Intensive care unit design and environmental factors in the acquisition of infection.

The incidence of infection in the intensive care unit (ICU) is one of the highest in the hospital and yet facilities to prevent infection are often inadequate in this important clinical area. Many antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), Serratia marcescens and vancomycin-resistant enterococci (VRE), may survive and persist in the environment leading to recurrent outbreaks. A number of professional and scientific bodies in the UK, the USA and Europe have published guidelines on the design and layout of ICUs. All emphasize the importance of adequate isolation facilities (at least one cubicle for every six beds), sufficient space around each bed (20 m2), wash hand basins between every other bed, ventilation including positive and negative pressure ventilation for high risk patients and sufficient storage and utility space. Common sense and considerations of safety and comfort should guide decisions on floors, walls etc. Appropriate cleaning and disinfection programmes are essential to render the ICU relatively pathogen free and compliance with handwashing is imperative in minimizing infection in this high-risk area. Infection control teams should support ICU personnel in their efforts to upgrade facilities and help ensure that this is a priority when resources are limited.