Infection Prevention and Control in the ICU

Critical Care Nursing Quarterly presents another one of its stellar topic issues: Infection Control in the ICU (intensive care unit). This issue addresses successful strategies and barriers encountered by nursing and medical professionals in implementing evidence-based infection prevention and control practices in the ICU. Targeted infections commonly associated with ICUs include ventilator-associated pneumonia, central venous line-associated bloodstream infections, and catheter-associated urinary tract infections. The articles in this issue build on the idea that change must be holistic and consider factors such as unit culture, interdisciplinary cooperation, protocol development, supply management, and leadership support.

Infection control professionals from diverse practice settings share their extensive knowledge and noted expertise gained from the daily "shoe leather" style of epidemiology they practice. Some infection control professionals have numerous types of ICUs within their institutions, deal with the ever-learning and rivaling world of healthcare workers (HCWs), and are delegated multiple program management responsibilities beyond any other department or entity. The other multidisciplinary authors who provide their perspective on infection prevention and control in the ICU have expertise in associated fields, such as skin care, pharmacology, and team building. Together, the assembled articles of this issue reflect updated information on the ICU environment with its spiraling advanced technology and critical approaches to complex and complicated patients with multiple system involvement compounded by multidrug-resistant microbes and the diminishing arsenal of effective antimicrobial agents.

The intent of this issue is to update practice with evidence-based references and to provide an opportunity for the reader to reassess his or her own practices performed within the ICU. HCWs are decreasing in numbers, which implies that smarter, consistent, constant application of evidence-based practices and processes is essential to each ICU patient. Whether it is new equipment requiring mandatory in-service before use, HCWs should shoulder that responsibility and compete willingly in this patient safety culture. Whether it is writing, revising, or just reading the honed critical processes accompanying the new technology or new knowledge, patients expect the very best from HCWs, especially those assigned to an ICU. The patient believes that to be in the ICU is to be cared for by "the best of the best," and each patient expects nothing less. Whether it is a new multidisciplinary patient rounding process where a holistic review of the patient's current status occurs, HCWs gather to share their expertise to this planning of customized patient care. No longer is the physician the ultimate authority on all aspects of patient care. Team building, rapport, affirmation, respect, and confidence in one another are what keep the focus on excellence of patient care in an ICU.

I challenge each of you to share your best practices from lessons learned in your ICU world. Other HCWs are open to receive new ideas and approaches, to learn a better way for their patient population, and to apply applications of fundamental principles in infection prevention and control. Together, we can enhance the ICU to exceed patient expectations.

Nancy B. Bjerke, MEd, MPH, RN, CIC

Issue Editor, Infection Control Associates, San Antonio, Tex