The Importance of Ground Critical Care Transport

Critical care transport (CCT) teams are specialized transport services, comprised of highly trained paramedics, nurses, and occasionally respiratory therapists, offering an expanded scope of practice beyond advanced life support (ALS) emergency medical service teams. We report 4 cases of patients with severe acute respiratory distress syndrome from influenza in need of extracorporeal membrane oxygenation evaluation at a tertiary care center, transported by ground. Our medical center did not previously have a ground CCT service, and therefore, in these cases, a physician and/or a respiratory therapist was sent with the paramedic team. In all 4 cases, the ground transport team enhanced the intensive care provided to these patients prior to arrival at the tertiary care center. In 2 of the cases, although limited by the profound hypoxemia, the team decreased the pressures and tidal volumes in an effort to approach evidence-based ventilator goals. In 3 cases, they stopped bicarbonate drips being used to treat mixed metabolic and respiratory acidosis, and in 1 case, they administered furosemide. In 1 case, they started cisatracurium, and in 3 others, they initiated inhaled epoprostenol. Existing literature supports the use of CCT teams over ALS teams for transport of the most critically ill patients, and helicopter CCT is not always available or practical. Therefore, offering comparable air and ground options, with similar staffing and resources, is a hallmark of a mature medical system with an integrated approach to CCT.

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Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.325 ◽

2021 ◽

pp. 1-26

Author(s):

Akane Takamatsu ◽

Hitoshi Honda ◽

Tomoya Kojima ◽

Kengo Murata ◽

Hilary Babcock

Keyword(s):

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Vaccination Rate ◽

Multifaceted Intervention ◽

Vaccine Hesitancy ◽

Healthcare Personnel ◽

Tertiary Care Center ◽

Post Intervention ◽

Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

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Defining the role of the pediatric critical care nurse practitioner in a tertiary care center

Critical Care Medicine ◽

10.1097/00003246-200007000-00074 ◽

2000 ◽

Vol 28 (7) ◽

pp. 2626-2630 ◽

Cited By ~ 28

Author(s):

Shari L. Derengowski ◽

Sharon Y. Irving ◽

Pamela V. Koogle ◽

Robert M. Englander

Keyword(s):

Critical Care ◽

Nurse Practitioner ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Pediatric Critical Care ◽

Care Nurse ◽

Critical Care Nurse

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Incidence, etiology, and course of hypercalcemia-induced AKI in a tertiary care center from northern India

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-021-00067-8 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Nucksheeba Aziz Bhat ◽

Farhat Mustafa ◽

Rayees Yousuf Sheikh ◽

Imtiyaz Wani

Keyword(s):

Multiple Myeloma ◽

Critical Care ◽

Primary Hyperparathyroidism ◽

Serum Creatinine ◽

Serum Calcium ◽

Care Setting ◽

Care Center ◽

Tertiary Care ◽

Critical Care Setting ◽

Tertiary Care Center

Abstract Background Hypercalcemia is known to cause acute kidney injury (AKI). Literature related to hypercalcemic AKI is predominantly in the form of case reports and case series. The purpose of this study is to find the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. To our knowledge, this is the first study done to look for the incidence, etiology, and course of hypercalcemia-induced AKI in a non-critical care setting. This is a prospective observational study conducted in the Department of Medicine in a tertiary care center from Jammu and Kashmir, India, from June 2010 to June 2012. Patients admitted with hypercalcemia were assessed for AKI and evaluated and treated for hypercalcemia. Renal function was monitored during hospitalization and at 1 month of discharge. AKI and hypercalcemia were arbitrarily defined as serum creatinine > 1.5 mg/dl and corrected serum calcium of ≥ 11.5 mg/dl (as per reference hospital lab), respectively. Results Thirty patients are included. Hyperparathyroidism and multiple myeloma accounted for 13(43.3%) and 10 (33.3%) cases, respectively. Mean ±SD corrected serum calcium at diagnosis and after treatment at 1 month was 13.56 ± 1.86 mg/dl and 9.49±1.35 mg/dl, respectively; p < 0.001. Mean ±SD serum creatinine at baseline and after treatment of hypercalcemia was 2.87 ±1.68 mg/dl and 1.49±1.34 mg/dl, respectively; p < 0.001. Twenty-three (76.7%) patients had AKI. AKI recovered after treating hypercalcemia in 25 (83.3 %) patients. Mean ± SD days taken for the decrease in serum creatinine to ≤ 1.5 mg/dl was 8.28 ± 4.17 days. Mean ± SD serum creatinine after treatment of hypercalcemia in hyperparathyroidism group versus non-parathyroid group was 0.97 ± 0.35 mg/dl and 1.88 ±1.67 mg/dl, respectively; p value 0.009. Conclusions Hypercalcemia is commonly associated with AKI. Primary hyperparathyroidism and multiple myeloma account for the majority of the cases. Hypercalcemic AKI with primary hyperparathyroidism is less common and the outcome is better, as compared to non-hyperparathyroidism-related causes. AKI is reversible in most cases.

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First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Pathogens ◽

10.3390/pathogens10020157 ◽

2021 ◽

Vol 10 (2) ◽

pp. 157

Author(s):

Fatima Allaw ◽

Nada Kara Zahreddine ◽

Ahmad Ibrahim ◽

Joseph Tannous ◽

Hussein Taleb ◽

...

Keyword(s):

Infection Control ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Arab Countries ◽

Infection Prevention And Control ◽

Tertiary Care Center ◽

Candida Auris ◽

American University ◽

American University Of Beirut

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

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Trends in trauma care before and after the introduction of ‘Mukhyamantri Santwana Harish Scheme’ in a tertiary care hospital at Kolar

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20181725 ◽

2018 ◽

Vol 5 (5) ◽

pp. 2072

Author(s):

Vikas Sankar Kottareddygari ◽

Vishwas S. ◽

Praveen G. P. ◽

Amal Abraham ◽

Sreeramulu P. N.

Keyword(s):

Critical Care ◽

Low Income ◽

Life Support ◽

Road Traffic ◽

Tertiary Care ◽

Advanced Life Support ◽

Low Income Countries ◽

Care Hospital ◽

Number Of Patients ◽

Before And After

Background: Road traffic injuries (RTI) are responsible for 1.2 million global deaths and rank 9th as cause of death in both the high and low income countries. Polytrauma cases make the bulk of emergencies in our centre and the victims were previously given only first aid and critical care before being referred to a government aided institute for further management due to monetary issues. After the introduction of Mukhyamantri Santwana - 'Harish' Scheme (MSHS), all the patients are entitled for cashless treatment for the first 48 hoursand this improved the quality of care they received.Methods: All the polytrauma cases brought to the emergency and critical care department for a period of 7months before the introduction of MSHS (October 2015- April 2016) and for a period of 7 months from the introduction of MSHS (May 2016- November 2016) were studied retrospectively. Data on the number of patients referred, admitted and underwent intervention during the time periods were collected and compared.Results: The number of cases that were admitted and given intervention in our centre increased considerably and number of cases referred to other centres decreased after the introduction of MSHS.Conclusions: Introduction of MSHS lead to patients receiving more advanced life support and interventions as necessary. However this cannot be generalised to all the centres as data is still lacking. Multicentric studies need to be done in this aspect.

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Anemia among Pediatric Critical Care Survivors: Prevalence and Resolution

Critical Care Research and Practice ◽

10.1155/2013/684361 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Quang N. Ngo ◽

Doreen M. Matsui ◽

Ram N. Singh ◽

Shayna Zelcer ◽

Alik Kornecki

Keyword(s):

Critical Care ◽

Observational Study ◽

Critical Care Unit ◽

Prospective Observational Study ◽

Care Center ◽

Tertiary Care ◽

Medical Intervention ◽

Tertiary Care Center ◽

Pediatric Critical Care ◽

Discharge From Hospital

To determine the incidence of anemia among pediatric critical care survivors and to determine whether it resolves within 6 months of discharge.Design. A prospective observational study. Patients with anemia upon discharge from the pediatric critical care unit (PCCU) underwent in hospital and post hospital discharge followup (4–6 months) for hemoglobin (Hb) levels.Setting. A medical-surgical PCCU in a tertiary care center.Patients. Patients aged 28 days to 18 years who were treated in the PCCU for over 24 hours.Measurements and Main Results. 94 (24%) out of 392 eligible patients were anemic at time of discharge. Patients with anemia were older, median 8.0 yrs [(IQR 1.0–14.4) versus 3.2 yrs (IQR 0.65–9.9) (P<0.001)], and had higher PeLOD [median 11 (IQR 10–12) versus 1.5 (1–4) (P<0.001)], and PRISM [median 5 (IQR 2–11) versus 3 (IQR 0–6) (P<0.001)] scores. The Hb level normalized in 32% of patients before discharge from hospital. Of the 28 patients who completed followup, all had normalization of their Hb in the absence of medical intervention.Conclusions. Anemia is not common among patients discharged from the PCCU and recovers spontaneously within 4–6 months.

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Nursing Challenges in the Care of Very Low Birth Weight Infants (<1,000 Grams)

AACN Advanced Critical Care ◽

10.4037/15597768-1994-3002 ◽

1994 ◽

Vol 5 (3) ◽

pp. 231-241

Author(s):

Carole Kenner ◽

Carol Hetteberg

Keyword(s):

Critical Care ◽

Birth Weight ◽

Very Low Birth Weight ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Care Needs ◽

Low Birth Weight Infants ◽

Gestational Period ◽

Neonatal Population

It is not unusual for neonates to be born before the 24th week of gestation and weigh less than 1,000 g. These neonates are surviving to be transferred to a tertiary care center, and many are discharged eventually to home. When one considers that these infants arc only “half developed” by the standard 40-week gestational period, it is understandable that the challenges for nurses caring for them are enormous. In this article, the authors review gestational development and the critical care needs of this special neonatal population

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Building and Validating a Computerized Algorithm for Surveillance of Ventilator-Associated Events

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.127 ◽

2015 ◽

Vol 36 (9) ◽

pp. 999-1003 ◽

Cited By ~ 13

Author(s):

Tal Mann ◽

Joseph Ellsworth ◽

Najia Huda ◽

Anupama Neelakanta ◽

Thomas Chevalier ◽

...

Keyword(s):

Infection Control ◽

Predictive Value ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Mechanically Ventilated ◽

Automated Method ◽

Sensitivity Specificity ◽

Infection Preventionists

OBJECTIVETo develop an automated method for ventilator-associated condition (VAC) surveillance and to compare its accuracy and efficiency with manual VAC surveillanceSETTINGThe intensive care units (ICUs) of 4 hospitalsMETHODSThis study was conducted at Detroit Medical Center, a tertiary care center in metropolitan Detroit. A total of 128 ICU beds in 4 acute care hospitals were included during the study period from August to October 2013. The automated VAC algorithm was implemented and utilized for 1 month by all study hospitals. Simultaneous manual VAC surveillance was conducted by 2 infection preventionists and 1 infection control fellow who were blinded to each another’s findings and to the automated VAC algorithm results. The VACs identified by the 2 surveillance processes were compared.RESULTSDuring the study period, 110 patients from all the included hospitals were mechanically ventilated and were evaluated for VAC for a total of 992 mechanical ventilation days. The automated VAC algorithm identified 39 VACs with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%. In comparison, the combined efforts of the IPs and the infection control fellow detected 58.9% of VACs, with 59% sensitivity, 99% specificity, 91% PPV, and 92% NPV. Moreover, the automated VAC algorithm was extremely efficient, requiring only 1 minute to detect VACs over a 1-month period, compared to 60.7 minutes using manual surveillance.CONCLUSIONSThe automated VAC algorithm is efficient and accurate and is ready to be used routinely for VAC surveillance. Furthermore, its implementation can optimize the sensitivity and specificity of VAC identification.Infect. Control Hosp. Epidemiol. 2015;36(9):999–1003

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Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath

Antibiotics ◽

10.3390/antibiotics10081016 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1016

Author(s):

Amanda Chamieh ◽

Rita Zgheib ◽

Sabah El-Sawalhi ◽

Laure Yammine ◽

Gerard El-Hajj ◽

...

Keyword(s):

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Infection Prevention And Control ◽

P Value ◽

Tertiary Care Center ◽

Antimicrobial Consumption ◽

Dynamic Collaboration

Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.

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