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- W2087380095 abstract "Abstract Traditional approaches to definitions of nosocomial infections and their prophylaxis focus on time cut-offs and non-antibiotic manoeuvres. In general, the time cut-off of 48 h has been applied to distinguish community and hospital infection from ICU infection, and hand washing has been the cornerstone of conventional policies for the prevention of ICU infections occurring after 48 h. In contrast, the philosophy of antibiotic prophylaxis using selective decontamination of the digestive tract is based on the criterion of the carrier state of a limited range of potential pathogens that are involved in three different types of infection: endogenous infections, both primary and secondary, and exogenous infections. Most infections are of primary endogenous development due to micro-organisms carried in the admission flora and are controlled by parenteral cefotaxime administered immediately on admission. The aim of polymyxin E/tobramycin/amphotericin B applied topically in the throat and gut is to prevent secondary endogenous infections due to micro-organisms acquired on the unit, and generally occurring after 7 days. Exogenous infections caused by micro-organisms not previously carried can occur at any time during the stay on the unit and only high standards of hygiene are able to prevent them. The most extensive meta-analysis reports data on 5727 patients enrolled in 33 randomized trials and indicates a significant reduction of both infections (OR=0.35; 95% CI=0.29–0.41) and total mortality (OR=0.80; 95% CI=0.69–0.93). There are no randomized trials available which show that rigid implementation of hand washing reduces morbidity or mortality. The aim of this review is to help readers distinguish between what is evidence-based, and what is still largely opinion-based." @default.
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- W2087380095 date "2001-02-01" @default.
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- W2087380095 title "Prevention of intensive care unit infections" @default.
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- W2087380095 doi "https://doi.org/10.1054/cacc.2001.0320" @default.
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