Skip to main content
SpringerLink
Log in

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

  • Current Topic: Review
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wiklund, P. E. Intensive care units: design, location, staffing ancillary areas, equipment. Anesthesiology 1969, 31: 122–136.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    Article  Google Scholar 

  5. Vidotto, V., Caramello, S., Lucchini, A. Sources of fungal contamination in a burn-care unit. Mycopathologica 1986, 95: 77–80.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  7. Ayliffe, G. A. J., Lowbury, E. J. L. Airborne infection in hospital. Journal of Hospital Infection 1982, 3: 217–240.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  11. Tobin, M. J., Grenvik, A. Nosocomial lung infection and its diagnosis. Critical Care Medicine 1984, 12: 191–199.

    PubMed  Google Scholar 

  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. Korvick, J. A., Yu, V. L., Fang, G. Legionella species on hospital-acquired respiratory pathogens. Seminars in Respiratory Infections 1987, 2: 34–47.

    PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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. Barton, F. L., Branthwaite, M. A., English, I. C. W., Prentis, J. J. Atmospheric contamination in intensive therapy units. Anaesthesia 1973, 28: 160–163.

    PubMed  Google Scholar 

  18. Josephson, A., Gombert, M. E. Airborne transmission of nosocomial varicella from localized zoster. Journal of Infectious Diseases 1988, 158: 238–241.

    PubMed  Google Scholar 

  19. Gaya, H. Infection control in intensive care. British Journal of Anaesthesia 1976, 48: 9–12.

    PubMed  Google Scholar 

  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. Burn, J. M. B. Design and staffing of an intensive care unit. Lancet 1970, i: 1040–1043.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  28. Jelenko, C. Systemic response to burn injury: a survey of some current concepts. Journal of Trauma 1970, 10: 877–884.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  40. du Moulin, G. C. Airway colonization byFlavobacterium in an intensive care unit. Journal of Clinical Microbiology 1979, 10: 155–160.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  51. du Moulin, G. C., Hedley-Whyte, J. Hospital-associated viral infection and the anesthesiologist. Anesthesiology 1982, 59: 51–65.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  56. Scheidt, A., Drusin, L. M. Bacteriologic contamination in an air-fluidized bed. Journal of Trauma 1983, 23: 241–242.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesia, DA-717, Charles A. Dana Research Foundation, Harvard Medical School, Beth Israel Hospital, 330 Brookline Avenue, 02215, Boston, Massachusetts, USA

    G. du Moulin

Authors
  1. G. du Moulin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

du Moulin, G. Minimizing the potential for nosocomial pneumonia: Architectural, engineering, and environmental considerations for the intensive care unit. Eur. J. Clin. Microbiol. Infect. Dis. 8, 69–74 (1989). https://doi.org/10.1007/BF01964123

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01964123

Keywords

Search

Navigation