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Elsheikh R, Makram AM. Multidrug-resistant Organisms: The Silent Plight of Burn Patients. J Burn Care Res 2024:irae075. [PMID: 38695094 DOI: 10.1093/jbcr/irae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 07/20/2024]
Abstract
The global increasing spread of multidrug-resistant organisms (MRDOs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is burn patients, who are prone to hyperinfection as they suffer from a hypermetabolic state and weakened immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, there are some consensuses that we discuss here. In this review, we aim to present the current knowledge on multidrug-resistance with a special focus on burn patients, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
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Affiliation(s)
- Randa Elsheikh
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
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2
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Pittiruti M, Celentano D, Barone G, D'Andrea V, Annetta MG, Conti G. A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases. J Vasc Access 2023; 24:1477-1488. [PMID: 35533085 DOI: 10.1177/11297298221074472] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. METHODS The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. RESULTS All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. CONCLUSION The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, University Hospital "A. Gemelli," Rome, Italy
| | - Davide Celentano
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, "Infermi" Hospital, Rimini, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
| | | | - Giorgio Conti
- Pediatric Intensive Care Unit, University Hospital "A. Gemelli," Rome, Italy
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3
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Prochaska EC, Caballero TM, Fabre V, Milstone AM. Infection prevention requires attention to patient and caregiver language: Removing language barriers from infection prevention education. Infect Control Hosp Epidemiol 2023; 44:1707-1710. [PMID: 37039600 PMCID: PMC10691433 DOI: 10.1017/ice.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Erica C. Prochaska
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
| | - Tania Maria Caballero
- Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M. Milstone
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, MD, USA
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Schaffzin JK, Sickbert-Bennett EE, Deloney VM, Weber DJ. Implementation should be a standard component of practice guidelines and guidance documents. Infect Control Hosp Epidemiol 2023; 44:1365-1368. [PMID: 36858810 DOI: 10.1017/ice.2022.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Joshua K Schaffzin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
| | - Valerie M Deloney
- Society for Healthcare Epidemiology of America (SHEA), Arlington, Virginia
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
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5
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Lee MO, Lee SK, Song YG. Midline catheters in the operating room. Niger J Clin Pract 2023; 26:1097-1100. [PMID: 37635602 DOI: 10.4103/njcp.njcp_843_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Backgrounds Among various vascular access devices, midline catheters (MCs) are commonly used in emergency departments, but rarely in operating rooms. Aims To evaluate the feasibility and safety of MCs in the operating room. Materials and Methods This was a retrospective study. The medical records of patients who underwent MC placement in the operating room from October 2020 to July 2022 were reviewed. The rates of successful catheter insertion as well as major and minor complications were assessed. Results Successful catheter insertions were achieved in 149 of 161 patients (92.5%). The median dwell time of midlines was eight days (IQR: 6-10 days). A major or minor complication occurred in 6.7% of the midlines. The rates of major complications of occlusion, upper extremity deep vein thrombosis (DVT), and catheter-related bloodstream infection were 1.3%, 0.7%, and 0%, respectively. Conclusions Placement of MCs in the operating room was feasible and safe. Also, the procedure provides an acceptable alternative for replacing central line catheters and peripherally inserted central catheters.
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Affiliation(s)
- M O Lee
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
| | - S K Lee
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
| | - Y G Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), Changwon, Republic of Korea
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Hemmati J, Azizi M, Asghari B, Arabestani MR. Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles). THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:8854311. [PMID: 37521436 PMCID: PMC10386904 DOI: 10.1155/2023/8854311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.
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Affiliation(s)
- Jaber Hemmati
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Azizi
- Department of Tissue Engineering and Biomaterials, School of Advanced Medical Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Babak Asghari
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Arabestani
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Infectious Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Al-Tawfiq JA, Abdrabalnabi R, Taher A, Mathew S, Al-Hassan S, AlRashed H, Al-Yami SS. Surveillance of device associated infections in intensive care units at a Saudi Arabian Hospital, 2017-2020. J Infect Public Health 2023; 16:917-921. [PMID: 37084617 DOI: 10.1016/j.jiph.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Device-associated infections (DAIs) are important components of healthcare associated infection and are associated with increased morbidity and mortality. This study describes DAIs across different intensive care units (ICUs) in a hospital in Saudi Arabia. METHODS The study was conducted between 2017 and 2020 and followed the definitions of National Healthcare Safety Network (NHSN) for DAIs. The calculated the rates of ventilator-associated events (VAE), catheter-associated urinary tract infections (CAUTI) and central line-associated blood stream infections (CLABSI) followed NHSN definitions. RESULTS During the study period, there were 82 DAIs in adult ICUs and of these 16 (19.5%) were CLABSI, 26 (31.7%) were CAUTI and 40 (48.7%) were VAE. The overall rates for adult ICUs were 1.6, 1.9, 3.8 per 1000 device-days for CAUTI, CLABSI and VAE, respectively. The device-utilization ratio was 0.5, 0.6, and 0.48 for urinary catheters, central lines, and ventilators, respectively. VAE rates for medical and surgical ICU were about 2.8 times the rate in the coronary care unit and the rates were high in 2020 corresponding with the COVID-19 pandemic. Of the adult ICUS, medical ICU had a CLABSI rate of 2.13/1000 device-days and was about double the rate in surgical and cardiac ICU. For CAUTI, the rates per 1000 device-days were 2.19, 1.73, and 1.65 for medical, surgical, and coronary ICUs, respectively. The rate of CLABSI per 1000 device-days for pediatric and neonatal ICUs were 3.38 and 2.28, respectively. CONCLUSIONS CAUTI was the most common infections among adult ICUs and medical ICU had higher rates than other adult ICUs. VAE rate was higher in the first year of the COVID-19 pandemic, indicating increased device-use, change in patients characteristics as well as possible change in practices across the ICUs.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Rana Abdrabalnabi
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Alla Taher
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Shantymole Mathew
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Sami Al-Hassan
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Halima AlRashed
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Saeed S Al-Yami
- Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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8
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Kreitmann L, Vasseur M, Jermoumi S, Perche J, Richard JC, Wallet F, Chabani M, Nourry E, Garçon P, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Preda C, Labreuche J, Nseir S. Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med 2023; 49:154-165. [PMID: 36592202 DOI: 10.1007/s00134-022-06954-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/05/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The impact of immunosuppression on intensive care unit (ICU)-acquired colonization and infection related to multidrug-resistant (MDR) bacteria (ICU-MDR-col and ICU-MDR-inf, respectively) is unknown. METHODS We carried out an observational prospective cohort study in 8 ICUs in France (all with single-bed rooms and similar organizational characteristics). All consecutive patients with an ICU stay > 48 h were included, regardless of immune status, and followed for 28 days. Patients underwent systematic screening for colonization with MDR bacteria upon admission and every week subsequently. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, solid-organ transplant, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic. The primary endpoint was the incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. RESULTS 750 patients (65.9% males, median age 65 years) were included, among whom 264 (35.2%) were immunocompromised. Reasons for ICU admission, severity scores and exposure to invasive devices and antibiotics during ICU stay were comparable between groups. After adjustment for center and pre-specified baseline confounders, immunocompromised patients had a lower incidence rate of ICU-MDR-col and/or ICU-MDR-inf (adjusted incidence ratio 0.68, 95% CI 0.52-0.91). When considered separately, the difference was significant for ICU-MDR-col, but not for ICU-MDR-inf. The distribution of MDR bacteria was comparable between groups, with a majority of Enterobacteriacae resistant to third-generation cephalosporins (~ 74%). CONCLUSION Immunocompromised patients had a significantly lower incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. This finding points to the role of contact precautions and isolation measures, and could have important implications on antibiotic stewardship in this population.
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Affiliation(s)
- Louis Kreitmann
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France.,Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Margot Vasseur
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France
| | - Sonia Jermoumi
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France
| | | | - Jean-Christophe Richard
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, 69004, Lyon, France
| | - Florent Wallet
- Service de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, 69637, Pierre Bénite, France.,Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon University, Villeurbanne, France
| | - Myriam Chabani
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Emilie Nourry
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Pierre Garçon
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-La-Vallée, Jossigny, France
| | - Yoann Zerbib
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | | | - Cristian Preda
- Department of Medical Research, Biostatistics, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.,Laboratoire Paul Painlevé, Université de Lille, CNRS UMR 8524, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France. .,Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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Lydeamore MJ, Mitchell BG, Bucknall T, Cheng AC, Russo PL, Stewardson AJ. Burden of five healthcare associated infections in Australia. Antimicrob Resist Infect Control 2022; 11:69. [PMID: 35562837 PMCID: PMC9107205 DOI: 10.1186/s13756-022-01109-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Healthcare associated infections are of significant burden in Australia and globally. Previous estimates in Australia have relied on single-site studies, or combinations thereof, which have suggested the burden of these infections is high in Australia. Here, we estimate the burden of five healthcare associated infections (HAIs) in Australian public hospitals using a standard international framework, and compare these estimates to those observed in Europe.
Methods
We used data from an Australian point prevalence survey to estimate the burden of HAIs amongst adults in Australian public hospitals using an incidence-based approach, introduced by the ECDC Burden of Communicable Diseases in Europe.
Results
We estimate that 170,574 HAIs occur in adults admitted to public hospitals in Australia annually, resulting in 7583 deaths. Hospital acquired pneumonia is the most frequent HAI, followed by surgical site infections, and urinary tract infections. We find that blood stream infections contribute a small percentage of HAIs, but contribute the highest number of deaths (3207), more than twice that of the second largest, while pneumonia has the higher impact on years lived with disability.
Conclusion
This study is the first time the national burden of HAIs has been estimated for Australia from point prevalence data collected using validated surveillance definitions. Per-capita, estimates are similar to that observed in Europe, but with significantly higher occurrences of bloodstream infections and healthcare-associated pneumonia, primarily amongst women. Overall, the estimated burden is high and highlights the need for continued investment in HAI prevention.
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Kim CJ. Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs. Infect Chemother 2022; 54:674-698. [PMID: 36596680 PMCID: PMC9840952 DOI: 10.3947/ic.2022.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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11
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McCarthy SL, Stewart L, Shaikh F, Murray CK, Tribble DR, Blyth DM. Prognostic Value of Sequential Organ Failure Assessment (SOFA) Score in Critically-Ill Combat-Injured Patients. J Intensive Care Med 2022; 37:1426-1434. [PMID: 35171072 PMCID: PMC9378752 DOI: 10.1177/08850666221078196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Infection is a frequent and serious complication after combat-related trauma. The Sequential Organ Failure Assessment (SOFA) score has been shown to have predictive value for outcomes, including sepsis and mortality, among various populations. We evaluated the prognostic ability of SOFA score in a combat-related trauma population. Methods: Combat casualties (2009-2014) admitted to Landstuhl Regional Medical Center (LRMC; Germany) intensive care unit (ICU) within 4 days post-injury followed by transition to ICUs in military hospitals in the United States were included. Multivariate logistic regression was used to determine predictive effect of selected variables and receiver operating characteristic (ROC) curve analysis was used to evaluate overall accuracy of SOFA score for infection prediction. Results: Of the 748 patients who met inclusion criteria, 436 (58%) were diagnosed with an infection (32% bloodstream, 63% skin and soft tissue, and 40% pulmonary) and were predominantly young (median 24 years) males. Penetrating trauma accounted for 95% and 86% of injuries among those with and without infections, respectively (p < 0.001). Median LRMC admission SOFA score was 7 (interquartile range [IQR]: 4-9) in patients with infections versus 4 (IQR: 2-6) in patients without infections (p < 0.001). Thirty-day mortality was 2% in both groups. On multivariate regression, LRMC SOFA score was independently associated with infection development (odds ratio: 1.2; 95% confidence interval: 1.1-1.3). The ROC curve analysis revealed an area under the curve of 0.69 for infection prediction, and 0.80 for mortality prediction. Conclusions: The SOFA scores obtained up to 4 days post-injury predict late onset infection occurrence. This study revealed that for every 1 point increase in LRMC SOFA score, the odds of having an infection increases by a factor of 1.2, controlling for other predictors. The use of SOFA score in admission assessments may assist clinicians with identifying those at higher risk of infection following combat-related trauma.
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Affiliation(s)
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | | | - David R. Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Dana M. Blyth
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA
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12
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Papanikolopoulou A, Maltezou HC, Stoupis A, Kalimeri D, Pavli A, Boufidou F, Karalexi M, Pantazis N, Pantos C, Tountas Y, Koumaki V, Kantzanou M, Tsakris A. Catheter-Associated Urinary Tract Infections, Bacteremia, and Infection Control Interventions in a Hospital: A Six-Year Time-Series Study. J Clin Med 2022; 11:jcm11185418. [PMID: 36143064 PMCID: PMC9501203 DOI: 10.3390/jcm11185418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96−0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65−0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75−0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94−0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs.
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Affiliation(s)
- Amalia Papanikolopoulou
- Clinical Pharmacology Department, Athens Medical Center, 5-7 Distomou Str., Marousi, 15125 Athens, Greece
| | - Helena C. Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, 3-5 AgrafonStr., Marousi, 15123 Athens, Greece
- Correspondence: ; Tel.: +30-210-5212175
| | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 58 Kifissias Avenue, Marousi, 15125 Athens, Greece
| | - Dimitra Kalimeri
- Nurse Department Athens Medical Center, 5-7 Distomou Str., Marousi, 15125 Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, 3-5 Agrafon Str., Marousi, 15123 Athens, Greece
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Karalexi
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Constantinos Pantos
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Yannis Tountas
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 15772 Athens, Greece
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Cohen R, Gesser-Edelsburg A, Singhal A, Benenson S, Moses AE. Translating a theory-based positive deviance approach into an applied tool: Mitigating barriers among health professionals (HPs) regarding infection prevention and control (IPC) guidelines. PLoS One 2022; 17:e0269124. [PMID: 35657940 PMCID: PMC9165831 DOI: 10.1371/journal.pone.0269124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Although a wide range of intervention programs and methods have been implemented to increase health professionals’ (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice.
Objectives
This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy.
Methods
A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020).
Results
The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem.
Conclusion
Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers.
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Affiliation(s)
- Ricky Cohen
- School of Public Health, University of Haifa, Haifa, Israel
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
- * E-mail:
| | - Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel
- The Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
| | - Arvind Singhal
- Department of Communication, The University of Texas at El Paso, El Paso, Texas, United States of America
- School of Business and Social Sciences, Inland University of Applied Sciences, Hamar, Norway
| | - Shmuel Benenson
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Allon E. Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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McAlearney AS, MacEwan SR, Gregory ME, Sova LN, Hebert C, Gaughan AA. Identifying management practices for promoting infection prevention: Perspectives on strategic communication. Am J Infect Control 2022; 50:593-597. [PMID: 34890704 DOI: 10.1016/j.ajic.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Engaging leaders to share information about infections and infection prevention across their organizations is known to be important in initiatives designed to reduce healthcare-associated infections (HAIs). Yet the topics and communication strategies used by leaders that focus on HAI prevention are not well understood. This study aimed to identify and describe practices around information sharing used to support HAI prevention. METHODS We visited 18 U.S. hospitals between 2017 and 2019 and interviewed 188 administrative and clinical leaders to ask about management practices they used to facilitate HAI prevention. Interview transcripts were analyzed to characterize practices involving strategic communications. RESULTS Sharing information to support infection prevention involved strategic communications around two main topics: (1) facilitators of success and best practices, and (2) barriers to success and lessons learned. In addition, the practice of storytelling reportedly allowed leaders to highlight impact and elicit emotion, provide education, and acknowledge success in infection prevention by providing examples of real events. CONCLUSIONS Our findings provide insight about how strategic communication of information around HAIs and HAI prevention can be used to support improvement. Organizations and leaders should consider the different opportunities to incorporate the practice of strategic communication, including using storytelling, to advance their infection prevention efforts.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH; The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH.
| | - Sarah R MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Megan E Gregory
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Lindsey N Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
| | - Courtney Hebert
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH; Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH
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Day SR, Sobhanie MM, Colburn NE, Liscynesky C. Experiential learning and mentorship as the foundation of clinical epidemiology training during infectious diseases fellowship: Response to "Training infectious diseases fellows for a new era of hospital epidemiology". ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e59. [PMID: 36483420 PMCID: PMC9726490 DOI: 10.1017/ash.2022.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 06/17/2023]
Abstract
A specific, clinical-epidemiology, month-long rotation for all infectious disease fellows as well as a 1-year subspecialty track provides education in clinical epidemiology during infectious disease fellowship training. We describe the educational process created at our institution to provide this training.
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Affiliation(s)
- Shandra R. Day
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mohammad Mahdee Sobhanie
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nora E. Colburn
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christina Liscynesky
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Central line-associated bloodstream infections, multidrug-resistant bacteraemias and infection control interventions: a six-year time-series analysis in a tertiary-care hospital in Greece. J Hosp Infect 2022; 123:27-33. [PMID: 35149172 DOI: 10.1016/j.jhin.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) are serious healthcare-associated infections with substantial morbidity and hospital costs. AIM To investigate the association between the incidence of CLABSI, the implementation of specific infection control measures, and the incidence of multidrug-resistant (MDR) bacteraemias in a tertiary-care hospital in Greece from 2013-2018. METHODS Analysis was applied for the following monthly calculated indices: 1.CLABSI rate, 2.use of hand hygiene disinfectants, 3.isolation rate of patients with MDR bacteria, 4.incidence of bacteraemias [total resistant Gram-negative: carbapenem-resistant (CR) Acinetobacter baumanii, Pseudomonas aeruginosa, Klebsiella pneumoniae and/or Gram-positive: meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci]. FINDINGS Total bacteraemias from CR-Gram-negative pathogens statistically correlated with increased CLABSI rate in total Hospital Departments (IRR: 1.17, 95% CI: 1.05-1.31, p-value: 0.006) and Adults ICU (IRR: 1.37, 95%CI: 1.07-1.75, p-value: 0.013). In Adults ICU, every increase in the incidence of each resistant Gram-negative pathogen significantly correlated with decreased CLABSI rate (CR-A. baumanii: IRR: 0.59, 95%CI: 0.39-0.90, p-value=0.015; CR-K. pneumoniae: IRR: 0.48, 95%CI: 0.25-0.94, p-value=0.031; CR-P. aeruginosa: IRR: 0.54, 95%CI: 0.33-0.89, p-value=0.015). The use of hand disinfectants correlated with decreased CLABSI rate 1-3 months before the application of this intervention, in total Hospital Departments (IRR: 0.80, 95%CI: 0.69-0.93, p-value: 0.005), and for scrub disinfectants the current month in Adults ICU (IRR: 0.34, 95%CI: 0.11-1.03, p-value: 0.057). Isolation of patients with MDR pathogens was not associated with CLABSI incidence. CONCLUSION Hand hygiene was associated with a significant reduction of CLABSI incidence in our hospital. Time-series analysis is an important tool to evaluate infection control interventions.
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Swaminathan L, Flanders S, Horowitz J, Zhang Q, O'Malley M, Chopra V. Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study. JAMA Intern Med 2022; 182:50-58. [PMID: 34842905 PMCID: PMC8630646 DOI: 10.1001/jamainternmed.2021.6844] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Peripherally inserted central catheters (PICCs) and midlines are frequently used for short-term venous access; whether one is safer than the other in this setting has not been adequately reported. OBJECTIVE To compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a multihospital registry including patients admitted to a participating site from December 2017 through January 2020 who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Data were analyzed from October 2020 to March 2021. EXPOSURES PICC and midline placement. MAIN OUTCOMES AND MEASURES Major complications, including a composite of symptomatic catheter-associated deep vein thrombosis (DVT), catheter-related bloodstream infection, and catheter occlusion. Logistic regression and Cox proportional hazards regression models (taking into account catheter dwell) were used to estimate risk for major complications, adjusting for patient and device characteristics and the clustered nature of the data. Sensitivity analyses limiting analyses to 10 days of device dwell were performed. RESULTS Data on 10 863 patients, 5758 with PICCs and 5105 with midlines (median [IQR] age of device recipients, 64.8 [53.4-75.4] years; 5741 [52.8%] were female), were included. After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% CI, 1.61-2.47). Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74). Results were robust to sensitivity analyses. CONCLUSIONS AND RELEVANCE In this cohort study among patients with placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Randomized clinical trials comparing these devices for this indication are needed.
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Affiliation(s)
| | - Scott Flanders
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Hospital Medicine Safety Consortium, Ann Arbor, Michigan
| | - Jennifer Horowitz
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Hospital Medicine Safety Consortium, Ann Arbor, Michigan
| | - Qisu Zhang
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Hospital Medicine Safety Consortium, Ann Arbor, Michigan
| | - Megan O'Malley
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Hospital Medicine Safety Consortium, Ann Arbor, Michigan
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor.,Hospital Medicine Safety Consortium, Ann Arbor, Michigan.,Department of Medicine, University of Colorado Denver
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Preventing Central Line Blood Stream Infections in Critical Care Patients. Crit Care Nurs Clin North Am 2021; 33:419-429. [PMID: 34742498 DOI: 10.1016/j.cnc.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Currently, the Centers for Disease Control reports close to 40,000 central line-associated bloodstream infections (CLABSI) occur in acute care facilities in the United States each year. Most are considered preventable. Evidence-based practices such as the CLABSI bundle and central line maintenance bundles have demonstrated their effectiveness in reducing CLABSI. This article reviews these best practices and provides a framework for consistent implementation.
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Tsai TH, Gerst MD, Engineer C, Lehmann HP. Applying Decision Science to the Prioritization of Healthcare-Associated Infection Initiatives. J Patient Saf 2021; 17:506-512. [PMID: 28858967 DOI: 10.1097/pts.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Improving patient quality remains a top priority from the perspectives of both patient outcomes and cost of care. The continuing threat to patient safety has resulted in an increasing number of options for patient safety initiatives, making choices more difficult because of competing priorities. This study provides a proof of concept for using low-cost decision science methods for prioritizing initiatives. METHODS Using multicriteria decision analysis, we developed a decision support model for aiding the prioritization of the four most common types of healthcare-associated infections: surgical site infections, central line-associated bloodstream infections, ventilator-associated events, and catheter-associated urinary tract infections. In semistructured interviews, we elicited structure and parameter values of a candidate model, which was then validated by six participants with different roles across three urban teaching and nonteaching hospitals in the Baltimore, Maryland area. RESULTS Participants articulated the following structural attributes of concern: patient harm, monetary costs, patient mortality, reputational effects, and patient satisfaction. A quantitative decision-making model with an associated uncertainty report for prioritizing initiatives related to the four most common types of healthcare-associated infections was then created. CONCLUSIONS A decision support methodology such as our proof of concept could aid hospital executives in prioritizing the quality improvement initiatives within their hospital, with more complete data. Because hospitals continue to struggle in improving quality of care with tighter budgets, a formal decision support mechanism could be used to objectively prioritize patient safety and quality initiatives.
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20
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Yao L, Xiao M, Luo Y, Yan L, Zhao Q, Li Y. Research on the factors that influence patients with colorectal cancer participating in the prevention and control of surgical site infection: Based on the extended theory of planned behaviour. Health Expect 2021; 24:2087-2097. [PMID: 34510675 PMCID: PMC8628591 DOI: 10.1111/hex.13355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/20/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Background The most common and severe type of nosocomial infection in patients with colorectal cancer is surgical site infection (SSI). Patient‐related factors are an important components of SSI. So it is necessary to participate in SSI prevention and control. It is important to identify the factors that influence patients' participation behaviour and to explore the mechanism of these effects. Methods A total of 580 patients with colorectal cancer completed relevant measures. Based on the extended theory of planned behaviour, a structural equation model was used to analyse the relationship among the influencing factors. Results The factors influencing participation of patients with colorectal cancer in SSI prevention and control were participation intention, participation ability, self‐efficacy, participation attitude, perceived medical staff support, trust in physicians and social support. The direct effect coefficients of participation intention, participation ability and physician trust on SSI prevention and control behaviour were 0.67, 0.21 and 0.11, respectively. Self‐efficacy, participation attitude, perceived medical staff support and social support indirectly affect participation behaviour through participation intention, and their effect values are 0.21, 0.11, 0.11 and 0.08, respectively. Conclusions Based on the structural equation model developed in this study, targeted intervention measures should be implemented to mobilize the intention and enthusiasm of patients with colorectal cancer to participate in the prevention and control of SSI. Patient or Public Contribution Patients or public contribute to spreading research findings, and promote broad participation in the implementation of policies or strategies.
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Affiliation(s)
- Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Nosocomial Infection Control, The Second affiliated Hospital of Army Medical University, Chongqing, China
| | - Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dhar S, Sandhu AL, Valyko A, Kaye KS, Washer L. Strategies for Effective Infection Prevention Programs: Structures, Processes, and Funding. Infect Dis Clin North Am 2021; 35:531-551. [PMID: 34362533 DOI: 10.1016/j.idc.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Successful Infection Prevention Programs (IPPs) consist of a multidisciplinary team led by a hospital epidemiologist and managed by infection preventionists. Knowledge of the economics of health care-associated infections (HAIs) and the ability to make a business plan is now essential to the success of programs. Prevention of HAIs is the core function of IPPs with impact on patient outcomes, quality of care, and cost savings for hospitals. This article discusses the structure and responsibilities of an IPP, the regulatory pressures and opportunities that these programs face, and how to build and manage a successful program.
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Affiliation(s)
- Sorabh Dhar
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA; Department of Hospital Epidemiology and Infection Prevention, John D. Dingell VA Medical Center, Detroit, MI, USA.
| | - Avnish L Sandhu
- Division of Infectious Diseases, Wayne State University, Harper University Hospital, 5 Hudson, 3990 John R, Detroit, MI 48201, USA
| | - Amanda Valyko
- Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls - NIB8B02, Ann Arbor, MI 48109-5479, USA
| | - Keith S Kaye
- Division of Infectious Diseases, University of Michigan, University of Michigan Medical School, 5510A MSRB 1, SPC 5680, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA
| | - Laraine Washer
- Department of Infection Prevention and Epidemiology, Michigan Medicine, F4151 University Hospital South, 1500 East Medical Center Drive, SPC 5226, Ann Arbor, MI 48109-5226, USA; Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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Local Application of Vancomycin in One-Stage Revision of Prosthetic Joint Infection Caused by Methicillin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2021; 65:e0030321. [PMID: 34181479 DOI: 10.1128/aac.00303-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rate of eradication of periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is still not satisfactory with systemic vancomycin administration after one-stage revision arthroplasty. This study aimed to explore the effectiveness and safety of intraarticular (IA) injection of vancomycin in the control of MRSA PJI after one-stage revision surgery in a rat model. Two weeks of intraperitoneal (IP) and/or IA injection of vancomycin was used to control the infection after one-stage revision surgery. The MRSA PJI rats treated with IA injection of vancomycin showed better outcomes in skin temperature, bacterial counts, biofilm on the prosthesis, serum α1-acid glycoprotein levels, residual bone volume, and inflammatory reaction in the joint tissue, compared with those treated with IP vancomycin, while the rats treated with IP and IA administration showed the best outcomes. However, only the IP and IA administration of vancomycin could eradicate MRSA. Minimal changes in renal pathology were observed in the IP and IP plus IA groups but not in the IA group, while no obvious changes were observed in the liver or in levels of serum markers, including creatinine, alanine aminotransferase, and aspartate aminotransferase. Therefore, IA use of vancomycin is effective and safe in the MRSA PJI rat model and is better than systemic administration, while IA and systemic vancomycin treatment could eradicate the infection with a 2-week treatment course.
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Adherence to the central line bundle in intensive care: An integrative review. Am J Infect Control 2021; 49:937-956. [PMID: 33221472 DOI: 10.1016/j.ajic.2020.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) occurring in intensive care units are associated with increased morbidity and mortality, increased length of hospitalization, and cost of care associated with treating CLABSIs. The Centers for Disease Control and Prevention guidelines and checklist bundle are intended to provide evidence-based recommendations for the prevention of CLABSIs. Despite the promotion of central line bundle policies, wide variability exists in compliance and infection rates in intensive care units. OBJECTIVE To evaluate and synthesize the existing literature on adherence to the central line bundle recommendations for the prevention of CLABSI. DESIGN Integrative literature review. DATA SOURCES CINHAL, PubMed, and SCOPUS databases were searched. REVIEW METHODS Whittmore and Knafl's integrative review method. RESULTS A total of 608 articles were identified, 407 articles were screened for topic of interest and adherence to the inclusion criteria, and 19 articles were included in this review. None of the 19 studies addressed adherence to all 14 recommendations of the central line bundle checklist. CONCLUSION This integrative review identified gaps in adherence to the central line bundle. Research is needed to determine the actual adherence to each item in the bundle, and to investigate factors that contribute to nonadherence. To achieve complete compliance with all the bundle items creative and innovative technology is needed.
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Vascular Access Device Care and Management: A Comprehensive Organizational Approach. JOURNAL OF INFUSION NURSING 2021; 43:246-254. [PMID: 32881811 DOI: 10.1097/nan.0000000000000385] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency.
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Qin C, Li T, Zhao B, Wang Y, Li Z, Cao H, Zhou X, Yang X, Wang W. Subcuticular Sutures versus Staples in Reducing Surgical Site Infections after Open Abdominal Digestive Surgery: A System Review and Meta-Analysis of Randomized Controlled Trials. Surg Infect (Larchmt) 2021; 22:877-883. [PMID: 33989064 DOI: 10.1089/sur.2021.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Wound complications, primarily surgical site infections (SSIs), impose heavy a heavy burden on public health. This study aimed to compare the difference in the abilities of subcuticular sutures and staples to prevent SSIs after open abdominal surgery on the digestive system. Methods: A comprehensive search in Ovid-MEDLINE, Embase, Web of Science, and Cochrane Library (Central Register of Controlled Trials) was performed in January 2021. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICOS (population, intervention, control, outcome, study type) model was applied to guide study selection and data extraction. Results: Six studies including 3,863 participants were included. According to analysis of SSI incidence, there was no obvious difference between the incidence of SSI when subcuticular sutures and staples were used (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.61-1.08; p = 0.15). In the subsequent subgroup analysis of different operation procedures, the pooled results also failed to show significance for upper gastrointestinal surgery (OR, 1.09; 95% CI, 0.63-1.9; p = 0.75), lower gastrointestinal surgery (OR, 0.77; 95% CI, 0.56-1.05; p = 0.1), or hepatobiliary-pancreatic surgery (pooled OR, 0.72; 95% CI, 0.34-1.54; p = 0.4). Conclusions: Subcuticular sutures and staples did not show differences in their ability to prevent SSI incidence after open abdominal operation. These results require further verification by large-scale, high-quality randomized controlled trials.
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Affiliation(s)
- Cheng Qin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianhao Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bangbo Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanyang Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zeru Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongtao Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingtong Zhou
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoying Yang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weibin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Harris AD, Morgan DJ, Pineles L, Magder L, O'Hara LM, Johnson JK. Acquisition of Antibiotic-Resistant Gram-negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial. Clin Infect Dis 2021; 72:431-437. [PMID: 31970393 PMCID: PMC7850534 DOI: 10.1093/cid/ciaa071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background The Benefits of Universal Glove and Gown (BUGG) cluster randomized trial found varying effects on methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and no increase in adverse events. The aim of this study was to assess whether the intervention decreases the acquisition of antibiotic-resistant gram-negative bacteria. Methods This was a secondary analysis of a randomized trial in 20 hospital intensive care units. The intervention consisted of healthcare workers wearing gloves and gowns when entering any patient room compared to standard care. The primary composite outcome was acquisition of any antibiotic-resistant gram-negative bacteria based on surveillance cultures. Results A total of 40 492 admission and discharge perianal swabs from 20 246 individual patient admissions were included in the primary outcome. For the primary outcome of acquisition of any antibiotic-resistant gram-negative bacteria, the intervention had a rate ratio (RR) of 0.90 (95% confidence interval [CI], .71–1.12; P = .34). Effects on the secondary outcomes of individual bacteria acquisition were as follows: carbapenem-resistant Enterobacteriaceae (RR, 0.86 [95% CI, .60–1.24; P = .43), carbapenem-resistant Acinetobacter (RR, 0.81 [95% CI, .52–1.27; P = .36), carbapenem-resistant Pseudomonas (RR, 0.88 [95% CI, .55–1.42]; P = .62), and extended-spectrum β-lactamase–producing bacteria (RR, 0.94 [95% CI, .71–1.24]; P = .67). Conclusions Universal glove and gown use in the intensive care unit was associated with a non–statistically significant decrease in acquisition of antibiotic-resistant gram-negative bacteria. Individual hospitals should consider the intervention based on the importance of these organisms at their hospital, effect sizes, CIs, and cost of instituting the intervention. Clinical Trials Registration NCT01318213.
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Affiliation(s)
- Anthony D Harris
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lyndsay M O'Hara
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Šuljagić V, Bajčetić M, Mioljević V, Dragovac G, Mijović B, Janićijević I, Đorđević Z, Krtinić G, Rakić V, Ćirković I, Nikolić V, Marković-Denić L. A nationwide assessment of the burden of healthcare-associated infections and antimicrobial use among surgical patients: results from Serbian point prevalence survey, 2017. Antimicrob Resist Infect Control 2021; 10:47. [PMID: 33676578 PMCID: PMC7936242 DOI: 10.1186/s13756-021-00889-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As the only non-European Union (EU) country, Serbia participated in a second point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use (AMU) organized by the European Centre for Disease Prevention and Control (ECDC) in the EU countries. Here, we aimed to estimate the prevalence of HAI and AMU in patients who had recently undergone a surgery and to compare risk profile, HAI rates, and AMU among surgical patients and non-surgical patients. METHODS A national PPS was performed in 65 Serbian acute-care hospitals, in November 2017. In this paper, the data of 61 hospitals for adult acute-care were analyzed. To ensure the comparability of study design we used the Serbian translation of ECDC case definitions and ECDC PPS protocol. The trained infection control staff, led by a hospital coordinator, reviewed medical records to identify HAI active at the time of the survey and AMU. Only inpatients admitted to the ward before 8 a.m. on the day if the survey were included. RESULTS A total of 12,478 patients from 61 hospitals for adult acute-care were eligible for inclusion in this study. Significantly higher proportions of surgical patients were female, belonged to the 60-to-79 age group, and were less severely ill. Also, extrinsic factors (invasive devices, hospitalization at the ICU, and prior antibiotics therapy) were more frequent in surgical patients. Prevalence of HAIs was higher among surgical patients (261/3626; 7.2%) than among non-surgical patients (258/8852; 2.9%) (p < 0.0001). The highest prevalence of all HAIs was noted in patients who had kidney transplantation (4/11; 36.4%), while SSIs were the most prevalent among patients who had peripheral vascular bypass surgery (3/15; 20.0%). Non-surgical patients received treatment for community-acquired infections in significantly higher proportion (2664/8852; 64.3) (p < 0.001). Surgical prophylaxis for more than 1 day was applied in 71.4% of surgical patients. CONCLUSION We have provided an insight into the burden of HAIs and AMU among Serbia acute-care hospitals, and highlighted several priority areas and targets for quality improvement.
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Affiliation(s)
- Vesna Šuljagić
- Faculty of Medicine of Military Medical Academy, University of Defence, Belgrade, Serbia.
| | - Milica Bajčetić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Gorana Dragovac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Biljana Mijović
- Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina.,General Hospital of Čačak, Čačak, Serbia
| | | | | | | | - Violeta Rakić
- Institute of Public Health of Serbia, Belgrade, Serbia
| | - Ivana Ćirković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Johansen M, Classen V, Muchantef K. Long-term IV access in paediatrics - why, what, where, who and how. Acta Anaesthesiol Scand 2021; 65:282-291. [PMID: 33147351 DOI: 10.1111/aas.13729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
Establishment of long-term central venous access imposes the risk of procedural adverse events (air embolism, pneumothorax, accidental arterial cannulation of the great vessels, tricuspid valve damage and cardiac tamponade) as well as the risk of increased morbidity and mortality due to catheter related blood stream infections, vessel stenosis, deep vein thrombosis and the often high risk anaesthetic management of syndromic children. This narrative review aims to provide a historical and clinical background for the development and use of CVADs (central venous access devices), origin and management of the most common complications (catheter related thrombosis, infections and persistent withdrawal occlusion) and present the reader with an update on the "why, what, where, who and how" in paediatric long-term central venous access. Finally, we will present the reader with a clinical method for applying a retrograde inserted tunnelled and cuffed catheter using the left brachiocephalic vein access.
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Affiliation(s)
- Mathias Johansen
- Department of Paediatric Anaesthesia Montreal Children's Hospital Montreal Canada
| | - Volker Classen
- Department of Paediatric Anaesthesia Rigshospitalet Copenhagen Denmark
| | - Karl Muchantef
- Department of Interventional Radiology Montreal Children's Hospital Montreal Canada
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29
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Ko RE, Huh K, Kim DH, Na SJ, Chung CR, Cho YH, Jeon K, Suh GY, Yang JH. Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation. PLoS One 2020; 15:e0243838. [PMID: 33362276 PMCID: PMC7757900 DOI: 10.1371/journal.pone.0243838] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known of nosocomial infections (NI) in patients who suffer from in-hospital cardiac arrest who undergoing extracorporeal cardiopulmonary resuscitation. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation. METHODS To evaluate the incidence and clinical characteristics of NI in patients who undergoing extracorporeal cardiopulmonary resuscitation, a retrospective cohort study was conducted in a single tertiary referral center between January 2010 and December 2018. We included adult patients who undergoing extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest and excluded patients who were out-of-hospital cardiac arrest or failed ECMO implantation. Clinical characteristics and outcomes were compared between NI and Non-NI patients, or multidrug-resistant (MDR) and non-MDR. The independent risk factors associated with NIs were also analyzed using multivariable logistic regression model. RESULTS Thirty-five (23.3%) patients developed a NI. These cases included 21 patients with a gram negative (G-) infection, 12 patients with a gram positive (G+) bacterial infection, and two patients with fungal infection. Pneumonia was the most common type of NIs, followed by catheter-related infection. The in-hospital mortality and neurologic outcomes at discharge were not different between the NI and non-NI groups. Multidrug-resistant (MDR) pathogens were detected in 10 cases (28.6%). The MDR NI patients had a higher ICU mortality than did those with non-MDR NI (80% vs. 32%, p = 0.028). Following multivariable adjustment, body mass index (adjusted OR 0.87, 95% CI, 0.77-0.97, p = 0.016) and cardiopulmonary resuscitation to pump on time (adjusted OR 1.04, 95% CI, 1.01-1.06, p = 0.001) were independent predictors of NI development. CONCLUSIONS In patients who received extracorporeal cardiopulmonary resuscitation, NIs were not associated with an increase in in-hospital mortality. However, NIs with MDR organisms do increase the risk of in-hospital mortality. Lower body mass index and longer low flow time were significant predictors of NI development.
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Affiliation(s)
- Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Kim
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e379-e406. [DOI: 10.1161/cir.0000000000000909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non–CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
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31
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What distinguishes positive deviance (PD) health professionals from their peers and what impact does a PD intervention have on behaviour change: a cross-sectional study of infection control and prevention in three Israeli hospitals. Epidemiol Infect 2020; 148:e259. [PMID: 33050958 PMCID: PMC7689599 DOI: 10.1017/s0950268820002484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Past studies using the positive deviance (PD) approach in the field of infection prevention and control (IPC) have primarily focused on impacts on healthcare-associated infection rates. This research aimed to determine if health professionals who exhibit PD behaviours have distinctive socio-cognitive profiles compared to non-PD professionals, and to examine the impact of a PD intervention on healthcare professionals’ (HPs) behavioural changes in maintaining IPC guidelines. In a cross-sectional study among 135 HPs, respondents first filled out a socio-cognitive characteristics questionnaire, and after 5 months were requested to complete a self-reported behavioural change questionnaire. The main findings indicate that socio-cognitive variables such as external locus of control, perceived threat and social learning were significant predictors of a person exhibiting PD behaviours. Almost 70% of HPs reported behavioural change and creating social networks as a result of the PD intervention in maintaining IPC guidelines, 16.9% of them are a ‘PD boosters’ (a new group of HPs who have adopted the positive practices of PDs that were originally identified, and also added additional practices of their own). Social networks can contribute to internalizing and raising personal accountability even among non-PD professionals, by creating a mind map that makes each person believe they are an important node in the network, regardless of their status and role. Health intervention programmes should purposely make visible and prominent social network connections in the hospital system.
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Salazar-Vargas K, Padilla-Orozco M, Garza-González E, Camacho-Ortiz A. Chlorhexidine impregnated surgical scrubs and whole-body wash for reducing colonization of health care personnel. Am J Infect Control 2020; 48:1216-1219. [PMID: 32057510 DOI: 10.1016/j.ajic.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of chlorhexidine as a strategy to reduce nosocomial infections in patients has been proven useful. Bacterial contamination of health care worker's uniforms during routine patient care has been demonstrated to have potential for horizontal transmission of pathogens. METHODS We performed a prospective, open comparative trial. We included nurses who were in direct patient care and evaluated clothing microbial growth during 3 interventions: (1) participants were given a sterile surgical scrub (SSS) to put on the beginning of the shift, (2) they were instructed to take a chlorhexidine bath (CHG-B) before putting on the SSS, and (3) participants were given a chlorhexidine impregnated SSS (CI-SSS). Cultures were obtained from 3 areas (chest pocket, chest, and abdominal) at hour 0, 6, and 12 hours after the start of the shift. RESULTS A total of 306 cultures processed with 17 bacterial groups. The uniform area with the highest number of CFU was the abdomen (818 CFU), followed by the thorax (654 CFU). Over 50% of the bacterial load occurred at 12 hours (1,092 CFU at 12 hours, 766 CFU at 6 hours, and 184 CFU at 0 hour). There was a significant reduction in CFU when SSS was compared to CHG-B (CFU mean = 12.5 [0-118] vs CFU mean = 3.5 [0-22], P = .003); and SSS versus CI-SSS (CFU mean = 12.5 [0-118] vs CFU mean = 3 [0-39], P = .007). No severe adverse events were reported. CONCLUSIONS Bacterial load in uniforms decreased when chlorhexidine was used (bathing of personnel or impregnation) when compared to the use of a sterile uniform.
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Affiliation(s)
- Karina Salazar-Vargas
- Department of Internal Medicine, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Magaly Padilla-Orozco
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Elvira Garza-González
- Gastroenterology service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrián Camacho-Ortiz
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to Staphylococcus aureus disease prevention. Infect Control Hosp Epidemiol 2020; 41:1251-1257. [PMID: 32921340 DOI: 10.1017/ice.2020.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Mwananyanda L, Pierre C, Mwansa J, Cowden C, Localio AR, Kapasa ML, Machona S, Musyani CL, Chilufya MM, Munanjala G, Lyondo A, Bates MA, Coffin SE, Hamer DH. Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle. Clin Infect Dis 2020; 69:1360-1367. [PMID: 30596901 DOI: 10.1093/cid/ciy1114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. METHODS We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. RESULTS Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period. CONCLUSIONS A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. CLINICAL TRIALS REGISTRATION NCT02386592.
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Affiliation(s)
- Lawrence Mwananyanda
- Right to Care, Lusaka, Zambia.,Department of Global Health, Boston University School of Public Health
| | - Cassandra Pierre
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Massachusetts
| | - James Mwansa
- Department of Pathology and Microbiology, University Teaching Hospital.,Lusaka Apex Medical University, Zambia
| | - Carter Cowden
- Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - A Russell Localio
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Monica L Kapasa
- Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia
| | - Sylvia Machona
- Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Angela Lyondo
- Department of Pathology and Microbiology, University Teaching Hospital
| | - Matthew A Bates
- School of Life Sciences, University of Lincoln, United Kingdom
| | - Susan E Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Massachusetts
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The impact of a bundle to prevent hospital-acquired pneumonia in a cohort of nonventilated patients on enteral nutrition. Infect Control Hosp Epidemiol 2020; 42:100-102. [PMID: 32847648 DOI: 10.1017/ice.2020.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We conducted a quasi-experimental study to evaluate a bundle to prevent nonventilator hospital-acquired pneumonia (NV-HAP) in patients on enteral tube feeding. After the intervention, there was an increase in bundle compliance from 55.9% to 70.5% (P < .01) and a significant decrease (34%) in overall NV-HAP rates from 5.71 to 3.77 of 1,000 admissions.
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36
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Fridkin SK. Advances in Data-Driven Responses to Preventing Spread of Antibiotic Resistance Across Health-Care Settings. Epidemiol Rev 2020; 41:6-12. [PMID: 31673712 DOI: 10.1093/epirev/mxz010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/08/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
Among the most urgent and serious threats to public health are 7 antibiotic-resistant bacterial infections predominately acquired during health-care delivery. There is an emerging field of health-care epidemiology that is focused on preventing health care-associated infections with antibiotic-resistant bacteria and incorporates data from patient transfers or patient movements within and between facilities. This analytic field is being used to help public health professionals identify best opportunities for prevention. Different analytic approaches that draw on uses of big data are being explored to help target the use of limited public health resources, leverage expertise, and enact effective policy to maximize an impact on population-level health. Here, the following recent advances in data-driven responses to preventing spread of antibiotic resistance across health-care settings are summarized: leveraging big data for machine learning, integration or advances in tracking patient movement, and highlighting the value of coordinating response across institutions within a region.
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Affiliation(s)
- Scott K Fridkin
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Poulakou G, Nseir S, Daikos GL. Less contact isolation is more in the ICU: pro. Intensive Care Med 2020; 46:1727-1731. [PMID: 32648089 PMCID: PMC7343898 DOI: 10.1007/s00134-020-06173-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/30/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Garyphallia Poulakou
- 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria General Hospital, Address 152 Mesogion st, 11527, Athens, Greece.
| | - Saad Nseir
- CHU de Lille, Centre de Réanimation, 59000, Lille, France.,Université de Lille, INSERM U995, Team Fungal Associated Invasive & Inflammatory Diseases, Lille Inflammation Research International Center, Lille, France
| | - George L Daikos
- National and Kapodistrian University of Athens, MITERA Hospital, Erythrou Stavrou 6, Marousi, 15125, Athens, Greece
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Fumarola S, Allaway R, Callaghan R, Collier M, Downie F, Geraghty J, Kiernan S, Spratt F, Bianchi J, Bethell E, Downe A, Griffin J, Hughes M, King B, LeBlanc K, Savine L, Stubbs N, Voegeli D. Overlooked and underestimated: medical adhesive-related skin injuries. J Wound Care 2020; 29:S1-S24. [DOI: 10.12968/jowc.2020.29.sup3c.s1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sian Fumarola
- Senior Clinical Nurse Specialist, Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust, UK
| | - Rachel Allaway
- Tissue Viability Clinical Nurse Specialist, Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Rosie Callaghan
- Tissue Viability Lead, Worcestershire Health and Care NHS Trust, UK
| | - Mark Collier
- Nurse Consultant and Associate Lecturer, Tissue Viability, UK
| | - Fiona Downie
- Formerly Nurse Consultant, Tissue Viability, Royal Papworth Hospital NHS Foundation Trust, UK
| | - Jemell Geraghty
- Nurse Consultant, Tissue Viability, Camden Health Improvement Practice; Clinical Nurse Specialist, HCA Healthcare (Princess Grace); Visiting Clinical Teacher King's College Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, UK
| | - Sarah Kiernan
- Consultant Nurse, Tissue Viability, Forest Primary Care Centre, London, UK
| | - Fran Spratt
- Lead Nurse Tissue Viability, University Hospital Southampton NHS Foundation Trust, UK
| | - Janice Bianchi
- Independent Tissue Viability Nurse; Dermatology Educator and Honorary Lecturer, Glasgow University, UK
| | - Elaine Bethell
- Lead Nurse, Tissue Viability, Royal Orthopaedic Hospital, Birmingham, UK
| | - Annette Downe
- Epidermolysis Bullosa Clinical Nurse Specialist, St Thomas' Hospital, London, UK
| | - Jackie Griffin
- Tissue Viability Clinical Nurse Specialist, NHS Wales, UK
| | - Maria Hughes
- Independent Tissue Viability Consultant and Queens Nurse, UK
| | - Brenda King
- Nurse Consultant, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Kimberly LeBlanc
- Chair, Wound Ostomy Continence Institute and Association of Nurses Specialized in Wound Ostomy Continence, Canada
| | - Louise Savine
- Tissue Viability Lead Nurse, Imperial College Healthcare NHS Trust, London, UK
| | - Nikki Stubbs
- Clinical Project Lead for Integrated Wound Clinics, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Voegeli
- Visiting Professor, Faculty of Health and Wellbeing, University of Winchester
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Pozuelo-Carrascosa DP, Herráiz-Adillo Á, Alvarez-Bueno C, Añón JM, Martínez-Vizcaíno V, Cavero-Redondo I. Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis. Eur Respir Rev 2020; 29:29/155/190107. [PMID: 32051169 PMCID: PMC9488747 DOI: 10.1183/16000617.0107-2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/21/2019] [Indexed: 12/18/2022] Open
Abstract
Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included. In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I2=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I2=0%, p=0.888). This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay. Subglottic secretion drainage is an effective measure to reduce mortality and VAP incidence, despite not improving the duration of mechanical ventilation or length of stay in ICU and/or hospital.http://bit.ly/2PeJLR1
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Affiliation(s)
- Diana P Pozuelo-Carrascosa
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Ángel Herráiz-Adillo
- Dept of Primary Care, Health Service of Castilla-La Mancha (SESCAM), Tragacete, Cuenca, Spain
| | - Celia Alvarez-Bueno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jose Manuel Añón
- Intensive Care Unit, Hospital Universitario La Paz-Carlos III, IdiPAZ, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.,Universidad Autónoma de Chile, Faculty of Health Sciences, Madrid, Spain
| | - Iván Cavero-Redondo
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
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Gatto V, Scopetti M, La Russa R, Santurro A, Cipolloni L, Viola RV, Di Sanzo M, Frati P, Fineschi V. Advanced Loss Eventuality Assessment and Technical Estimates: An Integrated Approach for Management of Healthcare-Associated Infections. Curr Pharm Biotechnol 2020; 20:625-634. [PMID: 30961487 DOI: 10.2174/1389201020666190408095050] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/15/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare Associated Infections (HAIs) represent a crucial issue in health and patient safety management due to the persistent nature, economic impact and possible preventability of the phenomenon. Compensation claims for damages resulting from HAI could provide insights that can improve the understanding of suboptimal steps in the therapeutic process, enable an estimate of costs related to infectious complications, and guide the development of planning tools for implementation of the quality of care. OBJECTIVE This paper analyzes all the HAI claims received at the Umberto I General Hospital of Rome across a five-year period with the aim of outlining a methodological approach to the litigation management and of characterizing the economic impact of infections on health facilities resources. METHODS All claims received during the study period have been classified according to the International Classification for Patient Safety (ICPS) system. Subsequently, claims related to Healthcare Associated Infections were evaluated through an innovative tool for determination of the risk of loss, the Advanced Loss Eventuality Assessment (ALEA) score. RESULTS The results obtained demonstrate the relevance of a correct management of HAI claims in the administration of a health care system. Specifically, the cases examined during the study highlighted the significant impact of infectious diseases of a nosocomial nature in terms of frequency and economic exposure. CONCLUSION The proposed methodological approach allows a productive analysis of the internal processes, providing fundamental data for the refinement of the preventive strategies and for the rationalization of the resources through the expenditure forecasts. Article Highlights Box: Healthcare-Associated Infections represent an essential element to consider in the management of health facilities. • Many studies highlight the economic burden of Healthcare-Associated Infections in health policies. • Litigation management represents a useful resource in the prevention of Healthcare Associated Infections. • Appropriate clinical risk management policies in the field of Healthcare-Associated Infections allow the implementation of preventive measures, the reduction of the incidence of the phenomenon and the quality of care. • The costs of Healthcare-Associated Infections can be limited through a systematic methodological approach based on Advanced Loss Eventuality Assessment and technical estimate of the value of each case. • The application of a standardized system would be desirable in any health facility despite the potential methodological, technical, behavioral and financial issues.
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Affiliation(s)
- Vittorio Gatto
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Cipolloni
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Rocco V Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Mariantonia Di Sanzo
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Via Atinense, 18, 86077, Pozzilli, Italy
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Saint S, Meddings J, Fowler KE, Vaughn VM, Ameling JM, Rohde JM, Popovich KJ, Calfee DP, Krein SL, Chopra V. The Guide to Patient Safety for Health Care-Associated Infections. Ann Intern Med 2019; 171:S7-S9. [PMID: 31569222 DOI: 10.7326/m18-3443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System,Ann Arbor, Michigan (J.M.)
| | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | - Valerie M Vaughn
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Jessica M Ameling
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., J.M.R.)
| | - Jeffrey M Rohde
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., J.M.R.)
| | - Kyle J Popovich
- Rush University Medical Center/Stroger Hospital of Cook County, Chicago, Illinois (K.J.P.)
| | | | - Sarah L Krein
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (S.S., V.M.V., S.L.K., V.C.)
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Castro AFD, Rodrigues MCS. Audit of standardized precautionary and contact practices in the Intensive Care Unit. Rev Esc Enferm USP 2019; 53:e03508. [PMID: 31433023 DOI: 10.1590/s1980-220x2018018603508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 04/09/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the structure and adherence to the standardized and specific precautionary measures of health professionals in the Intensive Care Unit of a teaching hospital in the Federal District of Brazil. METHOD A descriptive, cross-sectional and prospective study. A structured questionnaire was used via observations which recorded the practices of professionals with Individual Protection Equipment and indications of precautions. The chi-square test was applied, and the p-value was calculated. RESULTS A total of 52 professionals participated in the study, and 445 care procedures were observed in 36 audit sessions. The average adhesion rate for equipment use was 72.72%, with 94.91% for gloves, 91.43% for aprons, 80% for masks and 24.56% for safety glasses. When there was no indication and no personal protective equipment was used, the average rate was 68.01%, with 30.77% for gloves, 87.58% for aprons, 57.58% for masks, and 96.13% for safety glasses. Contact precautions were unnecessarily indicated for 35% of patients. CONCLUSION Good adherence to using gloves, aprons and masks were observed, but there was poor adherence to using safety glasses and unnecessary use of masks and admission contact precautions.
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Affiliation(s)
- Alaíde Francisca de Castro
- Universidade de Brasília, Programa de Pós-Graduação em Enfermagem, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Divisão de Enfermagem, Brasília, DF, Brasil
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Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center. Turk Arch Pediatr 2019; 54:105-112. [PMID: 31384145 PMCID: PMC6666360 DOI: 10.14744/turkpediatriars.2019.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/21/2019] [Indexed: 12/11/2022]
Abstract
Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1–205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion: Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
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Bonavina L, Arini A, Ficano L, Iannuzziello D, Pasquale L, Aragona SE, Ciprandi G, On Digestive Disorders ISG. Post-surgical intestinal dysbiosis: use of an innovative mixture (Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, Lactobacillus delbrueckii LDD01). ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:18-23. [PMID: 31292422 PMCID: PMC6776165 DOI: 10.23750/abm.v90i7-s.8651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022]
Abstract
Abdominal surgery represents a high risk for hospital-acquired infections and complication that may compromise the surgery outcome. Patients with recent abdominal surgery have an intestinal dysbiosis. There is evidence that probiotics may counterbalance the impaired microbiota. Therefore, the current survey evaluated the efficacy and safety of Abincol®, an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 millions of living cells), and Lactobacillus delbrueckii LDD01 (200 millions of living cells), in 612 outpatients (344 males and 268 females, mean age 58 years) undergoing digestive surgery. Patients took 1 stick/daily for 8 weeks. Abincol® significantly diminished the presence and the severity of intestinal symptoms and improved stool form. In conclusion, the current survey suggests that Abincol® may be considered an effective and safe therapeutic option in the management of patients undergoing digestivesurgery.
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46
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Pessin YJ, Matthews EP. Glow Powder: See the Germs? An Innovative Teaching Technique in a Student Sonography Laboratory. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319855006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to compare the disinfection rate of a laboratory environment before and after glow powder exposure and training of sonography students (n = 23) and establish if glow powder was an effective teaching technique for infection protection and control (IPC). Fourteen locations at four scanning stations were contaminated with glow powder, visible under ultraviolet light. Students were shown contaminated areas and debriefed on the importance of disinfection. This activity was repeated to ascertain effectiveness of the training. In total, 204 areas were examined for contamination. Observation 1 revealed 21 locations (30.8%), and observation 2 detected glow powder on 12 locations (17.6%). Overall decrease in contamination rate was 13%. The gel bottle was the most frequently contaminated. The curved 3.5-MHz transducer was consistently cleaned. Disinfectant spray, time gain compensation, bed, stool, screen, and handles of the machine remained contaminated. Students’ IPC increased significantly after glow powder training, and secondary spread was reduced by 16%.
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Affiliation(s)
- Yosefa J. Pessin
- Department of Diagnostic Medical Imaging, College of Health Related Professions, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Eric P. Matthews
- A. T. Still University, School of Graduate Studies, Mesa, AZ, USA
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47
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Pulmonary artery catheter epidemiology of risk in pre-heart-transplant recipients. Infect Control Hosp Epidemiol 2019; 40:632-638. [PMID: 31038098 DOI: 10.1017/ice.2019.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Central-line-associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre-heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC. DESIGN Retrospective cohort study. SETTING This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota. PATIENTS 61 pre-heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs. METHODS At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic's Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models. RESULTS Among pre-heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98-9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355). CONCLUSIONS The rate of CLABSI with PAC is high. Prolonged PAC use in the pre-heart-transplant population should be revisited.
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Abstract
Surgical site infection (SSI) following colorectal surgery is associated with worse postoperative outcomes, longer length of stay, and higher rates of readmission. SSI rates have been established as a surrogate metric for the overall quality of surgical care and are intricately tied to financial incentives and the public reputation of an institution. While risk factors and prevention mechanisms for SSI are well established, the rates of SSI remain high. This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices.
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Affiliation(s)
- Megan C Turner
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John Migaly
- Division of Advanced GI and Oncologic Surgery, Duke University Medical Center, Durham, North Carolina
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49
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Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol 2018; 40:1-17. [DOI: 10.1017/ice.2018.303] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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50
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Araujo da Silva AR, Marques AF, Biscaia di Biase C, Zingg W, Dramowski A, Sharland M. Interventions to prevent urinary catheter-associated infections in children and neonates: a systematic review. J Pediatr Urol 2018; 14:556.e1-556.e9. [PMID: 30126746 DOI: 10.1016/j.jpurol.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Few data are available to inform strategies for the prevention of catheter-associated urinary tract infection (CAUTI) in children and neonates. Many recommendations are derived from studies in adults and cannot be applied to the paediatric population. OBJECTIVE This study was aimed to identify all studies that measured the efficacy of an intervention for the prevention of CAUTI in children and neonates. METHODS A systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was conducted. Eligible studies published between January 1st, 1995 and December 31st, 2017, were identified in PubMed, the Cochrane Database of Systematic Reviews, LILACS, SciELO and DOAJ if applying an intervention with the aim of CAUTI prevention in inpatient children, infants or neonates. The following study designs were included: controlled and non-controlled before-and-after studies, (controlled) interrupted time series analyses and randomized controlled trials. Quantitative or qualitative studies on interventions in both adults and children were eligible if data on children could be extracted. Reviews, case series, letters, notes, conference abstracts and opinion articles were excluded. RESULTS Of 99 articles identified, six were included in the final analysis, after consensus from three independent investigators. Four studies used a multimodal strategy (using at least four or more different components at the same time) as follows: aseptic rules during catheter insertion and removal; cleaning the urethral meatus with sterile water; use of a new silicone catheter per insertion with a closed sterile drainage system by a sterile technique; daily evaluation of catheter requirement; placement of indwelling urinary catheters only for approved indications; reducing of urinary catheter days and positioning of the patient and collection device to assist in urine drainage. One study tested periurethral cleaning intervention to reduce CAUTI. One study described the association of the presence of a physician safety champion with urinary catheter device utilization ratios. Catheter-associated UTI reduction rates were reported in four studies; three achieved statistically significant decreases in CAUTI rates. Positive results were achieved only when a multimodal strategy was used with at least four or more components. This strategy could be adopted for paediatric healthcare institutions to reduce CAUTI rates in children and neonates. CONCLUSION Evidence exists to support the use of a multimodal strategy for CAUTI reduction in hospitalized children and neonates.
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Affiliation(s)
- A R Araujo da Silva
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rua Marquês Do Paraná, 303-Niterói, Rio de Janeiro State, Brazil.
| | - A F Marques
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rua Marquês Do Paraná, 303-Niterói, Rio de Janeiro State, Brazil
| | - C Biscaia di Biase
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Rua Marquês Do Paraná, 303-Niterói, Rio de Janeiro State, Brazil
| | - W Zingg
- Service de Prévention et Contrôle de L'infection, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - A Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's Healthcare NHS Trust and St George's University, London, UK
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