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January 1989

Risk Factors for Nosocomial Infection in Intensive Care: 'Devices vs Nature' and Goals for the Next Decade

Author Affiliations

Hamlet; Madison, Wis

Arch Intern Med. 1989;149(1):30-35. doi:10.1001/archinte.1989.00390010048003

Diseases desperate grown By desperate appliances are relieved, Or not at all.

The past 20 years have seen the emergence of two powerful and parallel movements in hospital care: specialized units for the care of physiologically unstable and critically ill patients—intensive care units (ICUs) or, as most in the field prefer, critical care units1-4—and formal programs in most hospitals for the prevention of hospital-acquired (nosocomial) infection.5-7 Over the past decade, these two movements have approached and are now, appropriately, inextricably intertwined.

There are numerous advantages in centralizing the care of critically ill patients with multiple trauma or other life-threatening conditions associated with reversible acute organ failure,8-11 especially shock syndromes, respiratory failure requiring mechanical ventilatory support, acute myocardial ischemia, renal failure, encephalopathy with coma, and, especially, failure of host defense to contain local infection, producing systemic sequelae (sepsis). A new generation of hospital-based professionals, the "intensivist"—physicians, nurses,

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