Infection Control in the Immunocompromised Host

Effective infection control and prevention within the intensive care unit (ICU) is crucial for minimizing morbidity and mortality. The immunocopromised patient, due to impairments in the immune response due a myriad of mechanisms, are at a heightened risk of hospital-acquired infections. This chapter examines the intricate challenges presented by diverse immunocompromising conditions, including solid organ transplant recipients, oncologic patients, recipients of cellular therapies, and people living with HIV. Hereby, we highlight the CDC-recommended standard precautions as mainstay with a focus on the concept of protective environments, vital for the care of the oncologic patient, and the hematopoietic cell transplant recipient. The different hospital-acquired infections in these patients are explored, providing insights into the in-hospital transmission of some infections of relevance in the immunocompromised patient, including tuberculosis, mold infections, Clostridioides difficile, and respiratory viral infections, including COVID-19. The pivotal role of antibiotic and antifungal prophylaxis to mitigate these risks is discussed. Furthermore, decolonization protocols targeting multidrug-resistant organisms including methicillin-resistant Staphylococcus aureus are outlined as an additional strategy to reduce risk of infections.