Skip to Main Content




  • Focused surveillance for health care–associated infections is the cornerstone of infection prevention activities in the ICU.

  • Commonly used invasive devices such as central venous and urinary catheters and endotracheal tubes are significant risk factors for health care–associated infection. Evidence-based ICU policies and procedures and staff education can reduce the risk of device-related infections.

  • Antibiotic resistance is an increasing problem, and its containment and prevention require a multifactorial approach, including adequate hand hygiene, surveillance for resistant pathogens, enforced infection control precautions, and prudent use of antibiotics.

  • Standard infection control precautions should be applied to all ICU patients. Precautions for contagious or epidemiologically significant pathogens are based on modes of transmission.




Health care–associated infections result in significant morbidity and mortality. Health care–associated infections have been reported to affect approximately 2 million hospitalized patients in the United States annually, at an estimated cost of $57.6 billion in 2000 and approximately 100,000 deaths.1-3 ICU beds, while only accounting for 5% to 10% of all hospital beds, are responsible for 10% to 25% of health care costs generated.4 Patients admitted to the ICU have been shown to be at particular risk for health care–associated infections, with a prevalence as high as 30%.5 Given the increasing strain on health care resources in the United States and other countries, and the personal impact that these infections have on patients, the prevention of nosocomial infections in the ICU should be an important goal of any critical care clinician.


A likely explanation to account for the observation that ICU patients are more vulnerable to acquiring a health care–associated infection compared with other hospitalized patients is that critically ill patients frequently require invasive medical devices, such as urinary catheters, central venous and arterial catheters, and endotracheal tubes. Data on a sample of ICUs from the Centers for Disease Control and Prevention (CDC) show that adult ICU patients have central venous catheters in place and receive mechanical ventilation an average of 53% and 42% of their total time spent in the ICU, respectively.6 These devices result in infection by compromising the normal skin and mucosal barriers and serving as a nidus for the development of biofilms, which provide a protected environment for bacteria and fungi. In a survey of cases of ICU-acquired primary bacteremia, 47% were catheter related.7 While the increased severity of illness of ICU patients makes intuitive sense as a potential risk factor for health care–associated infection, few studies have shown a consistent relationship.8 This may be explained, however, by the fact that scoring systems were developed primarily to predict mortality and may not adequately capture markers for health care–associated infection, such as the need for prolonged parenteral nutrition.


Infection control in the ICU arose from hospital-wide infection control programs developed in response to the staphylococcal pandemic of the late 1950s and early 1960s. In 1976, the CDC initiated the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.