scholarly journals Strengthening Adherence to a Central-Line–Associated Bloodstream Infection Prevention Bundle in a Surgical ICU in Vietnam

2020 ◽  
Vol 41 (S1) ◽  
pp. s392-s392
Author(s):  
Thuy Le ◽  
Hung Nguyen Thanh ◽  
Minh Ngo Ngoc Quang ◽  
Chau Nguyen Thi Tran ◽  
Ha Nguyen Thi Thanh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Central Line ◽  
Additional Patient ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Sterile Technique ◽  
Pdsa Cycle ◽  
Chlorhexidine Bathing ◽  
Clabsi Rate

Background: Central-line–associated bloodstream infections (CLABSIs) increase the length of hospital stay, healthcare costs, and patient mortality. Objective: We conducted a quality improvement (QI) approach with plan-do-study-act (PDSA) cycle to strengthen adherence to a central-line (CL) maintenance bundle and to reduce CLABSI rate in a surgical intensive care unit (ICU) of children’s hospital 1 (CH1). Methods: The baseline CLABSI rate per 1,000 CL days and the ratio of CL days to patient days (device utilization ration; DUR) were captured for 12 months preceding the intervention. Baseline process indicators were captured for 2 months preceding implementation, including hand hygiene adherence, sterile technique for dressing change and CL access, CL hub cleaning, dating of CL components and daily chlorhexidine bathing. A multimodal intervention of clinician training, bedside checklist, and poster reminders of best practices was implemented. Process and outcome measures were monitored over 12 months of implementation. Z-test was used to calculate statistical significance before and after intervention. Results: Among 46 clinical ICU staff trained on a CLABSI maintenance bundle, mean pre- and posttest knowledge scores increased from 63% to 86%. Staff adherence to each CL care bundle element improved significantly (P < .001) and sustainably over the intervention period: hand hygiene adherence increased from 54% to 82%; sterile technique for dressing increased from 60% to 94%; sterile technique for CL access increased from 51% to 97%; hub scrubbing increased from 52% to 93%; dating of CL elements increased from 63% to 85%; daily chlorhexidine bathing increased from 52% to 87%. During the first 9 months, the CLABSI rate and the DUR decreased from 5.8 to 3.7 and from 0.43 to 0.41, respectively. In the following 2 months, the CLABSI rate increased to 12.7 while bundle adherence remained high. A root-cause analysis identified inadequate environmental hygiene and use of multidose saline bottles for multiple patients as potential factors. A PDSA cycle to improve these elements (enhanced cleaning; single-patient saline bottles) led to a decrease in the CLABSI rate from 12.7 to 3.0 after these efforts. Conclusions: This is the first time CH1 has used quality improvement methodology to implement an HAI prevention enhancement, which proved effective at creating and sustaining adherence to a multimodal CL maintenance bundle and an overall decrease in CLABSI rates. A 2-month increase in CLABSI rates highlights the unique challenges faced in low-resource settings and demonstrates the need for IPC elements not captured in a typical CLABSI prevention bundle. The quality improvement methodology provided a structured approach to implementing change. This methodology will be used for additional patient safety improvements at CH1 and other Viet Nam hospitals interested in CLABSI prevention.Funding: NoneDisclosures: None

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit

2020 ◽  
Vol 250 ◽  
pp. 161-171
Author(s):  
Lan N. Bui ◽  
Joshua T. Swan ◽  
Katherine K. Perez ◽  
Michael L. Johnson ◽  
Hua Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Antimicrobial Utilization ◽  
Chlorhexidine Bathing

Trial of Universal Gloving with Emollient-Impregnated Gloves to Promote Skin Health and Prevent the Transmission of Multidrug-Resistant Organisms in a Surgical Intensive Care Unit

2010 ◽  
Vol 31 (05) ◽  
pp. 491-497 ◽  
Author(s):  
Gonzalo Bearman ◽  
Adriana E. Rosato ◽  
Therese M. Duane ◽  
Kara Elam ◽  
Kakotan Sanogo ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Phase 1 ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Phase 2 ◽  
Surgical Intensive Care ◽  
Contact Precautions ◽  
Hygiene Compliance ◽  
Device Associated Infection

Objective.To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.Design.Prospective before-after trial.Setting.An 18-bed surgical intensive care unit.Methods.During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistantEnterococcus(VRE) and methicillin-resistantStaphylococcus aureus(MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection andClostridium difficileinfection (CDI) were determined.Results.The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P= .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters;P= .001; after patient care, 63% vs 51% of encounters;P&lt; .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P= .10), 8.9 and 7.8 for urinary tract infection (P= .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P= .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P= .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P= .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P= .16). Hand skin health improved during phase 2.Conclusions.Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

Probabilistic Measurement of Central Line–Associated Bloodstream Infections

2015 ◽  
Vol 37 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Bala Hota ◽  
Paul Malpiedi ◽  
Scott K. Fridkin ◽  
John Martin ◽  
William Trick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Probabilistic Method ◽  
Bloodstream Infections ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Equal Distribution ◽  
Final Model ◽  
C Statistic

OBJECTIVETo develop a probabilistic method for measuring central line–associated bloodstream infection (CLABSI) rates that reduces the variability associated with traditional, manual methods of applying CLABSI surveillance definitions.DESIGNMulticenter retrospective cohort study of bacteremia episodes among patients hospitalized in adult patient-care units; the study evaluated presence of CLABSI.SETTINGHospitals that used SafetySurveillor software system (Premier) and who also reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).PATIENTSPatients were identified from a stratified sample from all eligible blood culture isolates from all eligible hospital units to generate a final set with an equal distribution (ie, 20%) from each unit type. Units were divided a priori into 5 major groups: medical intensive care unit, surgical intensive care unit, medical-surgical intensive care unit, hematology unit, or general medical wards.INTERVENTIONSEpisodes were reviewed by 2 experts, and a selection of discordant reviews were re-reviewed. Data were joined with NHSN data for hospitals for in-plan months. A predictive model was created; model performance was assessed using the c statistic in a validation set and comparison with NHSN reported rates for in-plan months.RESULTSA final model was created with predictors of CLABSI. The c statistic for the final model was 0.75 (0.68–0.80). Rates from regression modeling correlated better with expert review than NHSN-reported rates.CONCLUSIONSThe use of a regression model based on the clinical characteristics of the bacteremia outperformed traditional infection preventionist surveillance compared with an expert-derived reference standard.Infect. Control Hosp. Epidemiol. 2016;37(2):149–155

Quality Improvement in the Surgical Intensive Care Unit

2015 ◽  
Author(s):  
Mark R. Hemmila ◽  
Wendy L Wahl
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Propensity Score Analysis ◽  
Scoring Systems ◽  
Quality Improvement Program ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Improvement Program ◽  
Vte Prophylaxis

Programs to support clinical benchmarking of surgical outcomes have grown dramatically over the past decade. Selection of an appropriate project and preplanning with regard to strategy are often more important than management skill alone when undertaking and performing successful quality improvement in the intensive care unit (ICU) setting. This review covers an overview of a medical and surgical quality system, development of an ICU quality improvement program, scoring systems: risk assessment, evidence-based medicine and protocols, and a quality improvement framework. Figures show structure of the ICU quality improvement team, the C-index statistic reflecting the ability of a model to predict which patients will have the outcome of interest, a Shewhart statistical process control chart, venous thromboembolism (VTE) events by report number, and changes in the type of VTE prophylaxis agent administered over time.  Tables list Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored, registry-based collaborative quality initiatives, critical care societies’ collaborative-based quality improvement task force priorities for performance measurement, possible ICU quality measures, predictive scoring systems, and multivariate and propensity score analysis of the Michigan Trauma Quality Improvement Program pilot data for VTE events and type of VTE prophylaxis.   This review contains 5 highly rendered figures, 5 tables, and 59 references

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