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Update in Critical Care Medicine
- Robert Fromm, Jr., MD; and
- Kalpalatha Guntupalli, MD
- From Methodist Hospital and Ben Taub General Hospital, Houston, Texas.
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
The intensive care unit (ICU) is among the most expensive and technology-driven areas of the hospital and is the place where severely ill medical and surgical patients converge. Although advances in the machinery for cardiac and respiratory support helped create intensive care medicine, low-technology innovations are adding benefits today. The following studies from 1999 illustrate how relatively simple ideas and solutions in the ICU can reduce mortality and complication rates and save costs.
This year's Update in Critical Care Medicine highlights important literature that will lead to changes in the management of critically ill patients. Other articles discussed here are equally important because they reinforce key principles. We have chosen papers that are clinically useful and should be of interest to general internists and other specialists.
A Sign Serves as an Effective Reminder To Wash Hands
Mechanical ventilation is commonly required in critically ill patients. With passage of an endotracheal tube, normal defense mechanisms are bypassed. Contamination of the tracheal tree and cross-contamination with other patients further increase the risk for nosocomial pneumonia. Although hand washing has long been recognized as an important and effective infection control technique in mechanically ventilated patients, adherence among physicians and ancillary medical staff is poor.
In this study, Khatib and colleagues judged the effect of a simple sign that directed staff members to wash their hands and wear gloves. At the beginning of the study, an educational program was presented to remind therapists of the importance of washing hands. In the first of two observation periods, frequency of hand washing and use of gloves by the respiratory care practitioners was measured during four 1-hour periods over 4 weeks. In the second phase, a sign stating “Wash Hands Use Gloves” was placed …
