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Darjees D, Dhandapani S, Priyadarshi K, Cherian A, Sastry AS. Impact of care bundle audit on compliance to device care bundles and device associated infections in the Critical Care Unit of a tertiary care hospital, Southern India - A before-after interventional study. Indian J Med Microbiol 2024; 50:100651. [PMID: 38906328 DOI: 10.1016/j.ijmmb.2024.100651] [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: 12/12/2023] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND A care bundle comprises a set of evidence-based practices in patient care that are grouped together with the assumption that these practices when performed together will result in better clinical outcomes than when these practices are performed separately. Care bundles for devices when implemented effectively can bring about a reduction in device associated infection rates. METHODS The study was conducted in three phases, 1 month pre-interventional and interventional phases and 11 months of post-interventional phase in a critical care unit. Compliance to care bundles were recorded by direct observation during daily audit rounds. An educational intervention addressing the healthcare workers regarding bundle care approach was conducted and supplemented with bedside "audit and feedback" during the interventional phase. Audit was conducted in the post-interventional period to study the trend of device associated infections and compliance rates. RESULTS An increasing trend of month-wise compliance rates to the device care bundles were observed. The month-wise Ventilator Associated Events rates showed a decreasing trend. In the post-interventional phase, the average Catheter-associated Urinary Tract Infection, Central Line Associated Bloodstream Infection and Ventilator Associated Events rates showed a reduction from their respective baseline rates for the study setting. CONCLUSIONS An educational intervention targeted at the healthcare workers along with daily audit of care bundle practices in the critical care setting led to an increase in the compliance to device care bundles and a reduction in the incidence of Catheter-associated Urinary Tract Infection, Central Line Associated Bloodstream Infection and Ventilator Associated Events rates in the critical care setting.
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Affiliation(s)
- Dijo Darjees
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Sarumathi Dhandapani
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Ketan Priyadarshi
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna - Aurangabad Rd, Phulwari Sharif, Patna, Bihar, 801507, India.
| | - Anusha Cherian
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Apurba Sankar Sastry
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
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Vacher A, El Mhamdi S, d'Hollander A, Izotte M, Auroy Y, Michel P, Quenon JL. Impact of an Original Methodological Tool on the Identification of Corrective and Preventive Actions After Root Cause Analysis of Adverse Events in Health Care Facilities: Results of a Randomized Controlled Trial. J Patient Saf 2021; 17:483-489. [PMID: 29116954 DOI: 10.1097/pts.0000000000000437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness of a new methodological tool for the identification of corrective and preventive actions (CAPAs) after root cause analysis of health care-related adverse events. METHODS From January to June 2010, we conducted a randomized controlled trial involving risk managers from 111 health care facilities of the Aquitaine Regional Center for Quality and Safety in Health Care (France). Fifty-six risk managers, randomly assigned to two groups (intervention and control), identified CAPAs in response to two sequentially presented adverse event scenarios. For the baseline measure, both groups used their usual adverse event management tools to identify CAPAs in each scenario. For the experimental measure, the control group continued using their usual tools, whereas the intervention group used a new tool involving a systemic approach for CAPA identification. The main outcome measure was the number of CAPAs the participants identified that matched a criterion standard established by eight experts. RESULTS Baseline mean number of identified CAPAs did not differ between the two groups (P = 0.83). For the experimental measure, significantly more CAPAs (P = 0.001) were identified by the intervention group (mean [SD] = 4.6 [1.7]) than by the control group (mean [SD] = 2.8 [1.2]). CONCLUSIONS For the two scenarios tested, more relevant CAPAs were identified with the new tool than with usual tools. Further research is needed to assess the effectiveness of the new tool for other types of adverse events and its impact on patient safety.
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Affiliation(s)
- Anthony Vacher
- From the Institut de Recherche Biomédicale des Armées [French Armed Forces Biomedical Research Institute], Unité Sécurité des Systèmes à Risques, Brétigny sur Orge, France
| | | | - Alain d'Hollander
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Marion Izotte
- Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA) [Aquitaine Regional Centre for Quality and Safety in Health Care], Hôpital Xavier Arnozan, Pessac, France
| | | | | | - Jean-Luc Quenon
- Comité de Coordination de l'Evaluation Clinique et de la Qualité en Aquitaine (CCECQA) [Aquitaine Regional Centre for Quality and Safety in Health Care], Hôpital Xavier Arnozan, Pessac, France
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3
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Bendall AC, Tan SJ, See EJ, Toussaint ND. Electronic alerts for early detection of acute kidney injury: considering their implementation in Australian hospitals. Med J Aust 2021; 214:347-349.e1. [PMID: 33847000 DOI: 10.5694/mja2.51024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 01/07/2023]
Affiliation(s)
| | - Sven-Jean Tan
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Emily J See
- Royal Melbourne Hospital, Melbourne, VIC.,Austin Health, Melbourne, VIC
| | - Nigel D Toussaint
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D’Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D’Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, Catena F. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 2020; 15:13. [PMID: 32070390 PMCID: PMC7029591 DOI: 10.1186/s13017-020-00295-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Angelo Pan
- Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Iris Agreiter
- Bone Marrow Transplant Unit, Denis Burkitt, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Barchiesi
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valeria Benigni
- Clinical Administration, Senigallia Hospital, ASUR Marche, Senigallia, AN Italy
| | | | - Stefano Cappanera
- Infectious Diseases Clinic, Department of Medicine, “S. Maria” Hospital, Terni, University of Perugia, Perugia, Italy
| | | | - Valentina Cola
- Department of Hospital Pharmacy, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Daniela Corsi
- Department of Anesthesiology and Intensive Care Unit, Civitanova Marche Hospital, ASUR Marche, Civitanova Marche, MC Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Crapis
- Infectious Diseases Unit, Pordenone Hospital, Pordenone, Friuli-Venezia Giulia Italy
| | | | - Alessandro D’Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Belinda De Simone
- Operative Unit of General Surgery, Azienda USL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | | | - Abele Donati
- Department of Anesthesiology and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Elisei
- Department of Anesthesiology and Intensive Care Unit, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Anna Ferrari
- Department of Critical Care Medicine Unit, San Filippo Neri Hospital, Rome, Italy
| | - Domitilla Foghetti
- Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Gianni Gattuso
- Infectious Diseases Unit, Carlo Poma Hospital, Mantua, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biological Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Cristina Marmorale
- Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Daniela Padrini
- Clinical Administration Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | | | - Paola Pauri
- Unit of Microbiology and Virology, Senigallia Hospital, Senigallia, AN Italy
| | | | - Enrico Ricchizzi
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Vittorio Sambri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Cesena, Italy
| | | | - Walter Siquini
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Loredana Scoccia
- Unit of Hospital Pharmacy, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Giancarlo Scoppettuolo
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marcello Tavio
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence, Italy
| | - Fabio Tumietto
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Vivarelli
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | | | | | - Sameer Dhingra
- Faculty of Medical Sciences, School of Pharmacy, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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Aminzadeh Z, Simpson P, Athan E. Central venous catheter associated blood stream infections (CVC-BSIs) in the non-intensive care settings: Epidemiology, microbiology and outcomes. Infect Dis Health 2019; 24:222-228. [DOI: 10.1016/j.idh.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/23/2022]
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Hanger HC, Bloor M. Inpatient healthcare-associated bloodstream infections in older people. Intern Med J 2019; 49:1173-1177. [PMID: 31507044 DOI: 10.1111/imj.14430] [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: 11/11/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Abstract
This retrospective study describes inpatient healthcare-associated bloodstream infections (HABSI) in older adults and explores whether urinary catheters (presence/insertion/removal) were related to HABSI events. One hundred and sixty-seven HABSI events were identified, predominantly (124, 74%) with Gram-negative bacteria. HABSI was attributed to a urinary source in 110 patients (66%), with over half (63, 57%) of these associated with urinary catheters. Catheter-associated HABSI may be avoidable and potential preventative strategies are discussed.
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Affiliation(s)
- H Carl Hanger
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
| | - Michelle Bloor
- Older Persons Health Specialist Service, Burwood Hospital, Christchurch, New Zealand
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7
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Hade AD, Beckmann LA, Basappa BK. A checklist to improve the quality of central venous catheter tip positioning. Anaesthesia 2019; 74:896-903. [PMID: 31062348 DOI: 10.1111/anae.14679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
Central venous catheter insertion is a routine procedure performed by anaesthetists in the peri-operative setting. Upper body central venous catheters are usually placed such that their tip lies within the superior vena cava or at the cavo-atrial junction. Positioning the tip 'too low' in the right atrium has long been argued against on the basis that it increases the risk of perforation, leading to cardiac tamponade. Positioning the tip 'too high' in the brachiocephalic vein or above can also be problematic in that proximal migration can result in extravascular placement of the proximal lumen. Such an incident occurred at our hospital in 2016, resulting in extravasation of a vesicant medication causing tissue necrosis. We undertook a quality improvement project involving a standardised bundle of care and a peri-operative central venous catheter insertion checklist with the aim of reducing the risk of such an incident re-occurring. We conducted a three-month pre-intervention audit (n = 84) in 2016 and a post-intervention audit (n = 84) in 2017. Compared with the pre-intervention audit, the post-intervention audit coincided with a lower rate of central venous catheter tip malpositioning (5.6% vs. 9.2%); and a higher rate of 'optimal' central venous catheter tip position in the distal superior vena cava or cavo-atrial junction (45.1% vs. 29.2%). The central venous catheter insertion checklist also substantially improved documentation of sterility measures, insertion depth and post-insertional documentation of tip position on chest radiograph.
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Affiliation(s)
- A D Hade
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - L A Beckmann
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - B K Basappa
- Toowoomba Base Hospital, Toowoomba, QLD, Australia
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Abstract
Invasive candida infections are the most important causes of nosocomial infections in intensive care units and in risky groups such as immunosuppressed patients. These infections lead to undesirable consequences such as increased morbidity and mortality in patients, prolongation of hospital stay, and increased hospital costs. In recent years, the incidence of non-albicans Candida spp.'s has increased. Unfortunately, some of these species are naturally resistant to first-line antifungals. In addition, biofilm formation on the central venous catheter and invasive devices may cause treatment failure. The age of the patients, co-morbid diseases, the units where they are treated, the antibiotics and antifungals that are used for the treatment, and invasive devices are risk factors for invasive candida infections. Some of these risk factors can be reduced by the behavior of health-care workers. The most important goal is to take precautions before the occurrence of invasive candida infections. Infection control measures to prevent hospital transmission of candida are very important. Compliance with hand hygiene before and after contact with the patient is the most important step to prevent the spreading of Candida spp. Observation of maximal barrier precautions during invasive catheterization is another important clause of this aim. Avoiding unnecessary invasive devices, antibiotics, and parenteral nutrition are also important to reduce the colonization of candida.
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Affiliation(s)
- Zeynep Ture
- a Department of Infectious Diseases and Clinical Microbiology , Health Ministry University of Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Emine Alp
- b Department of Infectious Diseases and Clinical Microbiology, Infection Control Committee, Faculty of Medicine , Erciyes University , Kayseri , Turkey
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9
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Fernando SA, Gray TJ, Gottlieb T. Healthcare-acquired infections: prevention strategies. Intern Med J 2018; 47:1341-1351. [PMID: 29224205 DOI: 10.1111/imj.13642] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
Healthcare-acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health-care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi-resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence-based antimicrobial use; infection prevention strategies, to control MRO - particularly methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE) and, more recently, multi-resistant Gram-negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co-ordination at a national level. HAI prevention needs to be multi-modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.
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Affiliation(s)
- Shelanah A Fernando
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Timothy J Gray
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Thomas Gottlieb
- Department of Microbiology & Infectious Diseases, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Silva AGD, Oliveira ACD. IMPACTO DA IMPLEMENTAÇÃO DOS BUNDLES NA REDUÇÃO DAS INFECÇÕES DA CORRENTE SANGUÍNEA: UMA REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003540016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar as produções científicas nacionais e internacionais sobre o impacto dos bundles na prevenção de infecção da corrente sanguínea relacionada ao cateter venoso central em unidade de terapia intensiva adulta. Método: revisão integrativa de artigos publicados no Portal Capes, Biblioteca Virtual em Saúde, PubMed, Science Direct, Cochrane, CINAHL e SCOPUS, entre 2011 e 2016. Resultados: encontraram-se 16 artigos, 100% relacionados à implementação dos bundles para a inserção do cateter venoso central e 50% à manutenção deste dispositivo. O tempo de intervenção foi variado, bem como o número de medidas e o período analisado (inserção/manutenção do cateter). No entanto, a redução da infecção da corrente sanguínea relacionada ao dispositivo foi apontada em todos os estudos entre 26% e 100%. Conclusão: a adoção de bundle evidenciou um impacto positivo na redução da infecção. Todavia, não se observou uma relação direta entre o número de medidas descritas nos estudos ou o maior tempo de implementação e taxas mais altas de redução da infecção.
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11
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Duff J, Walker K, Edward KL, Ralph N, Giandinoto JA, Alexander K, Gow J, Stephenson J. Effect of a thermal care bundle on the prevention, detection and treatment of perioperative inadvertent hypothermia. J Clin Nurs 2018; 27:1239-1249. [DOI: 10.1111/jocn.14171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jed Duff
- School of Nursing and Midwifery; University of Newcastle; Newcastle NSW Australia
| | - Kim Walker
- St Vincent's Private Hospital Sydney; Sydney NSW Australia
| | - Karen-Leigh Edward
- School of Health Sciences; Swinburne University; Melbourne Vic. Australia
| | - Nicholas Ralph
- Research Program Leader (Clinical Services); Institute of Resilient Regions; School of Nursing and Midwifery, University of Southern Queensland; Toowoomba Qld Australia
- St Vincent's Private Hospital; Toowoomba Qld Australia
| | | | - Kimberley Alexander
- Holy Spirit Northside Private Hospital; Brisbane Australia
- Queensland University of Technology; Brisbane Qld Australia
| | - Jeff Gow
- School of Commerce; University of Southern Queensland; Toowoomba Qld Australia
- School of Accounting; Economics and Finance; University of KwaZulu-Natal; Durban South Africa
| | - John Stephenson
- Biomedical Statistics; University of Huddersfield; Huddersfield UK
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Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med 2018; 13:105-116. [PMID: 29154382 DOI: 10.12788/jhm.2856] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a narrative review process. The interventions were categorized using a conceptual model, with stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible, (stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective components that the 5 most successful (by reduction in infection rates) studies of each infection shared. Interventions that addressed multiple stages within the conceptual model were common in these successful studies. Assuring compliance with infection prevention efforts via auditing and timely feedback were also common. Hospitalists with patient safety interests may find this review informative for formulating quality improvement interventions to reduce these infections.
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Affiliation(s)
- Payal K Patel
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason D Mann
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica M Ameling
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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Guimarães T, Costa SF. New Interventions Targeting Healthcare-Associated Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Padilla Fortunatti CF. Impact of two bundles on central catheter-related bloodstream infection in critically ill patients. Rev Lat Am Enfermagem 2017; 25:e2951. [PMID: 29211195 PMCID: PMC5738873 DOI: 10.1590/1518-8345.2190.2951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022] Open
Abstract
Objective: To evaluate the impact of the implementation of insertion and maintenance bundles
on the rates of catheter-related bloodstream infection in an intensive care unit.
Method: This is a quasi-experimental, before-and-after study with a non-equivalent control
group. During a six-month period, insertion and maintenance bundles for the
central venous catheters were implemented. Supervision guidelines were developed
to assess compliance with the bundle and catheter characteristics. Results: A total of 444 central catheters corresponding to 390 patients were observed, of
which 68.7% were inserted in the unit. The maintenance and insertion bundles
reached 62.9% and 94.7% compliance, respectively, and 50.7% of the insertions were
supervised. It was possible to observe a 54.5% decrease in the rate of central
catheter infection (3.48 vs 1.52 x 1000 days/catheter, p<0.05) when compared
with the control group. Conclusion: The simultaneous implementation of insertion and maintenance bundles has a
positive impact on the reduction of catheter-related bloodstream infection;
therefore it is an efficient alternative to improve the quality and safety of care
in high complexity units.
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Affiliation(s)
- Cristobal Felipe Padilla Fortunatti
- Student in Master's degree, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile. RN, Unidad de Paciente Crítico, Hospital Clinico Red de Salud UC - CHRISTUS, Santiago, Chile
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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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Kolhe NV, Reilly T, Leung J, Fluck RJ, Swinscoe KE, Selby NM, Taal MW. A simple care bundle for use in acute kidney injury: a propensity score-matched cohort study. Nephrol Dial Transplant 2016; 31:1846-1854. [DOI: 10.1093/ndt/gfw087] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/21/2016] [Indexed: 11/14/2022] Open
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Retrospective Observational Review of Percutaneous Cannulation for Extracorporeal Membrane Oxygenation. ASAIO J 2016; 62:325-8. [DOI: 10.1097/mat.0000000000000339] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Wong SW, Gantner D, McGloughlin S, Leong T, Worth LJ, Klintworth G, Scheinkestel C, Pilcher D, Cheng AC, Udy AA. The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center risk-adjusted analysis. Am J Infect Control 2016; 44:587-92. [PMID: 26874406 DOI: 10.1016/j.ajic.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the risk-adjusted association between intensive care unit (ICU)-acquired central line-associated bloodstream infection (CLABSI) and in-hospital mortality. DESIGN Retrospective observational study. SETTING Forty-five-bed adult ICU. PATIENTS All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30, 2014, requiring a central venous catheter (CVC), with a length of stay > 48 hours, were included. METHODS Data were extracted from our infection prevention and ICU databases. A multivariable logistic regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality. RESULTS Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.16-5.77), CVC exposure > 7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater in-hospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR, 1.20; 95% CI, 0.54-2.68). CONCLUSIONS A greater propensity toward ICU-acquired CLABSI was independently associated with higher in-hospital mortality, although line infection itself was not. The requirement for prolonged specialized central venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a marker of persistent organ dysfunction.
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Affiliation(s)
- S W Wong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - D Gantner
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Perioperative and Critical Care Services, Intensive Care Unit, Footscray Hospital, Footscray, Victoria, Australia
| | - S McGloughlin
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - T Leong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - L J Worth
- Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - G Klintworth
- Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - C Scheinkestel
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - D Pilcher
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - A C Cheng
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - A A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
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Kim HY, Lee WK, Na S, Roh YH, Shin CS, Kim J. The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis. J Crit Care 2016; 32:126-37. [DOI: 10.1016/j.jcrc.2015.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/29/2015] [Accepted: 11/14/2015] [Indexed: 12/11/2022]
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Reasbeck PG, Flockhart S. Effectiveness of a care bundle to reduce central line-associated bloodstream infections. Med J Aust 2015. [PMID: 26224182 DOI: 10.5694/mja15.00381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Changing of bloodstream infections in a medical center neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:514-520. [PMID: 26440920 DOI: 10.1016/j.jmii.2015.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/22/2015] [Accepted: 08/31/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. METHODS We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992-2001 and 2002-2007). RESULTS The mortality rate decreased from 16.3% in 1992-2001 to 5.6% in 2008-2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. CONCLUSION Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI.
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