scholarly journals A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units

2016 ◽  
Vol 37 (7) ◽  
pp. 791-797 ◽  
Author(s):  
Kristen V. Dicks ◽  
Eric Lofgren ◽  
Sarah S. Lewis ◽  
Rebekah W. Moehring ◽  
Daniel J. Sexton ◽  
...  
Keyword(s):  
Time Series ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Bloodstream Infections ◽  
Interrupted Time Series ◽  
Incidence Rates ◽  
Chlorhexidine Gluconate ◽  
Interrupted Time Series Analysis ◽  
Icu Patients ◽  
Series Analysis

OBJECTIVETo determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).DESIGNInterrupted time series analysis.SETTINGThe study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.PARTICIPANTSAll ICU patients at study hospitals during the study period.METHODSOf the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line–associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.RESULTSChlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93–0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94–0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97–0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93–1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.CONCLUSIONSIn this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.Infect Control Hosp Epidemiol 2016;37:791–797

scholarly journals Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers

2017 ◽  
Vol 77 (5) ◽  
pp. 684-689 ◽  
Author(s):  
René Lindholm Cordtz ◽  
Samuel Hawley ◽  
Daniel Prieto-Alhambra ◽  
Pil Højgaard ◽  
Kristian Zobbe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Time Series ◽  
Time Series Analysis ◽  
Incidence Rate ◽  
Interrupted Time Series ◽  
Incidence Rates ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
National Patient ◽  
The Impact

ObjectivesTo study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark.MethodsNationwide register-based cohort and interrupted time-series analysis. Patients with incident RA between 1996 and 2011 were identified in the Danish National Patient Register. Patients with RA were matched on age, sex and municipality with up to 10 general population comparators (GPCs). Standardised 5-year incidence rates of THR and TKR per 1000 person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996–2001) were compared with the bDMARD era (2003–2016) using segmented linear regression interrupted by a 1-year lag period (2002).ResultsWe identified 30 404 patients with incident RA and 297 916 GPCs. In 1996, the incidence rate of THR and TKR was 8.72 and 5.87, respectively, among patients with RA, and 2.89 and 0.42 in GPCs. From 1996 to 2016, the incidence rate of THR decreased among patients with RA, but increased among GPCs. Among patients with RA, the incidence rate of TKR increased from 1996 to 2001, but started to decrease from 2003 and throughout the bDMARD era. The incidence of TKR increased among GPCs from 1996 to 2016.ConclusionWe report that the incidence rate of THR and TKR was 3-fold and 14-fold higher, respectively among patients with RA compared with GPCs in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction.

scholarly journals Outcomes of a Care Coordination Guardianship Intervention for Adults with Severe Mental Illness: An Interrupted Time Series Analysis

2019 ◽  
Vol 47 (3) ◽  
pp. 468-474
Author(s):  
Eliot Levine ◽  
Catherine Jett ◽  
Jeremiah Johnson ◽  
Heather Connors
Keyword(s):  
Time Series ◽  
Mental Illness ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Severe Mental Illness ◽  
Care Coordination ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Legal Outcomes

AbstractThis study investigates the impacts of an intensive care coordination intervention for adults with severe mental illness who have guardians. Program impacts on medical and legal outcomes were assessed using interrupted time series analysis. Program participation was associated with statistically significant reductions in the level and trend of psychiatric hospitalizations, number of days in psychiatric hospitals, emergency room visits, and arrests. Days incarcerated did not change significantly. The decrease in medical and legal outcomes may be associated with decreased spending on these services. The program and other intensive care coordination interventions for this population warrant further replication and research.

scholarly journals Did the ban on serving raw beef liver in restaurants decrease Enterohemorrhagic Escherichia coli infection in Japan?: an interrupted time-series analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kentaro Iwata ◽  
Michihiko Goto
Keyword(s):  
Escherichia Coli ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Incidence Rates ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Beef Liver ◽  
Series Analysis ◽  
The Impact

Abstract Background Enterohemorrhagic Escherichia coli (EHEC) is an important pathogen that causes diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). After an EHEC outbreak involving uncooked beef, serving raw beef liver dishes at restaurants was completely banned starting on July 1, 2012 in Japan. However, its long-term associations with the incidence rates of EHEC infections have never been assessed by formal interrupted time-series analysis (ITSA). Methods A retrospective cohort study to assess the impact of banning raw beef liver provision at restaurants was conducted. The weekly incidence of asymptomatic and symptomatic EHEC infections, the incidence of HUS, and deaths were extracted from the national reportable diseases database from January 2008 to December 2017. ITSA was conducted to evaluate the impact of banning raw beef liver from July 2012. To account for a potential simultaneous external effect, the additional regulation on raw beef red meat handling (implemented in May 2011) and the seasonality were also incorporated into the model. Results There were 32,179 asymptomatic and 21,250 symptomatic EHEC infections (including 717 HUS cases and 26 deaths) reported during the study period. During the pre-intervention period (before week 27, 2012), there were 0.45 asymptomatic EHEC infections per million-persons per week. The mean post-intervention asymptomatic EHEC infections were 0.51 per million-persons per week. ITSA revealed no baseline trend or change in the intercept and trend (0.002 infections per million-persons per week, 95% Confidence interval − 0.03-0.04, p = 0.93, 1.22, CI -1.96-4.39, p = 0.45, and − 0.006, CI -0.003-0.02, p = 0.68, respectively). For symptomatic EHEC infections, there were 0.30 cases per million per week during the pre-intervention period, and it became 0.33 cases per million per week after the intervention. Time series modeling again did not show a significant baseline trend or changes in the intercept and trend (0.0005, CI -0.02-0.02, p = 0.96, 0.69, CI -1.75-3.12, p = 0.58, and − 0.003, CI -0.02-0.01, p = 0.76, respectively). Conclusion We did not find a statistically significant reduction in the overall incidence rates of both asymptomatic and symptomatic EHEC infections in Japan after implementing measures, including a ban on serving raw beef liver dishes in the restaurant industry.

Mortality, Morbidity, and Costs After Implementation of a Vasopressin Guideline in Medical Intensive Care Patients With Septic Shock: An Interrupted Time Series Analysis

2019 ◽  
Vol 54 (4) ◽  
pp. 314-321
Author(s):  
Seth R. Bauer ◽  
Gretchen L. Sacha ◽  
Anita J. Reddy
Keyword(s):  
Septic Shock ◽  
Time Series ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Absolute Difference ◽  
Interrupted Time Series Analysis ◽  
Icu Mortality ◽  
Series Analysis ◽  
Norepinephrine Dose

Background: Vasopressin decreases vasopressor requirements in patients with septic shock. However, the optimal norepinephrine dose for initiation or cessation of vasopressin is unclear. Objective: Analyze monthly intensive care unit (ICU) mortality rates 1 year preimplementation and postimplementation of a guideline suggesting a norepinephrine dose of 50 µg/min or more for initiation of vasopressin and early cessation of vasopressin. Methods: This retrospective quasi-experimental study included adult patients with septic shock admitted to the medical ICU of a tertiary care medical center over 2 years. Time periods were evaluated with interrupted time series analysis. Results: A total of 1148 patients were included: 573 patients preguideline and 575 patients postguideline. Group characteristics were well balanced at baseline, except patients postguideline had higher sequential organ failure assessment scores. Postguideline, fewer patients were initiated on vasopressin (305 [53.2%] vs 217 [37.7%], absolute difference −15.5% [95% CI −21.2% to −9.8%]), and the norepinephrine dose at vasopressin initiation was higher (median 25 [interquartile range 18, 40] µg/min vs 40 [22, 52] µg/min; median difference 15 [95% CI 11 to 19] µg/min; P < 0.01). After guideline implementation, there was no evidence for a difference in ICU mortality rate slope (slope change 0.07% [95% CI −0.8% to 1.0%] per month; P 0.87), but the vasoactive cost level decreased by US$183 (95% CI −US$327 to −US$39) per patient immediately after implementation. Conclusion and Relevance: Implementation of a guideline suggesting a high norepinephrine dose threshold for vasopressin initiation and early vasopressin cessation in patients with septic shock appears to be safe and may decrease vasoactive costs.

Sign in / Sign up

Export Citation Format

Share Document