Minimizing the potential for nosocomial pneumonia: Architectural, engineering, and environmental considerations for the intensive care unit

  • G. du Moulin
Current Topic: Review

Abstract

The development of pneumonia in seriously ill patients remains an important concern of intensive care medicine. The design of the intensive care unit will have a direct effect upon the potential for infection. Persons involved in this design should consider engineering and architectural elements that will ultimately contribute to lower rates of infection. These include components to regulate the atmosphere, such as ventilation systems and temperature and humidity controls. Sources of contaminated water and the amplification mechanisms need to be addressed and minimized in the final designs. Architectural elements such as treatment space and lighting encourage optimal patient management and workable staffing patterns. Personnel who treat seriously ill patients should be part of the planning and design process in the construction and renovation of intensive care facilities.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wiklund, P. E. Intensive care units: design, location, staffing ancillary areas, equipment. Anesthesiology 1969, 31: 122–136.PubMedGoogle Scholar
  2. 2.
    McManus, A. T., McManus, W. F., Mason, A. D., Aitcheson, A. R., Pruitt, B. A. Microbial colonization in a new intensive care burn unit. A prospective cohort study. Archives of Surgery 1985, 120: 217–223.PubMedGoogle Scholar
  3. 3.
    du Moulin, G. C., Hedley-Whyte, J. The stomach as a bacterial reservoir: clinical significance. Internal Medicine for the Specialist 1982, 3: 47–55.Google Scholar
  4. 4.
    du Moulin, G. C., Paterson, D. G., Hedley-Whyte, J., Lisbon, A. Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonization of the airway. Lancet 1982, i: 242–245.CrossRefGoogle Scholar
  5. 5.
    Vidotto, V., Caramello, S., Lucchini, A. Sources of fungal contamination in a burn-care unit. Mycopathologica 1986, 95: 77–80.CrossRefGoogle Scholar
  6. 6.
    Lentino, J. R., Rosenkranz, M. A., Michaels, J. A., Kurup, V. P., Rose, H. D., Rytel, M. W. Nosocomial aspergillosis. American Journal of Epidemiology 1982, 116: 430–437.PubMedGoogle Scholar
  7. 7.
    Ayliffe, G. A. J., Lowbury, E. J. L. Airborne infection in hospital. Journal of Hospital Infection 1982, 3: 217–240.CrossRefPubMedGoogle Scholar
  8. 8.
    Klick, J. M., du Moulin, G. C., Hedley-Whyte, J., Teres, D., Bushnell, L. S., Feingold, D. S. Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. II. Effect on the incidence of pneumonia in seriously ill patients. Journal of Clinical Investigation 1975, 55: 514–519.PubMedGoogle Scholar
  9. 9.
    Feeley, T. W., du Moulin, G. C., Hedley-Whyte, J., Bushnell, L. S., Gilbert, J. P., Feingold, D. S. Aerosol polymyxin and pneumonia in seriously ill patients. New England Journal of Medicine 1975, 293: 471–475.PubMedGoogle Scholar
  10. 10.
    du Moulin, G. C., Dasse, P., Miller, M. G., Morrison, M., Friedland, G. H. Staphylococcal outbreak in an intensive care unit — a narrative account of its management. Heart and Lung 1979, 8: 94–99.PubMedGoogle Scholar
  11. 11.
    Tobin, M. J., Grenvik, A. Nosocomial lung infection and its diagnosis. Critical Care Medicine 1984, 12: 191–199.PubMedGoogle Scholar
  12. 12.
    Faling, L. J. New advances in diagnosing nosocomial pneumonia in intubated patients. American Review of Respiratory Diseases 1988, 137: 253–255.Google Scholar
  13. 13.
    Korvick, J. A., Yu, V. L., Fang, G. Legionella species on hospital-acquired respiratory pathogens. Seminars in Respiratory Infections 1987, 2: 34–47.PubMedGoogle Scholar
  14. 14.
    du Moulin, G. C., Stottmeier, K. D. Waterborne mycobacteria: an increasing threat to health. American Society for Microbiology (ASM) News 1986, 52: 525–529.Google Scholar
  15. 15.
    Murphy, R. C., Kucan, J. O., Robson, M. C., Heggers, J. P. The effect of 5 % mafenide acetate solution on bacterial control in infected rat burns. Journal of Trauma 1983, 23: 878–881.PubMedGoogle Scholar
  16. 16.
    Greene, V. W., Vesley, D. Environmental microbiology. In: Bond, R. G., Michaelsen, G. S., DeRoos, R. L. (ed.): Environmental health and safety in health care facilities. MacMillan, New York, 1973, p. 28–47.Google Scholar
  17. 17.
    Barton, F. L., Branthwaite, M. A., English, I. C. W., Prentis, J. J. Atmospheric contamination in intensive therapy units. Anaesthesia 1973, 28: 160–163.PubMedGoogle Scholar
  18. 18.
    Josephson, A., Gombert, M. E. Airborne transmission of nosocomial varicella from localized zoster. Journal of Infectious Diseases 1988, 158: 238–241.PubMedGoogle Scholar
  19. 19.
    Gaya, H. Infection control in intensive care. British Journal of Anaesthesia 1976, 48: 9–12.PubMedGoogle Scholar
  20. 20.
    Khanam, T., Branthwaite, M. A., English, I. C. W., Prentis, J. J. The control of pulmonary sepsis in intensive therapy units. Aanesthesia 1973, 28: 17–28.Google Scholar
  21. 21.
    Burn, J. M. B. Design and staffing of an intensive care unit. Lancet 1970, i: 1040–1043.CrossRefGoogle Scholar
  22. 22.
    Goldmann, D. A., Durbin, W. A., Freeman, J. Nosocomial infections in a neonatal intensive care unit. Journal of Infectious Diseases 1981, 144: 449–459.PubMedGoogle Scholar
  23. 23.
    Burke, J. F., Quinby, W. C., Bondoc, C. C., Sheehy, E. M., Moreno, H. C. The contribution of a bacterially isolated environment to the prevention of infection in seriously burned patients. Annals of Surgery 1977, 186: 377–387.PubMedGoogle Scholar
  24. 24.
    Pizzo, P. A. The value of protective isolation in preventing nosocomial infections in high risk patients. In: Dixon, R. E. (ed.): Nosocomial infections. Yorke Medical Books, New York, 1981, p. 256–262.Google Scholar
  25. 25.
    Demling, R. H., Perea, A., Maly, J., Moylan, J. A., Jarett, F., Balish, E. The use of a laminar airflow isolation system for the treatment of major burns. American Journal of Surgery 1978, 136: 375–378.CrossRefPubMedGoogle Scholar
  26. 26.
    Demling, R. H., Moylan, J. A., Ellerbe, S., Jarrett, F. Experience with laminar airflow in the management of major burns. Wisconsin Medical Journal 1977, 76: S149-S150.Google Scholar
  27. 27.
    Oberg, G., Bjerring, P. Comparison of microbiological contents of compressed air in two Danish hospitals. Effect of oil and water reduction in air-generating units. Acta Anaesthesiologica Scandinavica 1986, 30: 305–308.PubMedGoogle Scholar
  28. 28.
    Jelenko, C. Systemic response to burn injury: a survey of some current concepts. Journal of Trauma 1970, 10: 877–884.PubMedGoogle Scholar
  29. 29.
    Russell, J. T., Stewart, A. W., Kessler, A. The design and function of an intensive care unit. South African Medical Journal 1968, 42: 931–933.PubMedGoogle Scholar
  30. 30.
    Aulick, L. H., McManus, A. T., Pruitt, B. A., Mason, A. D. Effects of infection on oxygen consumption and core temperature in experimental thermal injury. Annals of Surgery 1986, 204: 48–52.PubMedGoogle Scholar
  31. 31.
    Kaufman, T., Alexander, J. W., Nathan, P., Brackett, K. A., MacMillan, B. G. The microclimate chamber: the effect of continuous topical administration of 96 % oxygen and 75 % relative humidity on the healing rate of experimental deep burns. Journal of Trauma 1983, 23: 806–815.PubMedGoogle Scholar
  32. 32.
    Farkas, L. G., Bannantyne, R. M., James, J. S., Umamaheswaran, B. Effect of two different climates on severely burned rats infected withPseudomonas aeruginosa. European Surgical Research 1974, 6: 295–300.PubMedGoogle Scholar
  33. 33.
    Headley, B. J., Robson, M. C., Krizek, T. J. Methods of reducing environmental stress for the acute burn patient. Physical Therapy 1975, 55: 5–8.PubMedGoogle Scholar
  34. 34.
    Farkas, L. G., McCain, W. G., Birch, J. R., James, J. The effects of four different chamber climates on oxygen consumption and healing of severely burned rats. Journal of Trauma 1973, 13: 911–916.PubMedGoogle Scholar
  35. 35.
    Department of Health, Education, and Welfare: General standards of construction and equipment for hospital and medical facilities. Public Health Service, U.S. Department of Health, Education, and Welfare, Washington, DC, 1969, Public Health Service Publication No. 930-A-7.Google Scholar
  36. 36.
    Ollstein, R. N., Symonds, F. C., Crikelair, G. F., Corliss, S. Creation of a burn center. Plastic and Reconstructive Surgery 1969, 43: 260–265.PubMedGoogle Scholar
  37. 37.
    Shirani, K. Z., McManus, A. T., Vaughan, G. M., McManus, W. F., Pruitt, B. A., Mason, A. D. Effects of environment on infection in burn patients. Archives of Surgery 1986, 121: 31–36.PubMedGoogle Scholar
  38. 38.
    Favero, M. S., Carson, L. A., Bond, W. W., Peterson, N. J. Factors that influence microbiologic contaminations of fluids associated with hemodialysis machines. Applied Microbiology 1974, 28: 822–823.PubMedGoogle Scholar
  39. 39.
    Eichhorn, J. H., Bancroft, M. L., Laasberg, L. H., du Moulin, G. C., Saubermann, A. J. Contamination of medical gas and water pipelines in a new hospital building. Anesthesiology 1977, 46: 286–289.PubMedGoogle Scholar
  40. 40.
    du Moulin, G. C. Airway colonization byFlavobacterium in an intensive care unit. Journal of Clinical Microbiology 1979, 10: 155–160.PubMedGoogle Scholar
  41. 41.
    du Moulin, G. C., Doyle, G. O., MacKay, J., Hedley-Whyte, J. Bacterial fouling byPseudomonas fluorescens of a hospital closed loop cooling system. Journal of Clinical Microbiology 1981, 13: 1060–1065.PubMedGoogle Scholar
  42. 42.
    du Moulin, G. C., Coleman, E. C., Hedley-Whyte, J. Bacterial colonization and endotoxin content of a new renal dialysis water system composed of acrylonitrile butadiene styrene. Applied and Environmental Microbiology 1987, 53: 1322–1326.PubMedGoogle Scholar
  43. 43.
    Bancroft, M. L., du Moulin, G. C. Re-evaluating the role of respiratory care equipment and practices in the prevention of nosocomial pneumonia. Respiratory Care 1983, 28: 165–168.PubMedGoogle Scholar
  44. 44.
    Teres, D., Schweers, P., Bushnell, L. S., Hedley-Whyte, J., Feingold, D. S. Sources ofPseudomonas aeruginosa infection in a respiratory/surgical intensive therapy unit. Lancet 1973, i: 415–417.CrossRefGoogle Scholar
  45. 45.
    Pelletier, P. A., du Moulin, G. C., Stottmeier, K. D. Mycobacteria in public water supplies: comparative resistance to chlorine. Microbiological Sciences 1988, 5: 147–148.PubMedGoogle Scholar
  46. 46.
    du Moulin, G. C., Sottmeier, K. D., Pelletier, P. A., Tsang, A. Y., Hedley-Whyte, J. Concentration ofMycobacterium avium by hospital hot water systems. Journal of the American Medical Association 1988, 260: 1599–1601.CrossRefPubMedGoogle Scholar
  47. 47.
    Pierson, C. L. Infection control in burn care facilities. In: Roderick, M. A. (ed.): Infection control in critical care. Aspen Systems Corporation, Rockville, MD, 1983, p. 143–154.Google Scholar
  48. 48.
    Fujita, K., Lilly, H. A., Ayliffe, G. A. J. Spread of resistant gram-negative bacilli in a burns unit. Journal of Hospital Infection 1982, 3: 29–37.CrossRefPubMedGoogle Scholar
  49. 49.
    Arnow, P. M., Allyn, P. A., Nichols, E. M., Hill, D. L., Pezzlo, M., Bartlett, R. H. Control of methicillin-resistantStaphylococcus aureus in a burn unit. role of nurse staffing. Journal of Trauma 1982, 22: 954–959.PubMedGoogle Scholar
  50. 50.
    Espersen, F., Bo Nielsen, P., Lund, K., Sylvest, B., Jensen, K. Hospital-acquired infections in a burns unit caused by an imported strain ofStaphylococcus aureus with unusual multi-resistance. Journal of Hygiene 1982, 88: 535–541.PubMedGoogle Scholar
  51. 51.
    du Moulin, G. C., Hedley-Whyte, J. Hospital-associated viral infection and the anesthesiologist. Anesthesiology 1982, 59: 51–65.Google Scholar
  52. 52.
    Lowbury, E. J. L. Control of infection in the hospital: problems in surgery and the management of burns. Reviews of Infectious Diseases 1981, 3: 728–733.PubMedGoogle Scholar
  53. 53.
    Larson, E., McGinley, K. J., Grove, G. L., Leyden, J. J., Talbot, G. H. Physiologic, microbiologic, and seasonal effects of handwashing on the skin of health care personnel. American Journal of Infection Control 1986, 14: 51–59.PubMedGoogle Scholar
  54. 54.
    Ansari, S. A., Sattar, S. A., Springthorpe, S., Wells, G. A., Tostowaryk, W. Rotavirus survival on human hands and transfer of infectious virus to animate and nonporous inanimate surfaces. Journal of Clinical Microbiology 1988, 26: 1513–1518.PubMedGoogle Scholar
  55. 55.
    Holzman, B. H., Scott, G. B. Control of infection and techniques of isolation in the pediatric intensive care unit. Pediatric Clinics of North America 1981, 28: 703–721.PubMedGoogle Scholar
  56. 56.
    Scheidt, A., Drusin, L. M. Bacteriologic contamination in an air-fluidized bed. Journal of Trauma 1983, 23: 241–242.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1989

Authors and Affiliations

  • G. du Moulin
    • 1
  1. 1.Department of Anaesthesia, DA-717, Charles A. Dana Research Foundation, Harvard Medical SchoolBeth Israel HospitalBostonUSA

Personalised recommendations