Infection Prevention and Control: Simple Measures, Challenging Implementation

  • Sonia O. LabeauEmail author
  • Stijn I. Blot
  • Silvia Calviño-Günther
  • Mireia Llauradó Serra


The intensive care unit (ICU) is the hospital’s hot zone for healthcare-associated infection (HAI), especially ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection and surgical site infection. Evidence-based guidelines to prevent these Big Four are widely available, but healthcare professionals’ compliance is recognised as limited. This chapter discusses the basics of HAI prevention and proposes strategies to improve adherence to evidence-based prevention guidelines to promote a timely and successful ICU discharge by prevention of complications.


Healthcare-associated infection Standard Precautions Ventilator-associated pneumonia Central line-associated bloodstream infection Catheter-associated urinary tract infection Surgical site infection Guideline adherence 


  1. 1.
    World Health Organization. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: World Health Organization; 2016.Google Scholar
  2. 2.
    Currie K, Melone L, Stewart S, King C, Holopainen A, Clark AM, et al. Understanding the patient experience of health care-associated infection: a qualitative systematic review. Am J Infect Control. 2018;46(8):936–42.CrossRefGoogle Scholar
  3. 3.
    Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101–14.CrossRefGoogle Scholar
  4. 4.
    European Centre for Disease Prevention and Control. Annual Epidemiological report for 2016—healthcare-associated infections acquired in intensive care units. Stockholm; 2018.Google Scholar
  5. 5.
    Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903.CrossRefGoogle Scholar
  6. 6.
    Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(8):915–36.CrossRefGoogle Scholar
  7. 7.
    Zingg W, Walder B, Pittet D. Prevention of catheter-related infection: toward zero risk? Curr Opin Infect Dis. 2011;24(4):377–84.CrossRefGoogle Scholar
  8. 8.
    Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015;43(1):29–36.CrossRefGoogle Scholar
  9. 9.
    O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections 2011 [updated 1 October 2017]. Accessed 27 May 2019.
  10. 10.
    Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, The Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009 [updated 15 February 2017]. Accessed 27 May 2019.
  11. 11.
    Lo E, Nicolle LE, Coffin SE, Gould C, Maragakis LL, Meddings J, et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(Suppl 2):S32–47.CrossRefGoogle Scholar
  12. 12.
    Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.CrossRefGoogle Scholar
  13. 13.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132; quiz 3-4; discussion 96.CrossRefGoogle Scholar
  14. 14.
    World Health Organization. Global guidelines for the prevention of surgical site infection: WHO; 2016. Accessed 27 May 2019.
  15. 15.
    Suetens C, Latour K, Karki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):181122e1.CrossRefGoogle Scholar
  16. 16.
    Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.CrossRefGoogle Scholar
  17. 17.
    Schreiber PW, Sax H, Wolfensberger A, Clack L, Kuster SP. The preventable proportion of healthcare-associated infections 2005-2016: systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018;39(11):1277–95.CrossRefGoogle Scholar
  18. 18.
    European Centre for Disease Prevention and Control. Incidence and attributable mortality of healthcare-associated infections in intensive care units in Europe, 2008–2012. Stockholm; 2018.Google Scholar
  19. 19.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 Suppl 2):S65–164.CrossRefGoogle Scholar
  20. 20.
    Curran ET. Standard precautions: what is meant and what is not. J Hosp Infect. 2015;90(1):10–1.CrossRefGoogle Scholar
  21. 21.
    World Health Organization. WHO guidelines on hand hygiene in health care. First global patient safety challenge clean care is safer care. Geneva: WHO; 2009. p. 270.Google Scholar
  22. 22.
    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefGoogle Scholar
  23. 23.
    Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(Suppl 2):S89–107.PubMedGoogle Scholar
  24. 24.
    Talbot TRI, Stone EC, Irwin K, Overholt AD, Dasti M, Kallen A, et al. Recommendations on use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections: an update to the 2011 guidelines for the prevention of intravascular catheter-related infections from the Centers for Disease Control and Prevention. 2017. Accessed 27 May 2019.
  25. 25.
    Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59–74.CrossRefGoogle Scholar
  26. 26.
    National Institute for Health and Care Excellence (NICE). Surgical site infections: prevention and treatment, NICE guideline [NG125]. 2019. Accessed 22 Jul 2019.
  27. 27.
    Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31(3):283–94.CrossRefGoogle Scholar
  28. 28.
    Allegranzi B, Sax H, Pittet D. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. J Hosp Infect. 2013;83(Suppl 1):S3–10.CrossRefGoogle Scholar
  29. 29.
    Rello J, Lorente C, Bodi M, Diaz E, Ricart M, Kollef MH. Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?: a survey based on the opinions of an international panel of intensivists. Chest. 2002;122(2):656–61.CrossRefGoogle Scholar
  30. 30.
    Ricart M, Lorente C, Diaz E, Kollef MH, Rello J. Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia. Crit Care Med. 2003;31(11):2693–6.CrossRefGoogle Scholar
  31. 31.
    Labeau SO, Rello J, Dimopoulos G, Lipman J, Sarikaya A, Ozturk C, et al. The value of E-learning for the prevention of healthcare-associated infections. Infect Control Hosp Epidemiol. 2016;37(9):1052–9.CrossRefGoogle Scholar
  32. 32.
    Blot SI, Labeau S, Vandijck D, Van Aken P, Claes B, Executive Board of the Flemish Society for Critical Care N. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among intensive care nurses. Intensive Care Med. 2007;33(8):1463–7.CrossRefGoogle Scholar
  33. 33.
    Labeau S, Vandijck D, Rello J, Adam S, Rosa A, Wenisch C, et al. Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses. J Hosp Infect. 2008;70(2):180–5.CrossRefGoogle Scholar
  34. 34.
    Labeau SO, Vandijck DM, Rello J, Adam S, Rosa A, Wenisch C, et al. Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Crit Care Med. 2009;37(1):320–3.CrossRefGoogle Scholar
  35. 35.
    Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, et al. Nurses’ knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews Evid Based Nurs. 2010;7(1):16–24.CrossRefGoogle Scholar
  36. 36.
    Lydon S, Power M, McSharry J, Byrne M, Madden C, Squires JE, et al. Interventions to improve hand hygiene compliance in the ICU: a systematic review. Crit Care Med. 2017;45(11):e1165–e72.CrossRefGoogle Scholar
  37. 37.
    Mauger B, Marbella A, Pines E, Chopra R, Black ER, Aronson N. Implementing quality improvement strategies to reduce healthcare-associated infections: a systematic review. Am J Infect Control. 2014;42(10 Suppl):S274–83.CrossRefGoogle Scholar
  38. 38.
    Blot S, Koulenti D, Labeau S. Optimizing educational initiatives to prevent ventilator-associated complications. Am J Infect Control. 2017;45(1):102–3.CrossRefGoogle Scholar
  39. 39.
    Labeau SO. Closing the theory-practice gap: a bridge too far? Intensive Crit Care Nurs. 2019;52:61–2.CrossRefGoogle Scholar
  40. 40.
    Labeau SO, Vandijck DM, Vandewoude KH, Blot SI. Obstacles to implementing evidence-based guidelines. Respir Care. 2008;53(4):505–6; author reply 6.PubMedGoogle Scholar
  41. 41.
    Labeau SO. Is there a place for e-learning in infection prevention? Aust Crit Care. 2013;26(4):167–72.CrossRefGoogle Scholar
  42. 42.
    Labeau SO, Vandijck DM, Vandewoude KH, Blot SI. Education reduces ventilator-associated pneumonia rates. Clin Infect Dis. 2008;46(3):479.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sonia O. Labeau
    • 1
    • 2
    Email author
  • Stijn I. Blot
    • 1
  • Silvia Calviño-Günther
    • 3
  • Mireia Llauradó Serra
    • 4
  1. 1.Department of Internal Medicine and PediatricsGhent UniversityGhentBelgium
  2. 2.Department of Nursing, Faculty of Education, Health and Social WorkUniversity College GhentGhentBelgium
  3. 3.CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine AiguëGrenobleFrance
  4. 4.Nursing Department, Faculty of Medicine and Health SciencesUniversitat Internacional de CatalunyaBarcelonaSpain

Personalised recommendations