MRSA colonisation rates on a neonatal and paediatric intensive care unit

Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is a challenge in healthcare institutions worldwide. In this retrospective nation-wide study, the rates of MRSA colonisation and infection from 2012 to 2015, on the only neonatal and paediatric intensive care unit (NPICU) in the country, were determined. Mean local rates were compared to rates of MRSA colonisation reported in units in North America, Asia and Europe between 2001 and 2010. The average rate of MRSA colonisation on admission to NPICU from 2012 to 2015 was 3.71% (95% confidence interval [CI] 2.17–5.25), while the mean rate of acquired colonisation was 14.60% (95% CI 6.16–23.04). Both were significantly higher than in units abroad: 1.9% and 4.1%, respectively ( P = 0.04 and P < 0.001). There were no cases of invasive MRSA infection, while the mean rate of non-invasive infection was 0.77% (95% CI 0.54–1.01). Improved adherence to infection control measures and newer molecular diagnostic techniques are needed to further decrease the acquisition of MRSA.

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Introduction of a prescribing ward round to reduce prescribing errors on a paediatric intensive care unit

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2019-318732 ◽

2020 ◽

pp. edpract-2019-318732

Author(s):

Aisling Walsh ◽

Rachelle Booth ◽

Kalindi Rajani ◽

Lynne Cochrane ◽

Mark Peters ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Paediatric Intensive Care Unit ◽

Ward Round ◽

Paediatric Intensive Care ◽

Prescribing Errors ◽

Prescription Errors ◽

Total Prescription ◽

The Mean ◽

Almost All

Our paediatric intensive care unit (PICU) performs active surveillance for prescribing errors and detects a mean of 1.66 with an SD of 0.18 total prescription errors per occupied bed day. The primary aim of this project was to reduce the number of prescribing errors in PICU. The secondary aims were to improve the workflow in the unit and reduce the time staff spent on medication queries/prescribing. We introduced a daily multidisciplinary prescribing round to our PICU. Prescribing errors reduced, with the mean number of total prescription errors per bed day falling from 1.66 (0.18) to 1.19 (0.13), the mean number of clinical prescription errors per bed day falling from 0.46 (0.09) to 0.3 (0.07), and the mean number of non-clinical prescribing errors per bed day falling from 1.12 (0.15) to 0.67 (0.1). Forty-eight staff responded to the survey, 39 of whom had been directly involved in the rounds. The majority (37 of 39; 95%) said the prescribing round reduced the overall time they spent on prescribing/medication queries during their shift, and 9 of 10 (90%) prescribers said that they were interrupted fewer times for medication queries while doing other tasks. Almost all (47 of 48; 98%) said that they thought the prescribing ward round should continue. Introduction of a prescribing round with senior medical and pharmacist involvement was associated with a reduction in prescribing errors as well as reduction in the overall time staff spent on medication queries and prescribing. The round was well received by staff, with 98% wanting it to continue.

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Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v38i3.23146 ◽

2018 ◽

Vol 38 (3) ◽

pp. 149-152

Author(s):

Shrikiran Aroor ◽

Sandeep Kumar ◽

Pushpa Kini ◽

Suneel Mundkur

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Logistic Regression Analysis ◽

Paediatric Intensive Care Unit ◽

Death Rate ◽

Paediatric Intensive Care ◽

P Value ◽

The Mean

Introduction: Research on critically ill children admitted to the intensive care unit has shown the usefulness of Paediatric Index of Mortality 2 (PIM2) score at admission to predict outcome. This study was conducted to estimate PIM2 score in children admitted to Paediatric Intensive Care Unit and its correlation with clinical outcome. Methods: This prospective observational study was conducted in children of age group one month to 18 years admitted to the paediatric intensive care unit of a tertiary care hospital. Data including demographics, diagnostic categories, duration of hospital stay, predicted death rate (PDR) measured by PIM2 score was compared between survivors and non survivors. Logistic regression analysis was performed to arrive at a risk adjusted relationship between the different predictor variables and the probability of death. Results: Consecutive 130 children admitted to PICU during the study period were enrolled. The mean PDR (%) of the total study population was 22.4 ± 10.60. The mean PDR in survivors was 12.4 ± 7.80 while the PDR in non survivors was 44.2 ± 12.62 (p value < 0.001). Children with PDR < 1% had a mortality rate of 2.4% when compared to 71.4% in children with PDR > 5% (p value < 0.001). PDR by PIM2 score and the presence of hypo-albuminemia remained significant even after adjusting for age in multivariate logistic regression analysis. Conclusion: PDR measured by PIM2 score differentiated well between survivors and non survivors in PICU. The predicted death rate was less than the observed death rate. PIM2 score is a useful tool to assess the severity of illness and predict outcome.

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Update in Viral Infections in the Intensive Care Unit

Frontiers in Medicine ◽

10.3389/fmed.2021.575580 ◽

2021 ◽

Vol 8 ◽

Author(s):

Paraskevi C. Fragkou ◽

Charalampos D. Moschopoulos ◽

Emmanouil Karofylakis ◽

Theodoros Kelesidis ◽

Sotirios Tsiodras

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Viral Infections ◽

De Novo ◽

Control Measures ◽

Hospital Environment ◽

Molecular Diagnostic ◽

Molecular Diagnostic Techniques ◽

Viral Pathogens ◽

Mortality And Morbidity

The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.

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