Effectiveness of Routine Patient Cleansing with Chlorhexidine Gluconate for Infection Prevention in the Medical Intensive Care Unit

2009 ◽  
Vol 30 (10) ◽  
pp. 959-963 ◽  
Author(s):  
Kyle J. Popovich ◽  
Bala Hota ◽  
Robert Hayes ◽  
Robert A. Weinstein ◽  
Mary K. Hayden
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Real World ◽  
Medical Center ◽  
Venous Catheter ◽  
Chlorhexidine Gluconate ◽  
Management Decision ◽  
Beneficial Effects ◽  
Infection Control Practitioner ◽  
Medical Intensive Care

Background.Controlled studies that took place in medical intensive care units (MICUs) have demonstrated that bathing patients with Chlorhexidine gluconate (CHG) can reduce skin colonization with potential pathogens and can lessen the risk of central venous catheter (CVC)-associated bloodstream infection (BSI).Objective.TO examine, without oversight of practice by research study staff, the effectiveness or real-world effect of patient cleansing with CHG on rates of CVC-associated BSI.Design.In the fall of 2005, the MICU at Rush University Medical Center discontinued bathing patients daily with soap and water and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was a clinical management decision without research input.Setting.A 21-bed MICU at Rush University Medical Center.Patients.Patients hospitalized in the MICU during the period from September 2004 through October 2006.Methods.In a pre-post study design, we gathered data from administrative and laboratory databases, infection control practitioner logs, and patient medical charts to compare rates of CVC-associated BSI and blood culture contamination between the baseline soap-and-water bathing period (September 2004-October 2005) and the CHG bathing period (November 2005-October 2006). Rates of secondary BSI, Clostridium difficile infection (CDI), ventilator-associated pneumonia (VAP), and urinary tract infection (UTI) served as control variables that were not expected to be affected by CHG bathing.Results.Bathing with CHG was associated with a statistically significant decrease in the rate of CVC-associated BSI (from 5.31 to 0.69 cases per 1,000 CVC-days; P = .006) and in the rate of blood culture contamination (from 6.99 to 4.1 cases per 1,000 patient-days; P = .04). Rates of secondary BSI, CDI, VAP, and UTI did not change significantly.Conclusions.In our analysis of real-world practice, daily bathing of MICU patients with CHG was effective at reducing rates of CVC-associated BSI and blood culture contamination. Controlled studies are needed to determine whether these beneficial effects extend outside the MICU.

Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Caroline Ong ◽  
Albert Lui ◽  
John A Dodson ◽  
Jordan B Strom ◽  
Carlos Alviar
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Older Age ◽  
Icu Mortality ◽  
Differential Outcomes ◽  
Medical Intensive Care ◽  
Cardiac Intensive Care

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

A Prediction Rule For Mortality in the Medical Intensive Care Unit Based on Early Acute Organ-System Failure

1994 ◽  
Vol 9 (4) ◽  
pp. 172-178 ◽  
Author(s):  
Victor Gordan ◽  
Roger K. Pitman ◽  
Thérese A. Stukel ◽  
Daniel Teres ◽  
Edward Gillie
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Prediction Rule ◽  
Organ System ◽  
System Failure ◽  
Classification Rate ◽  
Organ System Failure ◽  
Medical Intensive Care

We evaluated early acute organ-system failure (AOSF) as a predictor of mortality in medical intensive care unit (MICU) patients. Prospective data were obtained on 825 men admitted to a Veterans Administraion (VA) Medical Center MICU. Clinical criteria were used to diagnose the presence of 7 types of AOSF. Of the 2,364 AOSFs detected, 1,847 (78%) were “early” (i.e., detected within the first 48 hours of MICU stay). A random sample of 550 patients was selected for derivation of a prediction rule for MICU mortality based on age and number of early AOSFs. For each additional early AOSF, the adjusted odds of mortality increased by 3.3 (95% confidence interval: 2.7, 4.0; p < 0.0001). When applied to the cross-validation sample of 275 patients, this rule yielded a sensitivity of 77%, a specificity of 86%, and an overall correct classification rate of 82%. These results suggest that a simple rule based on number of AOSFs detected in the early portion of a patient's MICU stay may be a useful predictor of mortality.

scholarly journals The Potential for Arrhythmia during Central Venous Catheter Insertion- to where does the guidewire migrate?

2021 ◽  
Author(s):  
Daphna Reichmann ◽  
Re'em Sadeh ◽  
Ori Galante ◽  
Yaniv Almog ◽  
Victor Novack ◽  
...  
Keyword(s):  
Intensive Care ◽  
Right Ventricle ◽  
Real Time ◽  
Right Atrium ◽  
Medical Center ◽  
Insertion Site ◽  
Vena Cava ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
The Right

Abstract BackgroundCentral Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study1 observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown.ObjectiveIn this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration.DesignThis is a retrospective study of the prospectively and systematically collected data on CVC insertion under real time trans thoracic ultrasound.SettingThe medical Intensive Care Unit in Soroka Medical Center, among patients that have received CVC during the study years 2014–2020.Main outcome measures:The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well.ResultsOne hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC.ConclusionAbout a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.

scholarly journals Relationship between Chlorhexidine Gluconate Skin Concentration and Microbial Density on the Skin of Critically Ill Patients Bathed Daily with Chlorhexidine Gluconate

2012 ◽  
Vol 33 (9) ◽  
pp. 889-896 ◽  
Author(s):  
Kyle J. Popovich ◽  
Rosie Lyles ◽  
Robert Hayes ◽  
Bala Hota ◽  
William Trick ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Chlorhexidine Gluconate ◽  
Gram Positive ◽  
Microbial Density ◽  
Medical Intensive Care ◽  
Skin Cleansing ◽  
The Relationship

Objective and Design.Previous work has shown that daily skin cleansing with Chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.Patients and Setting.MICU patients at Rush University Medical Center.Methods.CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.Results.For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0–18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log10CFUs;P= .014). CHG concentration increased postbath and decreased over 24 hours (P< .001). In parallel, median log10CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 (P= .001). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs (P= .004). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.Conclusion.In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.

Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination

2002 ◽  
Vol 23 (7) ◽  
pp. 397-401 ◽  
Author(s):  
Barbara W. Trautner ◽  
Jill E. Clarridge ◽  
Rabih O. Darouiche
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Isopropyl Alcohol ◽  
Tertiary Care ◽  
Chlorhexidine Gluconate ◽  
The Other ◽  
Contamination Rate ◽  
Skin Preparation ◽  
Skin Antisepsis

Objective:Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.Design:Prospective, blinded clinical trial.Setting:Tertiary-care teaching hospital.Patients:Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.Interventions:House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.Results:Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%;P= .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.Conclusions:Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.

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