scholarly journals 824. Isolation Rounding - Enforcing Existing Isolation Policies to Conserve Personal Protective Equipment

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S454-S454
Author(s):  
Joshua K Schaffzin ◽  
Stephanie Herber ◽  
Nicole Kneflin ◽  
Matthew Frazier ◽  
Alyssa Paolella ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Personal Protective Equipment ◽  
Return On Investment ◽  
Effective Means ◽  
Pediatric Intensive Care ◽  
Nurse Educator ◽  
Protective Equipment ◽  
Time Period ◽  
Number Of Patients ◽  
Over Time

Abstract Background During the COVID-19 pandemic, supplies of personal protective equipment (PPE) have been limited and sold at increased cost. Prior to the pandemic, we had initiated a project to improve PPE adherence and decrease cost by removing eligible patients from transmission based precautions (TBPs). At baseline, ordering providers are responsible for TBP utilization with orders through the electronic medical record. We observed that patients were in TBP when not indicated; remained in TBP beyond the appropriate time; and a reluctance on the part of providers to discontinue the orders. We tested the effect on TBP duration and PPE utilization house-wide through frequent review of TBP by a nurse educator with communication to providers of discontinuation opportunities. Methods From November 2019 to February 2020, all TBP orders in the pediatric intensive care unit (PICU) were reviewed intermittently. In March 2020, review was expanded to all inpatients with daily reviews in all units. Changes recommended and completed were tracked for all reviewed patients. We estimated cost of PPE in the PICU over time based on the number of patients in isolation and type of TBP utilized to determine whether our intervention resulted in reduced PPE use. Results Regular rounding in the PICU increased the proportion of patients in appropriate TBP and reduced the need to communicate with providers directly (33% vs 3% requiring intervention, Figure 1). Over the same time period, less PPE was used and PPE-related costs lowered (average total PPE cost $306.18 vs $95.15 per day, Figure 2). Less of an effect was seen when analyzing house-wide data. Figure 1 - P-chart of Percent Interventions Among Patients in TBP Figure 2 - X-chart of Total PPE Cost in the ICU Conclusion Isolation rounds is an effective means to ensure proper TBP adherence and manage PPE use appropriately. Additional study is needed to confirm a return on investment, to account for variation among units, and to sustain COVID-19-influenced gains beyond the pandemic. Disclosures All Authors: No reported disclosures

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals Hospital beds and personal protective equipment planning for COVID-19 pandemic: A computer simulation approach

2020 ◽  
Author(s):  
Yiruo Lu ◽  
Yongpei Guan ◽  
Jennifer Fishe ◽  
Thanh Hogan ◽  
Xiang Zhong
Keyword(s):  
Computer Simulation ◽  
Personal Protective Equipment ◽  
Census Data ◽  
Discrete Event ◽  
Hospital Setting ◽  
Case Fatality ◽  
Protective Equipment ◽  
Simulation Approach ◽  
Number Of Patients ◽  
Hospital Resources

Abstract Health care systems are at the frontline to fight the COVID-19 pandemic. An emergent question for each hospital is how many general ward and intensive care unit beds are needed and how much personal protective equipment to be purchased. However, hospital pandemic preparedness has been hampered by a lack of sufficiently specific planning guidelines. In this paper, we developed a computer simulation approach to evaluating bed utilizations and the corresponding supply needs based on the operational considerations and constraints in individual hospitals. We built a data-driven SEIR model which is adaptive to control policies and can be utilized for regional forecast targeting a specific hospital’s catchment area. The forecast model was integrated into a discrete-event simulation which modeled the patient flow and the interaction with hospital resources. We tested the simulation model outputs against patient census data from UF Health Jacksonville, Jacksonville, FL. Simulation results were consistent with the observation that the hospital has ample bed resources to accommodate the regional COVID patients. After validation, the model was used to predict future bed utilizations given a spectrum of possible scenarios to advise bed planning and stockpiling decisions. Lastly, how to optimally allocate hospital resources to achieve the goal of reducing the case fatality rate while helping a maximum number of patients to recover was discussed. This decision support tool is tailored to a given hospital setting of interest and is generalizable to other hospitals to tackle the pandemic planning challenge.

scholarly journals Factors to Consider in the Use of Vital Signs Wearables to Minimize Contact With Stable COVID-19 Patients: Experience of Its Implementation During the Pandemic

2021 ◽  
Vol 3 ◽  
Author(s):  
Esther Monica Pei Jin Fan ◽  
Shin Yuh Ang ◽  
Ghee Chee Phua ◽  
Lee Chen Ee ◽  
Kok Cheong Wong ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Vital Signs ◽  
Healthcare Facility ◽  
Wearable Device ◽  
Protective Equipment ◽  
Healthcare Industry ◽  
Patient Contact ◽  
Vital Signs Monitoring ◽  
Number Of Patients ◽  
Patients Experience

The COVID-19 pandemic has created a huge burden on the healthcare industry worldwide. Pressures to increase the isolation healthcare facility to cope with the growing number of patients led to an exploration of the use of wearables for vital signs monitoring among stable COVID-19 patients. Vital signs wearables were chosen for use in our facility with the purpose of reducing patient contact and preserving personal protective equipment. The process of deciding on the wearable solution as well as the implementation of the solution brought much insight to the team. This paper presents an overview of factors to consider in implementing a vital signs wearable solution. This includes considerations before deciding on whether or not to use a wearable device, followed by key criteria of the solution to assess. With the use of wearables rising in popularity, this serves as a guide for others who may want to implement it in their institutions.

scholarly journals Examining the cost-effectiveness of personal protective equipment for formal healthcare workers in Kenya during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacob Kazungu ◽  
Kenneth Munge ◽  
Kalin Werner ◽  
Nicholas Risko ◽  
Andres I. Vecino-Ortiz ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Healthcare Worker ◽  
Personal Protective Equipment ◽  
Return On Investment ◽  
Healthcare Workers ◽  
Health Economic Evaluation ◽  
Response Strategy ◽  
Decision Analytic Model ◽  
Protective Equipment

Abstract Background Healthcare workers are at a higher risk of COVID-19 infection during care encounters compared to the general population. Personal Protective Equipment (PPE) have been shown to protect COVID-19 among healthcare workers, however, Kenya has faced PPE shortages that can adequately protect all healthcare workers. We, therefore, examined the health and economic consequences of investing in PPE for healthcare workers in Kenya. Methods We conducted a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model following the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. We examined two outcomes: 1) the incremental cost per healthcare worker death averted, and 2) the incremental cost per healthcare worker COVID-19 case averted. We performed a multivariate sensitivity analysis using 10,000 Monte Carlo simulations. Results Kenya would need to invest $3.12 million (95% CI: 2.65–3.59) to adequately protect healthcare workers against COVID-19. This investment would avert 416 (IQR: 330–517) and 30,041 (IQR: 7243 – 102,480) healthcare worker deaths and COVID-19 cases respectively. Additionally, such an investment would result in a healthcare system ROI of $170.64 million (IQR: 138–209) – equivalent to an 11.04 times return. Conclusion Despite other nationwide COVID-19 prevention measures such as social distancing, over 70% of healthcare workers will still be infected if the availability of PPE remains scarce. As part of the COVID-19 response strategy, the government should consider adequate investment in PPE for all healthcare workers in the country as it provides a large return on investment and it is value for money.

scholarly journals Testing the efficacy and acceptability of video-reflexive methods in personal protective equipment training for medical interns: a mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052985
Author(s):  
Mary Wyer ◽  
Su-Yin Hor ◽  
Ruth Barratt ◽  
G L Gilbert
Keyword(s):  
Mixed Methods ◽  
Personal Protective Equipment ◽  
Self Efficacy ◽  
Mixed Methods Study ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Time Points ◽  
Medical Interns ◽  
Video Group ◽  
Over Time

ObjectivesTo test the efficacy and acceptability of video-reflexive methods for training medical interns in the use of personal protective equipment (PPE).DesignMixed methods study.SettingA tertiary-care teaching hospital, Sydney, January 2018–February 2019.Participants72 of 90 medical interns consented to participate. Of these, 39 completed all three time points.InterventionsParticipants received a standard infection prevention and control (IPC) education module during their hospital orientation. They were then allocated alternately to a control or video group. At three time points (TPs) over the year, participants were asked to don/doff PPE items based on hospital protocol. At the first two TPs, all participants also participated in a reflexive discussion. At the second and third TPs, all participants were audited on their performance. The only difference between groups was that the video group was videoed while donning/doffing PPE, and they watched this footage as a stimulus for reflexive discussion.Primary and secondary outcome measuresThe efficacy and acceptability of the intervention were assessed using: (1) comparisons of audit performance between and within groups over time, (2) comparisons between groups on survey responses for evaluation of training and self-efficacy and (3) thematic analysis of reflexive discussions.ResultsBoth groups improved in their PPE competence over time, although there was no consistent pattern of significant differences within and between groups. No significant differences were found between groups on reported acceptability of training, or self-efficacy for PPE use. However, analysis of reflexive discussions shows that the effects of the video-reflexive intervention were tangible and different in important respects from standard training.ConclusionsVideo reflexivity in group-based training can assist new clinicians in engagement with, and better understanding of, IPC in their clinical practice. Our study also highlights the need for ongoing and targeted IPC training during medical undergraduate studies as well as regular workplace refresher training.

scholarly journals Examining the Cost-effectiveness of Personal Protective Equipment for Formal Healthcare Workers in Kenya during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Jacob Kazungu ◽  
Kenneth Munge ◽  
Kalin Werner ◽  
Nicholas Risko ◽  
Andres Vecino Ortiz ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Healthcare Worker ◽  
Personal Protective Equipment ◽  
Return On Investment ◽  
Healthcare Workers ◽  
Health Economic Evaluation ◽  
Response Strategy ◽  
Decision Analytic Model ◽  
Protective Equipment ◽  
The Cost

Abstract Background: Healthcare workers are at a higher risk of COVID-19 infection during care encounters compared to the general population. Personal Protective Equipment (PPE) have been shown to protect COVID-19 among healthcare workers, however, Kenya has faced PPE shortages that can adequately protect all healthcare workers. We, therefore, examined the health and economic consequences of investing in PPE for healthcare workers in Kenya. Methods: We conducted a cost-effectiveness and return on investment (ROI) analysis using a decision-analytic model following the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. We examined two outcomes: 1) the cost per healthcare worker death averted, and 2) the cost per healthcare worker COVID-19 case averted. We performed a multivariate sensitivity analysis using 10,000 Monte Carlo simulations. Results: Kenya would need to invest $3.12 million to adequately protect healthcare workers against COVID-19. This investment would avert 416 and 30,041 healthcare worker deaths and COVID-19 cases respectively. Additionally, such an investment would result in a societal ROI of $170.64 million – equivalent to an 11.04 times return. Conclusion: Despite other nationwide COVID-19 prevention measures such as social distancing, over 70% of healthcare workers will still be infected if the availability of PPE remains scarce. As part of the COVID-19 response strategy, the government should consider adequate investment in PPE for all healthcare workers in the country as it provides a large return on investment and it is value for money.

Transfusion Practice in the Intensive Care Unit: A Ten-Year Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2111-2111
Author(s):  
Giora Netzer ◽  
Xinggang Liu ◽  
Anthony Harris ◽  
Bennett Edelman ◽  
John Hess ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Single Unit ◽  
Medical Center ◽  
Transfusion Practice ◽  
Transfusion Strategy ◽  
Time Period ◽  
The Mean ◽  
Restrictive Transfusion Strategy ◽  
Over Time

Abstract Abstract 2111 Poster Board II-88 Introduction: Since the 1990s, there has been increasing evidence to support a restrictive transfusion strategy in the intensive care unit. While prior studies have evaluated transfusion practice in the short term, the impact of the Transfusion Requirements in Critical Care (TRICC) recommendations and related guidelines over the course of a prolonged time period has not been evaluated. We describe and assess transfusion practice during the period 1997-2007 in a large, academic medical center medical intensive care unit (MICU). Patients and Methods: We conducted a single center, retrospective, observational study of 3533 patients with single admissions to the University of Maryland Medical Center MICU between 1997 and 2007. Patients with acute coronary syndromes, hemorrhage and hemoglobinopathies were excluded, as were patients less than 13 years of age. Baseline characteristics of transfused and non-transfused patients were compared. We described the mean MICU admission hemoglobin (Hgb) levels, percentages of patients transfused as a whole and by MICU admission Hgb strata, mean pre-transfusion Hgb levels in transfused patients and nadir Hgb in the non-transfused, proportion of patients transfused with pre-transfusion Hgb<7.0 g/dL, mean number of units transfused in patients receiving transfusion, and the proportion of single unit transfusion episodes over time. Changes over 9 intervals of time between 1997-2007 were assessed with linear or logistic regression. Results: MICU admission Hgb did not change in any important way over the study period (-0.022 g/dL per interval, 95% CI -0.0051–0.007, p=0.13). The proportion of transfused patients decreased over time from 31.0% in 1997-1998 to 18.0% in 2006-2007 (p<0.001). The strongest and most consistent evidence of a steep decline in percentage of patients transfused was in the first half of the decade studied, among patients whose MICU admission Hgb levels were ≥7.0 g/dL and <10.0 g/dL. Among patients receiving transfusion, the mean pre-transfusion Hgb decreased over time from 7.9±1.3 to 7.3±1.3 g/dL (p<0.001). The nadir Hgb in non-transfused patients also decreased from a mean Hgb 11.2±2.2 g/dL in 1997-1999 to Hgb10.4±2.3 in 2006–2007 (p<0.001). The mean number of units transfused decreased during this time period from 4.3 to 3.0 units per patient transfused (p<0.001). The proportion of patients transfused at Hgb<7.0 g/dL increased by an absolute increment of 3.2% (95%CI: 2.1-4.3%) per interval (p<0.001), as did the proportion of single unit transfusions during the first transfusion episode with an absolute proportion of 1.4% per year (95% CI:0.2-2.6%, p=0.03) from 40.2% in 1997-1998 to 53.1% in 2006-2007. Conclusions: Between 1997 and 2007, important and sustained changes have occurred in MICU physician transfusion behavior, with overall reductions in the proportion of patients transfused, mean pre-transfusion Hgb level, and nadir Hgb level in patients who were not transfused. While physicians moved closer to the restrictive transfusion strategy reflected in guidelines and tested in a multi-center clinical trial, there may still be room for improvement. Disclosures: No relevant conflicts of interest to declare.

Rethinking Physiologic Stability: Touch and Intracranial Pressure

1999 ◽  
Vol 1 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Pamela H. Mitchell ◽  
Barbara Habermann
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Parental Care ◽  
Intracranial Hypertension ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Time Period ◽  
The Stability ◽  
The Impact

The purpose of this research was to examine the contingent nature of physiologic stability with respect to the impact of nursing and parental care touch on intracranial pressure (ICP) in children. Data were reanalyzed from those previously collected in eight children in a pediatric intensive care unit who had intracranial hypertension from a variety of causes and whose ICP was invasively monitored. One hundred forty-nine clusters of spontaneous touch/talking were available for analysis after those occurring close in time to procedures and drugs affecting ICP were dropped. Twenty-three episodes of investigator touch (without talking) were also analyzed. ICP stability was defined as any tracing over a defined time period in which the peak-to-trough amplitude did not exceed twice the calculated resting variability. Such an approach allowed classification and counting of stable versus unstable baselines, and stable versus unstable responses to touch. Therefore, ICP stability was examined by comparing the stability of the ICP tracing the last minute prior to a cluster of nonprocedural touch (baseline) with the first minute after the cluster. Clusters of spontaneous touch were nearly always associated with talking to the child and rarely were followed by change in level of ICP greater than that child’s ICP variability at rest. Investigator stroking without talking never was followed by a significant change in level of ICP. There was a contingent relationship between stability of the ICP tracing prior to a cluster of touching/talking such that the probability of ICP becoming more stable when the touch/talk occurred on an unstable baseline was twice that of touch/talk occurring on an stable baseline.

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