The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

Critical Care Nurse ◽

10.4037/ccn2021340 ◽

2021 ◽

Vol 41 (5) ◽

pp. e1-e8

Author(s):

Leigh Chapman ◽

Lisa Hargett ◽

Theresa Anderson ◽

Jacqueline Galluzzo ◽

Paul Zimand

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Chlorhexidine Gluconate ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Telemetry Unit ◽

Health Care Associated Infections ◽

The Impact

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

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Serratia marcescans Contamination of Antiseptic Soap Containing Triclosan: Implications for Nosocomial Infection

Infection Control ◽

10.1017/s0195941700060690 ◽

1984 ◽

Vol 5 (9) ◽

pp. 427-430 ◽

Cited By ~ 29

Author(s):

M. Anita Barry ◽

Donald E. Craven ◽

Theresa A. Goularte ◽

Deborah A. Lichtenberg

Keyword(s):

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Nosocomial Infection ◽

Surgical Intensive Care Unit ◽

Minimal Bactericidal Concentration ◽

Surgical Intensive Care ◽

Time Kill ◽

The Impact

Abstract During a recent investigation in our surgical intensive care unit, we found that several bottles of the antiseptic handwashing soap, OR Scrub®, were contaminated with Serratia marcescens. OR Scrub® contains 1% triclosan, lanolin, and detergents. The antimicrobial efficacy of OR Scrub® was examined in vitro using serial two-fold dilutions of soap inoculated with various concentrations of different nosocomial pathogens. The minimal bactericidal concentration (MBC) of OR Scrub® against Pseudomonas aeruginosa and several strains of S. marcescens was ≤1:2 By comparison, a non-antiseptic soap from the same manufacturer (Wash®) and 4% chlorhexidine (Hibiclens®) had MBCs for all strains tested of at least 1:64. Time-kill curves confirmed the findings of the initial experiments.This is the first report of extrinsic contamination of antiseptic soap containing triclosan. No infections could be attributed to the contaminated soap, but sporadic outbreaks of Serratia have occurred in the intensive care unit with no identifiable source. Although there have been few studies on the impact of antiseptic soap in reducing nosocomial infection, we question whether a soap with the limitations of OR Scrub® should be used in intensive care units or operating rooms.

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A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study

Journal of Clinical Microbiology ◽

10.1128/jcm.01053-20 ◽

2020 ◽

Vol 58 (10) ◽

Author(s):

Valeria Fabre ◽

Eili Klein ◽

Alejandra B. Salinas ◽

George Jones ◽

Karen C. Carroll ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Control Units ◽

Stewardship Program ◽

Academic Center ◽

Before And After ◽

The Impact

ABSTRACT Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

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