1. ICU Infections and their Medical
Management
Dr. Aniket Geete

2. .
The very f irst
requirement in a
hospit al is t hat it
should do t he sick no
harm

3. Background
ICUs-<10% of total beds in most hospitals,
>20% of all infections
ICU inf-Leading cause of death in non-cardiac
ICUs and account for 40% of all ICU expenditures.
Prevalence of hosp acquired infections (HAIs) in
ICU patients
26.4 per cent and higher than overall prevalence of
7.03 per cent. It has doubled in the last 3 years*
*Point prevalence surveys of hospital acquired infections, device and antimicrobial use over three years in a tertiary care
hospital in India. Aug 2012. Kumar A, Dhaliwal N, Manisha, Ray P Department of Microbiology and Department of Hospital
Administration

4. 4,209 patients in 124 ICUs (17 states)
26% contracted sepsis, 42.2% of them died of
sepsis
UTIs-Most freq HAIs in high-income countries
Surgical site infection-Leading cause-India,
affecting 1/3 of operated patients,
Nine times higher than in developed countries.
Device-associated infection densities in India are
up to 13 times higher than in the US.
Only one in 10 ICUs observes practices that are
vital to keep it infection free.
Indian Intensive Care Case Mix and Practice Patterns
(INDICAPS)

5. Consequences
SIRS
Sepsis
Severe sepsis
Septic shock
Multiple organ dysfunction
syndrome (MODS)

6. Antibiotics

7. Rx
 β Lactams
 Vancomycin
 Aminoglycosides

8. Candidaemia
 1% - 2% of ICU patients
 90% occur in general pts
 Mortality rate 30% to 40%
 ↑ length of ICU stay / health care costs

9. Risk factors
 Immunosuppression
 CVC
 TPN
 Recent GI surgery
 Burns
 DM
 Length of stay
 Prolonged exposure to antibiotics
 High APACHE II score
 Prior colonisation

10. Anti-fungal agent ←ICU
Rx
 General ICU → Fluconazole
 Prior azole or Haem pt → Caspofungin

11. Summary
 Aggressive investigation
 Aggressive in starting and stopping
antibiotics
 Knowing the microbiology
 Prevention

12. Hand hygiene
 Hand washing w alcohol-based solution for 90
seconds is the single most important
intervention that can cut down 90% of HAIs
 Alcohols →excellent in vitro activity against
Gram+ and Gram-bacteria, including
 MDR pathogens, viz MRSA and Vancomycin-
resistant enterococci, Myco tuberculosis,
 a variety of fungi, and
 most viruses.
Crit Care Med. 2010 Aug;38(8 Suppl):S299-305. doi: 10.1097/CCM.0b013e3181e6a23f., Hand hygiene in the intensive care unit.
Tschudin-Sutter S, Pargger H, Widmer AF

13. New advances
 Varanasi doctors have developed an electro-mechanical
device called 'Exit all', which can prevent the infections
susceptible in ICUs. "Once attached to the ventilator, it
does not allows the infected air to go in the environment
of ICU and rather purifies it”
 Patients cared for in ICU rooms with copper alloy
surfaces had a significantly lower rate of incident HAI
and/or colonization with MRSA or VRE than did patients
treated in standard rooms. *
Infect Control Hosp Epidemiol.2013 May;34(5):479-86. Copper surfaces reduce the rate of healthcare-acquired infections in the
intensive care unit. Salgado CD

14. Thank you!
.