Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure.

Objective: The efficacy of non-invasive mechanical ventilation (NIMV) on the postoperative ARF is conflicting and the failure rate of NIMV in this patient population is high. In our study, we hypothesized that the use of dexmedetomidine during NIMV in major abdominal surgical patients can reduce NIMV failure without significant side affect. Methods: Medical records of patients who underwent major abdominal surgery, admitted to our general surgery intensive care unit (ICU), developed postoperative ARF, received NIMV (with oro-nasal mask) and dexmedetomidine infusion were enrolled in this study. The infusion rate was adjusted to maintain a target sedation level of a Richmond Agitation-Sedation Scale (RASS) (-2)-(-3). The sedation was stopped when NIMV was discontinued. Results: A total of 60 patients, 42 (70.0%) male, and 18 (30.0%) female, with a mean age of 68 ± 11 years were included in the study. The mean APACHE II score was 20 ± 6. Dexmedetomidine was infused for a median of 25 h (loading dose of 0.2 mcg/kg for 10 min, maintained at 0.2-0.7 mcg/kg/h, titrated every 30 min). RASS score of all study group significantly improved at the 2 h of dexmedetomidine initiation (+3 vs. -2, p = 0.01). A targeted sedation level was achieved in 92.5% of patients. Six (10.0%) patients developed bradycardia and 5 (8.3%) patients had hypotension. The mean NIMV application time was 23.4 ± 6.1 h. Seven (11.6%) patients experienced NIMV failure, all due to worsening pulmonary conditions, and required intubation and invasive ventilation. Fifty-three (88.3%) patients were successfully weaned from NIMV with dexmedetomidine sedation and discharged from ICU. The duration of NIMV application and ICU stay was shorter in NIMV succeded group (21.4 ± 3.2 vs. 29.9 ± 6.4; p = 0.012). Conclusion: Our study suggests that dexmedetomidine demonstrates effective sedation in patients with postoperative ARF during NIMV application after abdominal surgery. Dexmedetomidine can be considered safe and capable of improving NIMV success.

Self-powered stable high-performance UV-Vis-NIR broadband photodetector based on PVP-Cobalt@Carbon nanofibers/n-GaAs heterojunction.

The self-powered PVP-Co@C nanofibers/n-GaAs heterojunction photodetector (HJPD) was fabricated by electrospinning of the nanofibers onto GaAs. An excellent rectification ratio of 6.60 × 106was obtained fromI-Vmeasurements of the device in the dark. TheI-Vmeasurements of the fabricated device under 365 nm, 395 nm and 850 nm lights, as well asI-Vmeasurements in visible light depending on the light intensity, were performed. The HJPD demonstrated excellent photodetection performance in terms of a good responsivity of âˆ¼225 mA W-1(at -1.72 V) and at zero bias, an impressive detectivity of 6.28 × 1012Jones, and a high on/off ratio of 8.38 × 105, all at 365 nm wavelength. In addition, the maximum external quantum efficiency and NPDR values were 3495% (V = -1.72 V) and 2.60 × 1010W-1(V= 0.0 V), respectively, while the minimum NEP value was ∼10-14W.Hz-1/2for 365 nm atV= 0.V volts. The HJPD also exhibited good long-term stability in air after 30 d without any encapsulation.

Development and characterization of self-powered, highly sensitive optoelectronic device based on PVA-rGO nanofibers/n-Si.

This study provided a promising way to fabricate low-cost and high-performance Poly (vinyl alcohol)-reduced graphene oxide (PVA-RGO) nanofibers/n-Si heterojunction photodetector. For this purpose, the hybrid heterojunction with a very-high rectification ratio (2.4 × 106) was achieved by successfully coating PVA-RGO nanofibers on n-Si wafer by electrospinning method. When the electro-optical analysis of the fabricated heterojunction photodetector under visible light depending on the light intensity, ultraviolet (UV) and infrared (IR) lights was examined in detail, it was observed that the photodetector exhibited both self-powered behavior and very high photo-response under each light sources. However, the highest optical performance was obtained under UV (365 nm) originated from PVA-RGO layer and IR (850 nm) light from both interfacial states between PVA-RGO nanofibers and Si and from Si layer. Under 365 nm UV light, the maximum performance values of R, D, ON/OFF ratio, normalized photo-dark-current ratio and external quantum efficiency (%) were obtained as 688 mA W-1, 1.15 × 1015Jones, 2.49 × 106, 8.28 × 1010W-1and 234%, respectively.

Long-term efficacy, safety, and drug survival of secukinumab in patients with psoriasis in Turkey: a retrospective analysis of real-world experience.

Introduction: Secukinumab (SEC) has been shown to be highly effective and safe in the treatment of moderate to severe plaque psoriasis (PsO), but data on SEC's long-term drug survival are limited. Aim: To analyse the survival rate of SEC and its predictive factors of survival, together with the drug safety and efficacy. Material and methods: Data of 268 patients who received SEC between May 2018 and April 2022 with moderate to severe psoriasis and/or psoriatic arthritis were analysed retrospectively. Psoriasis Area Severity Index (PASI) was used to define effectiveness. Drug survival was examined using the Kaplan-Meier analysis and Cox regression analysis was used to analyse predictive factors. Results: PASI 75/90/100 responses achieved at week 16 (89.5%, 78%, and 16.2%, respectively) were well maintained at week 52 (96.3%, 90.7%, and 15.4%, respectively). The drug survival probability rates for SEC were 94.4% at 12 months, 88.4% at 24 months, 78.6% after 3 years, 52.7% after 4 years. Concomitant treatments, dose escalation and family history of psoriasis were associated with a higher risk for SEC withdrawal. Conclusions: Close monitoring may improve SEC survival in psoriasis patients who require dose escalation and concomitant drugs.

The relationship between the clinical course of SARS-CoV-2 infections and ACE2 and TMPRSS2 expression and polymorphisms.

BACKGROUND: The viral spike (S) protein and host ACE2 and TMPRSS2 genetic variations may act as a barrier to viral infections or determine susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. OBJECTIVES: We investigated the relationship between the expression patterns and polymorphisms of the ACE2 and TMPRSS2 receptor genes associated with coronavirus disease 2019 (COVID-19) and the clinical course of SARS-CoV-2 infections. MATERIAL AND METHODS: We examined 147 COVID-19 patients (41 asymptomatic, 53 symptomatic and 53 cases treated in the intensive care unit (ICU)) and 33 healthy controls. The ACE2 and TMPRSS2 expression was determined using the One-Run RT-qPCR kit. Genotypic distributions of single nucleotide polymorphisms (SNPs) of ACE2 and TMPRSS2 were obtained using reverse transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS: The expressions of ACE2 and TMPRSS2 were different between SARS-CoV-2-positive and -negative groups. The ACE2 rs714205GG genotype and G-allele showed significant differences in the asymptomatic SARS-CoV-2-positive group. A significant correlation was found between the expression of TMPRSS2 rs8134378GA, rs2070788GA, rs7364083GA, and rs9974589AC genotypes and SARS-CoV-2 positivity. The rs1978124 C-allele and rs8134378 A-allele expressions were significant in the symptomatic SARS-CoV-2-positive group. The TMPRSS2 rs2070788GA expression was different in all patient groups compared to the control group. There was a difference between SARS-CoV-2-positive and -negative groups regarding the CTTA haplotype formed by ACE2 variants. The AGCAG and AGAAG haplotypes formed by the TMPRSS2 variants were more common in the asymptomatic patient group than in other patient groups. CONCLUSIONS: Identifying the relationship between host genetic variants and COVID-19 susceptibility will contribute to further studies, enabling new vaccines and potential therapeutic approaches to be discovered.

The Effect of Kangaroo Care on Paternal Attachment: A Randomized Controlled Study.

BACKGROUND: During the first interaction between the father and the infant, touch can be very important especially father-infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment. PURPOSE: This randomized controlled study was conducted to determine the effect of KC on paternal attachment. METHODS: A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father-Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical analysis. RESULTS: The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) ( P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group ( P < .05). IMPLICATIONS FOR PRACTICE AND RESEARCH: Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father-infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father-infant attachment and evidence-based practices that increase attachment.

The Prognostic and Functional Impact of Sprouty 2 Expression in Non-small Cell Lung Cancer.

OBJECTIVE: We represent Sprouty 2 (Spry2) expression analysis and its association with key driver mutations and clinical features of patients with non-small cell lung cancer as the largest ex vivo data. METHODS: The strength of Spry2 expression was evaluated using the immunoreactivity score (IRS), which was calculated using the following formula: IRS=(staining intensity score) SI×(percentage of positively stained cells) PP. The median IRS score was defined as the cutoff value. Patients were grouped as "weak immunoreactivity score" (IRS: 0 to 4) or "strong immunoreactivity score" (IRS: ≥4) with respect to the IRS score. RESULTS: The intensity and percentage of Spry2 staining were significantly lower in tumor tissues than in normal lung tissues ( P <0.0001). Patients' characteristics were similar for both groups, except for smoking status and, brain and lymph node metastasis. Overall survival of patients with a strong immunoreactivity score was significantly lower than those with a weak immunoreactivity score among metastatic patients (6.9 mo vs. 13.6, P =0.023) and adenocarcinoma histology (7.0 mo vs. not reached, P =0.003). CONCLUSION: Spry2 expression was lower in tumor tissues than in normal lung parenchyma. Increased expression of Spry2 is associated with poor prognosis. There were no significant associations between epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1 rearrangement and Spry2 expression. Despite the absence of KRAS mutational analysis, the clinical and epidemiological features of patients suggested that KRAS mutation might be an underlying determinant factor of the functional role of Spry2 in non-small cell lung cancer.

Efficacy and Safety of Omalizumab Updosing in Chronic Urticaria: A Retrospective Study.

Omalizumab is an effective and safe treatment option with licensed doses in patients with chronic spontaneous urticaria (CSU); however, some patients are not responsive to licensed doses and require updosing. As studies concerning updosing were insufficient, the present study evaluated the effectiveness and safety of omalizumab updosing (300 mg every 2 weeks) in CSU patients. Data of CSU patients treated with omalizumab were analyzed retrospectively. As an outcome measure, physician assessment of treatment response (complete response [CR], partial response, and unresponsiveness) was used. In all, 49 patients depicting CR to omalizumab 300 mg every 4 weeks and 54 patients treated with omalizumab 300 mg every 2 weeks were included in the study. Mean duration of the disease in updosing group was significantly lengthier than the CR group. The mean percentage level of eosinophils and basophils was significantly higher in the CR group. The history of systemic corticosteroid and oral cyclosporine treatment was significantly more frequent in the updosing group. Treatment with omalizumab 300 mg every 2 weeks for 12 weeks led to CR in 41 patients (75.9%). Our results confirmed the efficacy and safety of omalizumab updosing. Low baso-phil and eosinophil levels could also be important factors in defining the need for updosing.

Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey.

OBJECTIVE: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear. METHODS: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality). RESULTS: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group. CONCLUSION: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Effect of Tea Tree Oil and Coconut Oil on Nipple Crack Formation in the Early Postpartum Period.

Background: The aim of the study was to determine the effect of tea tree oil and coconut oil applied to the nipples during the early postpartum period on nipple crack formation. Methods: This randomized controlled experimental research included a total of 90 women in the research sample abiding by the research criteria, with 30 each in the intervention groups (coconut oil or tea tree oil application) and 30 in the control group. Women in the intervention groups applied coconut oil or tea tree oil to the nipples on the 3rd, 7th, and 10th days postpartum, whereas the control group did not have any intervention. Data in the research were collected with the Descriptive Information Form for Mothers, Early Postpartum Period Breast Problem Assessment Form, and Visual Analog Scale (VAS). Analysis of data used the chi-square test, Kruskal-Wallis test, and Friedman's test. Results: Mean age of women participating in the research was 28.23 ± 5.21 years. The differences between the groups applying coconut oil and tea tree oil on the 3rd, 7th, and 10th days postpartum and the control group were significant in terms of incidence of nipple cracks. In addition, the difference in mean VAS points for nipple pain in the groups using coconut oil and tea tree oil and the control group was found to be statistically significant (p < 0.05). Conclusions: According to the research findings, coconut oil and tea tree oil were determined to reduce nipple crack formation and nipple pain. It is recommended to increase the use of coconut oil and tea tree oil related to breast problems in nursing care during the postpartum period. Clinical Trials Registration Number: NCT05456438.

Succesful Use of Lipid Emulsion Theraphy In a Case of Extremely High Dose Olanzapine Intoxication.

In olanzapine intoxication alterations in consciousness defined as "agitation despite sedation" as well as cardiovascular and extrapyramidal side effects due to anticholinergic effects can be seen. In this case report, we aimed to present a patient who received a very high dose of olanzapine for suicide purposes benefited from intravenous lipid emulsion treatment (LET). A 20-year-old male patient, who received 840 mg of olanzapine for suicide, was brought to the emergency room, when the Glasgow Coma Scale was 5, he was intubated and given a single dose of activated charcoal. Later, he was admitted to the intensive care unit (ICU) intubated. The olanzapine level was measured as 653 µg L-1. The patient was started on LET and woke up at the sixth hour. In addition to the lack of strong evidence regarding the use of LET in olanzapine intoxication, it is seen that lipid therapy has been used successfully in patients. Compared with the cases in the literature, LET was successfully applied in our case, where the blood olanzapine level was very high. Although there is no evidence-based treatment in olanzapine intoxication, we believe that LET has a positive effect on neurological recovery and survival.

Secondary Infections in Critical Patients with COVID-19 Associated ARDS in the ICU: Frequency, Microbiologic Characteristics and Risk Factors.

OBJECTIVE:  To determine frequency, microbiologic characteristics and risks of secondary infections in patients with Coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS). STUDY DESIGN: An Observational study. PLACE AND DURATION OF STUDY:  COVID-19 intensive care unit (ICU), University of Health Sciences, Diskapi Yildirim Beyazit Research and Training Hospital, Turkey, from July 2020 to January 2021. METHODOLOGY: Demographic data of the COVID-19 patients with ARDS, was collected with reference to (age, gender), comorbidities, illness scores, ICU management modalities, hospital, and ICU stay durations and ICU outcomes. Secondary infections [bloodstream infection (BSI), possible lower respiratory tract infection (pLRTI) or urinary tract infections (UTI)], microbiologic pathogens, and resistant patterns were recorded. RESULTS:  A total of 205 COVID-19-related ARDS patients were included in this study. Out of them, 61 (29.8%) were diagnosed with secondary infection, 27 (13.1%) had at least one BSI, 20 (9.8%) had at least one pLRTI, and 34 (16.6%) had at least one UTI. Gram-negative pathogens were the most common cause of secondary infections (66/91, 72.5%). Klebsiella spp for BSI (10/19, 52.6%), Acinetobacter baumannii for pLRTI (10/18, 55.6%), and Escherichia coli for UTI (29/40, 72.5%) were the main causative agents. Among all Gram-negative bacteria, Carbapenem resistant was 62.1% (41/66) and extended-spectrum beta-lactamases positivity was 22.7% (15/66). At multivariable analysis, application of mechanical ventilation (MV) longer than 48 h, central catheterisation longer than 72 h, ICU stay longer than 10 days, and the time from hospitalisation to admission to the ICU longer than 48 h were associated with secondary infections. CONCLUSION: Patients with COVID-19 associated ARDS had a high rate of secondary infections. In order to reduce secondary infection in these patients, MV duration and ICU stay should be shortened and invasive catheters should be removed as soon as possible. KEY WORDS: SARS-CoV-2, COVID-19, Acute respiratory distress syndrome, Secondary infections.

Knowledge levels and attitudes of medical faculty students related to whole body donation in Türkiye.

BACKGROUND: Cadaver is a very important educational material for medical faculty students, students of health sciences, residents of any specialty in medicine and specialists. In developed countries, cadavers are mainly obtained by individual donations. However, like in other developing or underdeveloped countries, whole-body donations for cadaveric use in Türkiye are extremely scarce. This study sought to investigate the knowledge and awareness levels of medical faculty students about body donation and the factors that might influence their attitudes to body donation. The aim of the study is, with the results of the questionnaire, to raise public awareness for whole-body donation by creating public spots and by giving place in the official website of the Ministry of Health and make medical faculties to put lectures about body donation and its importance into their anatomy curriculum. METHODS: A 31-item questionnaire with close-ended statements was administered to 291 students at Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty. RESULTS: Only two of the participants (0.7%) stated that they had already donated their bodies to be used as a cadaver. Of note, those who reported considering whole body donation had higher maternal education levels (p = 0.002). The presence or absence of religious belief and the degree of religiosity were also significant factors, for significantly higher rates of non-believers and those who defined themselves as having a low degree of religiosity were in favor of body donation (p < 0.0001). CONCLUSIONS: According to the religion of Islam, we should inform the relevant media that there is no harm in donating a body. In addition, considering the effect of mother's education level on the decisions of young people on this issue, we can state that we see once again how important women's education is in order to make progress in every field.

The Effect of Menopause on the Sexual Functions and Marital Adjustment of the Spouses.

Background: This study was conducted as a cross-sectional descriptive study to determine the effect of menopause on the SFs and marital adjustment (MA) of the spouses. Materials and Methods: The sample of the study consisted of a total of 254 people, 127 of whom were postmenopausal women and their spouses. The data were collected with the Descriptive Information Form, the Female Sexual Function Scale (FSFS), the Arizona Sexual Experiences Scale (ASES), and the Marital Adjustment Scale (MAS). The t-test, Mann-Whitney U-test, Kruskal-Wallis test, and correlation analysis were used in the analysis of the data. Results: Sexual dysfunctions (SDs) were detected in 91.3% of women and 77.2% of men. MA was found to be low in 74.1% of the women. The relationship between the level of MA and the total mean score of the women's FSFS was found to be statistically significant (P < 0.05). In addition, the relationship between the presence of SD in the postmenopausal women and the mean ASES score in the husband was found to be statistically significant (P < 0.05). According to Spearman's rho correlation coefficient, the positive correlation between the total mean score of the MAS and the mean total score of the FSFS was weak (r = 0.290; P = 0.001), and the negative correlation between the mean score of the total score of the ASES was weak (r = -0.381; P = 0.000) which was found to be a relationship (P < 0.05). Conclusion: In this study, it was determined that menopause affects the marriage and sexual adjustment of spouses negatively.

Air Embolism Developed As A Result Of Opening The Central Catheter Tip By The Patient's Relative.

Central catheterization can be placed in critically ill patients in the intensive care unit (ICU) for some purposes such as dialysis, nutrition, and hemodynamic monitoring. Air embolism is a very rare complication of central catheterization. A 46-year-old male patient with no known comorbidities underwent laparoscopic total colectomy and protective loop ileostomy for colon cancer. He was taken to the general surgery ICU for close hemodynamic follow-up in the postoperative period. Since he was cachectic and could not reach the target of oral nutrition within 1 week, a central catheter was inserted in the right internal jugular vein with ultrasonographic imaging, and total parenteral nutrition (TPN) was started. The patient, who had no additional problems in the follow-up, was transferred to the general surgery ward. Three and half hours after the transfer, the patient became unconscious and had extensor posture. Therefore, emergency cranial computed tomography (CT) was performed and he was taken back to the ICU. There was no finding in favour of bleeding in cranial CT. The patient was intubated to protect the airway, as he had a generalized tonic-clonic seizure during his follow-up. Air bubbles were seen in the main pulmonary artery and right ventricle in the multidetector thorax CT. Cranial CT angiography was taken at the 24th hour, and diffusion cranial MRI was performed for diagnosis of central air embolism. No air was detected to be aspirated in the cerebral arteries in cranial CT angiography. On the 6th day, the patient regained consciousness, extubated, and physical therapy was started. On the 12th day of hospitalization, the patient was discharged with 2/5 loss of motor power in the left upper extremity. When the patient's wife's anamnesis was detailed, it was learned that in order to mobilize the patient, she separated the TPN from the catheter and left the catheter tip open.

Role Of Il-6 In The Adjustment Of The Medical Treatment Of Patients With Covid-19 Associated Acute Respiratory Distress Syndrome.

BACKGROUND: Many cytokines propose to play a role in the pathogenesis of Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) associated COVID-19 disease. High interleukin-6 (IL-6) levels are associated with mortality and other poor clinical outcomes in COVID-19. METHODS: In this retrospective study, the correlation of IL-6 level with clinical and other inflammatory parameters, its role in treatment change and its relationship with mortality in COVID-19 patients developing acute respiratory distress syndrome (ARDS) were investigated. RESULTS: Totally 76 patients were included in the study; Thirty-four (44.7%) patients were female and 42 (55.3%) patients were male. All patients had IL-6 levels above the upper reference value (>5.9 pg/mL). Overall, 48 patients (63.1%) had a severe clinical presentation (tachypnoea, tachycardia, fever) that was clinically compatible with IL-6 values, and medical treatment was changed for COVID-19 in this group. A positive correlation was detected between IL-6 and CRP on the day of the change in treatment (p=0.035, r=0.76). There was no decrement observed in IL-6 level on the 3rd day in patients that was clinically thought to have cytokine storm and whose treatment was changed. Mortality was higher in the group whose treatment was changed. CONCLUSIONS: We believe that IL-6 level alone is insufficient to decide on a change in treatment, and correlation of IL-6 with the patient's clinical status is more significant in such decision.

Is every microorganism detected in the intensive care unit a nosocomial infection? Isn't prevention more important than detection?

The present letter to the editor is related to the study entitled "Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors." Not every microorganism grown in samples taken from critically ill patients can be considered as an infectious agent. Accurate and adequate information about nosocomial infections is essential in introducing effective prevention programs in hospitals. Therefore, the development and implementation of care bundles for frequently used medical devices and invasive treatment devices (e.g., intravenous catheters and invasive ventilation), adequate staffing not only for physicians, nurses, and other medical staff but also for housekeeping staff, and infection surveillance and motivational feedback are key points of infection prevention in the intensive care unit.