ICU ACQUIRED INFECTIONS - DOCUMENTATION AND ANALYSIS Role of Diagnostic Microbiology

1. Dr.T.V.Rao MD
An ICU is a consolidated area of a hospital where patients with acutely life-
threatening illnesses or injuries receive around the clock specialized medical
and nursing care, such as mechanical ventilation and invasive cardiac
monitoring. Mortality rates in patients admitted to the ICU average 10-20% in
most hospitals. Today many patients are subjected to ICU care in spite of lack
of Indications, who deserves ICU care lacks clarity for whom to admit or not ,
many public Institutions are overcrowded with ICU patients, so every hospital
should have a plan to expand ICU capacity and I will present some data mainly
focusing on the nurses AND resident Doctors, care in hospital ICU s is strongly
influenced by whether “intensivists” are providing care and the staff
organization in the ICU are following the guidelines in infection control and
prevention. Intensivists are familiar with the complications that can occur in
the ICU and, thus, are better equipped to minimize errors. Leapfrog defines
intensivists as either: if we understand principles of caring the patients nursing
care remain the boon for better survival of patients and reduction of infections
Staff organization in the ICU is also important. In general, hospitals have either
“open” or “closed” ICU s. In an open system, patients receive care primarily
from physicians with responsibilities outside the ICU. Critical care specialists
are often available to provide expertise on a consultation basis. In a closed
system, patients are cared for exclusively by critical-care specialists or teams
that are closer on hand for both fine-tuning routine care and dealing with
emergencies. “Never forget the ICU care involves the physical aspects of the
caring and above all main theme remain with caring to reduce the Infection
Another proposal would be to have different team organization. One might
have one nurse with expertise in ICU procedures, while you have another

2. nurse with no specific expertise, assigning the specific responsibility remain
with the chief consultant and mixing of the duties creates confusion and
spread of Infection, human management with expertise remain with reduction
of infections however If they work together they may be able to share the
workload, and might be able to handle more patients. But probably it will be
the most difficult issue related to crises. When so many people deserve ICU
care ”As a Microbiologist that major issues in ICU care remain with Hospital
Associated Infections, If I see laboratory reports if well documented many
patients attain the Multi drug resistance strains during the care, and remain
the Major cause of Mortality and morbidity, if audited well.. Surveillance of
infections acquired in ICU s specifically targets a group of patients at high risk
of morbidity and mortality associated with health care-associated infections
(HAI). It is one of the most frequently implemented surveillance protocols in
the national networks for the surveillance of Hospital associated Infections.
Microbiologists should plan to document the results originated in the
Diagnostic Microbiology laboratories on the incidence of ICU-acquired
pneumonia, bloodstream infections, urinary tract infections and catheter-
related infections. The established documentation system also collects data on
common antimicrobial resistance markers in microorganisms responsible for
ICU-acquired infections and, optionally, on antimicrobial use in the ICU. The
hospitals using the WHONET can easily retrieve the information documented
from the patients in critical care units, surveillance of ICU-acquired infections
can compare its own infection rates to those of other hospitals/ICU s. This
supports sharing of best practices and allows assessing the effect of infection
control measures. We can connect our computers to Internet we can compare
and document results of ongoing drug resistance patterns with other
professional colleagues anywhere in the world, which alone can enlighten on
trends in Infection.
I wish the Young generation of Medical Microbiologists should play
a greater role as Clinical Microbiologists for effective use of our
Knowledge on matters of Infection.
Dr.T.V.Rao MD Professor of Microbiology Travancore Medical College, Kollam
Kerala