The risk of nosocomial infection remains high among intensive care unit patients, who frequently require invasive devices, which provide access for microbes to enter the body, and antibiotics, which apply selection pressure favoring colonization and superinfection by resistant organisms and also the development of antibiotic resistance among initially susceptible strains. Coagulase-negative staphylococci, Candida, and enterococci have each caused infections more frequently in recent years and multiple outbreaks of antibiotic resistant pathogens have been reported. Rates of handwashing by heath care staff after contact and between intensive care unit patients have remained as low as 40%, leading to multiple outbreaks of infection documented by molecular techniques. Other outbreaks have been linked to failure to comply with universal precautions. Scheduled replacement of central venous catheters has not resulted in lower infection rates in randomized trials and selective digestive tract decontamination remains an experimental approach that has been associated with development of antibiotic resistance in some intensive care units.
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