INFECTION CONTROL IN THE ICU ENVIRONMENT

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1 INFECTION CONTROL IN THE ICU ENVIRONMENT

2 PERSPECTIVES ON CRITICAL CARE INFECTIOUS DISEASES Jordi Rella, M.D., Series Editor t. N. Singh and J.M. Aguado (eels.): Infectious Complications in Transplant Recipients ISBN P.O. Eichacker and J. Pugin (eels.): Evolving Concepts in Sepsis and Septic Shock. 200t. ISBN J. Rello and K. Leeper (eels.): Severe Community Acquired Pneumonia. 200t. ISBN R.G. Wunderink and J. Rello (eels.): Ventilator Associated Pneumonia. 200t. ISBN R.A. Weinstein and M. Bonten (eels.): Infection Control in the ICU Environment ISBN

3 INFECTION CONTROL IN THE ICU ENVIRONMENT Edited by ROBERT A. WEINSTEIN Cook County Hospital and Rush Medical College 1835 W. Harrison St. Room 129, Durand Bldg. Chicago, Illinois, USA MARe J.M. BONTEN Department of Internal Medicine Divisi~n of Infectious Diseases and Aids University Medical Center Utrecht Heidelberglaan 100 Utrecht The Netherlands SPRINGER SCIENCE+BUSINESS MEDIA, LLC

4 Library of Congress Cataloging-in-Publication Data Infection control in the ICU environment / edited by Robert A. Weinstein, Marc J.M. Bonten. p. ; cm. -- (Perspectives on critical care infectious diseases ; 5) Inc1udes bibliographical references and index. ISBN ISBN (ebook) DOI / Intensive care units. 2. Nosocomial infections--prevention. 3. Critical care medicine. 1. Weinstein, Robert A. (Robert Alan), II. Bonten, Marc J. M. III. Series. [DNLM: 1. Infection Control--methods. 2. Cross Infection--prevention & control. 3. Intensive Care Units. WX ] RA975.5.I '4--dc21 Copyright 2002 by Springer Science+Business Media New York Originally published by Kluwer Academic Publishers in 2002 Softcover reprint ofthe hardcover Ist edition Ali rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photo-copying, recording, or otherwise, without the prior written permission ofthe publisher, Springer Science+Business Media, LLC. Printed an acid-free paper. The Publisher offers discounts on this book for course use and bulk purchases. For jurther injormation, send tomelissa.ranwndetta@wkap.com.

5 CONTENTS Introduction JORD! RELLO Vll Preface IX 1. Scope and Magnitude of Nosocomial ICU Infections JUAN ALONSO-ECHANOVE AND ROBERT P. GAYNES 2. Scope xand Magnitude of Nosocomial ICU Infections 15 MAAIKE M.S. IBELINGS AND HAJO A. BRUINING 3. Vancomycin-Resistant Enterococci: A Threat for the ICU? 33 MARY K. HAYDEN 4. Vancomycin-Resisitant Enterococci in Europe: A Changing Epidemiology? 49 MARC J.M. BONTEN 5. Methicillin-Resistant Staphylococcus Aureus: Is Control Necessary? 57 JOHN M. BOYCE 6. Acinetobacter: Epidemiology and Control 67 JAMES J. RAHAL AND CARL URBAN

6 vi Contents 7. Acinetobacter: Epidemiology and Control 77 JAVIER ARIZA AND XAVIER CORBELLA 8. Fungal Infections: The Role of Prophylactic and Empiric Antifungal Therapy in ICU Patients 93 u.s. Perspective: PAUL O. GUBBINS 9. Fungal Infections: The Role of Prophylaxis and Empiric Therapy in ICU Patients 107 JACQUES F.G.M. MEIS AND PAUL E. VERWEIJ 10. Newer Approaches to Preventing Vascular Catheter-Related Sepsis 115 RABIH o. DAROUICHE 11. Newer Approaches to Preventing Intravascular Device-Related Bloodstream Infections 129 J.A.J.W. KLUYTMANS 12. Is Prevention of Ventilator-Associated Pneumonia Cost Effective? 141 North American Perspective: MARIN H. KOLLEF 13. Ventilator-Associated Pneumonia: Is Prevention Cost Effective? 155 RICARD FERRER, TORS TEN BAUER AND ANTONI TORRES 14. Cross-Colonization in Intensive Care Units: Fact or Fiction? 169 MATTHEW SAMORE 15. Cross-Colonization: Fact or Fiction? 181 MIGUEL SANCHEZ GARdA 16. Conventional Infection Control Measures: Value or Ritual? 195 JOHN P. FLAHERTY, JANIS WIENER AND ROBERT A. WEINSTEIN 17. Conventional Infection Control Measures: Value or Ritual? 213 C.A.M. SCHURINK AND M.J.M. BONTEN 18. Modeling of Antibiotic Resistance in the ICU 231 MARC LIPSITCH AND CARL T. BERGSTROM 19. Mathematical Models in the ICU: Dynamics, Infection Control and Antibiotic Resistance 245 DAREN J. AUSTIN Index 267

7 PERSPECTIVES ON CRITICAL CARE INFECTIOUS DISEASES An Introduction to the Series Different models of intensive care medicine have been developed worldwide, involving surgeons, anesthetists, internists and critical care physicians. All intensive care departments of hospitals have in common, the highest incidence of antibiotic consumption, the highest incidence of nosocomial infections and community-acquired infections with high degrees of severity. Intensive care areas of hospitals have the largest number of infection outbreaks and require differentiated strategies of prevention. The specific characteristics of the involved population require differentiated approaches in diagnosis and therapy from those required in classical infectious problems. The specific pharmacodynamic conditions of patients requiring mechanical ventilation or continuous renal replacement, require participation of experts in pharmacology. The specific objective of this Series is to update therapeutic implications and discuss controversial topics in specific infectious problems involving critically ill patients. Each topic will be discussed by two authors representing the different management perspectives for these controversial and evolving topics. The Guest Editors, one from North America and one from Europe, have invited contributors to present the most recent findings and the specific infectious disease problems and management techniques for critically ill patients, from their perspective. Jordi Rello, M.D. Series Editor

8 PREFACE Infections are serious and common complications of the treatment of critically ill patients. Intensive Care Unit (ICU) patients become more prone to develop infections as their severity of illness, the complexity of underlying diseases, and the numbers of interventions that breach their host defenses increase. To further complicate care, resistance of ICU pathogens to the newest antimicrobial therapy is emerging, despite current prevention efforts. In such an environment, heightened infection control is of key importance. Infection Control in the ICU Environment provides an overarching review that details the most current and high profile infection control problems in ICUs. Authors include noted scientists, intensivisits, and epidemiologists from the United States and Europe and infection control experts from the U.S. Centers for Disease Control and Prevention. The latest problem pathogens in ICUs, particularly Acinetobacter, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococci, are examined in detail. Cutting edge information regarding the potential for prophylactic and/or pre-emptive therapy offungal infections in ICUs is reviewed. The latest innovations in vascular catheter care and prevention of bloodstream infections are discussed. An up-to-date review of ventilator-associated pneumonia and its prevention is provided. Dissecting fact from fiction and value from ritual in ICU procedures is thoughtfully explored. Finally, the newest innovations in use of mathematical modeling to understand the epidemiology and control of infections in ICUs are presented. The issues discussed in this book are timely, are of global importance, and will remain on our agenda well into the next decade(s). Marc Bonten, M.D., Ph.D. Robert A. Weinstein, M.D.

9 INFECTION CONTROL IN THE ICU ENVIRONMENT

ESSENTIALS OF ANTIMICROBIAL PHARMACOLOGY

ESSENTIALS OF ANTIMICROBIAL PHARMACOLOGY Essentials of Antimicrobial Pharmacology A Guide to Fundamentals for Practice PAUL H. AXELSEN, MD University of Pennsylvania School of Medicine Philadelphia, PA