Epidemic nosocomial pneumonia in the intensive care unit.

The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients. This article reviews the epidemiology of nosocomial NP outbreaks and outlines guidelines for investigating suspected epidemics of NP within the ICU. Preventive strategies including appropriate surveillance for recognizing epidemic clusters, adherence to barrier isolation precautions, proper disinfection and sterilization of respiratory care equipment, and judicious use of antimicrobial agents are also discussed.