scholarly journals Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-ResistantStaphylococcus aureusColonization at the Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (2) ◽  
pp. 161-170 ◽  
Author(s):  
James A. McKinnell ◽  
Susan S. Huang ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Loren G. Miller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Weighted Average ◽  
Icu Admission ◽  
High Prevalence ◽  
Healthcare Associated ◽  
Low Prevalence ◽  
The Impact ◽  
Mrsa Colonization

Objective.Methicillin-resistantStaphylococcus aureus(MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.Design.We searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.Results.We reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis (n= 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%–69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%–86%) and low-prevalence (weighted average, 50%; range, 0%–150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.Conclusions.Extranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.

scholarly journals A Systematic Literature Review and Meta-Analysis of Factors Associated with Methicillin-ResistantStaphylococcus aureusColonization at Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (10) ◽  
pp. 1077-1086 ◽  
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Susan S. Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Hospital Admission ◽  
Systematic Evaluation ◽  
Factors Associated ◽  
Icu Admission ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Screening for methicillin-resistantStaphylococcus aureus(MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.Design.We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.Results.We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n= 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3–4.7];P<.01), nursing home exposure (OR, 3.8 [95% CI, 2.3–6.3];P< .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2–15.1];Clostridium difficileinfection: OR, 3.4 [95% CI, 2.2–5.3]; vancomycin-resistantEnterococcicarriage: OR, 3.1 [95% CI, 2.5–4.0];P< .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure;P< .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6–1.8];P= .87).Conclusions.MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.

scholarly journals A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Stefanie Kampmeier ◽  
Hauke Tönnies ◽  
Carlos L. Correa-Martinez ◽  
Alexander Mellmann ◽  
Vera Schwierzeck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Control Measures ◽  
Whole Genome Sequence ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

scholarly journals The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

2019 ◽  
Vol 9 (9) ◽  
pp. 104
Author(s):  
Fabiola Alves Gomes ◽  
Denise Von Dolinger de Brito Röder ◽  
Thúlio Marquez Cunha ◽  
Rosângela De Oliveira Felice ◽  
Guilherme Silva Mendonça ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Costs ◽  
University Hospital ◽  
Nursing Workload ◽  
Ventilator Associated Pneumonia ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Stay Time ◽  
The Impact

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

Evaluation of the Impact of Prior-to-Admission Sleep Aid Prescribing Practices on Sleep and Delirium in the Intensive Care Unit

2021 ◽  
pp. 106002802110426
Author(s):  
Melissa Chudow ◽  
Vittorio Paradiso ◽  
Nicole Silva ◽  
Jillian Collette
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Icu Admission ◽  
Icu Length Of Stay ◽  
The Impact ◽  
Time Point ◽  
Similar Incidence

Background: Sleep disruptions in the intensive care unit (ICU) may lead to complications such as delirium. There is limited evidence addressing how sleep aid use before and during ICU admission affects outcomes. Objective: The purpose of this study is to evaluate the impact of prior-to-admission sleep aid prescribing practices in the ICU on delirium and sleep outcomes. Methods: A retrospective review was conducted of adult patients admitted to any ICU from January to June 2018 receiving a sleep aid prior to admission. Patients were categorized based on sleep aid continuation, discontinuation, or alteration during the ICU admission. The primary end point was the incidence of delirium. Secondary end points included the incidence of sleep-wake cycle disturbances, delirium scores, and ICU length of stay. Results: A total of 291 patients were included with 109 in the continued group, 121 in the discontinued group, and 61 in the altered group. There was a similar incidence of delirium at 24 hours ( P = 0.71), 48 hours ( P = 0.60), 72 hours ( P = 0.25), and 5 days ( P = 0.48) after ICU admission. There was also no statistical difference in sleep-wake cycle disturbances or delirium scores at any time point. ICU length of stay was similar between the groups. Conclusion and Relevance: The incidence of delirium and sleep-wake cycle disturbances was not affected by differences in prior-to-admission sleep aid prescribing patterns during ICU admission.

Use of Active Surveillance Cultures to Detect Asymptomatic Colonization With Carbapenem-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients

2008 ◽  
Vol 29 (10) ◽  
pp. 966-968 ◽  
Author(s):  
David Calfee ◽  
Stephen G. Jenkins
Keyword(s):  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Active Surveillance ◽  
Invasive Infection ◽  
Subsequent Infection ◽  
Carbapenem Resistant ◽  
Healthcare Associated ◽  
The Impact

Carbapenem-resistant Klebsiella pneumoniae is emerging as a significant healthcare-associated pathogen. Clinical cultures detect only a fraction of the colonized population, and patients with asymptomatic colonization are at risk of invasive infection. Additional study of the impact of detection of asymptomatic colonization on subsequent infection and transmission is needed.

A Decision and Cost-Effectiveness Analysis of Healthcare-Associated Intensive Care Unit Infection Prevention Strategies

2014 ◽  
Vol 186 (2) ◽  
pp. 495
Author(s):  
C.A. Guidry ◽  
G.J. Stukenborg ◽  
S.W. Davies ◽  
D.F. Volles ◽  
Z.C. Dietch ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Infection Prevention ◽  
Cost Effectiveness Analysis ◽  
Prevention Strategies ◽  
Effectiveness Analysis ◽  
Healthcare Associated

Value of Performing Active Surveillance Cultures on Intensive Care Unit Discharge for Detection of Methicillin-ResistantStaphylococcus aureus

2007 ◽  
Vol 28 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Jon P. Furuno ◽  
Anthony D. Harris ◽  
Marc-Oliver Wright ◽  
David M. Hartley ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Active Surveillance ◽  
Tertiary Care ◽  
Large Percentage ◽  
Care Hospital ◽  
Icu Admission ◽  
Surveillance Cultures ◽  
Icu Discharge ◽  
Mrsa Colonization

Objective.To quantify the value of performing active surveillance cultures for detection of methicillin-resistantStaphylococcus aureus(MRSA) on intensive care unit (ICU) discharge.Design.Prospective cohort study.Setting.Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.Participants.We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.Results.Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.Conclusions.Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.

Intensive Care Unit prioritization: The impact of ICU bed availability on mortality in critically ill patients who requested ICU admission in court in a Brazilian cohort

2021 ◽  
Vol 66 ◽  
pp. 126-131
Author(s):  
Ana Cristina Santos ◽  
Simone Luzia Fidelis de Oliveira ◽  
Virgílio Luiz Marques Macedo ◽  
Paula Lauane Araujo ◽  
Francine Salapata Fraiberg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Icu Admission ◽  
The Impact ◽  
Brazilian Cohort

scholarly journals Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Theresa Rowe ◽  
Katy L. B. Araujo ◽  
Peter H. Van Ness ◽  
Margaret A. Pisani ◽  
Manisha Juthani-Mehta
Keyword(s):  
Older Adults ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Icu Admission ◽  
Baseline Characteristics ◽  
The Impact

Abstract Background.  Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods.  We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results.  Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P &lt; .001) and 117 (60%) vs 48 (42%) died within 1 year (P &lt; .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28–2.52; P &lt; .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87–1.84; P = .22). Conclusions.  The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced.

scholarly journals P0562DIFFERENT POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI WHEN USING AUTOMATED DECISION SUPPORT: IMPACT ON ASSOCIATED MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wim Van Biesen ◽  
Johan Steen ◽  
Johan Decruyenaere ◽  
Dominique Benoit ◽  
Eric Adriaan J Hoste ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Mortality Risk ◽  
Sofa Score ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Icu Admission ◽  
Definition Of ◽  
The Impact

Abstract Background and Aims The reported associated mortality risks of Acute Kidney Injury (AKI) in the intensive care unit (ICU) are variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of the definition, there is remaining variability in the actual implementation of this AKI definition, with variable use of the urinary output (UO) criterion, and different interpretations of the baseline serum creatinine (Screa). This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the associated ICU mortality risk of AKI stage 2 in the ICU. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all Screa data up to 1 year before ICU admission were retrieved from a dataset external to ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we either used a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we used either (in line with K-DIGO stage 2) a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Definition 8 and 9 identified patients who complied with at least one out of the Screa criteria 1-5 (def 8) or out of the UO criteria (def 9). Definition 10 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset comprised 16433 admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died in Intensive Care Unit (ICU). The SOFA score at admission was 6.9±4.1. The mortality risk associated with AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria (table). Most important, associated mortality risk was comparable whether a UO (RR 2.31, 95% CI 1.90-2.81) or a Screa (RR 2.00, 95% CI 1.57-2.55) criterium was used, and was highest in patients who complied with both at least one UO and one Screa criterium (RR 7.28, 95% CI 6.12-8.65). Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in AKI associated mortality risk. Omitting the UO criterium leads to substantial underestimation of associated risk.

Sign in / Sign up

Export Citation Format

Share Document