Disinfection for prevention and control of infections on the threshold of the 21 century for the critically ill patient.

In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units. The body's natural barriers are breached through medical interventions while, on the other hand, immunocompromising therapeutic agents such as cytostacis and glucocorticoids ensure that invading microorganisms will be able to multiply. Drugs administered as stress ulcus prophylaxis give rise to a shift in the bacterial flora of the throat, thus laying the foundation for a lower respiratory tract infection. With regard to bacterial resistance, antibiotic therapy, especially when used as prophylaxis, results in the bacteria becoming less sensitive to the drugs, while reinforcing selective pressures. The hands of personnel as well as the therapeutic devices ranging from the respirator to the catheter are the chief sources of infection in intensive care units. Disinfection, antibiotic therapy and, possibly, extracorporeal elimination methods can be contemplated to selectively prevent the establishment and multiplication of microorganisms. However, only disinfectants are able to unleash their full destructive might against microbes, especially when used for medical devices that are not amenable to sterilization, even if their subsequent removal and, possibly, the issue of staff hand protection, can be a problem. While it is not easy to furnish proof of a direct link between efficient control and prevention methods and the incidence of infection, there is by now a consensus on the role of hand hygiene and of disinfection of the human body and of surfaces. In an age when medicine, in particular intensive care medicine, is at risk of becoming impaled on its own sword, disinfection could serve as a bulwark against rising infection rates.