scholarly journals Effectiveness of a Multidisciplinary Team-Approach on Central-Line–Associated Bloodstream Infections

2021 ◽  
Vol 1 (S1) ◽  
pp. s7-s7
Author(s):  
Geehan Suleyman ◽  
Melissa Ahrens ◽  
Ann Keegan
Keyword(s):  
Multidisciplinary Team ◽  
Infection Prevention ◽  
Central Line ◽  
Physician Education ◽  
P Value ◽  
Team Approach ◽  
Multidisciplinary Team Approach ◽  
Sterile Technique ◽  
The Impact ◽  
Clabsi Rate

Background: Although there has been a significant reduction in central-line–associated bloodstream infection (CLABSI) rates in the past decade with the implementation of evidence-based practices, an estimated 30,100 CLABSI occur each year in acute-care facilities. CLABSIs are associated with increased length of stay, cost, morbidity, and mortality, and they are preventable. In this study, we assessed the impact of a multidisciplinary team approach on CLABSI rates at a 319-bed teaching hospital in northwestern Ohio. Methods: In this before-and-after retrospective study, we compared the CLABSI rate per 1,000 central-line days, standardized infection ratio (SIR), and standardized utilization ratio (SUR) in the preintervention period (January 1, 2016, to December 31, 2018) to those of the intervention period (January 1, 2019, to December 31, 2020). Despite hospital-wide nursing education focusing on central-line maintenance in 2017, our SIR and SUR remained above the national benchmark. Starting in August 2018, we began to focus on insertion practices and physician education. An infection preventionist observed resident central-line insertion training and noted that there was no emphasis on infection prevention measures. There was a best practice knowledge gap. Thus, the indications for central-line use were updated, the insertion checklist was standardized, and the vascular access policy was revised to limit femoral and internal jugular vein use. Infection prevention training was provided to all providers involved in central-line insertions. Nurses were tasked with observing insertion of every central line and stopping the procedure if there is was an observed break in sterile technique. A central-line report listing indications and duration was developed and was sent to the nursing directors who assessed daily need with providers and prompted removal of unnecessary lines. The infection prevention medical director provided CLABSI prevention education to providers. Results: The CLABSI rate per 1,000 central-line days decreased from 0.90 in the preintervention period to 0.34 in the postintervention period, resulting in a 62% reduction in CLABSI rate. The SIR decreased from 0.886 to 0.323 (p-value <0.05), yielding a 64% reduction. The SUR also decreased from 1.156 to 0.874 (p-value <0.001) with a 24% reduction. Conclusion: A multidisciplinary team-approach with emphasis on standardized insertion checklist to ensure adherence to sterile technique and prompt removal of unnecessary central lines, and physician insertion training focusing on IP practices may potentially reduce CLABSI rates.Funding: NoDisclosures: None

scholarly journals Implementing a Massive Personal Protective Equipment Education—A Multidisciplinary Team Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s280-s281
Author(s):  
Mayar Al Mohajer ◽  
Megan Fischer ◽  
Melissa Rouse ◽  
Takei Pipkins ◽  
John Byrne
Keyword(s):  
Nursing Education ◽  
Personal Protective Equipment ◽  
Multidisciplinary Team ◽  
Infection Prevention ◽  
Just In Time ◽  
Protective Equipment ◽  
Team Approach ◽  
Online Video ◽  
Staff Members ◽  
Multidisciplinary Team Approach

Background: Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration as specialized clothing or equipment worn by an employee for protection against infectious materials. They include gloves, gowns, masks, respirators, googles and face shields. The CDC has issued guidelines on appropriateness of when, what, and how to use PPE. Despite these guidelines, compliance with PPE remains challenging. Methods: We implemented a massive hospital-wide rapid education program on PPE donning and doffing of all employees and staff. This program included an online video, return demonstration and just-in-time training. To develop the program, we recorded PPE training video, reviewed PPE validation checklist, developed new isolation precaution signage with quick response (QR) code to video, developed a nutrition tray removal video and a equipment cleaning video, developed family and visitor guidelines for isolation precautions, and created an audit tool for PPE donning and doffing practices. The program required interdisciplinary collaboration including administration, infection prevention, nursing education, central supply, environmental services, facility maintenance, and security. Results: The first phase of the program was implemented through 30 separate 4-hour PPE skills fair offered over 48 hours. In total, 500 staff members were trained in the first 48 hours; 6 additional 3-hour sessions were provided on site in the following 3 month. Additionally, training was provided in off-site clinics, physician leadership meetings, new-hire orientation for nursing staff, and monthly resident and fellow training through graduate medical education. As needed, training was provided by infection prevention, nursing education, and floor nurses. In total, 5,237 staff members were trained within 3 months after implementation. Actual audit results (50 audits per week) showed improved and sustained compliance to >94%. Conclusions: A massive hospital-wide educational program including online video, return demonstration, and just-in-time training is a feasible and very effective method to improve compliance with PPE donning and doffing. A multidisciplinary team approach, administration support, and continuous education and audits are key factors in successful implementation.Funding: NoneDisclosures: None

scholarly journals 502. The Impact of Combating COVID-19 on Blood Culture Contamination and Central Line Associated Bloodstream Infection Rates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S316-S317
Author(s):  
Jennifer LeRose ◽  
Avnish Sandhu ◽  
Jordan Polistico ◽  
Joseph Ellsworth ◽  
Nancy Baran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Tertiary Care ◽  
Time Frame ◽  
Central Line ◽  
Positive Patient ◽  
P Value ◽  
The Impact ◽  
Clabsi Rate

Abstract Background Coronavirus disease (COVID-19) pandemic has presented challenges to every facet of the healthcare system. There is limited research evaluating the consequence of diverting resources from patient safety initiatives to COVID-19 crisis efforts. In an attempt to quantify the impact of COVID-19 on quality of patient care, we compared rates of blood culture contamination and central line associated bloodstream infections (CLABSIs) during COVID-19 to those before the pandemic. Methods A comparative retrospective cohort study was conducted to analyze blood culture contamination and CLABSI rate per 1,000 line days in a tertiary care hospital in Detroit within a “pre- COVID-19” timeframe, January - May 2019, and “COVID-19” timeframe, January - May 2020. The CLABSI rate data was obtained through Infection Control Surveillance System TheraDoc®. Blood culture contamination report was obtained through the Microbiology Department. Chi-square and t-test were used for statistical analysis. Results The blood culture contamination rate increased from 3.1% during pre COVID-19 timeframe to 4.0% during COVID-19 (p-value &lt; 0.01) (Figure 1) with the highest rate in March and April 2020 correlating with the peak of COVID-19 (Figure 2). The CLABSI rate per 1,000 line days increased from 0.71 in pre-COVID-19 time frame to 2.70 during COVID-19 (p-value &lt; 0.01) (Figure 1). Of the 33 CLABSIs identified during the COVID-19 time frame, 18 (54%) patients tested positive for COVID-19. When comparing COVID-19 positive and COVID-19 negative patients; average length of stay was 28.1 days shorter in the positive group (p-value &lt; 0.01). COVID-19 positive patient had higher mortality (p-value &lt; 0.01) (Table1). Refer to Table 1 for comparison of variables between pre COVID-19 and COVID-19 cohort and COVID-19 positive and negative cohort. Figure 1. Rate of blood culture contamination (top) and CLABSI per 1,000 Line Days Rate (below) Between Two Study Period (Pre COVID-19 and COVID-19) Figure 2. Unique COVID Positive results in a Tertiary Care Center, Detroit, January-May 2020 Table 1. Characteristics of Entire Cohort Conclusion A 29% increase in blood culture contamination and 280% increase in CLABSI rate represents an enormous burden on healthcare resources and decreased quality. Despite no increase in length of stay in COVID-19 positive patient, higher mortality and CLABSIs were noted in these patients. During a pandemic, healthcare systems should be allocated additional resources to accommodate the increased patient load without affecting quality of care. Disclosures Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member)

scholarly journals 770. Impact of COVID-19 Pandemic on Central Line-associated Bloodstream Infections in Metropolitan Detroit

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S482-S482
Author(s):  
Geehan Suleyman ◽  
Nicholas sturla ◽  
Smitha Gudipati ◽  
Indira Brar ◽  
Ramesh Mayur
Keyword(s):  
Blood Culture ◽  
Control Chart ◽  
Tertiary Care ◽  
Central Line ◽  
Utilization Rate ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
The Impact ◽  
Clabsi Rate

Abstract Background Recent publications suggest that central line-associated bloodstream infection (CLABSI) rates have increased in US hospitals during the COVID-19 pandemic. The objective of this study was to evaluate the impact of COVID-19 pandemic on CLABSIs. Methods This was a retrospective cross-sectional study comparing CLABSI rate per 1,000 central line (CL) days, blood culture (BC) utilization rate per 1,000 CL days, CL utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CLABSI, and BC and CL utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN). Results The average CLABSI rate per 1,000 CL days increased 24% from 1.66 to 2.06. Twenty percent of patients were hospitalized for COVID-19. The BC utilization rate per 1,000 CL days decreased from 0.43 to 0.32 with a 26% reduction. However, CL utilization increased by 28% from 0.25 to 0.32 (Figure 1). However, CLABSIs due to common commensals decreased from 13.8% to 10.9%. The SIR increased significantly from 1.055 to 1.795 (P-value 0.008), resulting in a 70% increase. The overall SUR also increased from 0.900 to 0.988 (P-value &lt; 0.001). Figure 2 is a control chart of the CLABSI rate from July 2019 to April 2021. Figure 1. CLABSI, blood culture utilization and central line utilization rates pre-and during COVID-19 pandemic Figure 2. CLABSI control chart pre-and during COVID-19 pandemic Conclusion During the COVID-19 pandemic, there was a significant increase in CL utilization, CLABSI rate, SIR and SUR likely due to higher acuity in COVID-19 patients despite a decrease in BC orders. Disclosures All Authors: No reported disclosures

Improving Outcomes in Carotid Body Tumors Treatment: The Impact of a Multidisciplinary Team Approach

2021 ◽  
Author(s):  
Mirko Menegolo ◽  
Andrea Xodo ◽  
Riccardo Bozza ◽  
Michele Piazza ◽  
Carmelo Pirri ◽  
...  
Keyword(s):  
Carotid Body ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Multidisciplinary Team Approach ◽  
Carotid Body Tumors ◽  
The Impact

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

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