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.

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 1099. The Correlation Between Antimicrobial Utilization and Resistance in a Medical Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S390-S391
Author(s):  
John W Ahern ◽  
Lindsay Smith ◽  
W Kemper Alston
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Resistance Index ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Antimicrobial Utilization ◽  
Multidrug Resistant Organisms ◽  
Medical Intensive Care ◽  
The Relationship

Abstract Background The relationship between antimicrobial utilization and the incidence of antimicrobial-resistant pathogens can be obscured by a lack of longitudinal data. We used 9 years of antimicrobial utilization data combined with a unique metric of antimicrobial resistance to examine this relationship. Methods The medical intensive care unit (MICU) at UVMMC has 22 beds. The unit’s size and location did not change during the study. Since 2010, defined daily doses (DDD) in the MICU for ceftazidime, ceftriaxone, cefepime, ciprofloxacin, levofloxacin, piperacillin–tazobactam, meropenem, and vancomycin were measured. Concurrently, a database of positive cultures acquired in MICU, whether colonization or infection, was built for 6 selected organisms: Clostridioides difficile, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, ceftazidime-resistant Gram-negative bacilli, fluoroquinolone-resistant Pseudomonas aeruginosa (QRPA), and Stenotrophomonas maltophilia. The occurrence of these 6 organisms/1,000 patient-days is termed “resistance index.” Data for both metrics were collected in the same way, by the same person, throughout. The relationship between these 2 measures was analyzed with simple linear regression. Results From 2010 to 2018, the use of 8 broad-spectrum antibiotics fell in a linear fashion from 12.11 to 4.39 DDD/100,000 patient-days. The resistance index for the 6 multidrug-resistant organisms in MICU also fell in parallel from 6.5 to 1.5/1,000 patient-days (figure, r = 0.9, P = 0.001). For the 2 quinolones specifically, use fell from 2.26 to 0.18 DDD/100,000 patient-days, while the occurrence of QRPA fell from 1.5 to 0/1,000 patient-days (figure, r = 0.84, P = 0.004). Conclusion These longitudinal data, collected consistently over 9 years, clearly demonstrate a significant correlation between broad-spectrum antibiotic use and the occurrence of multidrug-resistant organisms in a MICU. A steep, linear decline in antibiotic use was correlated with a parallel fall in these 6 organisms. These data demonstrate that sustained, meaningful reductions in antimicrobial utilization in a MICU can result in significant reductions in the incidence of antimicrobial-resistant pathogens. Disclosures All authors: No reported disclosures.

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.

Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review

2016 ◽  
Vol 38 (2) ◽  
pp. 189-195 ◽  
Author(s):  
John M. Boyce ◽  
Philip M. Polgreen ◽  
Mauricio Monsalve ◽  
David R. Macinga ◽  
James W. Arbogast
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Review Of Literature ◽  
Frequent Use ◽  
Frequency Of Use ◽  
The Us ◽  
Medical Intensive Care ◽  
Hygiene Compliance ◽  
Individual Healthcare

BACKGROUNDRecently, the US Food and Drug Administration requested that a “maximal use” trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers.OBJECTIVETo establish how frequently volunteers should be exposed to ABHR during a maximal use trial.DESIGNRetrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems.METHODSWe reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour.RESULTSOf 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour.CONCLUSIONSHand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial.Infect Control Hosp Epidemiol 2017;38:189–195

scholarly journals The Timing of Family Meetings in the Medical Intensive Care Unit

2019 ◽  
Vol 36 (12) ◽  
pp. 1049-1056 ◽  
Author(s):  
Gina M. Piscitello ◽  
William M. Parham ◽  
Michael T. Huber ◽  
Mark Siegler ◽  
William F. Parker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Death ◽  
Family Meeting ◽  
Family Meetings ◽  
Medical Intensive Care

Purpose: Family meetings in the medical intensive care unit can improve outcomes. Little is known about when meetings occur in practice. We aimed to determine the time from admission to family meetings in the medical intensive care unit and assess the relationship of meetings with mortality. Methods: We performed a prospective cohort study of critically ill adult patients admitted to the medical intensive care unit at an urban academic medical center. Using manual chart review, the primary outcome was any attempt at holding a family meeting within 72 hours of admission. Competing risk models estimated the time from admission to family meeting and to patient death or discharge. Results: Of the 131 patients who met inclusion criteria in the 12-month study period, the median time from admission to family meeting was 4 days. Fewer than half of patients had a documented family meeting within 72 hours of admission (n = 60/131, 46%), with substantial interphysician variability in meeting rates ranging from 28% to 63%. Patients with family meetings within 72 hours were 30 times more likely to die within 72 hours (32% vs 1%, P < .001). Of the 55 patients who died in the intensive care unit, 27 (49%) had their first family meeting within 1 day of death. Conclusions: Family meetings occur considerably later than 72 hours and are often held in close proximity to a patient’s death. This suggests for some physicians, family meetings may primarily be used to negotiate withdrawal of life support rather than to support the patient and family.

Risk of Hand or Glove Contamination After Contact With Patients Colonized With Vancomycin-ResistantEnterococcusor the Colonized Patients' Environment

2008 ◽  
Vol 29 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Mary K. Hayden ◽  
Donald W. Blom ◽  
Elizabeth A. Lyle ◽  
Charity G. Moore ◽  
Robert A. Weinstein
Keyword(s):  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Routine Care ◽  
Intact Skin ◽  
Vancomycin Resistant Enterococci ◽  
After Care ◽  
Before And After ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

Objective.To estimate the level of hand or glove contamination with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) who touch a patient colonized with VRE and/or the colonized patient's environment during routine care.Design.Structured observational study.Setting.Medical intensive care unit of a 700-bed, tertiary-care teaching hospital.Participants.VRE-colonized patients and their caregivers.Methods.We obtained samples from sites on the intact skin of 22 patients colonized with VRE and samples from sites in the patients' rooms, before and after routine care, during 27 monitoring episodes. A total of 98 unique HCWs were observed during 131 HCW observations. Observers recorded the sites touched by HCWs. Culture samples were obtained from HCWs' hands and gloves before and after care.Results.VRE were isolated from a mean (±SD) of 55% ± 24% of patient sites (n= 256) and 17% ± 12% of environmental sites (n= 1,572). Most HCWs (131 [56%]) touched both the patient and the patient's environment; no HCW touched only the patient. Of 103 HCWs whose hand samples were negative for VRE when they entered the room, 52% contaminated their hands or gloves after touching the environment, and 70% contaminated their hands or gloves after touching the patient and the environment (P= .101). In a univariate logistic regression model, the risk of hand or glove contamination was associated with the number of contacts made (odds ratio, 1.1 [95% confidence interval, 1.01-1.19). In a multivariate model, the effect of the number of contacts could not be distinguished from the effect of type of contact (ie, touching the environment alone or touching both the patient and the environment). Overall, 37% of HCWs who did not wear gloves contaminated their hands, and 5% of HCWs who wore gloves did so (an 86% difference).Conclusion.HCWs were nearly as likely to have contaminated their hands or gloves after touching the environment in a room occupied by a patient colonized by VRE as after touching the colonized patient and the patient's environment. Gloves were highly protective with respect to hand contamination.

Efficacy and Outcomes After Vasopressin Guideline Implementation in Septic Shock

2016 ◽  
Vol 51 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Janet Y. Wu ◽  
Joanna L. Stollings ◽  
Arthur P. Wheeler ◽  
Matthew W. Semler ◽  
Todd W. Rice
Keyword(s):  
Septic Shock ◽  
Medical Intensive Care Unit ◽  
Medical Center ◽  
Guideline Implementation ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Severity Of Illness ◽  
Medical Intensive Care ◽  
Vanderbilt University ◽  
Goal Map

Background: In septic shock, the dose of norepinephrine (NE) at which vasopressin (AVP) should be added is unknown. Following an increase in AVP price, our medical intensive care unit (MICU) revised its vasopressor guidelines to reserve AVP for patients requiring greater than 50 µg/min of NE. Objective: The purpose of this study is to compare efficacy and safety outcomes for patients admitted before the guideline revision with those for patients admitted after the revision. Methods: This was a single-center, retrospective cohort study of patients admitted to Vanderbilt University Medical Center from November 1, 2014, to November 30, 2015. Before June 1, 2015, the vasopressor guidelines recommended initiation of AVP for patients requiring 10 µg/min of NE or greater. After June 1, 2015, the guidelines recommended initiation of AVP at a NE dose of 50 µg/min or greater. Results: Time to achieve goal mean arterial pressure (MAP) was shorter in the postintervention group (2.0 vs 1.3 hours; P = 0.03) in univariate analysis but not after adjusting for prespecified confounders. Incidence of new arrhythmias was similar between the 2 groups (14.9% vs 10.9%; P = 0.567). In multivariable analysis accounting for baseline severity of illness, admission after the revision was associated with decreased 28-day mortality (odds ratio = 0.34; 95% CI = 0.16-0.71; P = 0.004). Conclusions: Use of a vasopressor guideline restricting AVP initiation in septic patients to those on at least 50 µg/min of NE appeared to be safe and did not affect the time to reach goal MAP.

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