Intensive care unit (ICU) patients represent 5–10% of all hospitalized patients, yet the incidence of infections in this patient population is 5- to 10-fold higher than in general hospital wards and some studies estimate that up to 25% of all nosocomial infections occur in the ICU setting. The majority of infections in critically ill patients are related to device utilization including catheter-related urinary tract infections (UTI), ventilator-associated pneumonia (VAP), and catheter-related bloodstream infections. Many studies have shown that these nosocomial infections not only increase morbidity and mortality but also add significantly to the cost and duration of hospitalization. In this chapter we review the workup of fever in the ICU, management of common infections encountered in the ICU, and infection control guidelines to prevent the spread of nosocomial infections among patients and caregivers.

WORKUP OF FEVER IN THE ICU

The definition of fever is variable, but it is generally agreed on that a temperature >38.3°C warrants investigation in a hospitalized patient. In patients in the neurosurgical ICU (NICU), fever can be an important sign of a potential complication or can be a consequence of the primary process requiring admission to the unit as seen with subarachnoid hemorrhage.

1. ▪ The development of fever is associated with a worse prognosis in the NICU, as is hypothermia.

2. ▪ Fever is often a physiologic and approprimate response, and the fever itself should not necessarily be treated except in cases of primary ischemic or traumatic brain injury.

3. […]