Adapt or perish--a relentless fight for survival: designing superbugs out of the intensive care unit.

Lethal microorganisms have terrorized man since the beginning of time, killing more human beings than anything else in history. The most infamous epidemic, the Black Death, wiped out almost half the population of Europe. To quote H.G. Wells, "adapt or perish, now as ever, is nature's inexorable imperative." Superbugs are nature's revenge on humans for their ingenuity. For decades antibiotics, which work by honing in on particular bacteria, have been the chief line of defense against infection. There is growing urgency for the judicious assessment of both conventional and innovative strategies with regard to antibiotic use, infection control, molecular detection of pathogens and adequate treatment of multidrug-resistant organisms in hospitals, especially critical care units. Financial restraints, changing demographics, an aging population and the limited introduction of new antibiotics have established an imperative for utilization of goal directed strategies in infection prevention and control. Research and development of both clinical and environmental weapons to combat these adversaries is essential if man is to adapt, not perish, in this fight for survival. This article will provide a snapshot of advances in infection prevention and control, including evidence based design, as they relate to the critical care environment.

Opening Pandora's (tool) Box: health care construction and associated risk for nosocomial infection.

There are approximately 5,700 hospitals in the United States, 3,000-4,000 that are antiquated or obsolescing. To meet increased service demands, remain financially viable; meet needs to upgrade aging infrastructure and incorporate medical and technology advancements, healthcare facilities are in a perpetual state of construction. Outbreaks of nosocomial infections have historically been documented in association with construction and renovation actives within health care facilities. For most healthy individuals, environmental exposures to etiological agents, results in no adverse effects but in immune-compromised patient, they are left susceptible to inadvertent exposures during construction to opportunistic bacteria, fungi and viruses. Evidence scientifically linking construction work and nosocomial infections as well as the efficacy and clinical relevance of infection control precautions is somewhat lacking but the empirical evidence and recommendations to support protective measures is steadily growing. Opening a "Pandora's Box" during construction can unleash unintended consequences therefore; it is imperative that a thorough, multidisciplinary approach towards an infection control plan is put clearly and firmly in place allowing health care construction projects to move forward with confidence that patient safety is the first specification.