The Alfred ICU provides care for patients with a wide range of infectious diseases while prioritising optimal and progressive infection control practices to minimise any risk to our patients and staff.

Infectious Diseases

In conjunction with the Infectious Diseases Unit the ICU manages a diverse range of complex infectious diseases, particularly in immunosuppressed patients such as bone marrow and solid organ transplant recipients. The Alfred also provides a State Service for HIV/Aids and the ICU has extensive experience in managing these patients if they become critically ill. There are a number of these patients in the Haemophilia Service, another State Service provided by the Alfred.

We have daily weekday rounds with our infectious diseases specialist, Dr Alex Padiglioni or members of his team, together with The Alfred’s microbiology laboratory team that provides up to date microbiology information on our patients as well as treatment advice in relation to antibiotic therapy. One of our intensive care specialists, Dr Steve McGloughlin, is also an infectious diseases specialist and works closely with Dr Padiglioni and the entire infectious diseases team.

Due to our expertise with ECMO we are also a referral center for patients with severe respiratory failure such as those with influenza, including “swine flu” (H1N1).

The intensive care unit and infectious diseases team also work closely together on national and international clinical research programs aimed at improving the care for our patients. Recently this has included an international study aimed at determining the optimal early management of sepsis and a federally funded program investigating the use of state of the art microbiological techniques for the early detection of infectious organisms.

Dr Padiglioni and Dr McGloughlin along with A/Prof Anton Peleg and A/Prof Allen Cheng from the infectious department also convene a biannual conference aimed specifically at the management and prevention of infections in the critically ill which attracts both international speakers and delegates.

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Infectious Diseases Prevention

The Alfred ICU has 4 class N rooms, each with anterooms, designed for the treatment of highly infectious diseases. In addition we regularly train staff in the use of personal Powered Air Purifying Respirators to provide even higher levels of personal protection for our staff in the event of having to care for patients with highly infectious, virulent diseases.

Infection Control

The Alfred ICU was specifically designed to optimise infection control. More than half of the cubicles can be closed and have advanced air-exchange capabilities. ICU in conjunction with the Infection Prevention Unit manages an active surveillance program that specifically targets hand washing, central line associated blood stream infections (CLABSI), ventilator associated pneumonia and urinary tract infections. All Junior Staff are provided with training in infection control techniques and procedures prior to commencing their ICU term. Underpinning our infection prevention campaign is our determination to improve compliance with the WHO “5 moments for Hand Hygiene”. With targeted staff education we have managed to double the compliance with hand hygiene over the last 2 years and now regularly exceed the national target of 80% compliance. All medical staff must be certified by the Hand Hygiene Australia on-line learning package.

We are dedicated to reducing the incidence of hospital-acquired infections. Our patients, particularly transplant recipients and those with burns, ECMO and ventricular assist devices, are especially vulnerable to infection. Therefore decreasing the incidence of central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) is a priority. Our CLABSI rate has fallen dramatically over the last 8 years. In 2004 our rate was 24 per 1000 line days. For the last three years we have bettered the national target and have had less than one CLABSI per 1000 line days. Our target is to have no central line infections. In order to meet this target we have implemented a comprehensive program which includes a dedicated vascular access registrar, daily central line review rounds, accreditation of all staff who insert vascular access and extensive refinement of our central line insertion technique and infection control procedures to minimize the risk of infection.

Dr Padiglioni manages our antibiotic stewardship program. Every six months our positive blood cultures are reviewed by Dr Padiglioni and Dr McGloughlin and discussed with the ICU consultants, the antibiotic sensitivity profiles analysed and our empiric antibiotic guidelines are adjusted accordingly. This guideline emphasizes the streamlining of antibiotic use ensuring they are optimized for each individual patient and avoiding unnecessary broad-spectrum antibiotics. This program has seen a successful reduction in the incidence of antibiotic resistance particularly in regard to MRSA bacteraemia.

We recognise that hospital acquired infections will always be a potential problem in the ICU. Our goal is an intensive care in which staff are only satisfied with zero hospital acquired infections. Our patients deserve nothing less. Our dedication to infection prevention was recognised in 2013 when we won a competitive national HAI watchdog award for our CLABSI infection prevention initiatives and also received an honorary mention for our infectious diseases liaison service.