Infection control in intensive care.

The accumulation of a number of acutely ill patients within a relatively small area, such as we see in the Intensive Care Unit (ICU), increases the potential for the development of infections, both endogenous and acquired. Infection has been a problem in ICUs for as long as these units have existed, especially in those undisciplined units where policies for antibiotic usage and infection control are conspicuous by their absence. The availability and use of complex and sophisticated machinery for maintaining life in moribund patients increase the proportion of patients in ICU who are unusually susceptible to infection, and who become potent sources for its spread. The large-scale and often indiscriminate use of broad-spectrum antibiotics is an infallible environmental influence for selecting a largely antibiotic-resistant endemic bacterial flora in the ICU. Many ICUs also suffer from inadequate numbers of trained nursing and medical staff, a rapid turnover of untrained (and "agency") staff, all working in overcrowded conditions with a surprising lack of support from the hospital and nursing administrators. This can lead only to poor morale and the consequent maintenance of a level of infection which would be intolerable elsewhere in hospital.