Mini Review

General Infection Control in the Intensive Care Unit

 

Burcu Tanay Demirdöven1, Mehmet Çağatay Gürkök2, Yasin Levent Uğur2, Uğur Koca2*

1Buca Seyfi Demirsoy Hospital Emergency Department, Turkey

 

2Dokuz Eylül Univercity School of Medicine Anesthesiology and Reanimation Department, Turkey

Received Date: 18/06/2020; Published Date: 13/07/2020

 

*Corresponding author: Uğur Koca, Department of Anesthesiology and Reanimation, Turkey

DOI: 10.46718/JBGSR.2020.03.000063

Cite this article: Uğur Koca, General Infection Control in The Intensive Care Unit, Op Acc J Bio Sci & Res 3(1)-2020.

Keywords: nutrition; infection; albumin

Nutrition

Globally, different abiotic stresses like heat, heavy metals, flooding, salinity, cold and drought are the major reasons for reduction in development, growth and agriculture crop production [1]. Among all these different abiotic stresses the drought or water scarcity is the most important factor which limits the agriculture crop production [2]. Insufficient availability of water during crop life cycles limits the crop growth and never allows crop to shows its full genetic potential. Mostly every crop is very sensitive to drought stress, mainly during the stage of flowering to seed development. Even drought-resistant crops are negatively affected due to scarcity of water at reproductive and seed development stage [3]. The starting response of drought is closure of stomata which decreases the ability of photosynthesis and final dry matter [4]. Crop gathers proteins and osmolytes mainly intent resilience of stress under conditions of water deficiency and reduces the damage. In addition, plant tolerance equilibrium acts as radicals scavenging and decreases the harmful effects of the cells in abiotic stress conditions [5]. The attributes related to crop morphology such as thickness of roots and its development like ability of crop roots to break compact soil layers, its biomass and depth reduces stress tolerance [6]. It results in lessened germination, growth and seedling development [7] causes death of plant at premature stage [8] and reduces the plant harvestable yield [9]. Many researchers reported the negative effects of water stress on seed germination, growth and development of many crops like sugar beet [10], sunflower [11], kochia [12], sorghum [13] and maize [14]. Therefore, it desired to study the drought mechanism and adopt some strategies to combat drought stress to improve crop production. There are many methods to improve drought tolerance in the crops but application of selenium under drought stress is the best and most economical way to improve drought tolerance and reduce yield losses caused by water scarcity. Selenium is quite similar with Sulphur in several ways such as atomic size, electronegativity and both have similar oxidation states [15]. The Se antioxidant and physiological properties increased the oddity of many agriculture scientists in last few decades. While it does not directly take part in different process of metabolism of plants but helps to decrease the damage of crops under many physiological stresses [16,17].

 

Different studies confirmed the Se positive role against different abiotic stresses like, high temperature [16], salt [18], senescence [19], cold [20] UV-B [21], heavy metals [22], low water and excess water [23]. Several reports on selenium role for improving drought resistance are scanty. Se can regulate the status of water [24] and significantly increases production of biomass [25] by antioxidant apparatus activation of plants facing water stress. In past few decades literature shows positive effects of selenium at very low concentration in increasing tolerance of plant to drought and improving plants growth [26], increasing carotenoids and chlorophyll contents in leaves of plants [27], regulating status of water [28], compatible solutes accumulation and antioxidant machinery activation. Keeping in mind the importance of selenium, the present review focuses on effect of drought on agriculture crop production and role of selenium for improving crop production under drought conditions.

Glycemic Control

Hyperglycemia negatively affects neutrophil function, phagocytosis and cytokine activation [6]. Strict glucose control reduces mortality and morbidity in intensive care [7].

Training Of Intensive Care Personnel

Periodic training reduces the rate of infection [8]. Reduced risk of infection in certified nurse care [9]. High patient / nurse ratio increases the risk of infection [10].

Intensive Care Environment

Microorganisms can be everywhere in intensive care; hands, door handles, computers, etc. Periodically, staff should be given environmental cleaning and hand hygiene training.

 

For the cleanliness of the environment [11]

ultraviolet light sterilization lamps hydrogen peroxide can be used in Steam decontamination instruments

even if the source patient leaves intensive care, his room may continue to harbor pathogens. Air and water filtration systems can be a source of pathogens [12]. Water tap P. may colonize with aeroginosa, water filter placement reduces this risk [13].

Isolation Measures

Standard measures [14]
a.        Gloves should be worn before contact with blood and body fluids, damaged skin and mucous membranes.
b.       Hands should be washed after the gloves are removed
c.        Mask, glasses and apron should be worn if there is a possibility of splash
d.       The apron should be waterproof
e.        Needles must be deposited in puncture-resistant containers
f.         Patients colonized with resistant pathogens should be entered into the room by wearing long aprons and gloves, MRSA and VRE transport should be prevented
Respiratory Isolation (Measles, Chickenpox, Lung-Larynx Tbc)

Particles smaller than 5µm can reach distant points by hanging in the air or sticking to dust particles.

Special room, negative pressure should be applied continuously, Air change should be 6-12 times per hour

Droplet isolation (haemophilus influenza, n. menengitidis, m. Pneumoniae, pertussis, plague, adenovirus,influenza, mumps, rubella)

It is intended for infections transmitted by particles larger than 5µm. These particles cannot remain suspended in the air and travel no further than 1 meter. Mask should be worn if the private room is to be approached more than 1 meter

Contact isolation (mrsa, vre, acinetobacter, pseudomonas, cl.difficile, enterohemorogic e. Coli, shigella, rotavirus)

Special room, gloves and hand disinfection, Apron should be worn, medical equipment used for the patient should not be used for any other patient

Tight Contact Isolation (Vre)

 

 Special room, gloves and hand disinfection, Apron, special medical devices, surfaces in the room should be disinfected every day

Patient Screening [15]

Colonized cases with multidrug resistant bacteria newly taken into intensive care are the new reservoir for infections. Surveillance cultures for MRSA and VRE reduce colonization and infection with these microorganisms

Patient Decolonization

Daily patient bath with 2% chlorhexidine-containing covers reduces hospital-based infection and multidrug-resistant bacterial colonization [16]. Bath with 2% chlorhexidine in most ICU has become standard practice

Hand Hygiene [17]

Hand hygiene training and monitoring reduces the rate of infection. Alcohol-based foam or gel has been found to reduce the number of colonies in hands and the number of multidrug-resistant pathogens compared to soap washing [18]. There was no difference between chlorhexidine-containing antiseptic and alcohol-based foam in terms of bacterial colonization in the hands [19]. If contaminated with contaminated / protein material or blood and other body fluids, wash with soap or antimicrobial soap and water. Alcohol-based hand antiseptic is used if there is no visible contamination and can be washed hand with antimicrobial soap as an alternative:
a.        Before direct contact with the patient
b.       Prior to wearing gloves during central venous catheter placement
c.        Before urinary catheter, peripheral vascular catheter and other invasive procedures
d.       Patient's integrity intact after contact with skin
e.        Body fluids, integrity impaired after contact with the skin
f.         When passing from a contaminated body area to a clean area during patient care
g.        After contact with inanimate objects and surfaces around the patient
h.       After the gloves are removed

Hand Hygiene

Products used Non-antimicrobial soap: removes dirt organic matter in hand with detergent properties

 

Alcholls: denaturation of proteins, rapid but short-acting antimicrobial activity. MRSA, VRE, gram positive and negative bacteria, M. tuberculosis, high effectiveness against fungi and viruses, bacterial spores, parasitic cysts and some non-enveloped viruses are less effective against.

Chlorhexidine

Acts by disrupting the cytoplasmic membrane. It has a good effect on Gram-positive bacteria and enveloped viruses, and less on gram-negative bacteria, fungi, and non-enveloped viruses.

Chloroxylenol

 Inactivates bacterial enzymes. It is more effective against Gram-positive bacteria.

Hexachlorophene

 Its effectiveness against Aureus is good but it is low against gram negatives and viruses

Iodine

It acts by disrupting protein synthesis and cell wall. Gram-positive-negative bacteria, viruses, fungi and myc. effective against tuberculosis.

Alkyl Benzalkonium Chloride

Acts on the cytoplasmic membrane. It is more effective against Gram positives.

Triclosan

 Affects the cytoplasm membrane and RNA synthesis. It is used as an active agent in antimicrobial soaps. It is more effective against Gram positives.

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