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YAZICI G, BULUT H. Use of Care Bundles to Prevent Healthcare-Associated Infections in Intensive Care Units: Nurses' Views. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.887853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The purpose of this study was to determine the views of nurses working in intensive care units regarding the use of care bundles in preventing healthcare-associated infections.
Methods: This study used the focus-group interview method, which is one of the qualitative methods. Two focus-group interviews, each lasting about half an hour, were conducted with 14 intensive care unit nurses. Qualitative data obtained from the interviews were recorded on tape and in note form. The interviews were then transcribed and analyzed. The transcribed data from the focus-group discussions were grouped by theme and concept, and the statements of the participants were coded numerically according to these groupings. Three themes and six subthemes emerged in analyzing the qualitative data.
Results: The nurses defined care bundles as "materials that provide integrated care for patients". They also stated that their benefits included providing a tool for self-monitoring, support and guidance for both patients and nurses. When whether they had experienced any difficulties while using care bundles, they stated that they had not experienced any. Furthermore, nurses stated that care bundles improved their perspectives, and that they were must-have items in intensive care units providing reminders rather than a waste of time.
Conclusion: It is that the participation of nurses is important so that care bundles are used more widespread in order to prevent healthcare-associated infections in intensive care units.
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Yang L, Dong Z. Adherence to Guidelines on Nutritional Support by Medical Residents in an Intensive Care Unit in China: A Prospective Observational Study. Med Sci Monit 2019; 25:8645-8650. [PMID: 31733142 PMCID: PMC6874836 DOI: 10.12659/msm.917684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The use of evidence-based clinical practice guidelines improves the quality of patient medical care. Although the implementation of clinical guidelines can be a challenge, nutritional support is important for critically ill patients. This prospective observational study aimed to investigate the attention to and implementation of guidelines for nutritional support in an Intensive Care Unit (ICU) in China and to identify factors that determine attention to these guidelines. Material/Methods The study included 16 medical residents who were interviewed while working in an emergency Intensive Care Unit (ICU) during one month. A structured interview questionnaire on attention to patient nutritional guidelines was used. Interviews were conducted daily after an early ICU ward round, and residents were asked questions regarding each patient. Results The response rate from medical residents was 99.6% (455/457). The rate of attention to and implementation of nutritional support guidelines was 57.1% (260/455) and 73.1% (334/457), respectively. Multivariate logistic regression analysis showed that weekdays and weekends (OR, 0.59; 95% CI, 0.38–0.91), medical groups (OR, 0.67; 95% CI, 0.46–0.98), and the numbers of patients admitted (OR, 0.91; 95% CI, 0.85–0.97) were independently associated with attention to nutritional support guidelines by the residents. Conclusions Nutritional guidelines for patients in the ICU were not fully paid attention to by medical residents or implemented. The reasons included high work demands and lack of standardized training. Further studies are needed to determine whether measures to reduce workload and improve medical training can improve adherence to nutritional support guidelines in the ICU.
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Affiliation(s)
- Lei Yang
- Intensive Care Unit (ICU), Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland).,Intensive Care Unit (ICU), Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China (mainland).,Department of Emergency Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhouzhou Dong
- Intensive Care Unit (ICU), Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland).,Intensive Care Unit (ICU), Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China (mainland)
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Bates KE, Connor J, Chanani NK, McLellan MC, McCormick A, Smith-Parrish M, Moga MA. Quality Improvement Basics: A Crash Course for Pediatric Cardiac Care. World J Pediatr Congenit Heart Surg 2019; 10:733-741. [PMID: 31663842 DOI: 10.1177/2150135119881393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lack of knowledge of quality improvement (QI) methodology and change management principles can explain many of the difficulties encountered when trying to develop effective QI initiatives in health care. METHODS An interactive QI workshop at the 14th Annual Meeting of the Pediatric Cardiac Intensive Care Society provided an overview of the role of QI in health care, basic QI frameworks and tools, and leadership and organizational culture pitfalls. The top five QI projects submitted to the meeting were later presented to an expert QI panel in a separate session to illustrate examples of QI principles. RESULTS Workshop presenters introduced two major QI methodologies used to design QI projects. Important first steps include identifying a problem, forming a multidisciplinary team, and developing an aim statement. Key driver diagrams were highlighted as an important tool to develop a project's framework. Several diagnostic tools used to understand the problem were discussed, including the "5 Why's," cause-and-effect charts, and process flowcharts. The importance of outcome, process, and balancing measures was emphasized. Identification of interventions, the value of plan-do-study-act cycles to fuel continuous QI, and use of statistical process control, including run charts or control charts, were reviewed. The importance of stakeholder engagement, transparency, and sustainability was discussed. Later, the top five QI projects presented highlighted multiple "QI done well" practices discussed during the preconference QI workshop. CONCLUSIONS Understanding QI methodology and appropriately applying basic QI tools are pivotal steps to realizing meaningful and sustained improvement.
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Affiliation(s)
- Katherine E Bates
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jean Connor
- Department of Pediatrics, Cardiovascular and Critical Care Patents Services, Boston Children's Hospital, Harvard University School of Medicine, Boston, MA, USA
| | - Nikhil K Chanani
- Division of Cardiology, Department of Pediatrics, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Mary C McLellan
- Cardiac Acute Care Unit, The Heart Center, Boston Children's Hospital, Boston, MA, USA
| | - Andrea McCormick
- Quality Management, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Smith-Parrish
- Division of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard University School of Medicine, Boston, MA, USA
| | - Michael-Alice Moga
- Department of Pediatrics, Labatt Family Heart Center, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine-Division of Cardiac Critical Care, Labatt Family Heart Center, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada
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Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt C, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar J, Bruyère R, Chanques G. Pneumonies associées aux soins de réanimation* RFE commune SFAR–SRLF. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhang ZN, Zhang XP, Lai XQ. Model of Healthcare-Associated Infection Control in Primary Health Care Institutions: A Structural Equation Modeling. Curr Med Sci 2019; 39:153-158. [PMID: 30868506 DOI: 10.1007/s11596-019-1967-9] [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: 03/11/2018] [Revised: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to construct the model of organization system, management, training and surveillance in healthcare-associated infection prevention and control (IC) of primary health care institutions and identify its effect on patient safety and decreasing economic burden by standardizing IC. A cross-sectional survey was conducted with questionnaires. Data were collected from 268 primary health care institutions in Hubei province, China. Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling. The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels: root mean square error of approximation (RMSEA)=0.071; comparative fit index (CFI)=0.965; tucker-lewis index (TLI)=0.956; weighted root mean square residual (WRMR)=1.014. The model showed that organization system had a direct effect on management (β=0.311, P<0.01), and training (β=0.365, P<0.01). Management and training played an intermediary role that partially promoted organization system impact on surveillance. Results also showed that institutional factors such as the number of physicians, the number of nurses, the designated capacity of beds, the actual number of open beds and surgery trips had positive impacts on management (β=0.050, P<0.01; β=0.181, P<0.01; β=0.111, P<0.01; β=0.064, P<0.01; β=0.084, P=0.04) and training (β=0.21, P=0.03; β=0.050, P=0.02; β=0.586, P=0.01; β=-0.995, P=0.02; β=-0.223, P=0.03). In conclusion, the model of organization system, management, training and surveillance in IC of primary health care institutions is valuable for guiding IC practice.
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Affiliation(s)
- Zi-Nan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin-Ping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao-Quan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Boots R. Prevention of Nosocomial Infection in the Neurosciences Intensive Care Unit: Remember the Basics. Neurocrit Care 2018; 25:167-9. [PMID: 27535771 DOI: 10.1007/s12028-016-0314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rob Boots
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.
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Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt CE, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar JR, Bruyère R, Chanques G. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 2018; 37:83-98. [DOI: 10.1016/j.accpm.2017.11.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Yazici G, Bulut H. Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study. Appl Nurs Res 2017; 39:4-10. [PMID: 29422174 DOI: 10.1016/j.apnr.2017.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 09/26/2017] [Accepted: 10/15/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Healthcare-associated infections extend hospitalization time, increase treatment costs and increase morbidity-mortality rates. OBJECTIVES To evaluate the efficacy of a care bundle aimed at preventing three most frequent intensive care unit-acquired infections. MATERIALS AND METHOD This quasi-experimental study occurred in an 18-bed tertiary care intensive care unit at a university hospital in Turkey. The sample consisted of 120 patients older than 18years and receiving invasive mechanical ventilation therapy, or had a central venous catheter or urinary catheter. The study comprised three stages. In stage one, the intensive care unit nurses were trained in infection measures, VAP, CA-UTIs and CLABSIs sections of the care bundle. In stage two, the trained nurses applied the care bundle and received feedback on any problematic issues. In stage three, the nurses' compatibility and efficacy of the infection prevention care bundle on the infection rates of VAP, CA-UTIs and CLABSIs were evaluated over three 3-month periods. RESULTS Over 1000 ventilation days, ventilator-associated pneumonia infection rates were 23.4, 12.6, and 11.5, during January-March, April-June and July-September, respectively, with January-March and April-June showing a significant decrease (χ2=6.934, p=0.031). The central line-associated bloodstream infection rates were 8.9, 4.2, and 9.9 per 1000 catheter days, during January-March, April-June and July-September, respectively, but were not significantly different based on pair-wise comparisons (p>0.05). The catheter-associated urinary tract infection rates were higher during July-September (6.7/1000 catheter days) compared to January-March (5.7/1000 catheter days) and April-June (10.4/1000 catheter days) but the differences were not significant (p>0.05). CONCLUSIONS The infection rates decreased with increased compatibility of the care bundle prepared from evidence-based guidelines.
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Affiliation(s)
- Gulay Yazici
- Ankara Yıldırım Beyazıt University, Faculty of Health Science, Department of Nursing, Turkey.
| | - Hulya Bulut
- Gazi University, Faculty of Health Science, Department of Nursing, Turkey
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Jones A, Johnstone MJ. Inattentional blindness and failures to rescue the deteriorating patient in critical care, emergency and perioperative settings: Four case scenarios. Aust Crit Care 2016; 30:219-223. [PMID: 27720335 DOI: 10.1016/j.aucc.2016.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Failure to identify and respond to clinical deterioration is an important measure of patient safety, hospital performance and quality of care. Although studies have identified the role of patient, system and human factors in failure to rescue events, the role of 'inattentional blindness' as a possible contributing factor has been overlooked. OBJECTIVES To explore the nature and possible patient safety implications of inattentional blindness in critical care, emergency and perioperative nursing contexts. METHODS Analysis of four case scenarios drawn from a naturalistic inquiry investigating how nurses identify and manage gaps (discontinuities) in care. Data were collected via in-depth interviews from a purposeful sample of 71 nurses, of which 20 were critical care nurses, 19 were emergency nurses and 16 were perioperative nurses. Case scenarios were identified, selected and analysed using inattentional blindness as an interpretive frame. RESULTS The four case scenarios presented here suggest that failures to recognise and act upon patient observations suggestive of clinical deterioration could be explained by inattentional blindness. In all but one of the cases reported, vital signs were measured and recorded on a regular basis. However, teams of nurses and doctors failed to 'see' the early signs of clinical deterioration. The high-stress, high-complexity nature of the clinical settings in which these cases occurred coupled with high cognitive workload, noise and frequent interruptions create the conditions for inattentional blindness. CONCLUSIONS The case scenarios considered in this report raise the possibility that inattentional blindness is a salient but overlooked human factor in failure to rescue events across the critical care spectrum. Further comparative cross-disciplinary research is warranted to enable a better understanding of the nature and possible patient safety implications of inattentional blindness in critical care nursing contexts.
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Affiliation(s)
- Angela Jones
- Deakin University, School of Nursing and Midwifery, Locked Bag 20000, Geelong, 3220 Victoria, Australia.
| | - Megan-Jane Johnstone
- Deakin University, School of Nursing and Midwifery, Locked Bag 20000, Geelong, 3220 Victoria, Australia.
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Borgert M, Binnekade J, Paulus F, Goossens A, Vroom M, Dongelmans D. Timely individual audit and feedback significantly improves transfusion bundle compliance—a comparative study. Int J Qual Health Care 2016; 28:601-607. [DOI: 10.1093/intqhc/mzw071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 04/22/2016] [Accepted: 06/02/2016] [Indexed: 11/12/2022] Open
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Mckelvie BL, Mcnally JD, Menon K, Marchand MG, Reddy DN, Creery WD. A PICU patient safety checklist: rate of utilization and impact on patient care. Int J Qual Health Care 2016; 28:371-5. [DOI: 10.1093/intqhc/mzw042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
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Al Ashry HS, Abuzaid AS, Walters RW, Modrykamien AM. Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Nonmechanically Ventilated Patients. J Intensive Care Med 2014; 31:252-7. [PMID: 24825860 DOI: 10.1177/0885066614533910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/23/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown. METHODS This is a retrospective analysis of data obtained during the implementation of a quality improvement project consisting of the utilization of a nurse-led ICU checklist. A consecutive series of checklists obtained from patients admitted in our ICU during 7 consecutive months were included. The ICU stay, hospital stay, and ventilator stay were compared between patients whose practitioners completed or did not complete the checklist. Variables were analyzed using Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. A 2-tailed P < .05 was considered statistically significant. RESULTS One thousand checklists, corresponding to 346 eligible patients, were collected over 7 months. Mechanical ventilation was used in 203 (59%) patients. Completed checklists were observed for 37.6% (n = 130) of all patients and 38.9% (n = 79) of mechanically ventilated patients. After adjusting for age, Acute Physiology and Chronic Health Evaluation II (APACHE II), body mass index, reason for admission, and type of ICU, completion of the checklist was associated with a 20% increase in the number of days in the ICU compared with the group with incomplete lists. In mechanically ventilated patients, completion of the checklist was associated with a 31% increase in hospital length of stay, a 34% increase in the number of ICU days, and a 32% increase in mechanical ventilation days. CONCLUSION Compliance with completion of a nurse-led ICU checklist was associated with prolonged ICU stay, hospital stay, and ventilator stay.
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Affiliation(s)
- Haitham S Al Ashry
- Department of Medicine, Division of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Ahmed S Abuzaid
- Department of Medicine, Division of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Ryan W Walters
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University Medical Center, Omaha, NE, USA
| | - Ariel M Modrykamien
- Department of Medicine, Division of Pulmonary, Sleep and Critical Care Medicine, Creighton University Medical Center, Omaha, NE, USA
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Measurable outcomes of quality improvement using a daily quality rounds checklist: two-year prospective analysis of sustainability in a surgical intensive care unit. J Trauma Acute Care Surg 2013; 75:717-21. [PMID: 24064888 DOI: 10.1097/ta.0b013e31829d27b6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The use of a "quality rounds checklist" (QRC) is an effective tool for improving compliance with evidence-based preventative measures and outcomes in the surgical intensive care unit (SICU). Our aim was to evaluate the long-term sustainability and outcome impact of this quality improvement strategy. METHODS Prospective observational study evaluates the use of the QRC in the SICU from July 2009 to June 2011. Daily compliance with evidence-based prophylactic measures was assessed using the QRC and reviewed monthly at a multidisciplinary meeting. Logistic regression was performed to evaluate patterns of compliance over time. Current compliance was compared with previously reported rates, and the impact on outcomes including catheter-related blood stream infection and ventilator-associated pneumonia rates was examined. RESULTS Over 2 years, 2,472 patients were admitted to the SICU. Mean (SD) age was 42.2 (22.4) years, 79% were male, and 35% had an Injury Severity Score (ISS) of greater than 15. The rate of compliance with head-of-bed elevation significantly improved during the study period (p = 0.01 for trend), with an overall compliance of 97%. Both deep venous thrombosis prophylaxis and gastrointestinal bleed prophylaxis compliance remained stable, with overall rates of 98% and 96%, respectively. The use of sedation holidays also remained stable, with an overall compliance rate of 94%. Compared with our previously published data, the compliance rates with preventative measures were stable or significantly improved; the incidence of catheter-related blood stream infections was lower (0.85/1,000 vs. 4.98/1,000 catheter days, p < 0.001); and the incidence of ventilator-associated pneumonia downtrended (1.66/1,000 vs. 8.74/1,000 ventilator days, p = 0.07). CONCLUSION Two years after implementation of a QRC, sustainable high rates of compliance with clinically relevant preventative measures in a SICU was demonstrated with minimal fading of clinically relevant outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Viana WN, Bragazzi C, Couto de Castro JE, Alves MB, Rocco JR. Ventilator-associated pneumonia prevention by education and two combined bedside strategies. Int J Qual Health Care 2013; 25:308-13. [DOI: 10.1093/intqhc/mzt025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Pincock T, Bernstein P, Warthman S, Holst E. Bundling hand hygiene interventions and measurement to decrease health care-associated infections. Am J Infect Control 2012; 40:S18-27. [PMID: 22546269 DOI: 10.1016/j.ajic.2012.02.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
Proper performance of hand hygiene at key moments during patient care is the most important means of preventing health care-associated infections (HAIs). With increasing awareness of the cost and societal impact caused by HAIs has come the realization that hand hygiene improvement initiatives are crucial to reducing the burden of HAIs. Multimodal strategies have emerged as the best approach to improving hand hygiene compliance. These strategies use a variety of intervention components intended to address obstacles to complying with good hand hygiene practices, and to reinforce behavioral change. Although research has substantiated the effectiveness of the multimodal design, challenges remain in promoting widespread adoption and implementation of a coordinated approach. This article reviews elements of a multimodal approach to improve hand hygiene and advocates the use of a "bundled" strategy. Eight key components of this bundle are proposed as a cohesive program to enable the deployment of synergistic, coordinated efforts to promote good hand hygiene practice. A consistent, bundled methodology implemented at multiple study centers would standardize processes and allow comparison of outcomes, validation of the methodology, and benchmarking. Most important, a bundled approach can lead to sustained infection reduction.
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Affiliation(s)
- Ted Pincock
- Department of Infection Prevention and Control, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
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Abstract
PURPOSE OF REVIEW The increasing number of hospitals reporting ventilator-associated pneumonia (VAP) rates at or close to zero begs the question of whether zero should become the national benchmark for VAP. This article explores the significance of very low VAP rates, reviews differences in surveillance and clinical rates, proposes reasons for their discrepancies, and suggests possible objective alternatives for surveillance. RECENT FINDINGS Surveillance rates of VAP are decreasing, whereas clinical diagnoses and antibiotic prescribing remain prevalent. This growing discrepancy reflects the lack of objective and definitive signs to diagnose VAP. External reporting pressures may be encouraging stricter interpretation of subjective signs and other surveillance initiatives that can artifactually lower rates. It is impossible to disentangle the relative contribution of care improvements versus surveillance effects to currently observed low VAP rates. SUMMARY The increasing mismatch between surveillance rates and clinical diagnoses limits the utility of official VAP rates to estimate disease burden and guide quality improvement. Advocates are advised to consider objective alternatives such as average duration of mechanical ventilation, length of stay, mortality, and antibiotic prescribing. Emerging surveillance definitions that use more objective criteria may better reflect and inform future clinical practice.
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Hübner NO, Fleßa S, Jakisch R, Assadian O, Kramer A. Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis - a perspective from structurally- and process-oriented hygiene. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc15. [PMID: 22558049 PMCID: PMC3334955 DOI: 10.3205/dgkh000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene.
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