Minimizing hospital acquired intensive care unit infections: A focus on prevention

Table 1 Staff-level infection prevention strategies and key components

Strategy	Key components
Hand hygiene	WHO 5 Moments framework, audits, alcohol-based rub availability, behavioral nudges
Personal protective equipment (PPE)	Proper donning and doffing techniques, use during high transmission or aerosol-generating procedures
Immunizations	Ensure all ICU personnel are vaccinated against transmissible diseases (e.g., influenza, hepatitis B)
Device decontamination	Regular cleaning of mobile phones and stethoscopes
Attire standards	Short sleeves, no rings or watches, daily uniform change
Structured protocol	Training, audits, and feedback to improve compliance

WHO: World Health Organization; ICU: Intensive care unit.

Table 2 Patient-level infection prevention strategies and key components

Strategy	Key components
VAP bundle	Minimized sedation, daily sedation interruption, oral care without chlorhexidine, early mobilization, head-of-bed elevation
CLABSI bundle	Sterile PPE, chlorhexidine skin prep, subclavian access, chlorhexidine dressings, insertion and maintenance auditing
CAUTI bundle	Use catheter only when necessary, aseptic insertion by trained staff, smallest catheter size, daily reassessment and prompt removal

VAP: Ventilator associated pneumonia; PPE: Personal protective equipment; CAUTI: Catheter-associated urinary tract infections; CLABSI: Central line associated blood stream infections.

Table 3 Systemic infection prevention strategies and details

Strategy	Details
ICU triage and admission protocols	Avoid futile care and reduce overcrowding
Closed ICU model	24/7 oversight by intensivist-led team
Single patient rooms	Reduce MDRO transmission
Nurse-to-patient ratios	Improve care quality and reduce infection risk
Palliative care and early goal discussions	Limit non-beneficial interventions and exposure to infection

ICU: Intensive care unit; MDRO: Multidrug-resistant organisms.

Table 4 Nursing quick-start checklist for intensive care unit infection prevention

Domain	Practical nursing actions
Hand hygiene	Perform hand hygiene at all WHO 5 Moments; ensure alcohol-based rub available at bedside
Personal protective equipment	Correct donning/doffing; use mask/respirator for aerosol-generating procedures
Invasive devices	Verify daily necessity of central lines, urinary catheters, and ventilators; request removal when no longer indicated
Ventilator care	Elevate head of bed 30°-45°; provide daily sedation interruption and readiness-to-wean assessment
Oral care and mobilization	Perform oral care with toothbrushing (no chlorhexidine); assist early mobilization/exercise at least once daily
Catheter care	Use aseptic technique during insertion; reassess and document catheter necessity daily
Environmental hygiene	Disinfect stethoscopes and mobile devices once per shift; ensure clean uniforms and bare forearms
Audit and feedback	Participate in hand hygiene/device audits; provide and accept immediate feedback
Family/patient engagement	Educate families on hand hygiene before and after patient contact; encourage participation in infection-prevention routines

WHO: World Health Organization.