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Health care‐associated infections account for approximately 1.7 million infections and 99 000 deaths annually in the USA. The two most common device‐related infections encountered in the ICU are central line‐associated bloodstream infections (CLABSIs) and catheter‐associated urinary tract infections (CAUTIs).

 A CLABSI is a bloodstream infection in a patient with a central venous catheter which cannot be attributed to an infection at any other site. CLABSIs are associated with increased hospital LOS, health care costs, and overall patient mortality. A 2013 meta‐analysis of the financial impact of health care‐associated infections in the USA found that CLABSIs had the highest financial cost in the health system at $45 814.

 Implementation of prevention bundles and checklists have led to a 46% decrease in CLABSIs from 2008 to 2013. However, there are still an estimated 30 100 CLABSIs per year across the ICU and acute care facilities of the USA. An infection prevention checklist focuses on some of the main methods of CLABSI prevention including optimal site selection (avoiding femoral access sites), proper hand hygiene, use of chlorhexidine disinfectants, and use of maximal sterile barrier precautions during insertion.The use of ultrasound guidance for placement of internal jugular catheter devices has been shown to reduce the risk of CLABSI and other non‐infectious complications and should be utilized when possible. Maintenance of these devices is important and may further reduce the rate of infection. Therefore, it is recommended to disinfect catheter hubs prior to access, maintain sterile dry dressing with routine dressing changes, and most importantly to remove the device as soon as it is no longer needed.

 Urinary tract infections (UTIs) are common hospital‐acquired infections with an estimated 93 000 UTIs documented in acute care hospitals in 2011 in the USA. UTIs account for approximately 12% of nosocomial infections reported in the ICU. Urinary catheters pose additional risk factors in the elderly such as need for physical restraint, reduced mobility leading to risk of venous thromboembolism, and hematuria.The use of procedure checklists and bundles similar to those utilized for CLABSIs have been shown to decrease the risk of CAUTIs and reduce the inappropriate use of urinary catheters. Hand hygiene and the use of aseptic placement of the urinary catheter are key in reducing the risk of infection. Maintenance of the catheter with a closed drainage system and prompt removal when no longer necessary are equally important in reducing CAUTI rates.

 Ventilator‐associated pneumonia (VAP) occurs in 9–27% of all intubated patients. The incidence of VAP not only increases the mortality rate but is also associated with increased ventilator days and increased LOS.Prevention strategies including patient positioning, equipment and hand hygiene, and bedside respiratory care (e.g. regular suctioning) have been shown to reduce VAP rates.The use of oral chlorhexidine decreases bacterial colonization of oropharyngeal secretions and therefore the incidence of VAP in those intubated for the short term.

 Please also refer to Chapter 44 (Infections Acquired in the Intensive Care Unit).