807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S241-S242
Author(s):  
Sydney Mullins ◽  
Sarah Bernardy ◽  
Marianne MacLachlan ◽  
Maureen Evans ◽  
Anna Olszewski ◽  
...  
Keyword(s):  
Wound Care ◽  
Central Line ◽  
Small Sample ◽  
Care Process ◽  
Care Bundle ◽  
Evidence Based ◽  
Burn Center ◽  
Significant Difference ◽  
Hospital Acquired ◽  
Clabsi Rate

Abstract Introduction Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections. Methods A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year. Results Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups. Conclusions Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences. Applicability of Research to Practice Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

35 Wound Improvement Project: Improving Skill Sustainment and Confidence

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S24-S25
Author(s):  
Sarah K Shingleton ◽  
Alexandra J Helms ◽  
Leopoldo C Cancio ◽  
Monica L Abbott ◽  
Corey A Miner
Keyword(s):  
Wound Care ◽  
Care Quality ◽  
Nurse Specialist ◽  
Positive Trend ◽  
Evaluation Tool ◽  
Improvement Project ◽  
Self Evaluation ◽  
Burn Center ◽  
Significant Difference ◽  
Student’S T

Abstract Introduction New burn intensive care unit (BICU) nurses in the Burn Center complete an evidence-based preceptorship to include standardized wound care education that is reinforced throughout preceptorship. A gap in skill sustainment was identified; factors include lack of a formal sustainment program, inconsistent reinforcement of wound care skills and a perceived decrease in pride in wound care. The purposes of this project are to 1) develop and implement a wound care skill sustainment program 2) re-establish confidence in wound care and 3) improve the quality of wound care delivered in the BICU. Methods A Wound Improvement Project (WIP) committee was formed FEB 2018 consisting 8 BICU nurses; the BICU Nurse Manager and Wound Clinical Nurse Specialist serve as consultants. WIP developed several learning modules and is now developing a wound skill sustainment program and evaluation tool based on the Burn Nurse Competency Initiative (BNCI) standards. BICU staff complete an anonymous survey about wound care confidence every 6 months. WIP mentors and evaluates competency through direct observation during 3 assigned shifts with each BICU nurse. Wound care documentation is audited monthly and a wound care quality audit tool is being developed. Descriptive statistics, student’s T-test, and ANOVA were used. Results The confidence survey was given in Spring 2018 (n=52), Winter 2019 (n=33) and Summer 2019 (n=64); each question showed significant improvement. Notably “how confident would you be doing a full body wound care by yourself with some help turning” improved from 4.12 (±1.17) to 4.64 (±0.65, p=.01). 24 BICU staff have been evaluated with 40 pending completion. No significant difference was found in skill competency between the 3 WIP assigned shifts; however self-evaluation for “how comfortable/confident do you feel advocating for a different type of wound care treatment for your patient” improved from 6.1 (±2.2) to 7.5 (±1.9, p< .0001). Average wound documentation scores improved from 85% in FEB 2018 to 99% in FEB 2019. Conclusions Wound care confidence and documentation have improved since initiation of WIP. Targeted education, bedside tools and workshops have all contributed. There is a positive trend (not significant) towards improved skill competency this is likely due to tool modifications and the small number of staff evaluated to date. Staff feedback has been positive with most staff finding WIP helpful. The long-term goal is to expand WIP to all areas of the Burn Center. Applicability of Research to Practice BNCI standards are a framework for skill sustainment and progression of staff from competent towards proficient and expert. Development and evaluation of nurse-led sustainment programs are needed across the burn community.

scholarly journals TPA Use for Central Line De-Occlusion and Its Relationship to Symptomatic Venous Thromboembolism in Pediatric Leukemia Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2111-2111
Author(s):  
Katherine Armstrong ◽  
Kavitha Ramaswamy ◽  
Victoria Cooley ◽  
Linda M Gerber ◽  
Nicole Kucine
Keyword(s):  
Venous Thromboembolism ◽  
Sample Size ◽  
Central Line ◽  
Small Sample ◽  
Myelogenous Leukemia ◽  
Pediatric Leukemia ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Significant Difference ◽  
Picc Line

Introduction: Venous thromboembolism (VTE) is a known complication of pediatric leukemia with reported incidence ranging widely from 1.5-40%. It is associated with significant morbidity including loss of venous access, post thrombotic syndrome, and thrombosis recurrence or embolization. Increased risk of VTE in these patients is often multifactorial. There are currently no standard guidelines for VTE prophylaxis in pediatric leukemia patients, and it is unclear which patients are at highest risk. Identifying potential markers for patients at risk for VTE could be helpful for guiding prophylaxis practices and ultimately decreasing rates of VTE in these children. Thrombolytic agents are commonly used to treat catheter obstruction by breaking down fibrin that forms within the catheter. Therefore, we hypothesize that patients requiring more tissue plasminogen activator (TPA) for treatment of catheter obstruction may be at higher risk of developing fulminant thromboses. Therefore, the primary objectiveof this study is to determine the association between central line clearance with TPA and development of symptomatic VTE (sVTE) in pediatric leukemia patients. Methods: This is a multi-center,retrospective cohort study of patients under 21 years old with a central line (CVC), including peripherally inserted central catheters (PICC), who began treatment at Weill Cornell Medicine (WCM) or Memorial Sloan Kettering Cancer Center (MSKCC) from January 2012-December 2015 for newly diagnosed or relapsed leukemia. Patients were excluded if they had a prior VTE, or an incidental VTE was identified. Transplant and CAR-T -cell patients were excluded, as were those who transferred into the institution over 30 days from start of treatment. Data collected included demographics, disease-specific information (including type of leukemia, treatment regimen, and CVC details), dates of TPA administration, and details of sVTE. Data analysis was performed with Fisher's exact test andWilcoxon rank-sum test. Results: A total of 96 patients with leukemia were included. The median age was 6.5 years (Q1, Q3: 3.15-15.05 years), and 55% (n=53) were male. 78% (n=75) were new diagnoses. Acute lymphoblastic leukemia (ALL; 72%, n=69) was most common, followed by acute myelogenous leukemia (AML; 25%, n=24), and mixed lineage leukemias (3%, n=3). There were no significant differences between gender, age, type of leukemia, or TPA use between the two centers. The overall incidence of sVTE over the 4-year period in this cohort was 6% (6/96). At the time of thrombosis, five of the six patients had a PICC line in place and one patient had a mediport (Table 1). Four sVTE patients were diagnosed with ALL. Four of the thromboses were line-associated, one was a sinus venous thrombosis, and one was an inferior vena cava thrombus. Five of the six sVTEs were diagnosed at WCM. There was no association found between use of TPA for line de-occlusion and development of sVTE (OR 0.55, CI 0.07-6.57, p=0.61) or between number of TPA doses needed and development of sVTE (p=0.830). The patients who developed sVTE were significantly older than those who did not develop sVTE (Figure 1, p=0.048). There was no significant difference between gender and development of sVTE. A significant difference (p <0.05) was seen when analyzing the association between PICC line and development of sVTE, however the sample size was too small to draw formal conclusions. Conclusions: In our cohort, neither TPA use for line occlusion nor the number of TPA doses was predictive of sVTE development. This may be due to the small sample size and low number of sVTE events. Single center analysis of data from WCM, however, previously indicated a significant association between TPA use and development of thrombosis in their patients. Given the increased use of PICC lines at WCM, this raises the question of whether TPA use may be predictive in patients who have PICC lines. Our data are consistent with previous pediatric studies, which found older age to be a risk factor for thrombosis. Analysis of a larger cohort of patients is necessary to further investigate our hypothesis. Given the importance of preventing sVTE in pediatric leukemia patients, further prospective studies are needed to investigate potential predictors of thrombosis in this population. Disclosures Cooley: off-label: Other: drug use.

scholarly journals Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit

2021 ◽  
Vol 10 (1) ◽  
pp. e001200
Author(s):  
Poonam Gupta ◽  
Mincy Thomas ◽  
Ashfaq Patel ◽  
Reeba George ◽  
Leena Mathews ◽  
...  
Keyword(s):  
Intensive Care ◽  
Single Case ◽  
Bloodstream Infections ◽  
Central Line ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Mortality And Morbidity ◽  
Healthcare Improvement ◽  
Critical Patients ◽  
Clabsi Rate

BackgroundCentral venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.MethodsIn collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.ResultsThe CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.ConclusionsImplementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.

scholarly journals 771. COVID-19 on the Line: A Significant Increase in CLABSI in Hospitalized Patients with COVID-19 at a Major Teaching Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S482-S483
Author(s):  
Pishoy Haroun ◽  
Michael Ben-Aderet ◽  
Meghan Madhusudhan ◽  
Matthew J Almario ◽  
Ryan C Raypon ◽  
...  
Keyword(s):  
Real Time ◽  
Teaching Hospital ◽  
Nurse Staffing ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contributing Factors ◽  
Subjective Data ◽  
Significant Difference ◽  
The Impact ◽  
Clabsi Rate

Abstract Background We observed an increase in central line associated bloodstream infections (CLABSI) associated with the 2020 COVID-19 pandemic and performed a retrospective analysis to better understand the impact of COVID-19 on CLABSI rates. Figure 1. CLABSI rate in 2019 vs CLABSI rate in 2020 A comparison of CLABSI rates (displayed in infections/1000 catheter days) in all adult inpatients at our institution for calendar-years 2019 and 2020 Methods Retrospective review was done for all CLABSI in adults meeting National Healthcare Safety Network (NHSN) criteria in 2020 at an 889-bed teaching hospital. CLABSIs in encounters with PCR-confirmed COVID-19 (COVID CLABSI) were compared with CLABSIs in encounters without a COVID diagnosis (non-COVID CLABSI). As a secondary analysis, we also reviewed all CLABSI occurrence in 2019. Characteristics were compared using Mid-P Exact (Poisson) and Chi Squared (categorical) Tests. Subjective data collected by infection preventionists during real-time case reviews with clinical staff of each CLABSI was also reviewed. Results In 2020, the rate of COVID CLABSI (CLABSI/1000 catheter days) was 6.6 times greater than the rate of non-COVID CLABSI (5.47 vs. 0.83, p&lt; 0.001). In the COVID CLABSI group we observed higher rates of occurrence in the ICU setting (94% vs 28%, p&lt; 0.001), in house mortality (53% vs 26% P=0.0187), presence of arterial lines (91% vs 20%, p&lt; 0.001) and increased number of catheter lumens (4 vs 3, p&lt; 0.001). No significant difference was observed in the distribution of pathogens. No significant differences were observed between 2019 CLABSI and 2020 non-COVID CLABSI. Real-time case reviews identified changes in nurse staffing, increased nurse: patient ratios, delays in routine central line dressing changes, and inconsistent use of alcohol-impregnated port protectors as possible contributing factors. Table 1. 2020 COVID CLABSI vs 2020 non-COVID CLABSI A comparison of selected patient and catheter characteristics in COVID CLABSI vs non-COVID CLABSI in 2020 Table 2. 2019 CLABSI vs 2020 non-COVID CLABSI A comparison of selected patient and catheter characteristics in CLABSI in 2019 vs non-COVID CLABSI in 2020 Figure 2. CLABSI rate in 2019 vs COVID CLABSI and non-COVID CLABSI in 2020 A comparison of CLABSI rates (displayed in infections/1000 catheter days) in all adult inpatients at our institution for calendar years 2019 and 2020, with the infections in 2020 divided into those that occurred during an encounter with a PCR -confirmed diagnosis of COVID-19 and those without. Conclusion We observed a dramatically higher rate of CLABSI in patients with COVID-19 in 2020, while the rate of CLABSI in patients without COVID-19 remained unchanged from the year prior. Higher rates of ICU admission, critical illness, increased numbers of lumens, increased presence of arterial lines, nurse staffing changes, and gaps in routine line prevention processes associated with emergency measures in the COVID-19 cohort ICU may have contributed to this finding. Further work is needed to better understand how to minimize process-related disruptions in central line care during a hospital response to a pandemic. Disclosures Jonathan Grein, MD, Gilead (Other Financial or Material Support, Speakers fees)

scholarly journals Assessing effect of catheter type and position on central line-associated bloodstream infections in the NICU

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e59-e59 ◽  
Author(s):  
Ariane Leveillee ◽  
Anie Lapointe ◽  
Christian Lachance ◽  
Myriam Descarries ◽  
Julie Autmizguine ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Dwell Time ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Catheter Insertion ◽  
Significant Difference ◽  
Picc Line ◽  
Clabsi Rate

Abstract BACKGROUND Central venous catheter usage in NICU remains associated with serious complications such as bloodstream infection. Also, low position (underdiaphragmatic) of umbilical venous catheter (UVC) is tolerated despite not recommended. To our knowledge, no previous study assessed the effect of such a position on central line associated bloodstream infections (CLABSI) rates in the NICU. OBJECTIVES The primary objectives of this study were to assess global CLABSI rates for each central catheter subtype and position, and specific rates according to birth weight and gestational age. Dwell time before infection and microorganisms involved were also evaluated. DESIGN/METHODS For this retrospective cohort study, all neonates hospitalized in Level 3 NICU, from April 1st 2011 to March 31st 2016, in whom a central line was inserted, were included. Data about catheter insertion, demographic characteristics and bloodstream infections was extracted from local CVC database, local CLABSI database, patient medical record, post catheter insertion X-rays and Canadian Neonatal Network database. Difference in CLABSI rates and type of microorganisms involved were analyzed using Cox regression and Chi2. Difference in dwell time was analyzed using a one-way ANOVA and evolution in time of the proportion of each type of catheter presented as observational data. RESULTS A total of 1577 neonates were included and 2440 CVC were studied. Median gestational age (GA) was 30 2/7 [26 6/, 37] weeks and birth weight (BW) was 1310 [680, 2796] g. Of the 2440 neonates, 1308 were boys (53.6%). There was a total of 197 CLABSI. Total number of catheter days over the study period was 23 479 days. CLABSI rate for high UVC was 11.49 per 1000 catheter days compared to 6.92 for PICC line (p < 0.001) and 5.14 for femoral CVC (p = 0.008). CLABSI rate for low UVC was 17.31 per 1000 catheter days (p = 0.002 when compared to high UVC). Median dwell time before infection is 7 days for high UVC, 5 days for low UVC and 11 days for PICC (p < 0.001). Microorganism involved in CLABSI was a majority of Coagulase-negative Staphylococcus in 57.1–71.9% without a statistically significant difference between groups (p= 0.33). CONCLUSION Evolution of CVC usage over years remained stable. CLABSI rates are significantly higher with all UVC compared with PICC line and femoral CVC, particularly for newborn < 1500g and < 32 weeks of GA. Low UVC are associated to higher CLABSI rates than high UVC. Health professionals should be cautious with indwelling UVC, especially when in low position. They might conisder replacing low lines by a PICC as soon as possible.

61 HIP Fracture Management of Older Adults in a Public Tertiary Hospital in Kuala Lumpur: Analysis and Comparison with the Standard of Care in UK

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Gordon Hwa Mang Pang ◽  
Elizabeth Gar Mit Chong ◽  
Rizah Mazzuin Razali ◽  
Fatt Soon Lee ◽  
Weng Keong Yau
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Operating Time ◽  
Small Sample ◽  
Evidence Based ◽  
Fracture Management ◽  
Operation Rate ◽  
Significant Difference ◽  
Bone Protection

Abstract Background There has been rapid improvement in evidence-based care for hip fracture in UK in which prompt, effective, multidisciplinary management has been shown to improve quality and reduce costs. The aim of this study was to evaluate the current outcome of hip fractures in our hospital, and to compare it to the outcome of evidence-based management of hip fractures in UK. Methods A cross-sectional study of all hip fracture patients aged 60 and above, admitted from 1st March 2018 until 28th Feb 2019. Medical records of 105 patients obtained from a hip fracture registry were reviewed. Clinical data such as patients’ sociodemographics, fall circumstances, fractures, peri-operative details, complications and mortality were extracted and analysed. Results The surgery rate was 67% (96.5% in UK). Among the 37 patients (35.2%) not operated, 15 refused operation. Rate of early surgery was only 9.3% (71.3% in UK). Medical stabilisation (28.2%) and no operating time (40.8%) were the main reasons for surgical delay. None had falls assessment (98% in UK) and only 7.6% was started on bone protection prior to discharge (60% in UK). The average length of stay was 17 days (15.8 days in UK). The 30 day mortality was 9.5% (8.5% in UK). Discussion Our results showed that there was no significant difference in length of stay and 30 day mortality compared to UK. However, this may be due to our small sample size. Lack of awareness of falls assessment and bone protection suggests that our current model of care needed improvement. Conclusion Our results highlighted the need to implement proactive strategies to improve the management of hip fracture in our centre. Ortho-geriatrics shared-care in hip fracture management was subsequently implemented in an effort to improve patient care and service. Further studies need to be done to re-evaluate the outcomes post implementation.

scholarly journals Reduction of Central Line-Associated Bloodstream Infection Rates in a Neonatal Intensive Care Unit after Implementation of a Multidisciplinary Evidence-Based Quality Improvement Collaborative: A Four-Year Surveillance

2013 ◽  
Vol 24 (4) ◽  
pp. 185-190 ◽  
Author(s):  
Joseph Y Ting ◽  
Vicki SK Goh ◽  
Horacio Osiovich
Keyword(s):  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Evidence Based ◽  
Central Catheter ◽  
Entire Study Period ◽  
Quality Improvement Collaborative ◽  
Entire Study ◽  
Clabsi Rate

BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line-associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter-related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.CONCLUSION: A multidisciplinary evidence-based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter-related bloodstream infections among low-birth-weight infants.

Neonatal Intravenous Extravasation Injuries: Evaluation of a Wound Care Protocol

2006 ◽  
Vol 25 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Doris Sawatzky-Dickson ◽  
Karen Bodnaryk
Keyword(s):  
Wound Healing ◽  
Birth Weight ◽  
Wound Infection ◽  
Gestational Age ◽  
Wound Care ◽  
Systemic Infection ◽  
Coagulase Negative Staphylococcus ◽  
Evidence Based ◽  
Infection Rates ◽  
Care Protocol

Purpose:To evaluate an evidence-based wound protocol for intravenous extravasation injuries in neonates.Sample:Nine newborns with intravenous extravasation injuries. Birth weight: 582–4,404 gm, gestational age: 24–40 weeks.Results:Five wounds were colonized with coagulase-negative Staphylococcus species, two with diphtheroids, three with Enterococcus. There was no evidence of wound infection or systemic infection. Rates of wound healing ranged from one to six weeks.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

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