DECONTAMINATION
Decontamination strategies in ICU
The recent pandemic has once again highlighted the importance of robust infection prevention strategies in all clinical settings, including ICUs. Anne Savage, a senior staff nurse, and Rachel Crisford, ICU lead nurse, at the Royal Berkshire NHS Foundation Trust, provide an insight into decontamination strategies and discuss the evidence to support best practice.
Nosocomial infections continue to be a significant cause of morbidity, mortality, and added costs in the healthcare setting. Half of all life-threatening nosocomial bloodstream infections and pneumonias occur in intensive care units (ICUs), despite ICUs representing only 15% to 20% of all hospital beds.1
This means that an efficient focus for prevention and control of life-threatening healthcare-associated infections should be in ICUs. This article examines the potential role of decontamination in ICU as part of an overall infection prevention strategy. Healthcare-associated infections (HCAIs) are described as ‘infections occurring in a healthcare setting that were not present prior to a patient entering that care setting,’.2 Estimates of HCAI prevalence vary and the most recent National Institute for Health and Care Excellence (NICE) data estimates a prevalence in hospitals in England of 6.4%.3 However, more recent modelling estimates that, in 2016/2017, in NHS hospitals in England, there could have been 834,000 HCAIs, which potentially cost the NHS £2.7 billion, accounted for 28,500 patient deaths and led to an additional 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England).4 Recent studies have found that 5%-15% of hospitalised patients acquire an HCAI and between 9%-37% of patients admitted to
intensive care units have an HCAI.5
There
is evidence that patients admitted to ICU with an HCAI have a worse clinical outcome (higher mortality and length of stay), and are more severely ill on admission than patients without.6
A study looking at infections in ICU patients found that 26.4% of infections were HCAIs and that they are associated with substantially increased morbidity and mortality.7
Nosocomial infections are caused by
Decontamination helps reduce transmission and prevent disease inStaphylococcus aureus carriers. Using an antimicrobial body wash and nasal gel has been shown to improve health outcomes as well as reduce costs.
DECEMBER 2021
a wide range of microorganisms, some of which are carried by patients themselves. Around 25% to 30% of the UK population are positive for skin or nasal carriage of Staphylococcus.8
include respiratory infections particularly pneumonia and infections of the lower respiratory tract.3 HCAIs are often caused by methicillin-
resistant Staphylococcus aureus (MRSA), methicillin-sensitive Staphylococcus aureus (MSSA), Clostridium difficile (C. diff) and Escherichia coli (E. coli).3
These bacterial
infections commonly occur as a direct result of healthcare interventions (such as medical or surgical treatment), or from being in contact with a healthcare setting.8
It is
recognised that most of these infections are caused by multidrug-resistant organisms.9 The emergence of new infections also poses a risk to patients and staff, as highlighted by
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The most common HCAIs
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