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Why are ICU patients vulnerable to infections?

Infections are a common reason for patients to be admitted to an intensive care unit. But, unfortunately, patients can also pick-up new infections while they are in the ICU. ICU patients are vulnerable to infection for several reasons:

  • The immune system does not function normally during critical illness. So the body’s natural defenses are not working properly;
  • Invasive devices – such as needles and tubes – are put into the body as part of the regular treatments of the ICU. These devices bypass the body’s normal defenses such as the outer layers of skin;
  • Invasive treatments that may increase the risk of infection include:

o Airway intubation to assist breathing;

o Intravenous (IV) lines to administer medications;

o Foley catheters to drain the bladder.

What are the most common types of infection in the ICU?

At any given time, about half of ICU patients are being treated for some type of infection. The most common ICU infections include:

  • Ventilator-associated pneumonia (related to being on a mechanical ventilator for breathing support);
  • Central line-associated bloodstream infection (related to the intravenous lines);
  • Catheter-associated urinary tract infections (related to the urinary or Foley catheters);
  • Surgical site infections (related to surgeries undergone before or during ICU stay);
  • Clostridium difficile infection (a bowel infection that can happen after antibiotic use).

What is being done to reduce the risk of infection?

It is impossible to prevent all infections in this critically ill group of patients, but the ICU and hospital teams work hard at implementing best practices to reduce the number of infections, diagnose them as early as possible, and treat them quickly and effectively when they do arise.

Some of these precautions start as soon as a new patient enters the ICU:

  • Upon arriving in the ICU, a bacterial screening swab is taken and sent to a lab for testing to determine if the patient is already carrying any antibiotic-resistant bugs;
  • Patients who are found to have an antibiotic-resistant bug are separated from the other patients to prevent it from spreading;
  • Patients are also isolated if they are suspected of having a possible viral respiratory infection, or a vomiting and diarrheal illness.

The teams also use other measures to keep infections in check. You might have noticed some of these approaches in the ICU, such as:

  • Keeping the head of the bed raised above 45 degrees to lower the risk of ventilator associated pneumonia;
  • Special sterile techniques to insert intravenous lines to prevent line-associated infections;
  • Avoiding unnecessary over treatment with antibiotics, because this can lower the risk of Clostridium difficile and reduce the emergence of new antibiotic resistant bugs.

What does it mean if a patient tests positive for an antibiotic-resistant bug?

In many cases, a positive test result simply means that an antibiotic-resistant organism is living on the skin or in the gut, but it doesn’t cause the patient any harm. However, it is important that the bug not be spread to other patients who may be more vulnerable to the infection. So certain precautions need to be taken to contain the bug, including separating the patient from the others.

  • A warning sign will be placed on the door of the isolation room;
  • The sign will indicate what type of personal protective equipment (PPE) is to be worn by staff and family, such as masks, gloves and gowns;
  • When in doubt, please ask staff for help.

How are infections treated in the ICU?

For those patients who get an infection in the ICU, the treatment usually includes:

  • A course of targeted antibiotic medication;
  • In some cases, certain measures can help control the source of infection, such as draining an abscess or removing an infected intravenous line.

What can family members do to reduce the spread of germs?

It is important to have as healthy an environment as possible. In order to reduce the spread of germs, we ask you to

  1. Stay home when you are sick;
  2. Don’t eat or drink in patient care areas;
  3. Clean hands using alcohol based hand rub before and after your visit;
  4. Don’t bring in pets;
  5. Eliminate or minimize the amount of personal belongings you are bringing to a visit.

If your loved one suffers from an infection and is in isolation, you are required to wear protective equipment. Watch these videos that show you how to put on and take off this equipment: putting on personal protective equipment and removing personal protective equipment.

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Location and contact

Critical Care Medicine

Sunnybrook Health Sciences Centre
2075 Bayview Avenue, 
D-wing, 1st floor
room D1 08
Toronto, ON M4N 3M5

Phone: 416-480-4522
Fax: 416-480-4999

For information about patients admitted to Sunnybrook's Intensive Care Units, please contact the unit through the hospital switchboard at 416-480-6100