Intensive of all neonatal deaths are due

Intensive Care Unit (ICU) is a part of the
hospital which manages critically ill cases, and it is considered as the most
important part in the hospital because it has an effect on health (1-2). There is an increasing requirement for
critical care services in KSA and worldwide, this requirement is
related to the increasing population age, longer survival of previously
incurable diseases, and developed surgical procedures that make post-operative
intensive care admission necessary, ICU in KSA now is able to provide
advanced medical treatment because the improvement in critical care medicine,
this improvement in critical care has made it possible to treat certain disease
leading to longer stay in Intensive Care Unit(3). A
large amount of hospital budget is consumed by ICU(4). Intensive
care unit spends about 8% – 30% of hospital expenditures. Compared to those in
other hospital areas, direct ICU costs per day are six times higher than those
for non-ICU care (4-5-6). MOH has completed the first stage of
development of ICU at King Fahad Hospital in Madinah (with a
capacity of 34 beds out of 67) (7)

Actually there is no specific
definition of prolonged stay in ICU, Zampieri et al., defined it as staying ?14
days in the ICU(8). It also defined as staying more than 10 days or
21 days in the ICU(9-10). Prolonged stay in ICU has a great negative
impact on patient, physically, physiologically, mentally, and socially. Mortality
is higher among prolonged-stay patients than short-stay patients (11),
It adversely affects health status by decreasing quality of life, increasing
risk for infection and by increasing risk for readmission to hospital,
Moreover; Ventilator-associated pneumonia (VAP) and mortality are higher among
prolonged-stay patients than short stay patients (2-11-15).

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Infection is one important reason that
leads to prolonged ICU stay, based on some studies that found ventilator
dependency, infectious complications, and coma are main reasons for LOS (11-13).
Up to 23% of healthcare-associated infections occurring in ICU and
about 40% of infections occurring in all units of a hospital are
device-associated (14).
According to World Health Organization (WHO), Infections are responsible for
about one fifth of the world’s annual 2.7 million neonatal deaths. In South
Asia and sub-Saharan Africa about one quarter of all neonatal deaths are due to
infections. Infection can be associated to many types of medical procedures
such as insertion of central line, ventilation and urinary catheterization. Central
line-associated blood stream infections (CLABSI), catheter-associated urinary
tract infections (CAUTI), and ventilator-associated pneumonia (VAP), are
possible infections occur to patients.(16)

CAUTI is classified as a
complicated UTI. Urinary tract infections are the most common type of
healthcare-associated infection(16). There are many
risk factors that cause CAUTI s, such as prolonged catheterization, using of
systemic antibiotics, diabetes mellitus. The main adaptable risk factor is the
duration of catheterization, by the 30th day of catheterization, infection
rates are about 100 % (17).

Central venous catheters (CVCs)
are very important in ICU and commonly used in modern medicine. Insertion of
Central Catheter is an invasive procedure, so the risk of developing central
line-associated bloodstream infection (CLABSIs) is high. Infectious risks
include femoral or internal jugular more than Subclavian catheterization (18).
There are many factors that causes (CLABSIs) such as ignoring hand washing
before handling CVC and not wearing Personal Protective Equipment (PPE). Also
long duration of catheterization has a negative impact on patient and increases
the risk of infection. So CVC should be removed immediately when there is no
longer needed. Atilla,.etal found that patients with longer
duration access were more affected with CLABSIs (19).

Ventilator-Associated Pneumonia
(VAP) is a widespread complication in ICU, it is a type of HAP that develops
more than 48–72 h after endotracheal intubation. VAP happens in 28% of patients
who receive mechanical ventilation, it occurs according to duration of
mechanical ventilation (20).