Effectiveness of a vancomycin dosing protocol guided by area under the concentration-time curve to minimal inhibitory concentration (AUC/MIC) with multidisciplinary team support to improve hospital-wide adherence to a vancomycin dosing protocol: A pilot study

2021 ◽  
pp. 1-6
Author(s):  
Panipak Katawethiwong ◽  
Anucha Apisarnthanarak ◽  
Kittiya Jantarathaneewat ◽  
David J. Weber ◽  
David K. Warren ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Multidisciplinary Team ◽  
Kidney Injury ◽  
University Hospital ◽  
Routine Practice ◽  
Post Intervention ◽  
Coagulase Negative Staphylococci ◽  
Time Curve ◽  
Concentration Time ◽  
Quasi Experimental

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

scholarly journals Maternity Nurses’ Performance Regarding Management of the Intrapartum Woman With Cardiac Disease

2018 ◽  
Vol 3 (3) ◽  
pp. 60
Author(s):  
Eman Mohammed Abd-Elhakam ◽  
Amira Mohammed Salama
Keyword(s):  
Nursing Care ◽  
Cardiac Disease ◽  
Statistical Significance ◽  
Neonatal Morbidity ◽  
University Hospital ◽  
Cardiac Diseases ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Knowledge And Practice ◽  
Nurses Knowledge

Background: Cardiac disease in pregnancy is a leading cause of maternal and neonatal morbidity and mortality. Effective management is based upon close fetal and maternal monitoring during pregnancy and labour. The aim of the present study was to evaluate maternity nurses’ performance regarding management of intrapartum woman with cardiac disease. Research design: A quasi-experimental design was utilized to fulfil the aim of the study. Sample: A convenient sample of a total 64 maternity nurses was included in the present study. Setting: The present study was conducted in Obstetrical and Gynecological Department at Benha University Hospital. Tools: Two tools were utilized for data collection. I-A structured interviewing questionnaire which include two parts; Part 1: Socio demographic characteristics. Part2: Assessment of nurses’ knowledge regarding cardiac disease during pregnancy and labour which includes Physiological changes of cardiovascular system during pregnancy. Causes and risk factors, etc. II-Maternity nurses' practice observational checklistwhich focus on management of cardiac women during labor including four stages of labour and Nursing care for moderate and high risk cases immediately after labour. Results: Shows significant improvement in nurses' knowledge 57.8% compared to 90.6% post intervention. Also, improvement is clear in satisfactory level of practice after intervention, in first stage for example was 32.8 % pre intervention compared to 87.5% post intervention. there were highly statistical significance differences between mean score of both knowledge and practice regarding management of intrapartum woman with cardiac diseases between the pre and post intervention phases (p<0.001).Conclusion: the study concluded that research hypotheses are supported and educational intervention had appositive effect on improvement nurses 'knowledge and practice and in turn their performance regarding management of intrapartum woman with cardiac diseases. Recommendation: Periodic educational program for nursing staff in Obstetrics and Gynecology Department regarding nursing care of cardiac patients.

scholarly journals Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wanjak Pongsittisak ◽  
Kashane Phonsawang ◽  
Solos Jaturapisanukul ◽  
Surazee Prommool ◽  
Sathit Kurathong
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Medical Intensive Care Unit ◽  
Kidney Injury ◽  
The Elderly ◽  
University Hospital ◽  
Medical Intensive Care

Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

scholarly journals P1324TARGETING ZERO INFECTIONS IN HEMODIALYSIS PATIENTS. AN EXPERIENCE OF ONLY TWO CATHETER-RELATED BLOODSTREAM INFECTION (CR-BSI) OVER A PERIOD OF 1430 DAYS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Claudio Luders ◽  
Carlucci Gualberto Ventura ◽  
Fabio DiNizo ◽  
Felicio Lopes Roque
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Venous Catheter ◽  
Routine Practice ◽  
Evidence Based ◽  
Intervention Package ◽  
Post Intervention ◽  
Lock Solution ◽  
Quasi Experimental ◽  
Catheter Related Bloodstream Infection

Abstract Background and Aims Patients undergoing hemodialysis (HD) through a tunneled central venous catheter are exposed to several risks. Catheter-related bloodstream infection (CR-BSI) is the second major cause of death in this population. To reduce the incidence of CR-BSI we conducted a non-randomized pre-post intervention study aimed to eliminate all preventable CR-BSI. Method A quasi-experimental study was conducted in an intra-hospital hemodialysis unit with 15 HD machines and attending 70 patients until March 2019, and 24 machines and 90 patients from that date until today. The CDC, CR-BSI criteria for dialysis event surveillance protocol, defined as the presence of a positive blood culture with the suspect source report as the vascular access or uncertain was used to define CR-BSI. A sequential implementation of evidence-based interventions, associated in literature with the reduction of CR-BSI rate, were developed between January 2011 and January 2020. The intervention package included: 1. Alcohol based gel delivery system fixed in every HD machine to enhance hand hygiene adherence 2. A new strict aseptic protocol for connecting/disconnecting HD lines that included: 2.1 Wrapping catheter rubs for 1-2 minutes with alcoholic chlorhexidine-saturated gauze before removal catheters caps 2.2 Nurses and patients wear masks during catheter manipulation 2.3 Apply a sterile fenestrate drape with sterile gloves before removing the caps 2.4 The scrub-the-hub aseptic technic after removing the caps with alcoholic chlorhexidine-saturated gauze 2.5 Precocious use of Tissue Plasminogen Activator (rTPA) to correct inadequate blood flow, avoiding excess of catheter manipulation 3. Use of chlorhexidine-impregnated dressing changed once a week 4. Training all nurse staff admitted, catheter care skill evaluation semiannually, re-training when necessary and monthly infection rate feedback 5. Use of citrate 30% as lock solution. Results During the follow-up period (January 2011 to January 2020) a mean of 45 patients (range 30-55) used tunneled catheter as vascular access each year. The mean age was 69±15 years (range 11-96 years), with 60% of patients been diabetic. After implementation the of the new strategies we observed a continuous reduction in the CR-BSI rate: 2010 the year before strategies implementation CR-BSI rate was 1.1/1000 catheter-days; 2011 CR-BSI rate 0.6/1000 catheter-days; 2012 CR-BSI rate 0.6/1000 catheter-days; 2013 CR-BSI rate 0.1/1000 catheter-days; 2014 CR-BSI rate 0.1/1000 catheter-days; 2015 CR-BSI rate 0.2/1000 catheter-days; 2016 CR-BSI rate 0.2/1000 catheter-days; 2017 CR-BSI rate 0.0/1000 catheter-days, 2018 CR-BSI rate 0.08/1000 catheter-days, and 2019 CR-BSI rate 0.06/1000 catheter-days. Between April 10th of 2016 and January 10th of 2020, a 1430 days period, we observed only 2 CR-BSI. Between April 10th of 2016 and January 3rd of 2018 there was a period of 633 days with no CR-BSI. Conclusion Implementation of several evidence-based practices and continuous education can reduce CR-BSI in HD patients to a very low level. Targeting zero infection proposing to eliminate all preventable infection should be the routine practice of all dialysis units.

scholarly journals 1243. Continuous vs. Intermittent Intraoperative Infusion of Cefazolin on Surgical Site Infections (SSIs) and Acute Kidney Injury in Patients Undergoing Cardiac Procedures

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S447-S448
Author(s):  
Michael Tichy ◽  
Jessica Seidelman ◽  
Sarah S Lewis ◽  
Richard H Drew ◽  
Richard H Drew ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Surgical Site Infections ◽  
Intermittent Infusion ◽  
University Hospital ◽  
Cardiac Procedures ◽  
Cardiac Bypass ◽  
Quasi Experimental ◽  
Duke University

Abstract Background Continuous infusion cefazolin (CI) has been investigated as a means to optimize antibiotic exposure for prophylaxis against SSI, notably in patients undergoing cardiac procedures involving cardiac bypass (CPB). However, data are limited on its impact on late SSIs and adverse events. In 6/16, the Duke University Hospital (DUH) Antimicrobial Stewardship Team implemented a program to promote CI. We compared the incidence of culture-confirmed SSIs through postoperative day 90 (POD90) between patients receiving either intermittent infusion cefazolin (INT) or CI intraoperatively. We also compared the rate of acute kidney injury (AKI) between groups. Methods This retrospective quasi-experimental design included adult and pediatric patients undergoing cardiac surgery at DUH between March 2014 and August 2018 and receiving intraoperative cefazolin (alone or in combination with other antibiotics). Patients were categorized as CI (having received at least 1 intraoperative CI infusion) or INT. Culture-confirmed SSIs utilizing NHSN definitions were recorded and a relative risk (RR) determined. AKI was defined as a ≥0.3 mg/dL rise in serum creatinine within 2 days postoperatively. Results A total of 2,172 unique surgical procedures (from 2,143 unique patients) were included. Comparisons of groups are summarized in Table 1. Rates of SSIs were 1.1% and 1.6% in the CI and INT groups, respectively (RR [95% confidence interval] for CI 0.73, [0.35, 1.52]). AKI was reported in 12.9% and 17.4% of patients, respectively. Conclusion We were unable to detect a difference in late SSIs between intraoperative CI and INT cefazolin. Differences observed between AKI between groups requires further investigation, but likely impacted by confounders, including pre-existing renal dysfunction. Disclosures All authors: No reported disclosures.

scholarly journals 1989. Impact of Pharmacist-Led β-Lactam Allergy Clarification Interview on Optimizing Preoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S667-S667
Author(s):  
Shaina Kwiatkowski ◽  
Surafel Mulugeta ◽  
Susan L Davis ◽  
Rachel Kenney ◽  
James Kalus ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Kidney Injury ◽  
Surgical Site Infections ◽  
Allergic Reactions ◽  
Post Intervention ◽  
Decision Algorithm ◽  
Allergy Testing ◽  
Clostridioides Difficile ◽  
Quasi Experimental ◽  
Preoperative Antibiotic Prophylaxis

Abstract Background Patients with reported β-lactam allergies (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSI), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview in the preoperative setting. Methods This single-center, IRB-approved, quasi-experimental study compared surgical patients with a BLA between November 2017 and March 2018 (pre-intervention) vs. November 2018 and March2019. From November 2018 to March 2019, a pharmacist performed BLA clarification phone interviews for patients scheduled for a surgical procedure. Based on the allergy history and decision algorithm, first-line antibiotics, alternative antibiotics, or an allergy testing referral were recommended and documented in the EHR. The allergy label was updated as well. The primary outcome was the use of β-lactams preoperatively. Secondary outcomes included 30-day SSI and CDI, AKI, allergic reactions, allergy labels updated or removed, time to incision, and vancomycin doses administered. Results 87 patients were included in the study; 50 (57%) and 37 (43%) in the pre- and post-group, respectively. Most common surgeries: orthopedic 41 (47%), neurosurgery 17 (20%). In the post-group, all EHR BLA labels were updated after interview. 23 patients were referred for allergy testing, 12 (52%) completed BLA testing, and 7 BLA allergies were removed. 76% of pharmacy antibiotic recommendations were accepted (figure). Cefazolin use significantly increased from 28% to 65% post-intervention, P = 0.001; vancomycin use also increased from 19 (38%) to 22 (59%), P = 0.047. Time to incision decreased by a median of 8 minutes (P = 0.484). SSI occurred in 5 (10%) patients in the pre-group only, P = 0.051. All of these were associated with alternative antibiotics. Incidence of AKI and CDI were similar between the groups (P > 0.05). No allergic reactions occurred in either group. Conclusion Clarifying reported BLA in the perioperative setting significantly increased β-lactam preoperative use without negative clinical sequelae. Disclosures All authors: No reported disclosures.

scholarly journals The Effect of Simulation-Based Educational Program on Maternity Nurses' Performance regarding Obstetrical Emergencies during Pregnancy

2020 ◽  
Vol 2 (4) ◽  
pp. 14
Author(s):  
Amal T. A. El Sharkawy ◽  
Fatma K. Ali ◽  
Ola A. A. Araby
Keyword(s):  
Nursing Education ◽  
Educational Program ◽  
Clinical Skills ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Post Intervention ◽  
Educational Approach ◽  
Simulation Based ◽  
Quasi Experimental

Context: Simulation-based nursing education is an increasingly and wide-spread preferred educational approach. It offers opportunities to acquire clinical skills and decision-making through various situational experiences. Aim: The research aimed to investigate the effect of simulation-based educational program on maternity nurses' performance regarding obstetrical emergencies during pregnancy. Methods: A quasi-experimental research (one group pre/post-test) design was adopted to fulfill the research aim. This research was conducted at the Clinical Obstetrics' Skill lab of the Faculty of Nursing, Benha University. Forty nurses were recruited (all nurses working at obstetrics and gynecology emergency department of Benha University Hospital at the time of collecting data). Three tools were used for data collection; a structured self-administered questionnaire, maternity nurses' attitude assessment scale, and maternity nurses' practices observational checklist. Results: showed a highly statistically significant improvement concerning maternity nurses' knowledge, attitude, and practices regarding obstetrical emergencies during pregnancy, immediate post-intervention, and at follow up phase compared to the pre-intervention phase (P ≤ 0.001). There was a positive, highly statistically significant correlation between total knowledge and total attitude and total practice scores at pre-intervention, immediate post-intervention, and at follow up phases (P ≤ 0.001).    Conclusion: The simulation-based educational program positively affected maternity nurses' performance regarding obstetrical emergencies during pregnancy. Simulation-based education regarding obstetrical emergencies during pregnancy is recommended for all nurses working at obstetrics and gynecology units.

scholarly journals Effect of Health Educational Program on Knowledge, Attitude, and Reaction of Pregnant Women Regarding Obstetric and Newborn Danger Signs

2020 ◽  
Vol 2 (4) ◽  
pp. 14
Author(s):  
Somaya O. Abd Elmoniem ◽  
Elham A. Ramadan ◽  
Ahlam E. M. Sarhan
Keyword(s):  
Pregnant Women ◽  
Educational Program ◽  
Positive Attitude ◽  
Negative Attitude ◽  
University Hospital ◽  
Post Intervention ◽  
Neonatal Deaths ◽  
Danger Signs ◽  
Significant Difference ◽  
Quasi Experimental

Context: Globally, every minute, at least one pregnant woman dies from obstetric complications.  Also, the majority of neonatal deaths occur during the first week of life. These mortality rates can be reduced by increased knowledge, positive attitude, and appropriate reaction regarding obstetric and newborn danger signs. Aim: of the study was to examine the effect of health education program on knowledge, attitude, and the reaction of pregnant women regarding obstetric and newborn danger signs. Methods: A quasi-experimental research (pre/post-intervention) design was utilized to achieve this study's aim. A purposive sample of 70 pregnant women was recruited according to inclusion criteria. This research was conducted in the Antenatal Outpatient Clinic at Benha University Hospital. Two tools were used for data collection. They were a Structured Interviewing Questionnaire and a Modified Likert Scale to assess women's attitude. Results: 77.1% had poor knowledge pre educational program compared by 92.9% post educational program intervention. Regarding attitude, 52.9% had a negative attitude preprogram compared to 87.1% had a positive attitude post-program with a statistically significant difference between the two phases regarding all knowledge elements. The majority of them (83.3%) had an appropriate reaction (seeking medical help) after the educational program than a few of them pre educational program. Conclusion: The implementation educational program significantly improved pregnant women’s knowledge, attitude, and reaction regarding obstetrics and newborn danger signs. The study recommended developing antenatal classes for all pregnant women about key danger signs, appropriate decisions, and reactions in obstetric and newborn danger signs. Further research regarding replicating this study on a large representative probability sample is highly recommended to achieve more generalization of the results.

scholarly journals Educational Workshop using games improves self-monitoring of blood glucose among children

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Léia Alves Kaneto ◽  
Elaine Buchhorn Cintra Damião ◽  
Maria de La Ó Ramallo Verissimo ◽  
Lisabelle Mariano Rossato ◽  
Aurea Tamami Minagawa Toriyama ◽  
...  
Keyword(s):  
Blood Glucose ◽  
School Children ◽  
Statistical Tests ◽  
University Hospital ◽  
Systematic Observation ◽  
Hospital Data ◽  
Post Intervention ◽  
Self Monitoring ◽  
Quasi Experimental ◽  
Educational Workshop

ABSTRACT Objective: to evaluate the effectiveness of an educational workshop using games to improve self-monitoring of blood glucose techniques for school children with type 1 diabetes. Method: a quasi-experimental study was conducted with school children who attended two outpatient clinics of a university hospital. Data were collected by systematic observation of the self-monitoring of blood glucose (SMBG) technique before and after the intervention. Data analysis consisted of verifying changes while performing the technique, using pre- and post-intervention compliance rates using statistical tests. The sample consisted of 33 children. Each child participated in one session; 17 educational workshops were conducted in total. Results: we found an increased frequency of SMBG, changing lancets, rotation of puncture sites, as well as calibration and periodic checking of date and time of the glucose meter. Comparisons pre- and post-intervention showed that the average number of steps in accordance with the SMBG technique increased from 5.30 to 6.58, whereas the steps “Changing the lancet of the lancing device”, “Pressing the puncture site” and “Disposing of materials used in a needlestick container” showed statistically significant differences. Conclusion: the educational workshop was effective, as it improved children’s performance of the SBMG technique.

scholarly journals Evaluation of Dose-Fractionated Polymyxin B on Acute Kidney Injury Using a Translational In Vivo Rat Model

2020 ◽  
Vol 64 (5) ◽  
Author(s):  
Jiajun Liu ◽  
Gwendolyn M. Pais ◽  
Sean N. Avedissian ◽  
Annette Gilchrist ◽  
Andrew Lee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Rat Model ◽  
Kidney Injury ◽  
Compartment Model ◽  
Polymyxin B ◽  
Time Curve ◽  
Daily Group ◽  
Concentration Time ◽  
Three Compartment Model

ABSTRACT We investigated dose-fractionated polymyxin B (PB) on acute kidney injury (AKI). PB at 12 mg of drug/kg of body weight per day (once, twice, and thrice daily) was administered in rats over 72 h. The thrice-daily group demonstrated the highest KIM-1 increase (P = 0.018) versus that of the controls (P = 0.99) and histopathological damage (P = 0.013). A three-compartment model best described the data (bias, 0.129 mg/liter; imprecision, 0.729 mg2/liter2; R2, 0.652,). Area under the concentration-time curve at 24 h (AUC24) values were similar (P = 0.87). The thrice-daily dosing scheme resulted in the most PB-associated AKI in a rat model.

Sign in / Sign up

Export Citation Format

Share Document