Nosocomial infections in intensive care units: an overview of their epidemiology, outcome, and prevention.

Among all hospitalized patients, ICU patients are at greatest risk for both endemic and epidemic nosocomial infections. The highest infection rates are seen in surgical, burn, trauma, and neonatal ICUs. Acquisition of infection is a major determinant of mortality in ICUs, and prolongs the length of ICU stay. Predominant pathogens include Pseudomonas aeruginosa, Enterobacter cloacae, Staphylococcus aureus, enterococci, and Candida spp. They are more likely to be resistant to antimicrobial agents than are isolates from elsewhere in the hospital. Exposure to invasive medical devices is the predominant risk factor for infection, and strategies to prevent infection are aimed at reducing microbial colonization on and around devices. Improvements in technology, such as coating devices with antimicrobial agents, have been shown to be efficacious in preventing infection. Handwashing, particularly with antiseptic soaps, remains the cornerstone of infection control in the ICU.