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Yuan H, Zhang J, Chen H. Evidence-based nursing in the prevention of central venous catheter-related bloodstream infections. Minerva Med 2024; 115:392-395. [PMID: 38287869 DOI: 10.23736/s0026-4806.23.08950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Affiliation(s)
- Haijuan Yuan
- Department of General Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, China
- School of Nursing Yangzhou University, Yangzhou, Jiangsu, China
| | - Jiannan Zhang
- Department of Neurosurgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, China
| | - Hong Chen
- School of Nursing Yangzhou University, Yangzhou, Jiangsu, China -
- Department of Nursing, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, China
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Aryan N, Grigorian A, Jeng J, Kuza C, Kong A, Swentek L, Burruss S, Nahmias J. Incidence, Risk Factors, and Outcomes of Central Line-Associated Bloodstream Infections in Trauma Patients. Surg Infect (Larchmt) 2024; 25:370-375. [PMID: 38752327 DOI: 10.1089/sur.2024.040] [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: 06/21/2024] Open
Abstract
Introduction: Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. Methods: The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. Results: From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, p = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, p = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, p < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, p < 0.001), intensive care unit LOS (median 21 vs. 6 days, p < 0.001), and mortality (23.7% vs. 19.6%, p = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all p < 0.05). Conclusion: Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.
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Affiliation(s)
- Negaar Aryan
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - James Jeng
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Catherine Kuza
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Allen Kong
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Lourdes Swentek
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Sigrid Burruss
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
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Al-Dorzi HM, Arabi YM. Quality Indicators in Adult Critical Care Medicine. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:75-84. [PMID: 38725886 PMCID: PMC11077517 DOI: 10.36401/jqsh-23-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 05/12/2024]
Abstract
Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
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Affiliation(s)
- Hasan M. Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Cheng W, Chen J, Ma X, Sun J, Gao S, Wang Y, Su L, Wang L, Du W, He H, Chen Y, Li Z, Li Q, Sun J, Luo H, Liu J, Shan G, Du B, Guo Y, Liu D, Yin C, Zhou X. Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients-the ECMO quality improvement action (EQIA) study: a national cohort study in China from 2017 to 2019. Front Med 2024; 18:315-326. [PMID: 37991709 DOI: 10.1007/s11684-023-1014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/24/2023] [Indexed: 11/23/2023]
Abstract
This cohort study was performed to explore the influence of intensive care unit (ICU) quality on in-hospital mortality of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO)-supported patients in China. The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019, using data from the National Clinical Improvement System and China National Critical Care Quality Control Center. ICU quality was assessed by quality control indicators and capacity parameters. Among the 2563 V-V ECMO-supported patients in 318 hospitals, a significant correlation was found between ECMO-related complications and prognosis. The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients (cutoff: 1.5% and 7.0%; 95% confidence interval: 1.05-1.48 and 1.04-1.45; odds ratios: 1.25 and 1.23; P = 0.012 and P = 0.015, respectively). Meanwhile, the V-V ECMO center volume was a protective factor (cutoff of ≥ 50 cases within the 3-year study period; 95% confidence interval: 0.57-0.83, odds ratio: 0.69, P = 0.0001). The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings. Thus, ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.
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Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jieqing Chen
- Information Center Department/Department of Information Management, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Jialu Sun
- National Institute of Hospital Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Sifa Gao
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Ye Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Lu Wang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Wei Du
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Huaiwu He
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yujie Chen
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zunzhu Li
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Qi Li
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jianhua Sun
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hongbo Luo
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jinbang Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Guangliang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Bing Du
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Yanhong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Dawei Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Chang Yin
- National Institute of Hospital Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China.
| | - Xiang Zhou
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
- Information Center Department/Department of Information Management, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Nasrollahian S, Moradi F, Hadi N, Ranjbar S, Ranjbar R. An update on alternative therapy for Escherichia coli causing urinary tract infections; a narrative review. Photodiagnosis Photodyn Ther 2024; 46:104075. [PMID: 38574879 DOI: 10.1016/j.pdpdt.2024.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most common type of nosocomial infection and severe health issues because of the difficulties and frequent recurrence. Today, alternative methods such as sonodynamic therapy (SDT), photodynamic therapy (PDT) and herbal materials use for treating infections like UTI in many countries. METHOD We conducted searches of the biomedical databases (Google Scholar, Scopus, PubMed, and Web of sciences) to identify related studies from 2008 to 2023. RESULT SDT aims to use ultrasound to activate a sonosensitizer, which causes a biological effect by raising reactive oxygen species (ROS). When bacteria are exposed to ROS, several important effects occur: oxidative damage, DNA damage, protein dysfunction etc. SDT with herbal medicine significantly reduced the number of colony-forming units and bactericidal activity for Klebsiella pneumonia and E. coli. PDT is a promising treatment for cancer and microbial infections, combining a photosensitiser, light and tissue molecular oxygen. It involves a photosensitizer, light source, and oxygen, with variations affecting microbial binding and bactericidal activity. Factors affecting antibacterial properties include plant type, growing conditions, harvesting, and processing. This review highlights the recent advancements in sonodynamic, photodynamic, herbal, and bio-material-based approaches in the treatment of E. coli infections. CONCLUSIONS These alternative therapies offer exciting prospects for addressing UTIs, especially in cases where traditional antibiotic treatments may be less effective. Further research and clinical studies are warranted to fully explore the potential of these innovative treatment modalities in combating UTIs and improving patient outcomes.
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Affiliation(s)
- Sina Nasrollahian
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Moradi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahal Hadi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sina Ranjbar
- Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Biazus-Dalcin C, Sincero T, Zamparette C, Tartari D, de Souza S, Silva T, Tomazoni A, Rocha P. Efficacy of disinfection procedures to reduce Acinetobacter baumanii blaOXA-23 contamination rate of needleless connectors: an in-vitro study. Infect Prev Pract 2024; 6:100328. [PMID: 38226398 PMCID: PMC10788527 DOI: 10.1016/j.infpip.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Aim This study aimed to verify the efficacy of disinfection procedures to reduce Acinetobacter baumannii blaOXA-23 bacterial load in needleless connectors that had been experimentally contaminated. Methods Two-way intermediate extender's hub and needle-free valve were contaminated with Acinetobacter baumannii blaOXA-23. To disinfect them, the following procedures were carried out: sterile gauze with 70% ethanol, sterile gauze with Incidin®, and 70% isopropyl alcohol single-use cap, with eight times friction for 10 s, followed by 5 s drying time. The statistical tests Kruskal-Wallis and post-hoc Conover were performed using MedCalc®. Results A total of 82 experiments were conducted. All tested disinfection procedures were efficacious in reducing the A. baumannii blaOXA-23 load. The 70% IPA single-use cap was found to be the best method for disinfecting the two-way intermediate extender's hub (87.28%), while all the methods were efficacious for the disinfection of the needle-free valve (more than 90%). During the inoculation period, A. baumannii blaOXA-23 showed less adherence to the needle-free valve during the inoculation period, probably due to the device's design. Conclusion The three tested disinfection procedures using sterile gauze with 70% ethanol, sterile gauze with Incidin®, and 70% IPA single-use cap were found to be efficacious in reducing the bacterial load of A. baumanni blaOXA-23 in needleless connectors. Proper disinfection of needleless connectors is a crucial nursing practice to prevent bloodstream infections, as it significantly reduces the bacterial load present in the device.
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Affiliation(s)
| | - T.C.M. Sincero
- Department of Clinical Analyses, Health Sciences Centre, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - C.P. Zamparette
- Department of Clinical Analyses, Health Sciences Centre, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - D.C. Tartari
- The State of Santa Catarina, Florianópolis, Brazil
| | - S. de Souza
- Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - T.L. Silva
- Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - A. Tomazoni
- Hospital de Clínicas of the Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - P.K. Rocha
- Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
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Abstract
Diagnostic stewardship refers to the responsible and judicious use of diagnostic tests to reduce low value care and improve patient outcomes. This article provides an overview of behavioral strategies, their relevance to diagnostic stewardship and highlights behavioral determinants that drive diagnostic testing behavior, drawing on theoretic frameworks. Additionally, we provide concrete examples of evidence-based behavioral strategies for promoting appropriate diagnostic testing while acknowledging associated challenges. Finally, we highlight the significance of evaluating these strategies and provide an overview of evaluation frameworks and methods.
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Affiliation(s)
- Sonali D Advani
- Department of Internal Medicine-Infectious Diseases, Duke University School of Medicine, 315 Trent Drive, Hanes House, Suite 154, Durham, NC 27710, USA.
| | - Kimberly Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Odada D, Munyi H, Gatuiku J, Thuku R, Nyandigisi J, Wangui A, Ashihundu E, Nyakiringa B, Kimeu J, Musumbi M, Adam RD. Reducing the rate of central line-associated bloodstream infections; a quality improvement project. BMC Infect Dis 2023; 23:745. [PMID: 37904103 PMCID: PMC10617146 DOI: 10.1186/s12879-023-08744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital. METHODS This was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions. RESULTS There were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252). CONCLUSIONS Improvement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.
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Affiliation(s)
- David Odada
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya.
| | - Hellen Munyi
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Japhet Gatuiku
- Department of Pharmacy, Aga Khan University Hospital, Nairobi, Kenya
| | - Ruth Thuku
- Department of Quality, Aga Khan University Hospital, Nairobi, Kenya
| | - Jared Nyandigisi
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Anne Wangui
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Emilie Ashihundu
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Jemimah Kimeu
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Martin Musumbi
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Rodney D Adam
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
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van de Pol I, Roescher N, Rigter S, Noordzij PG. Prolonged use of intravenous administration sets on central line associated bloodstream infection, nursing workload and material use: A before-after study. Intensive Crit Care Nurs 2023; 78:103446. [PMID: 37210225 DOI: 10.1016/j.iccn.2023.103446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES One of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. RESEARCH METHODOLOGY In this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. RESULTS In total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: -0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. CONCLUSION Extension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. IMPLICATIONS FOR CLINICAL PRACTICE Additional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.
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Affiliation(s)
- Ineke van de Pol
- Intensive Care Unit, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Nienke Roescher
- Department of Clinical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sander Rigter
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Anesthesiology and Intensive Care, UMC Utrecht, The Netherlands
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Alshahrani KM, Alhuwaishel AZ, Alangari NM, Asiri MA, Al-Shahrani NA, Alasmari AA, Alzahrani OJ, Ayedh AY, Qitmah MM. Clinical Impacts and Risk Factors for Central Line-Associated Bloodstream Infection: A Systematic Review. Cureus 2023; 15:e40954. [PMID: 37503497 PMCID: PMC10368959 DOI: 10.7759/cureus.40954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Background A central line-associated bloodstream infection (CLABSI) is defined as a primary bloodstream infection (BSI) in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream-related to an infection at another site. CLABSI is a common healthcare-associated infection and a significant cause of morbidity and mortality. Methods This systematic review included studies published within the past 13 years that examined risk factors and clinical impact variables associated with CLABSI, using the Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN) criteria for defining catheter-associated infection, and included participants of all ages. The terms "CLABSI," "central line-associated bloodstream infection," "risk factors," "predictors," "morbidity," "mortality," "healthcare costs," and "length of hospital stay" were used to find relevant publications on PubMed/Medline, Google Scholar, and Science Direct. The quality assessment of the included publications utilized the modified Newcastle-Ottawa scale (NOS) for observational studies. Results After the full-text screening, we identified 15 articles that met our inclusion and exclusion criteria. The majority of these studies were of good quality and had a low risk of bias based on our bias assessment. The studies included a total of 32,198 participants and covered a time period from 2010 to 2023. The mean age of the male patients included in the studies ranged from 0.1 months to 69.1 years. All of the included studies were either observational cohort studies, cross sectional studies, case-control studies, or case reports. The major study parameters/outcomes extracted were risk factors, CLABSI-associated mortality, hospital cost, length of hospital stay, and catheter days. With respect to predisposing factors, multilumen access catheters were identified as risk factors in three studies, use of more than one central venous catheter per case in four studies, hematologic malignancy in three studies, catheterization duration in four studies, surgical complexity in four studies, length of ICU stays in three studies, and parenteral nutrition in two studies. Conclusion The decision to place a venous device should be carefully considered by evaluating individual risk factors for the development of CLABSI. This is important due to the potential for severe clinical consequences and significant healthcare expenses associated with this complication.
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Affiliation(s)
| | | | - Norah M Alangari
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | - Malak A Asiri
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | - Norah A Al-Shahrani
- Department of Internal Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, SAU
| | - Ahmed A Alasmari
- Department of Internal Medicine, Aseer Central Hospital, Abha, SAU
| | | | | | - Meshari M Qitmah
- Department of Internal Medicine, King Fahad Specialized Hospital, Tabouk, SAU
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11
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Lin JC, Srivastava A, Malone S, Jennison S, Simino M, Traube C, LaRose K, Kawai Y, Neu L, Kudchadkar S, Wieczorek B, Hajnik K, Kordik CM, Kumar VK, Aghamohammadi S, Arteaga GM, Smith HAB, Spentzas T, Orman A, Landman BM, Valdivia H, Browne H, Fang T, Zimmerman JJ. Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF): Results of the Pediatric Collaborative. Pediatr Crit Care Med 2023:00130478-990000000-00194. [PMID: 37125798 DOI: 10.1097/pcc.0000000000003262] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN Prospective, multicenter, cohort study. SETTING Eight academic PICUs. PATIENTS Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months (p < 0.001). Subject-specific utilization for elements A and C did not change; utilization improved for B (0-12.5%; p = 0.007), D (22.2-61.1%; p < 0.001), E (17.7-50%; p = 0.003), and F (50-79.2%; p = 0.001). We observed no association between Bundle utilization and MV duration, PICU LOS, or delirium incidence. In contrast, on adjusted analysis, every 10% increase in subject-specific utilization correlated with mortality odds ratio (OR) reduction of 34%, p < 0.001; every 10% increase in day-specific utilization correlated with a mortality OR reduction of 1.4% (p = 0.006). CONCLUSIONS ABCDEF Bundle is applicable to children. Although enhanced Bundle utilization correlated with decreased mortality, increased utilization did not correlate with duration of MV, PICU LOS, or delirium incidence. Additional research in the domains of comparative effectiveness, implementation science, and human factors engineering is required to understand this clinical inconsistency and optimize PICU Liberation concept integration into clinical practice.
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Affiliation(s)
- John C Lin
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - Avantika Srivastava
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Sara Malone
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | | | | | - Chani Traube
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Weill-Cornell Medical College, New York, NY
| | - Kimberly LaRose
- Komansky Children's Hospital Family Advisory Council, New York Presbyterian Weill-Cornell Medical Center, New York, NY
| | - Yu Kawai
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
| | - Lori Neu
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
| | - Sapna Kudchadkar
- Department of Anesthesiology & Critical Medicine and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Beth Wieczorek
- Department of Anesthesiology & Critical Medicine and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Sara Aghamohammadi
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, UC Davis Children's Hospital, University of California at Davis School of Medicine, Sacramento, CA
| | - Grace M Arteaga
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
| | - Heidi A B Smith
- Department of Anesthesiology and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas Spentzas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, LeBonheur Children's Hospital, University of Tennessee, Memphis, TN
| | | | | | | | | | | | - Jerry J Zimmerman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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Orozco-Santana E, Fowlds T, Tamayo M, Jew C, Young P, Sheehan P, Murray K, Marcarian T. Reducing CLABSIs in an Adult Cardiothoracic ICU. Am J Nurs 2023; 123:43-49. [PMID: 37077018 DOI: 10.1097/01.naj.0000933940.28749.68] [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: 04/21/2023]
Abstract
LOCAL PROBLEM Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality and costs. In the cardiothoracic ICU (CTICU) of an academic medical center, nine CLABSIs occurred in fiscal year (FY) 2018. PURPOSE The aim of this project was to reduce the CLABSI rate in the CTICU and sustain the results. METHODS Nurse residents on the CTICU initiated a quality improvement project with a single intervention and expanded it into an ongoing initiative with additional interventions by the unit-based performance improvement committee. Evidence-based interventions were identified and implemented, including education; rounding; auditing; and other unit-specific interventions, which included "Central Line Sunday," accountability emails, and a blood culture algorithm with a tip sheet. RESULTS CLABSI incidence was reduced from nine in FY 2018 to one in each of the subsequent FYs (2019 and 2020), which had similar totals of central line days, and two in FY 2021, which had a slightly higher number of central line days. The CTICU was able to achieve zero CLABSIs from August 2019 through November 2020, more than 365 days. CONCLUSIONS Coupled with strong support from nursing leadership, nurses on the unit successfully reduced CLABSIs by adopting novel, evidence-based strategies; ongoing monitoring; and multiple interventions.
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Affiliation(s)
- Emmanuel Orozco-Santana
- Emmanuel Orozco-Santana , Taryn Fowlds , Michelle Tamayo , Christine Jew , and Patricia Young are clinical nurses II, Patty Sheehan is a cardiac clinical nurse specialist, Katrine Murray is the unit director, and Taline Marcarian is a clinical nurse III, all in the cardiothoracic ICU at Ronald Reagan UCLA Medical Center in Los Angeles. Contact author: Taline Marcarian, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Zand F, Vakili H, Asmarian N, Masjedi M, Sabetian G, Nikandish R, Shafiee E, Tabatabaei Esfehani A, Azadi F, Sanaei Dashti A. Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital. BMC Infect Dis 2023; 23:11. [PMID: 36609225 PMCID: PMC9821351 DOI: 10.1186/s12879-022-07962-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism. METHODOLOGY The present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March-October 2019) and after (March-October 2020) the onset of COVID-19 pandemic in three ICU's, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens. RESULTS Pre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43-1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22-1.98, P = 0.469). CONCLUSION The results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.
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Affiliation(s)
- Farid Zand
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hedayatollah Vakili
- grid.412571.40000 0000 8819 4698Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoor Masjedi
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- grid.412571.40000 0000 8819 4698Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Nikandish
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Shafiee
- grid.412571.40000 0000 8819 4698Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Tabatabaei Esfehani
- grid.412571.40000 0000 8819 4698Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Azadi
- grid.412571.40000 0000 8819 4698Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Sanaei Dashti
- grid.412571.40000 0000 8819 4698Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Pek Z, Canepa H, Gregg KL, Cabunoc MK, Leekha S, Baghdadi JD. Recurrent central-line-associated bloodstream infection in a single high-risk patient. Infect Control Hosp Epidemiol 2023; 44:166-168. [PMID: 35912686 DOI: 10.1017/ice.2022.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zachary Pek
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Hannah Canepa
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Karen L Gregg
- University of Maryland Medical Center-Midtown Campus, Baltimore, Maryland
| | - Marie K Cabunoc
- University of Maryland Medical Center-Midtown Campus, Baltimore, Maryland
| | - Surbhi Leekha
- University of Maryland School of Medicine, Baltimore, Maryland
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15
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Frödin M, Nellgård B, Rogmark C, Gillespie BM, Wikström E, Andersson AE. A co-created nurse-driven catheterisation protocol can reduce bladder distension in acute hip fracture patients - results from a longitudinal observational study. BMC Nurs 2022; 21:276. [PMID: 36224550 PMCID: PMC9559039 DOI: 10.1186/s12912-022-01057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urinary retention is common in elderly patients undergoing acute hip fracture surgery. Avoiding overfilling the urinary bladder is important to avoid detrusor muscle damage and associated motility problems. The aim of this study was to analyse associations between the co-creation of a nurse-driven urinary catheterisation protocol and the incidence of bladder distension in patients undergoing hip fracture surgery. Methods This is a single-centre implementation intervention with a retrospective longitudinal observation design, using five measures points, spanning from June 2015 to March 2020. The intervention was theory driven and the participants, together with the facilitators and researcher, co-created a nurse-driven urinary catheterisation protocol. Data were retrieved from the hip fracture register. Uni- and multivariable logistic regressions were used for analyses of changes in bladder distension and urinary volume of ≥500 ml over the years. Results A total of 3078 patients were included over a five-year period. The implementation intervention was associated with a reduction in the proportion of patients with bladder distension of 31.5% (95% confidence interval 26.0–37.0), from year 1 to year 5. The multivariable analysis indicated a 39% yearly reduction in bladder distension, OR 0.61 (95% confidence interval 0.57–0.64, p < 0001). There was a reduction in the proportion of patients with a bladder volume of ≥500 ml of 42.8% (95% confidence interval 36.2–49.4), from year 1 to year 5. The multivariable analysis found a 41% yearly reduction in patients with a bladder volume of ≥500 ml, OR 0.59 (95% confidence interval 0.55–0.64, p < 0.0001). The intervention was associated with improved documentation of both catheter indications and removal plans. Conclusion The use of predefined catheter indications and a tighter bladder scanning schedule were associated with a reduction in the incidence of both bladder distension and urine volume ≥ 500 ml in hip fracture patients. Registered nurses can play an active role in the facilitation of timely and appropriate catheter treatment in patients with hip fractures. Trial registration Clinical Trial Registry ISRCTN 17022695 registered retrospectively on 23 December 2021, in the end of the study, after data collection. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01057-z.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden.
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
| | - Cecilia Rogmark
- Skane University Hospital, Department of Orthopaedics Malmö, Lund University, Lund, Sweden.,The Swedish Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Brisbane, Australia.,Gold Coast University Hospital and Health Service, Southport, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
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16
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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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Diagnostic Value and Prognostic Significance of Procalcitonin Combined with C-Reactive Protein in Patients with Bacterial Bloodstream Infection. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6989229. [PMID: 35991149 PMCID: PMC9388258 DOI: 10.1155/2022/6989229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
Objective To study the clinical values and implications for the prognosis of procalcitonin (PCT) combined with C-reactive protein (hs-CRP) in patients with bacterial bloodstream infection. Methods One hundred and twenty patients with infection hospitalized from Mar. 2020 to Jun. 2021 were chosen as subjects. All participants were tested for serum PCT, hs-CRP, and blood culture. According to the types of pathogenic bacteria, they were divided into the gram-negative bacteria bloodstream infection group (n = 53) and the gram-positive bacteria bloodstream infection group (n = 31). Depending on the prognostic outcome of the participants after 28 days, they were categorized into survival and fatality cohorts. The PCT and hs-CRP levels were compared to explore diagnostic value implications for the prognosis of the cases with bacterial bloodstream infection. Results Serum PCT and hs-CRP values in the positive cohort were higher than those in the negative cohort. The levels of serum PCT and hs-CRP in pulmonary infection were higher than those in the group with negative cases, and the difference was statistically significant (P < 0.05). There were 27 gram-positive participants and 9 gram-negative cases in the positive cohort. The serum PCT value of gram-negative bacterial infection was greater than that of gram-positive bacterial infection. The value of serum PCT in the gram-negative bacterial infection group was higher than that in the gram-positive bacterial infection group, and the difference was statistically significant (P < 0.05). The areas under the curve (AUCs) of PCT, combination of hs-CRP and PCT, and hs-CRP were 0.946, 0.783, and 0.991, respectively. The combined examination of PCT and hs-CRP was the largest, PCT was the second, and hs-CRP was the lowest. These results indicated that the accuracy of combined detection of PCT and hs-CRP in the diagnostic bloodstream infection was the highest (0.991), followed by PCT (0.946) and the lowest (0.783). The PCT and hs-CRP levels of the survival cohort were lower than those in the death cohort. AUCs of PCT, hs-CRP and PCT, and hs-CRP were 0.848, 0.826, and 0.934, respectively. The combined examination of PCT and hs-CRP was the largest, followed by PCT and hs-CRP. The accuracy of the combination of PCT and hs-CRP was the highest (0.934), followed by PCT (0.848), and the diagnostic accuracy of hs-CRP was the lowest (0.826). Conclusion There were significant differences in the levels of PCT and CRP between the gram-positive bacteria group and the gram-positive bacteria group. PCT and CRP have high diagnostic values in predicting the short-term prognosis of patients. PCT and CRP assist clinical diagnosis and guide treatment and play a positive role in early treatment and prognosis evaluation of patients.
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18
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Ikeda-Sakai Y, Kubo K, Wada M, Seki R, Hijikata Y, Yoshioka T, Takahashi Y, Nakayama T. Effectiveness and safety of a program for appropriate urinary catheter use in stroke care: A multicenter prospective study. J Eval Clin Pract 2022; 28:542-549. [PMID: 34628703 DOI: 10.1111/jep.13626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Since patients with stroke frequently develop bladder dysfunction, a careful approach is required to reduce unnecessary indwelling urinary catheter (IUC) for preventing catheter-associated urinary tract infection (CAUTI). This study aimed to assess the effectiveness and safety of a program to promote appropriate IUC use in stroke care. METHODS We conducted a prospective interrupted time series study in three tertiary care hospitals in Japan. Adult patients with acute stroke were eligible. The study consisted of three phases: baseline, education and implementation. Our program included an assessment of IUC indications, educational meetings among healthcare professionals, reminders for removal of inappropriate IUC and a urinary retention protocol. The primary outcome was the proportion of inappropriate IUC use to assess effectiveness. The device utilization ratio and incidence of CAUTI were examined to assess effectiveness, and incidences of urinary retention and all symptomatic urinary tract infection (UTI) were examined to assess safety. RESULTS Among 976 patients who met the inclusion criteria, 738 were analysed. Inappropriate IUC use decreased from 50.1% in the baseline phase to 22.5% in the implementation phase (absolute risk reduction in interrupted time series analysis 42.4% [95% confidence interval, 19.2%-65.6%]). The device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter-days; incidence rate ratio 0.95 [0.44-1.94]). All symptomatic UTI decreased from 9.5% to 4.9% (p = 0.015), with no increase in urinary retention. CONCLUSIONS Our program improved the appropriateness of IUC use in stroke care while ensuring safety.
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Affiliation(s)
- Yasuko Ikeda-Sakai
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Kenji Kubo
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mikio Wada
- Fukuchiyama City Hospital Ooe-Branch, Fukuchiyama, Japan
| | - Rieko Seki
- Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan
| | | | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
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Ray-Barruel G. I-DECIDED ®-a decision tool for assessment and management of invasive devices in the hospital setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S37-S43. [PMID: 35439078 DOI: 10.12968/bjon.2022.31.8.s37] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.
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20
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Mudd SS, Slater T, Curless M. Central Line–Associated Bloodstream Infections and Advanced Practice Providers: Identifying Opportunities for Prevention Efforts. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Wei AE, Markert RJ, Connelly C, Polenakovik H. Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle. J Infect Prev 2021; 22:186-193. [PMID: 34659456 PMCID: PMC8512874 DOI: 10.1177/17571774211012471] [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: 05/20/2020] [Accepted: 02/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. AIM To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. METHODS A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. RESULTS The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. CONCLUSION Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.
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Affiliation(s)
- Abraham E Wei
- Department of Internal Medicine, Wright State
University Boonshoft School of Medicine, USA
| | - Ronald J Markert
- Department of Internal Medicine, Wright State
University Boonshoft School of Medicine, USA
| | | | - Hari Polenakovik
- Division of Infectious Diseases, Wright State
University Boonshoft School of Medicine, USA
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A Curious Case of MRSA Bacteremia and Septic Pulmonary Embolism Secondary to Peripheral Venous Catheter. Case Rep Crit Care 2021; 2021:5544505. [PMID: 33898068 PMCID: PMC8052165 DOI: 10.1155/2021/5544505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Central venous catheters (CVCs) have been frequently associated with septic thrombophlebitis, bacteremia, and septic emboli. Right-sided infective endocarditis is seen concurrently in patients with septic pulmonary emboli. A case of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and septic pulmonary emboli secondary to infected peripheral venous catheter (PVC) is reported. Transesophageal echocardiogram (TEE) showed no evidence of infective endocarditis. Case Presentation. A 44-year-old female presented to E.R. with left upper extremity pain and swelling at the previously inserted peripheral 18-gauge intravenous catheter site. She also had chest pain, which worsened with inspiration. The patient was found to be in septic shock. Her clinical condition deteriorated acutely. Right upper extremity deep venous thrombosis (DVT) and pulmonary emboli were seen on imaging. Blood cultures grew MRSA. Transthoracic and transesophageal echocardiograms showed no vegetations. The patient responded well to appropriate antibiotics and anticoagulation. Conclusion Peripherally inserted catheters are an important portal for pathogen entry and need periodic site assessment and frequent evaluation of their need for insertion. Septic pulmonary emboli can also be seen without any evidence of right-sided infective endocarditis.
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The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran. ACTA ACUST UNITED AC 2021; 2021:6650920. [PMID: 33680220 PMCID: PMC7905999 DOI: 10.1155/2021/6650920] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 01/17/2023]
Abstract
Background Coronavirus disease-19 (COVID-19) is a new type of coronavirus that has caused a global pandemic. The disease is highly contagious, and all people are susceptible to the disease. Therefore, extensive measures were taken to prevent the spread of the disease at the community and hospitals. This study aimed to investigate the impact of COVID-19 outbreak on nosocomial infection rate. Methods This cross-sectional study was conducted in an educational hospital, southeast Iran. The nosocomial infection rates of critical/intensive care units (CCU/ICUs) and medical-surgical units were assessed during and before the COVID-19 outbreak. Results There was a 19.75-point decrease in the total rate of nosocomial infection during the COVID-19 outbreak (P = 0.02). In addition, there was a 39.12-point decrease in the total rate of CCU/ICUs' nosocomial infection during the COVID-19 outbreak (P < 0.001). A 19.23-point decrease was also observed in the total rate of medical-surgical units' nosocomial infection during the COVID-19 outbreak (P = 0.13). All kinds of CCU/ICUs' nosocomial infections had between 31.22- and 100-point decreases during the COVID-19 outbreak. Among medical-surgical units, 33.33- and 30.70-point decreases were observed only in UTI and SSI, respectively, during the COVID-19 outbreak, while BSI had a 40-point increase during the COVID-19 outbreak. Conclusions Proper implementation of infection control protocols during the COVID-19 pandemic seems to reduce nosocomial infections.
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Fricker ZP, Mukthinuthalapati VVPK, Akinyeye S, Chalasani N, Attar BM, Balakrishnan M, Ghabril M, Long MT. MELD-Na Is More Strongly Associated with Risk of Infection and Outcomes Than Other Characteristics of Patients with Cirrhosis. Dig Dis Sci 2021; 66:247-256. [PMID: 32100160 PMCID: PMC7222109 DOI: 10.1007/s10620-020-06164-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The nature and outcomes of infection among patients with cirrhosis in safety-net hospitals are not well described. We aimed to characterize the rate of and risk factors for infection, both present on admission and nosocomial, in this unique population. We hypothesized that infections would be associated with adverse outcomes such as short-term mortality. METHODS We used descriptive statistics to characterize infections within a retrospective cohort characterized previously. We used multivariable logistic regression models to assess potential risk factors for infection and associations with key outcomes such as short-term mortality and length of stay. RESULTS The study cohort of 1112 patients included 33% women with a mean age of 56 ± 10 years. Infections were common (20%), with respiratory and urinary tract infections the most frequent. We did not observe a difference in the incidence of infection on admission based on patient demographic factors such as race/ethnicity or estimated household income. Infections on admission were associated with greater short-term mortality (12% vs 4% in-hospital and 14% vs 7% 30-day), longer length of stay (6 vs 3 days), intensive care unit admission (28% vs 18%), and acute-on-chronic liver failure (10% vs 2%) (p < 0.01 for all). Nosocomial infections were relatively uncommon (4%), but more frequent among patients admitted to the intensive care unit. Antibiotic resistance was common (38%), but not associated with negative outcomes. CONCLUSION We did not identify demographic risk factors for infection, but did confirm its morbid effect among patients with cirrhosis in safety-net hospitals.
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Affiliation(s)
- Zachary P. Fricker
- grid.38142.3c000000041936754XDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8th Floor, Boston, MA 02215 USA
| | - V. V. Pavan Kedar Mukthinuthalapati
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA ,grid.428291.4Division of Gastroenterology, Cook County Health, Chicago, IL USA
| | - Samuel Akinyeye
- grid.412332.50000 0001 1545 0811Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Medical Center, Columbus, OH USA
| | - Naga Chalasani
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA
| | - Bashar M. Attar
- grid.428291.4Division of Gastroenterology, Cook County Health, Chicago, IL USA
| | - Maya Balakrishnan
- grid.39382.330000 0001 2160 926XSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX USA
| | - Marwan Ghabril
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA
| | - Michelle T. Long
- grid.189504.10000 0004 1936 7558Section of Gastroenterology, Evans Department of Medicine, Boston University School of Medicine, Boston, MA USA
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Potugari BR, Umukoro PE, Vedre JG. Multimodal Intervention Approach Reduces Catheter-associated Urinary Tract Infections in a Rural Tertiary Care Center. Clin Med Res 2020; 18:140-144. [PMID: 32340983 PMCID: PMC7735443 DOI: 10.3121/cmr.2020.1533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/20/2020] [Accepted: 04/09/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the catheter-associated urinary tract infections (CAUTI) standardized infection rate (SIR) before and after implementation of a multimodal intervention approach in a rural tertiary hospital. DESIGN Before-after analysis of a multimodal intervention to evaluate primary outcomes of the incidence of inpatient CAUTI, the SIR for CAUTI, and number of urinary catheter days. SETTING All inpatient departments of a rural 504-bed tertiary care facility in the Midwest. PARTICIPANTS Patients admitted for in-patient care. INTERVENTIONS A multimodal intervention composed of: (a) physician and nurse education, (b) modification of progress note templates and daily provider reminders for the clinical necessity of catheters, (c) implementing established best practices for eliminating CAUTIs, (d) advocating for alternative toileting options, and (e) promoting aseptic techniques for insertion and removal of catheters. SIR, CAUTI, and the number of urinary catheter days were obtained before and after implementation of the multimodal intervention in 2015 and 2017, respectively. RESULTS After a one-year timeframe of intervention, CAUTI event rates decreased, and SIR for CAUTI was reduced by 60.2% (from 1.524 to 0.607) with P value<0.05. Urinary catheter days were also reduced from 16,195 in 2015 to 13,348 in 2017 (17.6% reduction) with P value <0.05. CONCLUSIONS Incidence of CAUTIs were significantly reduced with a team effort involving infection control, physician and nursing education, modification of progress note and templates and daily provider reminders for the clinical necessity of catheters and appropriate usage of urinary catheter with corresponding reduction in urinary catheter days.
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Affiliation(s)
- Bindu R Potugari
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI USA
| | - Peter E Umukoro
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI USA
| | - Jayanth G Vedre
- Critical Care Medicine, Marshfield Medical Center, Marshfield, WI USA
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Kauffman JD, Danielson PD, Chandler NM. Risk factors and associated morbidity of urinary tract infections in pediatric surgical patients: A NSQIP pediatric analysis. J Pediatr Surg 2020; 55:715-720. [PMID: 31126686 DOI: 10.1016/j.jpedsurg.2019.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study is to examine the incidence, risk factors, and morbidity of postoperative urinary tract infections (UTI) in pediatric surgical patients. METHODS All patients in the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program Pediatric database were included. Demographics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression was used to estimate the independent effects of patient and procedure characteristics on the risk for UTI and to estimate the effects of UTI on the risk for readmission and reoperation. RESULTS Of 369,176 patients, 1964 (0.5%) developed a postoperative UTI. Those undergoing urological and neurosurgical procedures were at greatest risk. Diabetes, ventilator dependence, and dependence on nutritional support each increased the odds of developing a UTI by more than 60% (P < 0.01). On multivariable analysis, UTI was an independent risk factor for unplanned readmission (OR, 4.93; 95% CI, 4.39-5.54; P < 0.001) and reoperation (OR, 1.21; 95% CI, 1.01-1.45; P = 0.041). CONCLUSION Urinary tract infection is an uncommon but not inconsequential complication following surgery in the pediatric population and is associated with increased risk of readmission and reoperation. The identification of risk factors for postoperative UTI provides the opportunity for targeted surveillance and patient-specific interventions to prevent UTIs in children at greatest risk. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
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He H, Ma X, Su L, Wang L, Guo Y, Shan G, He HJ, Zhou X, Liu D, Long Y, Zhao Y, Zhang S. Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:73. [PMID: 32131872 PMCID: PMC7057512 DOI: 10.1186/s13054-020-2790-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Patient safety and critical care quality remain a challenging issue in the ICU. However, the effects of the national quality improvement (QI) program remain unknown in China. METHODS A national ICU QI program was implemented in a controlled cohort of 586 hospitals from 2016 to 2018. The effects of the QI program on critical care quality were comprehensively investigated. MAIN RESULTS A total of 81,461,554 patients were enrolled in 586 hospitals, and 1,587,724 patients were admitted to the ICU over 3 years. In 2018, there was a significantly higher number of ICU beds (2016 vs. 2018: 10668 vs. 13,661, P = 0.0132) but a lower doctor-to-bed ratio (2016 vs. 2018: 0.64 (0.50, 0.83) vs. 0.60 (0.45, 0.75), P = 0.0016) and nurse-to-bed ratio (2016 vs. 2018: 2.00 (1.64, 2.50) vs. 2.00 (1.50, 2.40), P = 0.031) than in 2016. Continuous and significant improvements in the ventilator-associated pneumonia (VAP) incidence rate, microbiology detection rate before antibiotic use and deep vein thrombosis (DVT) prophylaxis rate were associated with the implementation of the QI program (VAP incidence rate (per 1000 ventilator-days), 2016 vs. 2017 vs. 2018: 11.06 (4.23, 22.70) vs. 10.20 (4.25, 23.94) vs. 8.05 (3.13, 17.37), P = 0.0002; microbiology detection rate before antibiotic use (%), 2016 vs. 2017 vs. 2018: 83.91 (49.75, 97.87) vs. 84.14 (60.46, 97.24) vs. 90.00 (69.62, 100), P < 0.0001; DVT prophylaxis rate, 2016 vs. 2017 vs. 2018: 74.19 (33.47, 96.16) vs. 71.70 (38.05, 96.28) vs. 83.27 (47.36, 97.77), P = 0.0093). Moreover, the 6-h SSC bundle compliance rates in 2018 were significantly higher than those in 2016 (6-h SSC bundle compliance rate, 2016 vs. 2018: 64.93 (33.55, 93.06) vs. 76.19 (46.88, 96.67)). A significant change trend was not found in the ICU mortality rate from 2016 to 2018 (ICU mortality rate (%), 2016 vs. 2017 vs. 2018: 8.49 (4.42, 14.82) vs. 8.95 (4.89, 15.70) vs. 9.05 (5.12, 15.80), P = 0.1075). CONCLUSIONS The relationship between medical human resources and ICU overexpansion was mismatched during the past 3 years. The implementation of a national QI program improved ICU performance but did not reduce ICU mortality.
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Affiliation(s)
- Huaiwu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lu Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yanhong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Guangliang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Hui Jing He
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS) & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
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Meddings J, Greene MT, Ratz D, Ameling J, Fowler KE, Rolle AJ, Hung L, Collier S, Saint S. Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates. BMJ Qual Saf 2020; 29:418-429. [PMID: 31911543 PMCID: PMC7176547 DOI: 10.1136/bmjqs-2019-009330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 01/02/2023]
Abstract
Background Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs). Objective The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates. Methods Invited hospitals had at least one adult ICU with elevated CLABSI or CAUTI rates, defined by a positive cumulative attributable difference metric (CAD >0) in the Centers for Disease Control and Prevention’s Targeted Assessment for Prevention strategy. This externally facilitated programme implemented by a national project team and state hospital associations included on-demand video modules and live webinars reviewing a two-tiered approach for implementing key technical and socioadaptive factors to prevent catheter infections, using principles and tools based on the Comprehensive Unit-based Safety Program. CLABSI, CAUTI and catheter use data were collected (preintervention 13 months, intervention 12 months). Multilevel negative binomial models assessed changes in catheter-associated infection rates and catheter use. Results Of 366 recruited ICUs from 220 hospitals in 16 states and Puerto Rico for two cohorts, 280 ICUs completed the programme including infection outcome reporting; 274 ICUs had complete outcome data for analyses. Statistically significant reductions in adjusted infection rates were not observed (CLABSI incidence rate ratio (IRR)=0.75, 95% CI 0.52 to 1.08, p=0.13; CAUTI IRR=0.79, 95% CI 0.59 to 1.06, p=0.12). Adjusted central line utilisation (IRR=0.97, 95% CI 0.93 to 1.00, p=0.09) and adjusted urinary catheter utilisation were unchanged (IRR=0.98, 95% CI 0.95 to 1.01, p=0.14). Conclusion This multistate programme targeted ICUs with elevated catheter infection rates, but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilisation in the first two of six planned cohorts. Improvements in the interventions based on lessons learnt from these initial cohorts are being applied to subsequent cohorts.
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Affiliation(s)
- Jennifer Meddings
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M Todd Greene
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Louella Hung
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Quinn M, Ameling JM, Forman J, Krein SL, Manojlovich M, Fowler KE, King EA, Meddings J. Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews. Jt Comm J Qual Patient Saf 2019; 46:99-108. [PMID: 31879072 DOI: 10.1016/j.jcjq.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. METHODS To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes. RESULTS Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges. CONCLUSION To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.
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Patel PK, Olmsted RN, Hung L, Popovich KJ, Meddings J, Jones K, Calfee DP, Fowler KE, Saint S, Chopra V. A Tiered Approach for Preventing Central Line-Associated Bloodstream Infection. Ann Intern Med 2019; 171:S16-S22. [PMID: 31569225 DOI: 10.7326/m18-3469] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Louella Hung
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (L.H.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Karen Jones
- University of Michigan Medical School, Ann Arbor, Michigan (K.J.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., J.M., S.S., V.C.)
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Patel PK, Greene MT, Jones K, Rolle AJ, Ratz D, Snyder A, Saint S, Chopra V. Quantitative Results of a National Intervention to Prevent Central Line-Associated Bloodstream Infection: A Pre-Post Observational Study. Ann Intern Med 2019; 171:S23-S29. [PMID: 31569230 DOI: 10.7326/m18-3533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infection (CLABSI) remains prevalent in hospitals in the United States. OBJECTIVE To evaluate the impact of a multimodal intervention in hospitals with elevated rates of health care-associated infection. DESIGN Pre-post observational evaluation of a prospective, national, clustered, nonrandomized initiative of 3 cohorts of hospitals. SETTING Acute care, long-term acute care, and critical access hospitals, including intensive care units and medical/surgical wards. PARTICIPANTS Target hospitals had a cumulative attributable difference above the first tertile of performance for Clostridioides difficile infection and another health care-associated infection (such as CLABSI). Some hospitals that did not meet these criteria also participated. INTERVENTION A multimodal intervention consisting of recommendations and tools for prioritizing and implementing evidence-based infection prevention strategies, on-demand educational videos, webinars led by content experts, and access to content experts. MEASUREMENTS Rates of CLABSI and device utilization ratio pre- and postintervention. RESULTS Between November 2016 and May 2018, 387 hospitals in 23 states and the District of Columbia participated. Monthly preimplementation CLABSI rates ranged from 0 to 71.4 CLABSIs per 1000 catheter-days. Over the study period, the unadjusted CLABSI rate was low and decreased from 0.88 to 0.80 CLABSI per 1000 catheter-days. Between the pre- and postintervention periods, device utilization decreased from 24.05 to 22.07 central line-days per 100 patient-days. However, a decreasing trend in device utilization was also observed during the preintervention period. LIMITATIONS The intervention period was brief. Participation in and adherence to recommended interventions were not fully assessed. Rates of CLABSI were low. Patient characteristics could not be assessed. CONCLUSION In hospitals with a disproportionate burden of health care-associated infection, a multimodal intervention did not reduce rates of CLABSI. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., M.T.G., S.S., V.C.)
| | - M Todd Greene
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., M.T.G., S.S., V.C.)
| | - Karen Jones
- University of Michigan Medical School, Ann Arbor, Michigan (K.J., A.S.)
| | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (A.J.R.)
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (D.R.)
| | - Ashley Snyder
- University of Michigan Medical School, Ann Arbor, Michigan (K.J., A.S.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., M.T.G., S.S., V.C.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., M.T.G., S.S., V.C.)
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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Meddings J, Manojlovich M, Ameling JM, Olmsted RN, Rolle AJ, Greene MT, Ratz D, Snyder A, Saint S. Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre-Post Observational Study. Ann Intern Med 2019; 171:S38-S44. [PMID: 31569231 DOI: 10.7326/m18-3534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI). OBJECTIVE To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI). DESIGN Prospective, national, nonrandomized, clustered, externally facilitated, pre-post observational quality improvement initiative, for 3 cohorts active between November 2016 and May 2018. SETTING Acute care, long-term acute care, and critical access hospitals, including intensive care and non-intensive care wards. PARTICIPANTS Target hospitals had a high burden of Clostridioides difficile infection plus central line-associated bloodstream infection, CAUTI, or hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection, defined as cumulative attributable differences above the first tertile in the Targeted Assessment for Prevention (TAP) strategy. Some additional nonrecruited hospitals also joined. INTERVENTION Multimodal intervention, including Practice Change Assessment tool to identify infection prevention and control (IPC) and HAI prevention gaps; Web-based, on-demand modules involving onboarding, foundational IPC practices, HAI-specific 2-tiered approach to prioritize and implement interventions, and TAP resources; monthly webinars; state partner-led in-person meetings; and feedback. State partners made site visits to at least 50% of their enrolled hospitals, to support self-assessments and coach. MEASUREMENTS Rates of CAUTI and urinary catheter device utilization ratio. RESULTS Of 387 participating hospitals from 23 states and the District of Columbia, 361 provided CAUTI data. Over the study period, the unadjusted CAUTI rate was low and relatively stable, decreasing slightly from 1.12 to 1.04 CAUTIs per 1000 catheter-days. Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the postintervention period. LIMITATIONS The intervention period was brief, with no assessment of fidelity. Baseline CAUTI rates were low. Patient characteristics were not assessed. CONCLUSION This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
| | | | - Jessica M Ameling
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., A.S.)
| | - Russell N Olmsted
- Integrated Clinical Services Team, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Andrew J Rolle
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (A.J.R.)
| | - M Todd Greene
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (D.R.)
| | - Ashley Snyder
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.A., A.S.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., M.T.G., S.S.)
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Patel PK, Popovich KJ, Collier S, Lassiter S, Mody L, Ameling JM, Meddings J. Foundational Elements of Infection Prevention in the STRIVE Curriculum. Ann Intern Med 2019; 171:S10-S15. [PMID: 31569229 DOI: 10.7326/m18-3531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Lona Mody
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
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Cohen R, Gesser-Edelsburg A, Singhal A, Benenson S, Moses AE. Deconstruction of central line insertion guidelines based on the positive deviance approach-Reducing gaps between guidelines and implementation: A qualitative ethnographic research. PLoS One 2019; 14:e0222608. [PMID: 31536568 PMCID: PMC6752780 DOI: 10.1371/journal.pone.0222608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Despite a proven association between the implementation of prevention guidelines for central line associated blood stream infections (CLABSI) and reduction in CLABSI rates, in practice there is poor adherence. Furthermore, current guidelines fail to address the multiple process on the care continuum. This research is based on the bottom-up "Positive Deviance" (PD) approach, through which multiple creative and safer solutions for central line (CL) insertion were identified that were not previously described in the guidelines. The aim of the study was to deconstruct CLABSI prevention guidelines ("during insertion" process only) through the PD approach, working with physicians to identify additional actions that, in practice, help maintain a sterile environment and contribute to patient safety. Methods and findings Our study included a qualitative ethnographic study involving 76 physicians, working in a division of internal medicine and two intensive care units (ICUs). We triangulated findings from a combination of data-collection methods: semi-structured interviews, focused observations, video documentation, Discovery & Action Dialogue (DAD), and simulations. Deconstruction analysis was performed. A total of 23 creative extensions and variations of CL insertion practices were identified. Conclusions The PD approach enables the identification of vital nuggets of hidden wisdom missing from the formal explicit CLABSI guidelines, and therefore helps bridge the gap between theory and praxis. During the guideline's deconstruction process, through collaborative staff learning, the written procedure is transformed into a living, breathing and cooperative one. It can reduce hospital stays and save lives, and therefore needs careful attention of healthcare scholars and practitioners.
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Affiliation(s)
- Ricky Cohen
- School of Public Health, 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, Elverum, 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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Saint S, Greene MT, Fowler KE, Ratz D, Patel PK, Meddings J, Krein SL. What US hospitals are currently doing to prevent common device-associated infections: results from a national survey. BMJ Qual Saf 2019; 28:741-749. [PMID: 31015378 PMCID: PMC6820292 DOI: 10.1136/bmjqs-2018-009111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of several established and novel practices to prevent device-associated infections. METHODS We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about the use of practices to prevent three common device-associated infections: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP). Using sample weights, we estimated the percentage of hospitals reporting regular use of each practice. We also conducted multivariable regression to determine associations between selected hospital characteristics (eg, perceived support from leadership) and use of CAUTI, CLABSI and VAP prevention practices. RESULTS The response rate was 59%. Several practices are reportedly used in over 90% of US hospitals: aseptic technique during indwelling urethral catheter insertion and maintenance (to prevent CAUTI); maximum sterile barrier precautions during central catheter insertion and alcohol-containing chlorhexidine gluconate for insertion site antisepsis (to prevent CLABSI); and semirecumbent positioning of the patient (to prevent VAP). Antimicrobial devices are used in the minority of hospitals for these three device-associated infections. CONCLUSIONS We provide an updated snapshot of the practices US hospitals are currently using to prevent device-associated infections. Compared with previous studies using a similar design and questions, we found that the use of recommended practices increased in US hospitals, especially for CAUTI prevention.
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Affiliation(s)
- Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Todd Greene
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Payal K Patel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Division of Infectious Diseases, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer Meddings
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Podkovik S, Toor H, Gattupalli M, Kashyap S, Brazdzionis J, Patchana T, Bonda S, Wong S, Kang C, Mo K, Wacker MR, Miulli DE, Wang S. Prevalence of Catheter-Associated Urinary Tract Infections in Neurosurgical Intensive Care Patients - The Overdiagnosis of Urinary Tract Infections. Cureus 2019; 11:e5494. [PMID: 31667030 PMCID: PMC6816532 DOI: 10.7759/cureus.5494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Hospital-acquired infections (HAIs) are profound causes of prolonged hospital stay and worse patient outcomes. HAIs pose serious risks, particularly in neurosurgical patients in the intensive care unit, as these patients are seldom able to express symptoms of infection, with only elevated temperatures as the initial symptom. Data from Center for Disease Control (CDC) and the Infectious Disease Society of America (IDSA) have shown that of all HAIs, urinary tract infections (UTIs) have been grossly over-reported, resulting in excessive and unnecessary antibiotic usage. Methods: We conducted a retrospective analysis of 686 adult patients that were evaluated by the neurosurgery service at Arrowhead Regional Medical Center between July 2018 and March 2019. Inclusion criteria were adults greater than 18 years of age with neurosurgical pathology requiring a minimum of one full day admission to the intensive care unit (ICU), and an indwelling urinary catheter. Exclusion criteria were patients under the age of 18, those who did not spend any time in the ICU, or with renal pathologies such as renal failure. Results: We reviewed 686 patients from the neurosurgical census. In total, 146 adult patients with indwelling urinary catheters were selected into the statistical analysis. Most individuals spent an average of 8.91 ± 9.70 days in the ICU and had an indwelling catheter for approximately 8.14 ± 7.95 days. Forty-two out of the 146 individuals were found to have a temperature of 100.4°F or higher. Majority of the patients with an elevated temperature had an infectious source other than urine, such as sputum (22 out of 42, 52.38%), blood (three out of 42, 7.14%) or CSF (one out of 42, 2.38%). We were able to find only two individuals (4.76%) with a positive urine culture and no evidence of other positive cultures or deep vein thrombosis. Conclusions: Our analysis shows evidence to support the newest IDSA guidelines that patients with elevated temperatures should have a clinical workup of all alternative etiologies prior to testing for a urinary source unless the clinical suspicion is high. This will help reduce the rate of unnecessary urine cultures, the over-diagnosis of asymptomatic bacteriuria, and the overuse of antibiotics. Based on our current findings, all potential sources of fever should be ruled out prior to obtaining urinalysis, and catheters should be removed as soon as they are not needed. Urinalysis with reflex to urine culture should be reserved for those cases where there remains a high index of clinical suspicion for a urinary source.
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Affiliation(s)
- Stacey Podkovik
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Harjyot Toor
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Maya Gattupalli
- Neurosurgery, Touro University College of Osteopathic Medicine California, Vallejo, USA
| | - Samir Kashyap
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Sruthi Bonda
- Neurosurgery, Touro University College of Osteopathic Medicine California, Vallejo, USA
| | - Serena Wong
- Neurosurgery, St. George's University School of Medicine, St. George's, GRD
| | - Christine Kang
- Neurosurgery, Touro University College of Osteopathic Medicine California, Vallejo, USA
| | - Kevin Mo
- Neurosurgery, Western University of Health Sciences, Pomona, USA
| | | | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Sharon Wang
- Infectious Disease, Arrowhead Regional Medical Center, Colton, USA
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