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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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Dodek P, McKeown S, Young E, Dhingra V. Development of a Provincial initiative to improve glucose control in critically ill patients. Int J Qual Health Care 2019; 31:49-56. [PMID: 29757412 DOI: 10.1093/intqhc/mzy101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/19/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To describe the development, implementation and initial evaluation of an initiative to improve glucose control in critically ill patients. DESIGN Glucose control in critically ill patients was chosen by critical care leaders as a target for improvement. This was an observational study to document changes in processes and measures of glucose control in each intensive care unit (ICU). ICU nurse educators were interviewed to document relevant changes between April 2012 and April 2016. SETTING 16 ICUs in British Columbia, Canada. PARTICIPANTS ICU leaders. INTERVENTION(S) A community of practice (CoP) was formed, guidelines were adopted, two learning sessions were held, and an electronic system to collect data was created. Then, each ICU introduced their own educational and process interventions. MAIN OUTCOME MEASURE(S) Average hyperglycemic index (area under the curve of serum glucose concentration versus time above the upper limit (10 mmol/l) divided by time on insulin infusion), number of hypoglycemic events (<3.5 mmol/l) divided by time on insulin infusion and standardized mortality rate (actual/predicted hospital mortality) for each 3-month period. RESULTS Although there were some isolated points and short trends that indicated special cause variation, there were no major trends over time and no obvious association with any of the process changes for each hospital. However, the average hyperglycemic index was higher in some of the smaller hospitals than in the larger hospitals. CONCLUSIONS In this, 4-year observation of glucose control in ICUs within a CoP, the lack of sustained improvement suggests the need for more active and durable interventions.
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Affiliation(s)
- Peter Dodek
- Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Shari McKeown
- BC Patient Safety & Quality Council, 201-750 Pender St W Vancouver, BC, Canada.,Faculty of Science, Department of Allied Health, Thompson Rivers University, 900 McGill Rd, Kamloops, BC, Canada
| | - Eric Young
- BC Patient Safety & Quality Council, 201-750 Pender St W Vancouver, BC, Canada
| | - Vinay Dhingra
- BC Patient Safety & Quality Council, 201-750 Pender St W Vancouver, BC, Canada.,Division of Critical Care Medicine, Vancouver General Hospital and University of British Columbia, 855 12th Ave W, Vancouver, BC, Canada
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Peña-López Y, Ramirez-Estrada S, Eshwara VK, Rello J. Limiting ventilator-associated complications in ICU intubated subjects: strategies to prevent ventilator-associated events and improve outcomes. Expert Rev Respir Med 2018; 12:1037-1050. [PMID: 30460868 DOI: 10.1080/17476348.2018.1549492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Intubation is required to maintain the airways in comatose patients and enhance oxygenation in hypoxemic or ventilation in hypercapnic subjects. Recently, the Centers of Disease Control (CDC) created new surveillance definitions designed to identify complications associated with poor outcomes. Areas covered: The new framework proposed by CDC, Ventilator-Associated Events (VAE), has a range of definitions encompassing Ventilator-Associated Conditions (VAC), Infection-related Ventilator-Associated Complications (IVAC), or Possible Ventilator-Associated Pneumonia - suggesting replacing the traditional definitions of Ventilator-Associated Tracheobronchitis (VAT) and Ventilator-Associated Pneumonia (VAP). They focused more on oxygenation variations than on Chest-X rays or inflammatory biomarkers. This article will review the spectrum of infectious (VAP & VAT) complications, as well as the main non-infectious complications, namely pulmonary edema, acute respiratory distress syndrome (ARDS) and atelectasis. Strategies to limit these complications and improve outcomes will be presented. Expert commentary: Improving outcomes should be the objective of implementing bundles of prevention, based on risk factors amenable of intervention. Promotion of measures that reduce the exposition or duration of intubation should be a priority.
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Affiliation(s)
- Yolanda Peña-López
- a Pediatric Critical Care Department , Vall d'Hebron Barcelona Hospital Campus , Barcelona , Spain
| | | | - Vandana Kalwaje Eshwara
- c Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education , Manipal University , Manipal , India
| | - Jordi Rello
- d Clinical Research/epidemiology In Pneumonia & Sepsis , Vall d'Hebron Institut of Research & Centro de Investigacion Biomedica en Red (CIBERES) , Barcelona , Spain
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Álvarez-Lerma F, Sánchez García M. "The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:420. [PMID: 30581828 PMCID: PMC6275409 DOI: 10.21037/atm.2018.08.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries. The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Sánchez García
- Department of Critical Care, Hospital Clínico San Carlos, Madrid, Spain
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Nyström ME, Höög E, Garvare R, Andersson Bäck M, Terris DD, Hansson J. Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region. BMC Health Serv Res 2018; 18:376. [PMID: 29793473 PMCID: PMC5968489 DOI: 10.1186/s12913-018-3129-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention. METHODS The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. RESULTS The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. CONCLUSIONS An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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Affiliation(s)
- M E Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden. .,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden.
| | - E Höög
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden
| | - R Garvare
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, SE 971 87, Luleå, Sweden
| | - M Andersson Bäck
- Department of Social work, Gothenburg University, Box 100, SE 405 30, Gothenburg, Sweden
| | - D D Terris
- Center for Family Research, University of Georgia, 1095 College Station Rd, Athens, GA, 30602, USA
| | - J Hansson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.,Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, SE 171 82, Solna, Sweden
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Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections. Intensive Care Med 2017; 44:48-60. [PMID: 29248964 DOI: 10.1007/s00134-017-5007-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. METHODS Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. RESULTS Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. CONCLUSIONS This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.
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Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf 2017; 27:226-240. [DOI: 10.1136/bmjqs-2017-006926] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2017] [Accepted: 10/07/2017] [Indexed: 12/16/2022]
Abstract
BackgroundQuality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.MethodWe searched Medline, Embase, CINAHL, PsycINFO and the Cochrane Library databases from January 1995 to December 2014. Studies were included if they met the criteria for a QIC intervention and the Cochrane Effective Practice and Organisation of Care (EPOC) minimum study design characteristics for inclusion in a review. We assessed study bias using the EPOC checklist and the quality of the reported intervention using a subset of SQUIRE 1.0 standards.ResultsOf the 220 studies meeting QIC criteria, 64 met EPOC study design standards for inclusion. There were 10 cluster randomised controlled trials, 24 controlled before-after studies and 30 interrupted time series studies. QICs encompassed a broad range of clinical settings, topics and populations ranging from neonates to the elderly. Few reports fully described QIC implementation and methods, intensity of activities, degree of site engagement and important contextual factors. By care setting, an improvement was reported for one or more of the study’s primary effect measures in 83% of the studies (32/39 (82%) hospital based, 17/20 (85%) ambulatory care, 3/4 nursing home and a sole ambulance QIC). Eight studies described persistence of the intervention effect 6 months to 2 years after the end of the collaborative. Collaboratives reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline.ConclusionsQICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.
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Corwin GS, Mills PD, Shanawani H, Hemphill RR. Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2017; 43:580-590. [PMID: 29056178 DOI: 10.1016/j.jcjq.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND ICUs' provision of complex care for critically ill patients results in an environment with a high potential for adverse events. A study was conducted to characterize adverse events in Veterans Health Administration (VHA) ICUs that underwent root cause analysis (RCA) and to identify the root causes and their recommended actions. METHODS This retrospective observational study of RCA reports concerned events that occurred in VHA ICUs or as a result of ICU processes from January 1, 2013, through December 31, 2014. The type of event, root causes, and recommended actions were measured. RESULTS Some 70 eligible RCAs were identified in 47 of the 120 facilities with an ICU in the VHA system. Delays in care (30.0%) and medication errors (28.6%) were the most common types of events. There were 152 root causes and 277 recommended actions. Root causes often involved rules, policies, and procedure processes (28.3%), equipment/supply issues (15.8%), and knowledge deficits/education (15.1%). Common actions recommended were policy, procedure, and process actions (34.4%) and training/education actions (31.4%). Of the actions implemented, 84.4% had a reported effectiveness of "much better" or "better." CONCLUSION ICU adverse events often had several root causes, with protocols and process-of-care issues as root causes regardless of event type. Actions often included standardization of processes and training/education. Several recommendations can be made that may improve patient safety in the ICU, such as standardization of care process, implementation of team training programs, and simulation-based training.
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Velasquez Reyes DC, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2017; 43:12-22. [PMID: 28663107 DOI: 10.1016/j.iccn.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. AIM Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. METHODS A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. RESULTS Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. CONCLUSIONS Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.
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Affiliation(s)
| | - Melissa Bloomer
- Deakin University, School of Nursing and Midwifery, PO Box 20000, Geelong, VIC, AUS 3217, Australia
| | - Julia Morphet
- Monash University, School of Nursing and Midwifery Peninsula campus, McMahons Road, Frankston VIC, 3199, Australia
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Banjar A, Felemban M, Dhafar K, Gazzaz Z, Al Harthi B, Baig M, Al Khatib K, Zakaria J, Hawsawi K, Isahac L, Akbar A. Surveillance of preventive measures for ventilator associated pneumonia (VAP) and its rate in Makkah Region hospitals, Saudi Arabia. Turk J Med Sci 2017; 47:211-216. [PMID: 28263492 DOI: 10.3906/sag-1510-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/05/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The present study aimed to assess the VAP rate and to identify VAP prevention activities in public sector hospitals situated in the Makkah Region, Saudi Arabia (SA). MATERIALS AND METHODS In this cross-sectional study, the VAP data from 13 public sector hospitals were collected from January to December 2013 and analyzed using SPSS 16. RESULTS The overall VAP rate in Makkah Region hospitals was 6.89 cases per 1000 ventilator-days. There was a significant difference in VAP rate among the hospitals of the Makkah Region (P < 0.001). There was no significant difference in the VAP rate among hospitals, which were using only one, two, or all three VAP preventive approaches (P = 0.26) accredited by the Joint Commission International (JCI) and Central Board for Accreditation of Health Care Institution (CBAHI) (P = 0.12), and using the form in intensive care units (ICUs) (P = 0.85). There was a significant difference in the VAP rate among hospitals having different bed capacities (P < 0.001), data regularly collected (P = 0.03), and had a team to supervise the VAP project (P = 0.04). CONCLUSION The VAP rate in Makkah Region hospitals is 6.89 cases per 1000 ventilator-days.
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Affiliation(s)
- Ahmad Banjar
- Department of Thoracic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Mohammed Felemban
- Department of Quality Management and Patient Safety, Makkah Region, Saudi Arabia
| | - Khalid Dhafar
- Department of General Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Zohair Gazzaz
- Department of Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Badr Al Harthi
- Department of Medicine, King Faisal Specialist Hospital, Taif, Saudi Arabia
| | - Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kasim Al Khatib
- Department of ICU, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Jameela Zakaria
- Department of Quality Management and Patient Safety, Makkah Region, Saudi Arabia
| | - Kawther Hawsawi
- Department of Nursing, King Faisal Hospital, Makkah, Saudi Arabia
| | - Lilma Isahac
- Department of Nursing, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Arbi Akbar
- Department of Nursing, Hera General Hospital, Makkah, Saudi Arabia
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Hsin HT, Hsu MS, Shieh JS. The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up. Postgrad Med J 2016; 93:133-137. [PMID: 27474228 DOI: 10.1136/postgradmedj-2016-134261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU). DESIGN Prospective longitudinal cohort study. SETTING CVICU of a tertiary referring medical centre in northern Taiwan. PARTICIPANTS Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team. MAIN OUTCOME MEASURES CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates. RESULTS From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001). CONCLUSIONS Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.
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Affiliation(s)
- Ho-Tsung Hsin
- Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
| | - Meng-Shiuan Hsu
- Division of Infectious Disease, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
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Shamshiri M, Fuh Suh B, Mohammadi N, Nabi Amjad R. A Survey of Adherence to Guidelines to Prevent Healthcare-Associated Infections in Iranian Intensive Care Units. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27435. [PMID: 27621932 PMCID: PMC5004621 DOI: 10.5812/ircmj.27435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 01/13/2016] [Accepted: 03/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are acquired by patients while receiving care. The highest incidence of HAIs has been documented in admissions to intensive care units. Adherence to evidence-based practices is the most important step for preventing HAIs. OBJECTIVES To determine the rate of adherence to evidence-based post-insertion recommended care practices after admission into the intensive care unit for the following devices: central line catheter, indwelling urinary catheter, and mechanical ventilator. PATIENTS AND METHODS A structured observational cross-sectional research design was used. Data were collected using a checklist and a self-report questionnaire. The minimum sample size required for this study was 276 post-insertion care episodes, and 332 episodes were observed. The ANOVA test was used to identify any significant differences among the mean scores of the three devices. RESULTS Overall observed adherence rates were 18.3%, 59.1%, and 43.1% for central line catheters, indwelling urinary catheter, and mechanical ventilator, respectively. Of the observed episodes of device care, only in 9.4% of the episodes was regular oral care performed for patients on mechanical ventilators and only in 19.3% of the episodes were indwelling urinary catheters properly secure after insertion. More so, in none (0.0%) of the episodes was the central line catheter hub disinfected before being accessed. CONCLUSIONS Evidence-based post-insertion recommended care practices were not consistently and uniformly implemented in the intensive care units. Establishment of a program for the surveillance of adherence to recommended guidelines is required for improving compliance by health professionals and the quality of preventive care.
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Affiliation(s)
- Mahmood Shamshiri
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, IR Iran
| | - Boudouin Fuh Suh
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences-International Campus, Tehran, IR Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran
| | - Reza Nabi Amjad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
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Mckelvie BL, Mcnally JD, Menon K, Marchand MG, Reddy DN, Creery WD. A PICU patient safety checklist: rate of utilization and impact on patient care. Int J Qual Health Care 2016; 28:371-5. [DOI: 10.1093/intqhc/mzw042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
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Ferreira CR, de Souza DF, Cunha TM, Tavares M, Reis SSA, Pedroso RS, Röder DVDDB. The effectiveness of a bundle in the prevention of ventilator-associated pneumonia. Braz J Infect Dis 2016; 20:267-71. [PMID: 27102778 PMCID: PMC9425466 DOI: 10.1016/j.bjid.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 02/03/2016] [Accepted: 03/04/2016] [Indexed: 11/27/2022] Open
Abstract
Objectives The aim of this study was to evaluate the impact of a bundle called FAST HUG in ventilator-associated pneumonia, weigh the healthcare costs of ventilator-associated pneumonia patients in the intensive care unit, and hospital mortality due to ventilator-associated pneumonia. Material and methods The study was performed in a private hospital that has an 8-bed intensive care unit. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data was obtained from each patient: age, gender, reason for hospitalization, use of three or more antibiotics, length of stay, intubation time, and outcome. Results After the implementation of FAST HUG, there was an observable decrease in the occurrence of ventilator-associated pneumonia (p < 0.01), as well as a reduction in mortality rates (p < 0.01). In addition, the intervention resulted in a significant reduction in intensive care unit hospital costs (p < 0.05). Conclusion The implementation of FAST HUG reduced the number of ventilator-associated pneumonia cases. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.
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Affiliation(s)
| | | | - Thulio Marques Cunha
- Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Marcelo Tavares
- Faculdade de Matemática, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, Helder OK. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:724-734. [PMID: 26907734 DOI: 10.1016/s1473-3099(15)00409-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Central-line-associated bloodstream infections (CLABSIs) are a major problem in intensive care units (ICUs) worldwide. We aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent these infections. METHODS We searched Embase, MEDLINE OvidSP, Web-of-Science, and Cochrane Library to identify studies reporting the implementation of central-line bundles in adult ICU, paediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 1990, and June 30, 2015. For the meta-analysis, crude estimates of infections were pooled by use of a DerSimonian and Laird random effect model. The primary outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Incidence risk ratios (IRRs) were obtained by use of random-effects models. FINDINGS We initially identified 4337 records, and after excluding duplicates and those ineligible, 96 studies met the eligibility criteria, 79 of which contained sufficient information for a meta-analysis. Median CLABSIs incidence were 5·7 per 1000 catheter-days (range 1·2-46·3; IQR 3·1-9·5) on adult ICUs; 5·9 per 1000 catheter-days (range 2·6-31·1; 4·8-9·4) on PICUs; and 8·4 per 1000 catheter-days (range 2·6-24·1; 3·7-16·0) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 19·5 per 1000 catheter-days (median 2·6, IQR 1·2-4·4) in all types of ICUs. In our meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·8-10·9) to 2·5 per 1000 catheter-days (1·4-4·8) after implementation of bundles (IRR 0·44, 95% CI 0·39-0·50, p<0·0001; I(2)=89%). INTERPRETATION Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs. FUNDING None.
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Affiliation(s)
- Erwin Ista
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
| | | | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Cynthia van der Starre
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, Netherlands
| | - Onno K Helder
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Borgert MJ, Goossens A, Dongelmans DA. What are effective strategies for the implementation of care bundles on ICUs: a systematic review. Implement Sci 2015; 10:119. [PMID: 26276569 PMCID: PMC4536788 DOI: 10.1186/s13012-015-0306-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Care bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles. METHODS The databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers. RESULTS In total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as 'fair' in 77 %, and the remaining as 'good' (13 %) and 'poor' (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible. CONCLUSIONS The three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.
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Affiliation(s)
- Marjon J Borgert
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Astrid Goossens
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Marang-van de Mheen PJ, van Bodegom-Vos L. Meta-analysis of the central line bundle for preventing catheter-related infections: a case study in appraising the evidence in quality improvement. BMJ Qual Saf 2015; 25:118-29. [DOI: 10.1136/bmjqs-2014-003787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
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Daniel M, Booth M, Ellis K, Maher S, Longmate A. Details behind the dots: How different intensive care units used common and contrasting methods to prevent ventilator associated pneumonia. BMJ QUALITY IMPROVEMENT REPORTS 2015; 4:bmjquality_uu207660.w3069. [PMID: 26734371 PMCID: PMC4645939 DOI: 10.1136/bmjquality.u207660.w3069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/20/2015] [Accepted: 03/12/2015] [Indexed: 11/29/2022]
Abstract
Care bundles promote delivery of effective care and improve patient outcomes. The understanding of how to improve delivery of care bundles is incomplete. The Scottish Patient Safety Programme is a national collaborative with the aim of improving the delivery of care to patients in acute hospitals in Scotland. Critical care is one of five workstreams in the programme. A programme goal is to reduce incidence of ventilator-associated pneumonia (VAP) to zero or 300 calendar days between events through use of a VAP Prevention bundle. We studied two ICUs participating in this programme. Each ICU had established infection surveillance system prior to the programme starting. Both units had an appreciable incidence of VAP. Initial VAP prevention bundle adherence was low in each ICU (35% and 41%). Comparing time periods before and after 80% bundle VAP prevention bundle adherence was achieved showed a similar reduction in VAP incidence (from 6.9 to 1.0, and from 7.8 to 1.4/1000 ventilation days). When compared each ICU used common and contrasting approaches to accomplish this improvement. We describe the five improvement knowledge systems used to improve bundle adherence to bundle elements in each hospital. The insights gained from these front-line clinical teams can be used as a template for improvement efforts in a variety of other healthcare settings.
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Affiliation(s)
| | - Malcolm Booth
- Forth Valley Royal Hospital and Glasgow Royal Infirmary
| | | | - Shaun Maher
- Forth Valley Royal Hospital and Glasgow Royal Infirmary
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Drees M, Hausman S, Rogers A, Freeman L, Frosh K, Wroten K. Underestimating the Impact of Ventilator-Associated Pneumonia by Use of Surveillance Data. Infect Control Hosp Epidemiol 2015; 31:650-2. [DOI: 10.1086/652776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We calculated rates of ventilator-associated pneumonia (VAP) by using surveillance data, clinical data, and coding data. Compared with the VAP rates calculated on the basis of surveillance data, the VAP rates calculated on the basis of coding data were significantly overestimated in 4 of 5 intensive, care units. Efforts to improve coding and clinical documentation will address much but not all of this discrepancy between surveillance and administrative data.
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20
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Mattison MLP, Catic A, Davis RB, Olveczky D, Moran J, Yang J, Aronson M, Zeidel M, Lipsitz L, Marcantonio ER. A standardized, bundled approach to providing geriatric-focused acute care. J Am Geriatr Soc 2014; 62:936-42. [PMID: 24749723 DOI: 10.1111/jgs.12780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine whether a bundled intervention can increase detection of delirium and facilitate safer use of high-risk medications. DESIGN Pre-post interventional trial. SETTING Large academic medical center. PARTICIPANTS Individuals aged 70 and older (n = 19,949) admitted between May 1, 2008, September 30, 2011. Individuals aged 80 and older admitted after April 26, 2010, received the intervention, those aged 80 and older admitted before were primary controls, and those aged 70 to 79 were concurrent controls. INTERVENTION The intervention uses a checklist promoting delirium prevention, recognition and management, and modifies the computerized provider order entry system to provide care focused on elderly adults. MEASUREMENTS Frequency of orders for activating the rapid response team for altered mental status, frequency of orders for haloperidol in excess of 0.5 mg or intravenous (IV) morphine in excess of 2 mg, and discharge disposition. RESULTS Participants receiving the intervention had a mean age of 86.1 ± 4.6; 58.2% were female. The number of orders to activate the rapid response team for altered mental status increased in participants receiving the bundle and in controls (odds ratio (OR) for the difference of differences = 1.23 (95% confidence interval (CI) = 0.68-2.24, P = .49)). Participants receiving the bundle were less likely to receive more than 0.5 mg of IV, intramuscular, or oral haloperidol (OR = 0.60, 95% CI = 0.39-0.91, P = .02) and more than 2 mg of IV morphine (OR = 0.52, 95% CI = 0.42-0.63, P < .001). Participants who received the bundle were more likely to be discharged home than to extended care facilities (OR = 1.18, 95% CI = 1.04-1.35, P = .01). CONCLUSION An intervention focused on delirium prevention and recognition by bedside staff combined with computerized decision support facilitates safer prescribing of high-risk medications and possibly results in less need for extended care.
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Affiliation(s)
- Melissa L P Mattison
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Kaier K, Lambert ML, Frank UK, Vach W, Wolkewitz M, Tacconelli E, Rello J, Theuretzbacher U, Martin M. Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide. BMC Infect Dis 2014; 14:199. [PMID: 24725914 PMCID: PMC4021349 DOI: 10.1186/1471-2334-14-199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 04/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures. METHODS Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries. RESULTS On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system. CONCLUSIONS The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany.
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Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis 2014; 59:96-105. [PMID: 24723276 DOI: 10.1093/cid/ciu239] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR, 0.39 [95% CI, .33-.46]; P < .001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI, .10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
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Affiliation(s)
- Koen Blot
- Faculty of Medicine and Health Sciences, Ghent University
| | - Jochen Bergs
- Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent
| | - Stijn Blot
- Faculty of Medicine and Health Sciences, Ghent University Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium
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23
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Simpson CD, Hawes J, James AG, Lee KS. Use of bundled interventions, including a checklist to promote compliance with aseptic technique, to reduce catheter-related bloodstream infections in the intensive care unit. Paediatr Child Health 2014; 19:e20-3. [PMID: 24855420 PMCID: PMC4028651 DOI: 10.1093/pch/19.4.e20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS A literature review was performed using methodology adapted from the American Heart Association's International Liaison Committee on Resuscitation. RESULTS Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections.
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Affiliation(s)
- C David Simpson
- Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, Nova Scotia
- Department of Paediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Judith Hawes
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Andrew G James
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Kyong-Soon Lee
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
- Department of Paediatrics, University of Toronto, Toronto, Ontario
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See KC, Ong V, Teoh CM, Ooi OC, Widjaja LS, Mujumdar S, Phua J, Khoo KL, Lee P, Lim TK. Bedside pleural procedures by pulmonologists and non-pulmonologists: a 3-year safety audit. Respirology 2014; 19:396-402. [PMID: 24506772 DOI: 10.1111/resp.12244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/07/2013] [Accepted: 11/21/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Pleural procedures such as tube thoracostomy and chest aspirations are commonly performed and carry potential risks of visceral organ injury, pneumothorax and bleeding. In this context limited information exists on the complication rates when non-pulmonologists perform ultrasound-guided bedside pleural procedures. Bedside pleural procedures in our university hospital were audited to compare complication rates between pulmonologists and non-pulmonologists. METHODS A combined safety approach using standardized training, pleural safety checklists and ultrasound-guidance was initially implemented in a ∼1000-bed academic medical centre. A prospective audit, over approximately 3.5 years, of all bedside pleural procedures excluding procedures done in operating theatres and radiological suites was then performed. RESULTS Overall, 529 procedures (295 by pulmonologists; 234 by non-pulmonologists) for 443 patients were assessed. There were 16 (3.0%) procedure-related complications, all in separate patients. These included five iatrogenic pneumothoraces, four dry taps, four malpositioned chest tubes, two significant chest wall bleeds and one iatrogenic hemothorax. There were no differences in complication rates between pulmonologists and non-pulmonologists. Presence of chronic obstructive pulmonary disease (COPD) independently increased the risk of complications by nearly sevenfold. CONCLUSIONS Results from this study support pleural procedural practice by both pulmonologists and non-pulmonologists in an academic medical centre setting. This is possible with a standard training program, pleural safety checklists and relatively high utilization rates of ultrasound guidance for pleural effusions. Nonetheless, additional vigilance is needed when patients with COPD undergo pleural procedures.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, National University Health System, University Medicine Cluster, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Popp JA, Layon AJ, Nappo R, Richards WT, Mozingo DW. Hospital-acquired infections and thermally injured patients: chlorhexidine gluconate baths work. Am J Infect Control 2014; 42:129-32. [PMID: 24485370 DOI: 10.1016/j.ajic.2013.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thermally injured patients are at high risk for infections, including hospital acquired infections (HAIs). We modeled a twice-daily chlorhexidine gluconate (CHG) bath protocol aimed at decreasing HAIs. METHODS Bathing with a 0.9% CHG solution in sterile water was provided twice daily as part of routine care. Institutional HAI prevention bundles were in place and did not change during the study. Baseline HAI rates were collected for 12 months before the quality study implementation. Centers for Disease Control and Prevention definitions for HAIs were used; our blinded Infection Control physician made each determination. This was an Institutional Review Board-exempt protocol. RESULTS The study cohort included 203 patients before the quality trial and 277 patients after the quality trial. The median burn area was 25% of total body surface area. Baseline HAI rates were as follows: ventilator-associated pneumonia, 2.2 cases/1,000 ventilator-days; cathether-associated urinary tract infection, 2.7 cases/1,000 catheter-days; central line-associated bloodstream infection, 1.4 cases/1,000 device-days. With implementation of this protocol, the rates dropped to zero and have stayed at that level with the exception of 1 cathether-associated urinary tract infection. There were no untoward effects or observed delays in wound healing with this protocol. All of these changes were clinically significant, although not statistically significant; the study was not powered for statistical significance. CONCLUSIONS Using this nurse-driven protocol, we decreased, in a sustainable manner, the HAI rate in our intensive care unit to zero. No integumentary difficulties or wound healing delays were related to this protocol.
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Affiliation(s)
- Janet A Popp
- Burn Center, Shands Hospital, University of Florida Health, Gainesville, FL
| | - A Joseph Layon
- Department of Critical Care Medicine, Geisinger Health System, Danville, PA.
| | - Robert Nappo
- Burn Center, Shands Hospital, University of Florida Health, Gainesville, FL
| | - Winston T Richards
- Division of Trauma and Burn Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - David W Mozingo
- Division of Trauma and Burn Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL
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Rehder KJ, Turner DA, Bonadonna D, Walczak Jr RJ, Cheifetz IM. State of the art: strategies for extracorporeal membrane oxygenation in respiratory failure. Expert Rev Respir Med 2014; 6:513-21. [DOI: 10.1586/ers.12.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhou Q, Lee SK, Jiang SY, Chen C, Kamaluddeen M, Hu XJ, Wang CQ, Cao Y. Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit. Am J Infect Control 2013; 41:1059-64. [PMID: 24041863 DOI: 10.1016/j.ajic.2013.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Measures employed in preventing ventilator-associated pneumonia (VAP) in developing countries are rarely reported. This study evaluates the efficacy of an infection control program in reducing VAP in a neonatal intensive care unit (NICU) in China. METHODS All neonates who received mechanical ventilation for at least 48 hours and were hospitalized in the NICU for ≥5 days during 3 epochs were included. The hospital relocated to a new site during phase 2 and a bundle of comprehensive preventive measures against VAP were gradually implemented using the evidence-based practice for improving quality method. Research physicians recorded associated information of patients diagnosed with VAP. RESULTS Of 491 patients receiving mechanical ventilation, 92 (18.7%) developed VAP corresponding to 27.33 per 1,000 ventilator-days. The rate decreased from 48.84 per 1,000 ventilator-days in phase 1 to 25.73 per 1,000 ventilator-days in phase 2 and further diminished to 18.50 per 1,000 ventilator-days in phase 3 (P < .001). Overall mortality rate of admitted neonates significantly decreased from 14.0% in phase 1 to 2.9% in phase 2 and 2.7% in phase 3 (P = .000). Gram-negative bacteria (95.5%) were the predominant organisms in VAP and Acinetobacter baumannii (65.2%) was the most frequently isolated microorganism. CONCLUSIONS Implementing a multifaceted infection control program resulted in a significant reduction in VAP rate with long-term effects. Such interventions could be extended to other low-income countries.
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Affiliation(s)
- Qi Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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See KC, Jamil K, Chua AP, Phua J, Khoo KL, Lim TK. Effect of a pleural checklist on patient safety in the ultrasound era. Respirology 2013; 18:534-9. [PMID: 23240898 DOI: 10.1111/resp.12033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/21/2012] [Accepted: 10/08/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Bedside ultrasound allows direct visualization of pleural collections for thoracentesis and tube thoracostomy. However, there is little information on patient safety improvement methods with this approach. The effect of a checklist on patient safety for bedside ultrasound-guided pleural procedures was evaluated. METHODS A prospective study of ultrasound-guided pleural procedures from September 2007 to June 2010 was performed. Ultrasound guidance was routine practice for all patients under the institution's care and the freehand method was used. All operators took a half-day training session on basic thoracic ultrasound and were supervised by more experienced operators. A 14-item checklist was introduced in June 2009. It included systematic thoracic scanning and a safety audit. Clinical and safety data are described before (Phase I) and after (Phase II) the introduction of the checklist. RESULTS There were 121 patients in Phase I (58.7 ± 18.9 years) and 134 patients in Phase II (60.2 ± 19.6 years). Complications occurred for 10 patients (8.3%) in Phase I (six dry taps, three pneumothoraces, one haemothorax) and for 2 patients (1.5%) in Phase II (one significant bleed, one malposition of chest tube) (P = 0.015). There were no procedure-related deaths. The use of the checklist alone was associated with fewer procedure-related complications. This was independent of thoracostomy rate, pleural effusion size and pleural fluid ultrasound appearance. CONCLUSIONS A pleural checklist with systematic scanning and close supervision may further enhance safety of ultrasound-guided procedures. This may also help promote safety while trainees are learning to perform these procedures.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, Singapore.
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Staff acceptance of a telemedicine intensive care unit program: a qualitative study. J Crit Care 2013; 28:890-901. [PMID: 23906904 DOI: 10.1016/j.jcrc.2013.05.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/04/2013] [Accepted: 05/15/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE We conducted an evaluation to identify factors related to intensive care unit (ICU) staff acceptance of a telemedicine ICU (Tele-ICU) program in preimplementation and postimplementation phases. METHODS Individual or group semistructured interviews and site observations were conducted with staff from the Veterans Affairs Midwest Health Care Network Tele-ICU and affiliated ICUs. A qualitative content analysis of preimplementation and postimplementation transcripts and field notes was undertaken to identify themes positively and negatively influencing Tele-ICU acceptance. RESULTS Telemedicine ICU training, Tele-ICU understanding, perceived need, and organizational factors emerged as influencing acceptance of the Tele-ICU before implementation. After implementation, Tele-ICU understanding, impact on work systems, perceived usefulness, and relationships were factors influencing acceptance and utilization. Barriers to implementation included confusion about how to use the Tele-ICU, disruptions to communication and workflows, unmet expectations, and discomfort with being monitored. Facilitators included positive experiences, discovery of new benefits, and recognition of Tele-ICU staff as complementing bedside care. CONCLUSIONS Telemedicine ICU implementation is complex. Time and resources should be allocated for local coordination, continuous needs assessment for Tele-ICU support, staff training, developing interpersonal relationships, and systems design and evaluation. Such efforts are likely to be rewarded with more rapid staff acceptance of this new technology.
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Mahmoud MA, Koch BL, Jones BV, Varughese AM. Improving on-time starts for patients scheduled with general anesthesia in a MRI suite. Paediatr Anaesth 2013; 23:607-13. [PMID: 23039198 DOI: 10.1111/pan.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We applied quality improvement methodology to identify unnecessary, redundant parts of processes that can lead to delayed on-time starts for patients scheduled with general anesthesia (GA) in the radiology department. AIM To address the issue of delayed on-time starts by improving work flow for the first patient scheduled with GA. BACKGROUND Unplanned imaging in a high-volume MRI suite can result in a significant ripple effect throughout the day. Delayed on-time starts can lead to patient, family, and staff dissatisfaction due to significant wait times. MATERIALS AND METHODS The team conducted a 5 month improvement project. Baseline data were obtained from pilot time studies allowed the team to identify reasons why the first case was not starting on time and to identify several key drivers to improve the process. Using the framework of small tests of change or the Plan-Do-Study-Act model, our key interventions primarily focused on standardizing the processes for completing the preimaging evaluation and for anesthesia induction. The primary objective measure of successful on-time start was defined as obtaining the first MRI image within 10 min of the scheduled start time, for the first patients of the day scheduled with GA. The secondary outcome measure was the extent of the delay quantified in minutes. RESULTS Prior to the initiation of the project, only 36% of the first patients scheduled with GA each day met the primary objective measure. At the conclusion of the project 84% started on time. The secondary measure also showed significant improvement. CONCLUSIONS Process improvement projects in anesthesia can yield positive results, using small incremental standardized changes. We used a quality improvement methods to successfully improve on-time start for patients scheduled with GA in high-volume MRI suite.
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Affiliation(s)
- Mohamed A Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Huddart S, Peden C, Quiney N. Emergency major abdominal surgery--'the times they are a-changing'. Colorectal Dis 2013; 15:645-9. [PMID: 23795746 DOI: 10.1111/codi.12198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S. Huddart
- Royal Surrey County Hospital NHS Foundation Trust; Guildford; UK
| | - C. Peden
- Royal United Hospital Bath NHS Trust; Bath; UK
| | - N. Quiney
- Royal Surrey County Hospital NHS Foundation Trust; Guildford; UK
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Abstract
The goal of this review is to evaluate best practices for preventing healthcare-associated infections (HAI) and to identify opportunities beyond best practice. Achieving an infection-free hospital stay for patients will require integration of infection prevention into routine bedside clinical care. The objectives are (1) to summarize the best practices for prevention of HAI; (2) to discuss the limitations of known best practices; and (3) to discuss potential approaches beyond best practice to prevent HAI. Rationale for comprehensive horizontal approaches with active caregiver participation is discussed.
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Exline MC, Ali NA, Zikri N, Mangino JE, Torrence K, Vermillion B, St Clair J, Lustberg ME, Pancholi P, Sopirala MM. Beyond the bundle--journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections. Crit Care 2013; 17:R41. [PMID: 23497591 PMCID: PMC3733431 DOI: 10.1186/cc12551] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/21/2012] [Accepted: 02/22/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI=0.37 to 1.65, P=0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI=0.06 to 0.65, P=0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI=0.25 to 0.88, P=0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies.
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Affiliation(s)
- Matthew C Exline
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of
Internal Medicine, Ohio State University Wexner Medical Center, 201 Davis Heart
& Lung Research Institute, 473 West 12th Ave, Columbus, OH, 43210, USA
| | - Naeem A Ali
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of
Internal Medicine, Ohio State University Wexner Medical Center, 201 Davis Heart
& Lung Research Institute, 473 West 12th Ave, Columbus, OH, 43210, USA
| | - Nancy Zikri
- Department of Clinical Epidemiology, Ohio State University Wexner Medical Center,
410 West 10th Ave, Columbus, OH, 43210, USA
| | - Julie E Mangino
- Division of Infectious Diseases, Department of Internal Medicine, Department of
Clinical Epidemiology, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Kelly Torrence
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Brenda Vermillion
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Jamie St Clair
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Mark E Lustberg
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State
University Wexner Medical Center, 410 West 10th Ave, Columbus, OH, 43210, USA
| | - Preeti Pancholi
- Department of Pathology, Ohio State University Wexner Medical Center, 1492 East
Broad St Columbus, OH, 43205, USA
| | - Madhuri M Sopirala
- Division of Infectious Diseases, Department of Internal Medicine, Department of
Clinical Epidemiology, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
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Chamberlain LJ, Wu S, Lewis G, Graff N, Javier JR, Park JSR, Johnson CL, Woods SD, Patel M, Wong D, Blaschke GS, Lerner M, Kuo AK. A multi-institutional medical educational collaborative: advocacy training in California pediatric residency programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:314-321. [PMID: 23348081 DOI: 10.1097/acm.0b013e3182806291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Educational collaboratives offer a promising approach to disseminate educational resources and provide faculty development to advance residents' training, especially in areas of novel curricular content; however, their impact has not been clearly described. Advocacy training is a recently mandated requirement of the Accreditation Council for Graduate Medical Education that many programs struggle to meet.The authors describe the formation (in 2007) and impact (from 2008 to 2010) of 13 California pediatric residency programs working in an educational collaboration ("the Collaborative") to improve advocacy training. The Collaborative defined an overarching mission, assessed the needs of the programs, and mapped their strengths. The infrastructure required to build the collaboration among programs included a social networking site, frequent conference calls, and face-to-face semiannual meetings. An evaluation of the Collaborative's activities showed that programs demonstrated increased uptake of curricular components and an increase in advocacy activities. The themes extracted from semistructured interviews of lead faculty at each program revealed that the Collaborative (1) reduced faculty isolation, increased motivation, and strengthened faculty academic development, (2) enhanced identification of curricular areas of weakness and provided curricular development from new resources, (3) helped to address barriers of limited resident time and program resources, and (4) sustained the Collaborative's impact even after formal funding of the program had ceased through curricular enhancement, the need for further resources, and a shared desire to expand the collaborative network.
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Affiliation(s)
- Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA 94304, USA.
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A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units*. Crit Care Med 2013; 40:2933-9. [PMID: 22890251 DOI: 10.1097/ccm.0b013e31825fd4d8] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the causal effects of an intervention proven effective in pre-post studies in reducing central line-associated bloodstream infections in the intensive care unit. DESIGN We conducted a multicenter, phased, cluster-randomized controlled trial in which hospitals were randomized into two groups. The intervention group started in March 2007 and the control group started in October 2007; the study period ended September 2008. Baseline data for both groups are from 2006. SETTING Forty-five intensive care units from 35 hospitals in two Adventist healthcare systems. INTERVENTIONS A multifaceted intervention involving evidence-based practices to prevent central line-associated bloodstream infections and the Comprehensive Unit-based Safety Program to improve safety, teamwork, and communication. MEASUREMENTS AND RESULTS We measured central line-associated bloodstream infections per 1,000 central line days and reported quarterly rates. Baseline average central line-associated bloodstream infections per 1,000 central line days was 4.48 and 2.71, for the intervention and control groups (p = .28), respectively. By October to December 2007, the infection rate declined to 1.33 in the intervention group compared to 2.16 in the control group (adjusted incidence rate ratio 0.19; p = .003; 95% confidence interval 0.06-0.57). The intervention group sustained rates <1/1,000 central line days at 19 months (an 81% reduction). The control group also reduced infection rates to <1/1,000 central line days (a 69% reduction) at 12 months. CONCLUSIONS This study demonstrated a causal relationship between the multifaceted intervention and the reduced central line-associated bloodstream infections. Both groups decreased infection rates after implementation and sustained these results over time, replicating the results found in previous, pre-post studies of this multifaceted intervention and providing further evidence that most central line-associated bloodstream infections are preventable.
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Begue A, Overcash J, Lewis R, Blanchard S, Askew TM, Borden CP, Semos T, Yagodich AD, Ross P. Retrospective Study of Multidisciplinary Rounding on a Thoracic Surgical Oncology Unit. Clin J Oncol Nurs 2012. [DOI: 10.1188/12.cjon.e198-e202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yoo JY, Oh EG, Hur HK, Choi MN. Level of Knowledge on Evidence-based Infection Control and Influencing Factors on Performance among Nurses in Intensive Care Unit. ACTA ACUST UNITED AC 2012. [DOI: 10.7475/kjan.2012.24.3.232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bauman KA, Hyzy RC. ICU 2020: five interventions to revolutionize quality of care in the ICU. J Intensive Care Med 2012; 29:13-21. [PMID: 22328598 DOI: 10.1177/0885066611434399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Intensive care units (ICUs) are an essential and unique component of modern medicine. The number of critically ill individuals, complexity of illness, and cost of care continue to increase with time. In order to meet future demands, maintain quality, and minimize medical errors, intensivists will need to look beyond traditional medical practice, seeking lessons on quality assurance from industry and aviation. Intensivists will be challenged to keep pace with rapidly advancing information technology and its diverse roles in ICU care delivery. Modern ICU quality improvement initiatives include ensuring evidence-based best practice, participation in multicenter ICU collaborations, employing state-of-the-art information technology, providing point-of-care diagnostic testing, and efficient organization of ICU care delivery. This article demonstrates that each of these initiatives has the potential to revolutionize the quality of future ICU care in the United States.
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Affiliation(s)
- Kristy A Bauman
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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Measuring sustainability within the Veterans Administration Mental Health System Redesign initiative. Qual Manag Health Care 2012; 20:263-79. [PMID: 21971024 DOI: 10.1097/qmh.0b013e3182314b20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine how attributes affecting sustainability differ across Veterans Health Administration organizational components and by staff characteristics. SUBJECTS Surveys of 870 change team members and 50 staff interviews within the Veterans Affairs' Mental Health System Redesign initiative. METHODS A 1-way ANOVA with a Tukey post hoc test examined differences in sustainability by Veteran Integrated Service Networks, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify "a priori" and "in vivo" themes. A simple stepwise linear regression explored predictors of sustainability. RESULTS Sustainability differed across Veteran Integrated Service Networks and staff tenure. Job classification differences existed for the following: (1) benefits and credibility of the change and (2) staff involvement and attitudes toward change. Sustainability barriers were staff and institutional resistance and nonsupportive leadership. Facilitators were commitment to veterans, strong leadership, and use of quality improvement tools. Sustainability predictors were outcomes tracking, regular reporting, and use of Plan, Do, Study, Adjust cycles. CONCLUSIONS Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the Veterans Affairs' best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than "one-size-fits-all" approaches. Further research is needed to understand how participation in a quality improvement collaborative affects sustainability.
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Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, Kamath PS. Intensive care of the patient with cirrhosis. Hepatology 2011; 54:1864-72. [PMID: 21898477 DOI: 10.1002/hep.24622] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute deterioration of patients with cirrhosis manifests as multiple organ failure requiring admission to an intensive care unit. Precipitating events may be viral hepatitis, typically in Asia, and drug or alcoholic hepatitis and variceal hemorrhage in the West. Patients with cirrhosis in the intensive care unit have a high mortality, and each admission is associated with a mean charge of US $116,200. Prognosis is determined by the number of organs failing (sequential organ failure assessment [SOFA] score), the presence of infection, and the degree of liver dysfunction (Child-Turcotte-Pugh or Model for End-Stage Liver Disease scores). The most common organ failing is the kidney; sepsis is associated with further deterioration in liver function by compromise of the microcirculation. Care of these critically ill patients with impending multiple organ failure requires a team approach with expertise in both hepatology and critical care. Treatment is aimed at preventing further deterioration in liver function, reversing precipitating factors, and supporting failing organs. Liver transplantation is required in selected patients to improve survival and quality of life. Treatment is futile in some patients, but it is difficult to identify these patients a priori. Artificial and bioartificial liver support systems have thus far not demonstrated significant survival benefit in these patients.
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Affiliation(s)
- Jody C Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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Iyer SB, Anderson JB, Slicker J, Beekman RH, Lannon C. Using Statistical Process Control to Identify Early Growth Failure Among Infants With Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2011; 2:576-85. [DOI: 10.1177/2150135111416264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although interventions to improve outcomes for children with congenital heart disease may be designed and tested, the rarity of any one specific defect presents a barrier to using traditional statistical methods to measure the effects of these interventions. The purpose of this report is to describe the innovative statistical approach taken by the Joint Council on Congenital Heart Disease (JCCHD) National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) to measure outcomes for infants with hypoplastic left heart syndrome—a relatively rare disease. We report our experience with the application of statistical process control methods to generate measures capable of identifying statistically significant change in the incidence of early growth failure—a clinically important outcome in this relatively small patient population.
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Affiliation(s)
- Srikant B. Iyer
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Julie Slicker
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
| | | | - Carole Lannon
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Kim JS, Holtom P, Vigen C. Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences. Am J Infect Control 2011; 39:640-646. [PMID: 21641088 DOI: 10.1016/j.ajic.2010.11.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/04/2010] [Accepted: 11/08/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Central venous lines (CVLs) are used extensively in intensive care units (ICUs) but can sometimes lead to catheter-related blood stream infections (CRBSIs). This study evaluated a "CVL bundle" to see whether the CRBSI rate would decrease, analyze any changes in the flora of CRBSIs, and project any decrease in health care costs. METHODS The CVL bundle was implemented on all patients admitted to the ICU starting January 2008. Data from CRBSI rates from 2006 and 2007 were pooled to compare the intervention. A Poisson analysis generated a relative risk reduction. Determination of costs were made by taking the excess length of stay multiplied by other costs (supplies, medications, cost of replacement of CVL) at our institution. RESULTS Overall infection rates decreased with an improvement in CRBSIs in all ICUs that participated. Although the proportion of gram-negative organisms did not change significantly, there was a decrease in the proportion of gram-positive infections (P = .05) and an increase in fungal infections (P = .04). The total excess cost per organism was determined by the following: total excess cost = excess length of stay + replacement of CVL + drug administration + antibiotic cost. The weighted excess cost took the total excess cost times a correction factor based on organism frequency. The total excess cost of any given CRBSI is approximately $32,254. CONCLUSION Preventing CRBSIs can improve patient care while reducing hospital stays, costs, and possible mortality. CVL bundles are fairly easy to perform with reproducible results.
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Affiliation(s)
- James S Kim
- USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA.
| | - Paul Holtom
- USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA; USC Department of Infection Control, USC and LAC Medical Center, Los Angeles, CA
| | - Cheryl Vigen
- Department of Biostatistics, Keck School of Medicine, Los Angeles, CA
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Stone ME, Snetman D, O' Neill A, Cucuzzo J, Lindner J, Ahmad S, Teperman S. Daily multidisciplinary rounds to implement the ventilator bundle decreases ventilator-associated pneumonia in trauma patients: but does it affect outcome? Surg Infect (Larchmt) 2011; 12:373-8. [PMID: 21933008 DOI: 10.1089/sur.2010.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The incidence of ventilator-associated pneumonia (VAP) in trauma patients can be decreased with use of the ventilator bundle (VAPB). Our VAP rate remained high despite the adoption of the VAPB. To better implement the VAPB, a multidisciplinary team composed of the surgical intensive care unit (SICU) nursing staff, physician, and respiratory therapist reviewed briefly a checklist of VAPB goals for each patient before morning attending rounds. We hypothesized that such daily goal rounds (GR) focused on the VAPB would decrease the VAP rate. METHODS A pre-GR ten-month period (November 2006 to August 2007) was compared with the ten-month period (September 2007 to June 2008) with daily GRs. The occurrence of VAPs was tallied prospectively in all intubated trauma patients using the National Nosocomial Infection Surveillance criteria. Patient characteristics and outcome data were obtained from our trauma registry and medical records. Patient characteristics were similar in the 85 pre-GR patients and the 89 GR patients. RESULTS The number of VAPs decreased 67% in the GR patients (15 pre-GR vs. 5 GR; p=0.02); however, the all-cause mortality rate remained similar (16.5% vs. 21.3%; p=0.41). When patients were divided into those with and without VAP, there was a significant increase in mean ventilator, SICU, and hospital days in patients with VAP (p=0.01 for all). There were only two deaths among trauma patients with VAP. CONCLUSION Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients. Ventilator-associated pneumonia correlated with extended mean ventilator, SICU, and hospital days. Interestingly, despite a significant decrease in VAP, a decrease in the mortality rate was not observed. Given the small number of deaths in the VAP cohort, this study has insufficient statistical power to elucidate the true impact of GR intervention or VAP on the mortality rate in trauma patients.
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Affiliation(s)
- Melvin E Stone
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Hofer RE, Nikolaus OB, Pawlina W. Using checklists in a gross anatomy laboratory improves learning outcomes and dissection quality. ANATOMICAL SCIENCES EDUCATION 2011; 4:249-255. [PMID: 21786427 DOI: 10.1002/ase.243] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/01/2011] [Accepted: 06/20/2011] [Indexed: 05/31/2023]
Abstract
Checklists have been widely used in the aviation industry ever since aircraft operations became more complex than any single pilot could reasonably remember. More recently, checklists have found their way into medicine, where cognitive function can be compromised by stress and fatigue. The use of checklists in medical education has rarely been reported, especially in the basic sciences. We explored whether the use of a checklist in the gross anatomy laboratory would improve learning outcomes, dissection quality, and students' satisfaction in the first-year Human Structure didactic block at Mayo Medical School. During the second half of a seven-week anatomy course, dissection teams were each day given a hardcopy checklist of the structures to be identified during that day's dissection. The first half of the course was considered the control, as students did not receive any checklists to utilize during dissection. The measured outcomes were scored on four practice practical examinations and four dissection quality assessments, two each from the first half (control) and second half of the course. A student satisfaction survey was distributed at the end of the course. Examination and dissection scores were analyzed for correlations between practice practical examination score and checklist use. Our data suggest that a daily hardcopy list of anatomical structures for active use in the gross anatomy laboratory increases practice practical examination scores and dissection quality. Students recommend the use of these checklists in future anatomy courses.
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Burrell AR, McLaws ML, Murgo M, Calabria E, Pantle AC, Herkes R. Aseptic insertion of central venous lines to reduce bacteraemia. Med J Aust 2011; 194:583-7. [PMID: 21644871 DOI: 10.5694/j.1326-5377.2011.tb03109.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/13/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To reduce the rate of central line-associated bacteraemia (CLAB). DESIGN A collaborative quality improvement project in intensive care units (ICUs) to promote aseptic insertion of central venous lines (CVLs). A checklist was used to record compliance with all aspects of aseptic CVL insertion, with maximal sterile barrier precautions for clinicians ("clinician bundle") and patients ("patient bundle"). CLAB was identified and reported using a standard surveillance definition. PARTICIPANTS AND SETTING Patients and clinicians in 37 ICUs in New South Wales, July 2007-December 2008. MAIN OUTCOME MEASURES Compliance with aseptic CVL insertion; rates of CLAB. RESULTS 10 890 CVL checklists were reviewed for compliance with the clinician and patient bundles: compliance with aseptic CVL insertion improved significantly (P < 0.001). The CLAB rate dropped from 3.0 to 1.2 per 1000 line-days (P < 0.001). Regardless of CVL type, the relative risk (RR) of CLAB in patients with CVLs inserted by clinicians not compliant with the clinician bundle was 1.62 times greater (95% CI, 1.1-2.4; P = 0.018) than the RR with CVLs inserted by clinicians compliant with both bundles. Compliance with both the bundles was associated with a 50% reduction in risk of CLAB (RR, 0.5; 95% CI, 0.4-0.8; P = 0.004). CONCLUSIONS Compliance with all aspects of aseptic CVL insertion significantly reduces the risk of CLAB. A difficulty we experienced was that most ICUs lacked the organisation and staff to support quality improvement and audit.
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Speroff T, Ely EW, Greevy R, Weinger MB, Talbot TR, Wall RJ, Deshpande JK, France DJ, Nwosu S, Burgess H, Englebright J, Williams MV, Dittus RS. Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches. J Hosp Med 2011; 6:271-8. [PMID: 21312329 DOI: 10.1002/jhm.873] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/14/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Collaborative and toolkit approaches have gained traction for improving quality in health care. OBJECTIVE To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs). DESIGN AND SETTING Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007. MEASUREMENT CLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement. RESULTS A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty-six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80). CONCLUSION The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve.
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Affiliation(s)
- Theodore Speroff
- Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
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Implementing quality initiatives using a bundled approach. Intensive Crit Care Nurs 2011; 27:117-20. [PMID: 21511476 DOI: 10.1016/j.iccn.2011.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/29/2011] [Indexed: 12/16/2022]
Abstract
Critical care has been criticised for its inconsistency in implementing and evaluating evidence based practice both at national and international level. A review of the critical care literature by Berenholtz et al. (2002) identified interventions that might help prevent morbidity or mortality in the intensive care unit; from this four elements were developed into the initial ventilator care bundle. The aim of this bundle was to improve the quality of care for mechanically ventilated patients by improving compliance with relevant evidence based practice; implementation of this or an adapted cluster of interventions has been shown consistently to reduce the incidence of ventilator-associated pneumonias across countries. There are now numerous care bundles and the bundle approach to quality improvement has been proven to be effective across a number of problems, international boundaries and in a wide variety of ICU's. The bundle approach recognises that core clinical interventions, are not always consistently applied across all appropriate patients, the range of interventions within a bundle tackles the problem from a variety of different angles. Other strengths include its adaptability to the wide variety of environments and working practices of intensive care units across the world. The bundle and the method of implementation can be adapted to suit individual teams and units; however, this can also be a weakness of this approach as it limits comparability across centres. The bundle approach to quality improvement requires significant multidisciplinary engagement and resources to be effective.
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Vincent JL, de Souza Barros D, Cianferoni S. Diagnosis, management and prevention of ventilator-associated pneumonia: an update. Drugs 2011; 70:1927-44. [PMID: 20883051 DOI: 10.2165/11538080-000000000-00000] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ventilator-associated pneumonia (VAP) affects 10-20% of mechanically ventilated patients and is associated with increased morbidity and mortality and high costs. Early diagnosis is crucial for rapid appropriate antimicrobial therapy to be instituted, but debate remains as to the optimal diagnostic strategy. Noninvasive clinical-based diagnosis is rapid but may not be as accurate as invasive techniques. Increased use of biomarkers and advances in genomics and proteomics may help speed up diagnosis. Management of VAP relies principally on appropriate antimicrobial therapy, which should be selected according to individual patient factors, such as previous antibacterial therapy and length of hospitalization or mechanical ventilation, and local infection and resistance patterns. In addition, once bacterial culture and sensitivity results are available, broad-spectrum therapy should be de-escalated to provide a more specific, narrower-spectrum cover. Optimum duration of antibacterial therapy is difficult to define and should be tailored to clinical response. Biomarker levels may be useful to monitor response to therapy. With the high morbidity and mortality, prevention of VAP is important and several strategies have been shown to reduce the rates of VAP in mechanically ventilated patients, including using noninvasive ventilation where possible, and semi-recumbent positioning. Other potentially beneficial preventive techniques include subglottal suctioning, oral decontamination strategies and antimicrobial-coated endotracheal tubes, although further study is needed to confirm the cost effectiveness of these strategies.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Rebmann T, Greene LR. Preventing ventilator-associated pneumonia: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control 2010; 38:647-9. [PMID: 20868931 DOI: 10.1016/j.ajic.2010.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 07/29/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
Abstract
This article is an executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide for ventilator-associated pneumonia. Infection preventionists are encouraged to obtain the original, full-length Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide for more thorough coverage of ventilator-associated pneumonia prevention.
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