Patient safety has always been the heart of healthcare practice and nursing through the history of medicine. However, all through the world occasional non deliberate accidental harm occurs to patients looking for care. Such unfavourable incidents can occur at all levels of healthcare whether clinical or managerial, curative or preventive, and in general healthcare, or private. It may occur at any stage of management radiology, laboratory, operating room, ward, or icu. The who, at the meeting held on july 2006, in new delhi, india, identified an adverse event as a separate unconnected incident associated with health care, which results in in deliberate injury, illness, or death. Published surveys on patient safety show that in industrialized advanced countries, more than half of these adverse events are preventable and occur because of a shortage in system or organization design or operation rather than because of poor performance of healthcare providing staff who report, 2006.

Harvard medical centre study in 1991 after who report, 2006 was the first to draw the attention to the volume of patient safety problem. Based on medical records review, the rate of adverse event in three us medical centres ranged between 3.2 to 5.4 percent. In uk, the rate was 11.7 percent and in denmark, the rate was 9 percent who report, 2002. Results of recent studies suggest the rate is between 3.2 and 16.6 percent per 100 hospital admissions. The situation in the less well documented health care centres in the developing countries is more serious who report, 2006. The cost of adverse events that endanger patient safety can be very high, considering all the aspects.

It includes, loss of confidence and credibility and reputation of health care institutions, loss of enthusiasm and job gratification among the working staff. In addition, the cost includes damage to the patients and their relatives especially when taking defensive attitudes and keeping information hidden from patient's families. Other added costs are those of prolonged hospital stay and increased medical expenses and those of lawsuit demands who report, 2006. The objective of this paper is to review, in brief, the problem of patient safety with particular attention to patient safety in the icu being one of the essential patient care systems in a health care organization. Besides, the vulnerability of icu patients augments the importance of patient safety concept.

The researcher performed an article search using the following internet databases: national centre for biotechnology – national library of medicine – national institutes for health ncbi , at medscape database, at world health organization – publications, at yahoo and google scholar general databases, site of.org. Terms of search were patient safety, basics, and principles of patient safety, review of patient safety, patient safety in the icu and the critically ill patient safety. Patient safety event is a wide term it does not only mean a medical error during the course of medical management and nursing. The department of health and human services, 2008, defined a patient safety event as an incident, which takes place during providing a health care service. It includes errors of not doing omission or errors of doing commission , it also includes faults and mistakes of the patient care processes involving drugs and equipment's or the environment where these processes are carried out. The phrase, one cannot manage what cannot be measured hold true for patient safety.

One of the reasons of the lack of effective patient safety strategies is the need for a measurement tool to provide measures, consequently, reduce medical errors and improve patient safety. The agency for healthcare research and quality ahrq developed an array of patient safety indicators planned to screen administrative data for events related to patient safety. This list of indicators includes 16 situations where a threat to patient safety may occur during the course of healthcare delivery. Using this measurement tool shows that patient safety incident of highest rates are failure to rescue, decubitus ulcers and postoperative wound infection which is specifically increased by 35% during the period 2002 2006 health grades inc, 2006. Bruke, 2006, has provided a comprehensive review of infection control as an important aspect in patient safety strategy.

Based on many studies, hospital acquired infection in this context, alternatively called health care associated infection, is one the most frequent risks for patient safety in patients admitted to hospitals. The answer to the question of why it is an important aspect for patient safety lies in the fact that 5 10 percent of patients admitted to acute care hospitals acquire one or more nosocomial infection. In the us, 2 million patients acquire hospital infection every year with 90.0 deaths. There are four types of hospital acquired infections, which account for 80% of the total rate. These are infection associated with urinary catheterization, blood borne infection usually with vascular invasive procedures , surgical wounds infections, and pneumonia usually associated with the use of ventilators. Therefore, it is understandable that 25 per cent of these infections occur in the icu bruke, 2006. The increased awareness of patient safety resulted in reorganizing the concepts of infection control and placing it in the domain of public health with consequent increased surveillance and epidemiological studies.

It is true that recognizing risk factors allows clarification of what is adjustable and what is not, however modification of some terms is advisable. Instead of saying avoiding the use of catheters, we should recommend reducing the duration of use of catheters. Many other terms as use antibiotics intelligently, and training and staff education are hazy and indistinct, accordingly, tricky to employ bruke, 2006. The report of the institute of medicine, 2004 after armstrong and laschinger, 2006 recognized nursing role as pivotal to patient safety. The report suggests the degree of activity of hospital nurses and the extent of giving them authority to take part in decisions, directly affects the quality and perception of patient safety.