1
|
Liu S, Zhou H, Zhang X, Yan Q, Zhang H, Wu C, Shen H. Knowledge, attitudes and practices of nurses regarding airway clearance in neurocritical illness patients: A cross-sectional study. J Clin Nurs 2024. [PMID: 38951120 DOI: 10.1111/jocn.17341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/09/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024]
Abstract
AIM We aimed to assess the level of knowledge, attitudes and practices regarding airway clearance among nurses and explore the factors affecting the knowledge, attitudes and practices. DESIGN A questionnaire-based cross-sectional study. BACKGROUND Airway clearance is an important method of eliminating excess secretions. In neuroscience nursing, nurses are important executors of airway management, and their knowledge, attitudes and practices can influence the effectiveness of airway clearance. METHODS This study was conducted from July to September 2023 in four hospitals in Jiangsu Province, China. A structured questionnaire about airway clearance was designed and used to collect the data. The nurses used this questionnaire to self-rate. The STROBE checklist for cross-sectional studies was followed. RESULTS The age, work experience, highest educational attainment and technical title of the nurses can significantly influence their knowledge. The age, highest educational attainment and technical title of the nurses can significantly impact their attitudes. Practice scores were significantly influenced by age, work experience, technical title, whether the nurses had received any training on airway clearance techniques, and whether the department developed procedures for implementing the airway clearance technology. Nurses' attitudes were significantly associated with knowledge and practice, and there was no significant correlation between knowledge and practice. CONCLUSION This study showed that age, work experience, highest educational attainment and training were related to knowledge, attitudes and practices. These findings suggest that nursing managers can conduct airway clearance training according to age group, working experience and education level of the nurses. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT The findings show that the level of knowledge, attitudes and practices related to airway clearance in neuroscience nursing among nurses were acceptable, which means that nurses can better perform airway management on patients. These findings serve as a significant reference for designing an airway clearance education for nurses and meet the needs of nurses in clinical nursing practice.
Collapse
Affiliation(s)
- Shengnan Liu
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Hui Zhou
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Xuelian Zhang
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Qi Yan
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Haiying Zhang
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Chao Wu
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| | - Hongying Shen
- Neurosurgery Department, The First Affiliated Hospital of Soochow University, Soochow, China
| |
Collapse
|
2
|
Li Y, Gao X, Diao H, Shi T, Zhang J, Liu Y, Zeng Q, Ding J, Chen J, Yang K, Ma Q, Liu X, Yu H, Lu G. Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study. Antimicrob Resist Infect Control 2024; 13:62. [PMID: 38867312 PMCID: PMC11170918 DOI: 10.1186/s13756-024-01420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE This study aimed to develop and apply a nomogram with good accuracy to predict the risk of CRAB infections in neuro-critically ill patients. In addition, the difficulties and expectations of application such a tool in clinical practice was investigated. METHODS A mixed methods sequential explanatory study design was utilized. We first conducted a retrospective study to identify the risk factors for the development of CRAB infections in neuro-critically ill patients; and further develop and validate a nomogram predictive model. Then, based on the developed predictive tool, medical staff in the neuro-ICU were received an in-depth interview to investigate their opinions and barriers in using the prediction tool during clinical practice. The model development and validation is carried out by R. The transcripts of the interviews were analyzed by Maxqda. RESULTS In our cohort, the occurrence of CRAB infections was 8.63% (47/544). Multivariate regression analysis showed that the length of neuro-ICU stay, male, diabetes, low red blood cell (RBC) count, high levels of procalcitonin (PCT), and number of antibiotics ≥ 2 were independent risk factors for CRAB infections in neuro-ICU patients. Our nomogram model demonstrated a good calibration and discrimination in both training and validation sets, with AUC values of 0.816 and 0.875. Additionally, the model demonstrated good clinical utility. The significant barriers identified in the interview include "skepticism about the accuracy of the model", "delay in early prediction by the indicator of length of neuro-ICU stay", and "lack of a proper protocol for clinical application". CONCLUSIONS We established and validated a nomogram incorporating six easily accessed indicators during clinical practice (the length of neuro-ICU stay, male, diabetes, RBC, PCT level, and the number of antibiotics used) to predict the risk of CRAB infections in neuro-ICU patients. Medical staff are generally interested in using the tool to predict the risk of CRAB, however delivering clinical prediction tools in routine clinical practice remains challenging.
Collapse
Affiliation(s)
- Yuping Li
- School of Public Health, Yangzhou University, Yangzhou, 225009, China
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Jiangsu Key Laboratory of Zoonosis, Yangzhou, 225009, China
| | - Xianru Gao
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Haiqing Diao
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Tian Shi
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Jingyue Zhang
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Yuting Liu
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
| | - Qingping Zeng
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - JiaLi Ding
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Juan Chen
- School of Nursing, Yangzhou University, Yangzhou, 225009, China
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Kai Yang
- School of Artificial Intelligence, School of Information Engineering, Yangzhou, 225009, China
| | - Qiang Ma
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Xiaoguang Liu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
| | - Hailong Yu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Guangyu Lu
- Department of Neurosurgery, Neuro-Intensive Care Unit, Clinical Medical College, Yangzhou, 225001, China.
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 225001, China.
| |
Collapse
|
3
|
Naik SS, Krishnakumar M, Bhadrinarayan V. Autonomic dysfunction as a predictor of infection in neurocritical care unit: a prospective cohort study. J Clin Monit Comput 2024; 38:399-405. [PMID: 37535219 DOI: 10.1007/s10877-023-01063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Infection in the neurocritical care unit ( NCCU) can cause significant mortality and morbidity. Autonomic nervous system plays an important role in defense against infection. Autonomic dysfunction causing inflammatory dysregulation can potentiate infection. We aimed to study the relationship between autonomic dysfunction and occurrence of infection in neurologically ill patients. METHODS Fifty one patients who were on mechanical ventilation were prospectively enrolled in this study. Autonomic dysfunction was measured for three consecutive days on admission to NCCU using Ansiscope. Patients were followed up for seven days to see the occurrence of infection. Infection was defined as per centre of disease control definition. RESULTS A total of 386 patients were screened for eligibility. 68 patients satisfied the eligibility criteria and 51 patients were finally included in the study. The incidence of infection was 74.5%. The commonest infection was pulmonary infection (38.8%) followed by urinary tract infection (33.3%), blood stream infection(14.8%), central nervous system infection (11.1%) and wound site infection (3.7%). The degree of autonomic dysfunction (AD) percentage was more in infection group (37.7% (25.2-49.7)) compared to non infection group (23.5% (18-33.5)) and maximal on day 3 (P = 0.02). Patients with increasing trend of AD% from day 1 to day 3 had the highest infection rates. The length of NCCU stay (20(10-23) days and mortality (42.1%) was higher in infection group (p < 0.001). CONCLUSION AD assessment can be used as a tool to predict development of infection in NCCU. This can help triage and institute early investigation and treatment.
Collapse
Affiliation(s)
- Shweta S Naik
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Mathangi Krishnakumar
- Department of Anaesthesia and Critical care, St John's Medical Collage Hospital, Bengaluru, Karnataka, India
| | - V Bhadrinarayan
- Department of Neuroanaesthesia and Neurocritical Care Neurosciences faculty centre, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur road, 560029, Bengaluru, Karnataka, India
| |
Collapse
|
4
|
Sultan A, Khan MF, Sohaib M, Shamim F. Clinical Characteristics and Outcomes of Neurosurgical Patients at a Level III Intensive Care Unit in Pakistan: A Retrospective Cohort Study. Cureus 2024; 16:e52990. [PMID: 38410336 PMCID: PMC10896463 DOI: 10.7759/cureus.52990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Objective Neurosurgical patients account for the majority of cases across all surgical specialties that are admitted to the surgical intensive care unit (ICU) at our institution. The goal of this study was to analyze factors leading to ICU admission, type of neurosurgical intervention, length of ICU/hospital stays, and outcomes in terms of complications and ICU and in-hospital mortality. Methods This retrospective study conducted at the surgical ICU, Aga Khan University Hospital, investigated clinical data of neurosurgical patients admitted between January 2020 and June 2022. Quantitative data were collected regarding patients' characteristics, such as age, gender, comorbidities, type of surgical intervention, mode of surgery, source of admission to ICU, and type of osmotherapy. The primary and secondary outcomes were in terms of ICU and hospital mortality and complications. Results Among 321 patients admitted to the SICU, 197 were included according to inclusion/exclusion criteria. A total of 168 patients (85.3%) required surgical intervention, of whom 101 (60%) underwent elective surgery and 67 (40%) required emergency surgery. Thirteen patients died during the ICU or hospital stay, representing a mortality rate of 6.6%. The average length of stay in the ICU had a median IQR of 4 (4,6) days while the average hospital stay median IQR was 11 (12,18) days. Tracheostomy was performed in 77 patients (39%), and the median IQR day for tracheostomy was 4 (3,5) days. APACHE-II (Acute Physiology and Chronic Health Evaluation) score, length of ICU, and length of hospital stay were significantly higher in the deceased patients with a p-value of 0.042, 0.019, and 0.043, respectively. Conclusion In conclusion, this study on neurosurgical patients from the surgical intensive care unit of a low-middle-income country provided valuable insights about factors and their influence on outcomes. The study implies that a high APACHE-II score is linked to poorer outcomes for neurosurgical patients in this particular setting. Undertaking a large multicenter prospective study is vital for tailoring interventions and improving patient care in regions with limited resources where healthcare challenges may be distinct.
Collapse
Affiliation(s)
- Atqua Sultan
- Anesthesiology, Nishtar Medical University/Hospital Multan, Multan, PAK
| | | | - Muhammad Sohaib
- Anesthesiology, The Aga Khan University Hospital, Karachi, PAK
| | - Faisal Shamim
- Anesthesiology, The Aga Khan University Hospital, Karachi, PAK
| |
Collapse
|
5
|
Salmanov AG, Shchehlov DV, Mamonova M, Bortnik IM, Chabanovych NB, Kudelskyi YE, Chekhunova D. Healthcare-associated infections after neurosurgical procedures in Ukraine: a multicentre study (2020-2022). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:17-24. [PMID: 38431802 DOI: 10.36740/wlek202401102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) after a neurosurgical procedure in Ukraine. PATIENTS AND METHODS Materials and Methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 10 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. RESULTS Results: Of 8,623 neurosurgical patients, 1,579 (18.3%) HAIs were observed. The most frequently of HAI types were pneumonia (38.4%), surgical site infection (34.2%), urinary tract infection (18.1%) and bloodstream infection (9.3%). Death during hospitalization was reported in 11.3% of HAI cases. There was an association between HAIs after neurosurgical procedures and patients with diabetes mellitus, end-stage renal disease undergoing dialysis, and leukaemia. The strongest independent associations were observed for intubation, urinary catheters, and vascular catheters. Klebsiella pneumoniae were most commonly reported, accounting for 25.1% of all organisms, followed by Escherichia coli (17.6%), Staphylococcus aureus (9.9%), Pseudomonas aeruginosa (8.9%), Acinetobacter baumannii (8.5%), coagulase-negative staphylococci (6.8%), and Streptococcus spp. (5.5%). In total, 76.3% isolates from neurosurgical patients were MDROs. Antimicrobial resistance in Ukraine varies greatly by bacterial species, antimicrobial group, and region. CONCLUSION Conclusions: Healthcare-associated infections are a cause for mortality and morbidity among neurosurgical patients. This is due to increase emergence of antimicrobial-resistant pathogens. Routinely collected surveillance data are of great value as a basis for studying the consequences of HAIs.
Collapse
Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Dmytro V Shchehlov
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Maryna Mamonova
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE; BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | - Ihor M Bortnik
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Nadiia B Chabanovych
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Yaroslav E Kudelskyi
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Daria Chekhunova
- SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY OF NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| |
Collapse
|
6
|
Abdalla JS, Albarrak M, Alhasawi A, Al-Musawi T, Alraddadi BM, Al Wali W, Elhoufi A, Habashy N, Hassanien AM, Kurdi A. Narrative Review of the Epidemiology of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Gulf Cooperation Council Countries. Infect Dis Ther 2023:10.1007/s40121-023-00834-w. [PMID: 37389707 PMCID: PMC10390449 DOI: 10.1007/s40121-023-00834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023] Open
Abstract
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the most common healthcare-associated infections, with rates varying between countries. Antimicrobial resistance (AMR) among common HAP/VAP pathogens has been reported, and multidrug resistance (MDR) is of further concern across Middle Eastern countries. This narrative review summarizes the incidence and pathogens associated with HAP/VAP in hospitals across Gulf Cooperation Council (GCC) countries. A PubMed literature search was limited to available data on HAP or VAP in patients of any age published within the past 10 years. Reviews, non-English language articles, and studies not reporting HAP/VAP data specific to a GCC country were excluded. Overall, 41 articles, a majority of which focused on VAP, were selected for inclusion after full-text screening. Studies conducted over multiple years showed a general reduction in VAP rates over time, with Gram-negative bacteria the most commonly reported pathogens. Gram-negative isolates reported across GCC countries included Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Rates of AMR varied widely among studies, and MDR among A. baumannii, K. pneumoniae, Escherichia coli, P. aeruginosa, and Staphylococcus aureus isolates was commonly reported. In Saudi Arabia, between 2015 and 2019, rates of carbapenem resistance among Gram-negative bacteria were 19-25%; another study (2004-2009) reported antimicrobial resistance rates in Acinetobacter species (60-89%), P. aeruginosa (13-31%), and Klebsiella species (100% ampicillin, 0-13% other antimicrobials). Although limited genotype data were reported, OXA-48 was found in ≥ 68% of patients in Saudi Arabia with carbapenem-resistant Enterobacteriaceae infections. Ventilator utilization ratios varied across studies, with rates up to 0.9 reported in patients admitted to adult medical/surgical intensive care units in both Kuwait and Saudi Arabia. VAP remains a burden across GCC countries albeit with decreases in rates over time. Evaluation of prevention and treatment measures and implementation of a surveillance program could be useful for the management of HAP and VAP.
Collapse
Affiliation(s)
| | - May Albarrak
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Tariq Al-Musawi
- Al Salam Hospital, Al Khobar, Saudi Arabia.
- Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI-MUB), Busaiteen, Bahrain.
| | - Basem M Alraddadi
- King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Walid Al Wali
- Hamad General Hospital, Doha, Qatar
- Al Wakra Hospital, Al Wakra, Qatar
| | | | | | | | | |
Collapse
|
7
|
Shen G, Zhang L, Fan W, Lv H, Wang F, Ye Q, Lin M, Yu X, Cai H, Wu X. Establishment of a risk prediction model for multidrug-resistant bacteria in deceased organ donors: a retrospective cohort study in China. Front Cell Infect Microbiol 2023; 13:1181630. [PMID: 37305411 PMCID: PMC10249958 DOI: 10.3389/fcimb.2023.1181630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background Multidrug resistance in bacteria is a serious problem in organ transplantations. This study aimed to identify risk factors and establish a predictive model for screening deceased organ donors for multidrug-resistant (MDR) bacteria. Methods A retrospective cohort study was conducted at the First Affiliated Hospital of Zhejiang University School of Medicine from July 1, 2019 to December 31, 2022. The univariate and multivariate logistic regression analysis was used to determine independent risk factors associated with MDR bacteria in organ donors. A nomogram was established based on these risk factors. A calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to estimated the model. Results In 164 organ donors, the incidence of MDR bacteria in culture was 29.9%. The duration of antibiotic use ≥3 days (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.62-8.81, p=0.002), length of intensive care unit (ICU) stay per day(OR 1.06, 95% CI 1.02-1.11, p=0.005) and neurosurgery (OR 3.31, 95% CI 1.44-7.58, p=0.005) were significant independent predictive factors for MDR bacteria. The nomogram constructed using these three predictors displayed good predictive ability, with an area under the ROC curve value of 0.79. The calibration curve showed a high consistency between the probabilities and observed values. DCA also revealed the potential clinical usefulness of this nomogram. Conclusions The duration of antibiotic use ≥3 days, length of ICU stay and neurosurgery are independent risk factors for MDR bacteria in organ donors. The nomogram can be used to monitor MDR bacteria acquisition risk in organ donors.
Collapse
Affiliation(s)
- Guojie Shen
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Li Zhang
- Department of Respiratory, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Weina Fan
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haifeng Lv
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Feifei Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qingqing Ye
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Miaozuo Lin
- Respiratory Care Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Yu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongliu Cai
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoliang Wu
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
8
|
Escamilla-Ocañas CE, Torrealba-Acosta G, Mandava P, Qasim MS, Gutiérrez-Flores B, Bershad E, Hirzallah M, Venkatasubba Rao CP, Damani R. Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study. BMJ Open Qual 2022; 11:bmjoq-2022-001824. [PMID: 36588320 PMCID: PMC9743379 DOI: 10.1136/bmjoq-2022-001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Structured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effect on patient outcomes. DESIGN/METHODS This quality improvement project followed a Plan-Do-Study-Act (PDSA) methodology. A checklist for medication reconciliation, thromboembolic prophylaxis, glycaemic control, daily spontaneous awakening, breathing trial, diet, catheter/lines duration monitoring and antibiotics de-escalation was implemented during daily patient rounds. Main outcomes included the rate of new infections, mortality and NCCU-length of stay (LOS). Intervened patients were compared with historical controls after propensity score and Euclidean distance matching to balance baseline covariates. RESULTS After several PDSA iterations, we applied checklists to 411 patients; the overall average age was 61.34 (17.39). The main reason for admission included tumour resection (31.39%), ischaemic stroke (26.76%) and intracerebral haemorrhage (10.95%); the mean Sequential Organ Failure Assessment (SOFA) score was 2.58 (2.68). At the end of the study, the checklist compliance rate throughout the full NCCU stays reached 97.11%. After controlling for SOFA score, age, sex and primary admitting diagnosis, the implementation of systematic checklists significantly correlated with a reduced LOS (ß=-0.15, 95% CI -0.24 to -0.06), reduced rate of any new infections (OR 0.59, 95% CI 0.40 to 0.87) and reduced urinary tract infections (UTIs) (OR 0.23, 95% CI 0.09 to 0.55). Propensity score and Euclidean distance matching yielded 382 and 338 pairs with excellent covariate balance. After matching, outcomes remained significant. DISCUSSION The implementation of safety checklists in the NCCU proved feasible, easy to incorporate into the NCCU workflow, and a helpful tool to improve adherence to practice guidelines and quality of care measurements. Furthermore, our intervention resulted in a reduced NCCU-LOS, rate of new infections and rate of UTIs compared with propensity score and Euclidean distance matched historical controls.
Collapse
Affiliation(s)
| | | | - Pitchaiah Mandava
- Neurology, Baylor College of Medicine, Houston, Texas, USA,Analytical Software and Engineering Research Laboratory, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | | | | | - Eric Bershad
- Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Rahul Damani
- Neurology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
9
|
Dibu JR, Haque R, Shoshan S, Abulhasan YB. Treatment of Fever in Neurologically Critically Ill Patients. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
10
|
de Araújo LX, Perez da Silva Pereira P, Cantanhêde de Deus J, Oliveira Pontes D, Tavares Hang A, Gadelha Freitas JL, Moreira da Silva V, de Paula Paiva K, Moura de Souza CJ, Suaris Meireles CV, Delfino Rodrigues M, da Silva Tavares DT, Sanches Rosa MM. Fatores de risco nas neurocirurgias: um estudo de coorte no norte do Brasil. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: Pacientes neurocirúrgicos apresentam elevado risco de complicações locais e sistêmicas que podem aumentar o tempo de internação e o risco de morte. Este estudo tem como objetivo avaliar a incidência de infecções relacionadas à assistência à saúde e os fatores de risco associados em pacientes submetidos às neurocirurgias. Materiais e Métodos: Estudo de coorte prospectiva, realizado em um Hospital de grande porte do estado de Rondônia, no período de 2018 a 2019, incluindo 36 pacientes. Resultados: A incidência de infecções relacionada à assistência à saúde foi 19,4 a cada 100 pacientes (IC95%: 8,19 – 36,02). Ter utilizado sonda nasoenteral aumentou em 6,5 vezes o risco de IRAS (IC 95%: 1,26 – 33,5), a ventilação mecânica aumentou 5,52 vezes o risco (IC95%: 1,23 – 24,6), a presença de traqueostomia aumentou seis vezes (IC95%: 1,34 – 26,8) e realização de exame invasivo aumentou o risco em 6,79 para ter infecção (IC95%: 1,31 – 35,05). Na análise ajustada as variáveis não apresentaram significância estatística. Discussão: A incidência de infecções foi maior do que em regiões com melhores condições socioeconômicas o que pode estar relacionado à menor adesão de boas práticas na assistência. Conclusão: Nas neurocirurgias além das infecções de sítio cirúrgico outras topografias também devem ser consideradas para investigação de infecção. O uso de dispositivos invasivos foi associado à ocorrência de infecções relacionadas à assistência à saúde, portanto as boas práticas no seu uso são essenciais no momento da indicação e uso destes dispositivos.
Collapse
|
11
|
Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
Collapse
Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
| |
Collapse
|
12
|
Borgio JF, Rasdan AS, Sonbol B, Alhamid G, Almandil NB, AbdulAzeez S. Emerging Status of Multidrug-Resistant Bacteria and Fungi in the Arabian Peninsula. BIOLOGY 2021; 10:biology10111144. [PMID: 34827138 PMCID: PMC8614875 DOI: 10.3390/biology10111144] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary The incidence and developing status of multidrug-resistant bacteria and fungi, as well as their related mortality, is reviewed by a systematic published literature search from nine countries in the Arabian Peninsula. In order to analyse the emerging status and mortality, a total of 382 research articles were selected from a comprehensive screening of 1705 papers. More than 850 deaths reported since 2010 in the Arabian Peninsula due to the infection of multidrug-resistant bacteria and fungi. Multidrug-resistant bacteria Acinetobacter baumannii, Mycobacterium tuberculosis, Staphylococcus aureus, and fungi Candida auris are the most prevalent and causing high deaths. To control these infections and associated deaths in the Arabian Peninsula, continuous preventive measures, accurate methods for early diagnosis of infection, active surveillance, constant monitoring, developing vaccines, eradicating multidrug resistance modulators, and data sharing among countries are required. Abstract We aimed to identify the prevalence and emerging status of multidrug-resistant bacteria and fungi and their associated mortality in nine countries in the Arabian Peninsula. Original research articles and case studies regarding multidrug-resistant bacteria and fungi in the Arabian Peninsula, published during the last 10 years, were retrieved from PubMed and Scopus. A total of 382 studies were included as per the inclusion and exclusion criteria, as well as the PRISMA guidelines, from a thorough screening of 1705 articles, in order to analyse the emerging status and mortality. The emerging nature of >120 multidrug-resistant (MDR) bacteria and fungi in the Arabian Peninsula is a serious concern that requires continuous monitoring and immediate preventive measures. More than 50% (n = 453) of multidrug-resistant, microbe-associated mortality (n = 871) in the Arabian Peninsula was due to MDR Acinetobacter baumannii, Mycobacterium tuberculosis and Staphylococcus aureus infection. Overall, a 16.51% mortality was reported among MDR-infected patients in the Arabian Peninsula from the 382 articles of this registered systematic review. MDR A. baumannii (5600 isolates) prevailed in all the nine countries of the Arabian Peninsula and was one of the fastest emerging MDR bacteria with the highest mortality (n = 210). A total of 13,087 Mycobacterium tuberculosis isolates were reported in the region. Candida auris (580 strains) is the most prevalent among the MDR fungal pathogen in the Arabian Peninsula, having caused 54 mortalities. Active surveillance, constant monitoring, the development of a candidate vaccine, an early diagnosis of MDR infection, the elimination of multidrug resistance modulators and uninterrupted preventive measures with enhanced data sharing are mandatory to control MDR infection and associated diseases of the Arabian Peninsula. Accurate and rapid detection methods are needed to differentiate MDR strain from other strains of the species. This review summarises the logical relation, prevalence, emerging status and associated mortality of MDR microbes in the Arabian Peninsula.
Collapse
Affiliation(s)
- J. Francis Borgio
- Department of Epidemic Diseases Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.R.); (B.S.); (G.A.)
- Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
- Correspondence: or ; Tel.: +966-013-3330864
| | - Alia Saeed Rasdan
- Department of Epidemic Diseases Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.R.); (B.S.); (G.A.)
| | - Bayan Sonbol
- Department of Epidemic Diseases Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.R.); (B.S.); (G.A.)
| | - Galyah Alhamid
- Department of Epidemic Diseases Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.S.R.); (B.S.); (G.A.)
| | - Noor B. Almandil
- Department of Clinical Pharmacy Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | - Sayed AbdulAzeez
- Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| |
Collapse
|
13
|
Al-Orphaly M, Hadi HA, Eltayeb FK, Al-Hail H, Samuel BG, Sultan AA, Skariah S. Epidemiology of Multidrug-Resistant Pseudomonas aeruginosa in the Middle East and North Africa Region. mSphere 2021; 6:e00202-21. [PMID: 34011686 PMCID: PMC8265635 DOI: 10.1128/msphere.00202-21] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Over the last decades, there has been a dramatic global increase in multidrug-resistant (MDR) pathogens particularly among Gram-negative bacteria (GNB). Pseudomonas aeruginosa is responsible for various health care-associated infections, while MDR P. aeruginosa causes significant morbidity and mortality. Middle East and North Africa (MENA) represent an unexplored geographical region for the study of drug resistance since many of these countries are at crossroads of high volume of travel, diverse expatriate populations, as well as high antibiotic consumption despite attempts to implement antimicrobial stewardship programs. This minireview analyzes epidemiology, microbiological, and genomic characteristics of MDR P. aeruginosa in the MENA region. Published data on MDR P. aeruginosa prevalence, antimicrobial resistance patterns, and genetic profiles from studies published during the past 10 years from 19 MENA countries have been included in this minireview. There is wide variation in the epidemiology of MDR P. aeruginosa in the MENA region in terms of prevalence, antimicrobial characteristics, as well as genetic profiles. Overall, there is high prevalence of MDR P. aeruginosa seen in the majority of the countries in the MENA region with similarities between neighboring countries, which might reflect comparable population and antibiotic-prescribing cultures. Isolates from critical care units are significantly resistant particularly from certain countries such as Saudi Arabia, Egypt, Libya, Syria, and Lebanon with high-level resistance to cephalosporins, carbapenems, and aminoglycosides. Colistin susceptibility patterns remains high apart from countries with high-level antibiotic resistance such as Saudi Arabia, Syria, and Egypt.
Collapse
Affiliation(s)
- Mahmood Al-Orphaly
- Department of Medical Education, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Hamad Abdel Hadi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | | | - Hissa Al-Hail
- Department of Medical Education, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Bincy Gladson Samuel
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Sini Skariah
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, Doha, Qatar
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW We have highlighted the recent advances in infection in neurocritical care. RECENT FINDINGS Central nervous system (CNS) infections, including meningitis, encephalitis and pyogenic brain infections represent a significant cause of ICU admissions. We underwent an extensive review of the literature over the last several years in order to summarize the most important points in the diagnosis and treatment of severe infections in neurocritical care. SUMMARY Acute brain injury triggers an inflammatory response that involves a complex interaction between innate and adaptive immunity, and there are several factors that can be implicated, such as age, genetic predisposition, the degree and mechanism of the injury, systemic and secondary injury and therapeutic interventions. Neuroinflammation is a major contributor to secondary injury. The frequent and challenging presence of fever is a common denominator amongst all neurocritical care patients.
Collapse
Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Alan Blake
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
| | - Daniel Collins
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital
| |
Collapse
|