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Sun ZW, Guo MR, Yang LZ, Chen ZJ, Zhang ZQ. Risk Factor Analysis and Risk Prediction Model Construction of Pressure Injury in Critically Ill Patients with Cancer: A Retrospective Cohort Study in China. Med Sci Monit 2020; 26:e926669. [PMID: 32948737 PMCID: PMC7523421 DOI: 10.12659/msm.926669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to analyze the risk factors of pressure injury (PI) in critically ill patients with cancer to build a risk prediction model for PI. Material/Methods Between January 2018 and December 2019, a total of 486 critically ill patients with cancer were enrolled in the study. Univariate analysis and binary logistic regression analysis were used to explore risk factors. Then, a risk prediction equation was constructed and a receiver operator characteristic (ROC) curve analysis model was used for prediction. Results Of the 486 critically ill patients with cancer, 15 patients developed PI. Risk factors found to have a significant impact on PI in critically ill patients with cancer included the APACHE II score (P<0.001), semi-reclining position (P=0.006), humid environment/moist skin (P<0.001), and edema (P<0.001). These 4 independent risk factors were used in the regression equation, and the risk prediction equation was constructed as Z=0.112×APACHE II score +2.549×semi-reclining position +2.757×moist skin +1.795×edema–9.086. From the ROC curve analysis, the area under the curve (AUC) was 0.938, sensitivity was 100.00%, specificity was 83.40%, and Youden index was 0.834. Conclusions The PI risk prediction model developed in this study has a high predictive value and provides a basis for PI prevention and treatment measures for critically ill patients with cancer.
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Affiliation(s)
- Zhong-Wen Sun
- Intensive Care Unit, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China (mainland)
| | - Min-Ru Guo
- Intensive Care Unit, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China (mainland)
| | - Li-Zi Yang
- Intensive Care Unit, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China (mainland)
| | - Ze-Jun Chen
- Intensive Care Unit, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China (mainland)
| | - Zhu-Qing Zhang
- Intensive Care Unit, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China (mainland)
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Shorr AF, Zilberberg MD. Going Viral: Importance of Viral Pathogens in Nonventilated Hospital-Acquired Pneumonia. Chest 2018; 150:991-992. [PMID: 27832891 DOI: 10.1016/j.chest.2016.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/07/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Andrew F Shorr
- Section of Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC.
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DeMellow J, Kim TY. Technology-enabled performance monitoring in intensive care: An integrative literature review. Intensive Crit Care Nurs 2018; 48:42-51. [PMID: 30054118 DOI: 10.1016/j.iccn.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/20/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Implementation of evidence-based bundles in intensive care units is integral to improving quality of care and patient outcomes. However, it increases the burden of data collection and analysis required for performance monitoring and feedback of an inter-disciplinary care team. Health information technology including electronic health records and data analytic tools could automate this process and provide real-time feedback to the team. AIM This integrative literature review aimed to examine the extent to which technology-enabled performance monitoring and feedback contributed to improving quality of care and patient outcomes when implementing evidence-based bundles. METHODS A literature search of scientific databases was conducted using PubMed, Embase, Scopus, CINHAL and Ovid Medline. RESULTS Of nine studies included in this review, all reported improved compliance of the team with evidence-based bundles, ranging from 3% to 60% post implementation of technology-enabled performance monitoring and feedback. Significant reductions (p < .05) in hospital acquired infections were also reported in five studies. CONCLUSIONS Overall, the addition of documentation fields to electronic health records was essential in providing real-time feedback to teams and improving their compliance with evidence-based bundles. Further research is needed to assess the effectiveness of technology-enabled performance monitoring and feedback in improving patient outcomes on a larger scale, especially in resource-limited settings such as community hospitals.
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Affiliation(s)
- Jacqueline DeMellow
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA 95817, United States.
| | - Tae Youn Kim
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA 95817, United States
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Borgert M, Binnekade J, Paulus F, Goossens A, Dongelmans D. A flowchart for building evidence-based care bundles in intensive care: based on a systematic review. Int J Qual Health Care 2017; 29:163-175. [PMID: 28453823 DOI: 10.1093/intqhc/mzx009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/23/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose The Institute for Healthcare Improvement is the founder of the care bundled approach and described the methods used on how to develop care bundles. However, other useful methods are published as well. In this systematic review, we identified what different methods were used to design care bundles in intensive care units. The results were used to build a comprehensive flowchart to guide through the care bundle design process. Data sources Electronic databases were searched for eligible studies in PubMed, EMBASE and CINAHL from January 2001 to August 2014. Study selection There were no restrictions on the types of study design eligible for inclusion. Methodological quality was assessed by using the Downs & Black-checklist or Appraisal of Guidelines, REsearch and Evaluation II. Data extraction Data extraction was independently performed by two reviewers. Results of data synthesis A total of 4665 records were screened and 18 studies were finally included. The complete process of designing bundles was reported in 33% (6/18). In 50% (9/18), one of the process steps was described. A narrative report was written about care bundles in general in 17% (3/18). We built a comprehensive flowchart to visualize and structure the process of designing care bundles. Conclusion We identified useful methods for designing evidence-based care bundles. We built a comprehensive flowchart to provide an overview of the methods used to design care bundles so that others could choose their own applicable method. It guides through all necessary steps in the process of designing care bundles.
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Affiliation(s)
- Marjon Borgert
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Jan Binnekade
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Astrid Goossens
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Dave Dongelmans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Viruses are prevalent in non-ventilated hospital-acquired pneumonia. Respir Med 2016; 122:76-80. [PMID: 27993295 PMCID: PMC7135153 DOI: 10.1016/j.rmed.2016.11.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hospital-acquired pneumonia arising in non-ventilated patients (NVHAP) is traditionally thought to be caused by bacteria, and little is known about viral etiologies in this syndrome. We sought to describe the prevalence of viruses causing NVHAP and to determine factors independently associated with the isolation of a virus. METHODS We identified patients with NVHAP over one year and reviewed their cultures to determine etiologies. Patients with a viral process were compared to those with either negative cultures or a bacterial infection to determine variables independently associated with the recovery of a virus. RESULTS Among 174 cases, cultures were positive in 46.0%, with viruses identified in 22.4%. Bacterial pathogens arose 23.6% of subjects. The most common viruses included rhinovirus, influenza, and parainfluenza. We noted no seasonality in the isolation of viral organisms, and most cases of viral NVHAP developed after more than a week length of stay (LOS). Outcomes in viral NVHAP were similar to those with bacterial NVHAP. Patients with viral and bacterial NVHAP were generally similar. Two variables were independently associated with isolation of a virus: a history of coronary artery disease (adjusted odds ratio: 5.16, 95% CI: 1.14-22.44) and a LOS of greater than 10 days prior to NVHAP diagnosis (adjusted odds ratio: 2.97, 95% CI: 1.35-6.51). As a screening test for a virus, neither had a good sensitivity or specificity. CONCLUSIONS Viruses represent a common cause of NVHAP. Clinicians should consider viral diagnostic testing in NVHAP, as this may represent a means to enhance antimicrobial stewardship.
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MESH Headings
- Adult
- Aged
- Bacteria/isolation & purification
- Cross Infection/diagnosis
- Cross Infection/epidemiology
- Cross Infection/virology
- Female
- Humans
- Influenza, Human/epidemiology
- Influenza, Human/virology
- Length of Stay/statistics & numerical data
- Male
- Middle Aged
- Paramyxoviridae Infections/epidemiology
- Paramyxoviridae Infections/virology
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/virology
- Prevalence
- Respiration, Artificial/statistics & numerical data
- Respiration, Artificial/trends
- Retrospective Studies
- Rhinovirus/isolation & purification
- Treatment Outcome
- Viruses/isolation & purification
- Viruses/pathogenicity
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine Service, Medstar Washington Hospital Center, Washington, DC, United States.
| | | | - Scott T Micek
- St. Louis College of Pharmacy, St. Louis, MO, United States
| | - Marin H Kollef
- The Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO, United States
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Abstract
BACKGROUND Hospital-acquired infections (HAIs) are a persistent concern and include surgical site infections, intravascular line-associated infections, pneumonia, catheter-associated urinary tract infections, and C. difficile infection. METHOD Review of the pertinent English-language literature. RESULTS Hospital-acquired infections result in significant increases in morbidity, mortality rates, and cost and are a focus of efforts at reduction. CONCLUSION I discuss efforts specific to each of the most common infections and a philosophical approach to prevention that strives to achieve zero potentially preventable hospital-acquired infections.
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Ali A, Diebel L, Liberati D. Stress Hormone Epinephrine Increases IgA Transport across Respiratory Epithelial Surfaces. J Am Coll Surg 2014; 218:450-8. [DOI: 10.1016/j.jamcollsurg.2013.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 01/01/2023]
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Making the case for de-escalation therapy in ventilator-associated pneumonia once again. Crit Care Med 2013; 41:1810-1. [PMID: 23774344 DOI: 10.1097/ccm.0b013e31828ce949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Åkerman E, Larsson C, Ersson A. Clinical experience and incidence of ventilator-associated pneumonia using closed versus open suction-system. Nurs Crit Care 2013; 19:34-41. [DOI: 10.1111/nicc.12010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/08/2012] [Accepted: 11/27/2012] [Indexed: 01/04/2023]
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Abstract
BACKGROUND Laboratory and clinical studies demonstrated a salutary effect of estradiol (E2) on pneumonia and other infectious complications after trauma, while dihydrotestosterone (DHT) failed to show a similar effect. Secretory immunoglobulin A is the principle antibody in the respiratory and other mucosal secretions. Immunoglobulin A (IgA) production and transport into the mucosal secretion is regulated by Toll-like receptor 4 (TLR-4). In addition, E2 may influence immune regulatory cells via TLR-4. We hypothesized that the protective effect of E2 on the development of pneumonia may be related to modulation of IgA transport into respiratory secretions. METHODS Calu-3 respiratory epithelial cell monolayers were established in a two-chamber cell culture system. Calu-3 cells were then treated with either E2 or DHT for 3 days for maximal cell stimulation. Dimeric IgA was added to the basal chamber of Calu-3 cells, and IgA transcellular transport was indexed by recovery of secretory immunoglobulin A in the apical chamber media. In separate experiments, Klebsiella pneumonia (10(5) CFU/mL) was added to the apical chamber of treated Calu-3 cell monolayers, and bacterial passage across Calu-3 cells was determined by bacterial recovery from the basal chamber. Calu-3 cells not treated with E2 or DHT served as control. RESULTS Calu-3 cells pretreated with E2 significantly increased IgA transport, and this effect was augmented in a dose-dependent fashion. Only cells pretreated with E2 significantly decreased bacterial passage, and this effect was exhibited in a dose- and time-dependent fashion. E2 led to a significant increase in TLR-4 expression. CONCLUSION The protective effect of E2 against pneumonia may be related to augmented transport of IgA into the respiratory mucosal secretions.
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Köck R, Siam K, Al-Malat S, Christmann J, Schaumburg F, Becker K, Friedrich AW. Characteristics of hospital patients colonized with livestock-associated meticillin-resistant Staphylococcus aureus (MRSA) CC398 versus other MRSA clones. J Hosp Infect 2011; 79:292-6. [PMID: 22024921 DOI: 10.1016/j.jhin.2011.08.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/22/2011] [Indexed: 01/24/2023]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) associated with the clonal complex (CC) 398 has emerged among livestock and humans exposed to these animals. MRSA CC398 has so far contributed relatively little to spread of MRSA and the burden of disease in the healthcare setting. This study aimed to assess whether demographic and clinical differences in patients colonized with MRSA CC398 and those carrying other MRSA clones contribute to the observed differences in transmission and infection rates. Age, sex, length of stay (LOS), diagnoses and medical procedures were assessed in all patients with MRSA admitted to a university hospital in 2008 and 2009. S. aureus protein A gene (spa) typing was performed on the first MRSA isolate from each patient. Patients colonized or infected with MRSA that had spa types indicative of CC398 (MRSA CC398) were compared with patients who had other MRSA clones (MRSA non-CC398). Age (53 vs 59 years), mean LOS (8 vs 13 days) and percentage of patients admitted to an intensive care unit (12% vs 17%) differed significantly between MRSA CC398 and MRSA non-CC398 patients, respectively. The mean numbers and types of diagnoses and medical procedures performed for patients in these two groups also differed significantly. The differences in patient characteristics could explain, at least in part, the relatively low rates of transmission and infection associated with MRSA CC398 in the healthcare setting.
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Affiliation(s)
- R Köck
- Institute of Hygiene, University Hospital Münster, Münster, Germany
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