Prevention of Infection in Intensive Care Unit

Recommendations

Nurse to patient ratio must be at least one nurse to two patients (Strong Recommendation, High Grade Evidence)

Use Standard Precautions as recommended for all patient interactions (Strong Recommendation, High Grade Evidence)

Provide supplies and equipment necessary for the consistent observance of Standard Precautions, including hand hygiene products and personal protective equipment (Strong Recommendation, Moderate Grade Evidence)                                        

In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens (Strong Recommendation, Moderate Grade Evidence)                                                                                                                            

During the delivery of healthcare, avoid unnecessary touching of surfaces in close proximity to the patient to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces. (Strong Recommendation, Moderate Grade Evidence)                                                                                                                                                   

Monitor the incidence of epidemiologically-important organisms and targeted HAIs that have substantial impact on outcome and for which effective preventive interventions are available; use information collected through surveillance of high-risk populations, procedures, devices and highly transmissible infectious agents to detect transmission of infectious agents in the healthcare facility. (Strong Recommendation, High Grade Evidence)                                                                                                 

Key Considerations for General Infection Prevention and Control in the ICU

Infection prevention and control in the ICU requires strict application of general IPC principles and close coordination with the hospital-wide IPC program. The ICU environment carries a high risk for HAIs due to frequent use of invasive devices, critical illness, and prolonged hospitalization.

The following key considerations highlight essential IPC practices in the ICU and indicate cross-reference to relevant general guideline sections.

1.  Standard Precautions

All ICU care activities must comply fully with Standard Precautions as outlined in the general IPC guidelines. These include:

·    Hand hygiene before and after patient contact and procedures. Refer to chapter of hand hygiene

·    Use of appropriate personal protective equipment (PPE). Refer to chapter of Personal protective equipment

·    Safe Injection Practices. Refer to chapters of aseptic technique and safe injection practices

·    Respiratory Hygiene / Cough Etiquette. Refer to chapter of Cough etiquette and respiratory hygiene practices

·    Linen and Laundry Handling. Refer to chapter of safe management of linen in hospitals

·    Environmental cleaning and disinfection. Refer to chapter of management of environmental safety and cleaning in hospitals

·    Waste Management. Refer to chapter of waste management

2.  Transmission-Based Precautions

Apply Contact, Droplet, or Airborne Precautions in addition to standard precautions whenever patients are known or suspected to be infected or colonized with specific pathogens.
Ensure appropriate patient placement, signage, dedicated equipment, and adherence to donning/doffing procedures.

→ Refer to Transmission-Based Precautions chapter

3.  Device-Associated Infection Prevention Bundles

Implementation of evidence-based care bundles is essential to reduce device-associated HAIs, including:

·    Ventilator-Associated Pneumonia (VAP) Prevention Bundle

·    Central Line-Associated Bloodstream Infection (CLABSI) Prevention Bundle

·    Catheter-Associated Urinary Tract Infection (CAUTI) Prevention Bundle

Bundle compliance should be monitored regularly and integrated into ICU quality indicators.

→ Refer to: prevention of central line associated bloodstream infections, prevention of catheter associated urinary tract infections, Prevention of Ventilator associated Pneumonia chapters

4.  Surveillance

Conduct continuous surveillance for HAIs within the ICU using standardized definitions and methods. Monitor infection rates (VAP, CLABSI, CAUTI, SSI), device utilization ratios, and antimicrobial resistance patterns.

Provide regular feedback to ICU teams to guide improvement actions.

→ Refer to: Surveillance of Healthcare associated Infections in Healthcare Facilities chapter

5.  Multidrug-Resistant Organisms (MDROs)

Prevent and control the spread of MDROs through:

·    Early identification and screening of high-risk patients.

·    Strict adherence to Contact Precautions and environmental cleaning.

·    Judicious antimicrobial use.

·    Communication of MDRO status during patient transfer.

→ Refer to: Management of multidrug-resistant organisms (MDROs) and outbreak situations chapter

6.  Post-Exposure Prophylaxis (PEP) and Occupational Safety

ICU staff are at increased risk of exposure to blood and body fluids.
Immediate reporting, risk assessment, and management following occupational exposure are mandatory. Ensure staff are vaccinated as per national recommendations.

→ Refer to:  Post-Exposure Prophylaxis Among Healthcare Workers chapter

7.  Antimicrobial Stewardship (AMS)

Rational antibiotic prescribing is a core element of ICU IPC.

·    Participate in daily antibiotic review and de-escalation based on culture results.

·    Limit prophylactic antibiotic use to defined indications and durations.

·    Regularly review antimicrobial resistance trends.

→ Refer to:  Implementing an Antibiotic Stewardship Program chapter

8.  Education, Training, and Auditing

All ICU healthcare workers should receive regular IPC training focusing on hand hygiene, aseptic technique, PPE use, and device-care bundles.
Routine auditing and feedback should be conducted to reinforce compliance and promote a culture of safety.

→ Refer to key performance indicators provided in each chapter

9.  Integration with Hospital IPC Program

The ICU IPC team must work in coordination with the hospital-wide IPC Committee for:

·    Data sharing and trend analysis.

·    Participation in outbreak investigations.

·    Implementation of corrective and preventive actions.