisms into the lower respiratory tract and lung parenchyma. Intubation too can lead to this issue as it compromises the integrity of the oropharynx and the trachea. This infection has a high mortality rate and can also greatly increase the hospitalization costs.
Bloodstream Infection: Central line associated bloodstream infection is a very serious infection in the ICU. This usually occurs when germs enter the bloodstream through the central intravenous line. This is exactly why there are strict protocols ensured when inserting the central line in a patient. Infection control practice every time the line is checked or the dressing is changed is prima facie. Patients with this infection often have red skin and soreness around the central line. There are tests that can help doctors identify the infection.
Urinary Tract Infections: Many patients in the ICU are bedridden and because of this they need to be attached to a catheter. Among all the UTIs contracted in hospitals, 75% are catheter related. Nearly 15-25% of patients in the hospitals receive catheters. There are protocols to ensure that the infection does not spread, but the sheer invasiveness of the device often makes them redundant.
Surgical Site Infections: Surgical site infections, unfortunately are very common in the ICU. An NCBI report studying over 300 patients found almost 269 cases of surgical site infections. The occurrence of this infection among patients requiring ICU treatment is so high that it urges an entirely different antibiotic treatment pattern for patients in intensive care. While this does not have a significant mortality rate, it behoves hospitals to be aware of the problem and work towards curtailing it.
Clostridium Difficile Infection: This is a bowel infection common among those that have been given long doses of antibiotics. People who have this infection can exhibit watery diarrhea three or more times a day, mild abdominal cramping and tenderness. Prolonged use of antibiotics can change the flora of your gut and can result in this infection. Serious cases of this infection may prove to be very painful.
Steps Taken to Reduce ICU Infections
At Regency Medical Center we give a great deal of attention to ensuring that our patients do not fall prey to infections in the ICU. We have a list of strict protocols that we follow and our doctors, nurses and other healthcare staff is constantly vigilant about infections and their spread.
Every patient is checked on arrival at the hospital. A swab is taken to check if they are carrying an antibiotic resistant bacteria. If they are, they are immediately separated from other patients to prevent its spread.
Patients at high risk are screened regularly to ensure they haven’t fallen prey to an infection.
Those with possible viral illness, respiratory infection or diarrheal infection are isolated to ensure the infection does not spread.
The bed is raised above 45 degrees to reduce the risk of ventilator-associated pneumonia.
A sterile protocol is implemented to ensure there are no infections spread through the central line.
Over treatment with antibiotics is strictly avoided to ensure gastrointestinal infections do not occur.
There are strict hygiene measures followed at every level of the procedure. All our doctors, nurses and healthcare professionals are thorough about maintaining the highest levels of hygiene.
Contact transfer is mitigated by a series of hygiene protocol strictly maintained at every level among the hospital staff.
Family Members and Infection Prevention
One of the biggest causes of concerns for ICU patients and doctors alike is visitors to intensive care. The common practice of restricting visitors to patients in intensive care arises out of the need to avoid infections. There are a number of things that family members can do to ensure that they are not bringing any infections into the ICU. Here are some of them:
Do not visit the patient even if you are slightly ill.
Do not bring food and drink in patient care areas, there can be germs in them that you are immune to but the patients might not.
Clean your hands with an alcohol based sanitizer to prevent the transfer of germs.
Pets are a strict no no.
Minimize or completely eliminate the number of personal belongings you bring to the hospital.
If the patient is in isolation, make sure you wear the required protective gear to protect them and yourself.
ICUs are some of the most vulnerable areas of the hospital and proper precautionary measures are essential to avoid infections. At Regency Medical Centre we make sure that we follow a strict protocol to protect our patients at every level of treatment, making their stay as pleasant as possible.