scholarly journals Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

2021 ◽  
Author(s):  
Danielle Bayoro ◽  
Matthew Meyer ◽  
Daniel Healy ◽  
Herman Groepenhoff ◽  
Andreas Waldmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Heated Humidifier ◽  
Mechanical Ventilators ◽  
Alarm Fatigue ◽  
Ambient Temperatures ◽  
Technological Advances ◽  
High Acuity ◽  
Heated Humidifiers ◽  
Anesthesia Machines ◽  
Care Surgery

Abstract Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.

scholarly journals Reducing Ventilator Alarms Through Decreased Rainout in Ventilator Circuits: A Bench Study

2021 ◽  
Author(s):  
Danielle Bayoro ◽  
Matthew Meyer ◽  
Daniel Healy ◽  
Herman Groepenhoff ◽  
Andreas Waldmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Heated Humidifier ◽  
Mechanical Ventilators ◽  
Alarm Fatigue ◽  
Ambient Temperatures ◽  
Technological Advances ◽  
High Acuity ◽  
Heated Humidifiers ◽  
Anesthesia Machines ◽  
Care Surgery

Abstract Background:Alarm fatigue is a significant problem in healthcare, particularly in high acuity settings such as intensive care, surgery, and emergency departments. Alarms are triggered by various devices such as anesthesia machines, ventilators, patient monitors or humidifiers. Heated humidifiers (HH) used with mechanical ventilators, while necessary to prevent other complications associated with mechanical ventilator, may cause condensation in the ventilator circuit, prompting occlusion alarms indicating a risk for the patient. Technological advances in heated humidifier (HH) circuits may reduce rainout and therefore occlusion alarms. Methods:Bench experiments measured alarms and rainout of two commercially available humidifiers (AirLife DuoTherm™ and Fisher & Paykel MR850) and four different pediatric and adult patient’s breathing. The tests examined condensation accumulation after 24 hours of low-, nominal-, or high-flow rates of gas at low-, nominal-, and high-ambient temperature settings. Dual-limb designs of adult- and neonate-sized circuits underwent evaluation. Data on alarms was collected for each system.Results:Low temperature and occlusion alarms were statistically significantly lower in DuoTherm vs. MR850 HH circuits (6 vs. 68 alarms, respectively; p<nn). DuoTherm products accumulated significantly less rainout for all three circuit sizes at all ambient temperatures. In general, the set flow rate did not dramatically affect the amount of rainout for adult and infant circuits, but low versus high ambient temperatures yielded increased rainout for all circuit types (p < 0.02). Conclusions:The DuoTherm HH device and patient circuits developed significantly less alarms due to rainout and low temperatures compared to those from MR850 under all the conditions tested. Such reduction in patient alarms should help reduce alarm fatigue among healthcare workers in critical care settings.

scholarly journals Candida auris and Carbapenemase-Producing Organism Prevalence in an Extended Stay Pediatric Hospital, Chicago, Illinois, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s145-s146
Author(s):  
Kelly Walblay ◽  
Tristan McPherson ◽  
Elissa Roop ◽  
David Soglin ◽  
Ann Valley ◽  
...  
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Pediatric Hospital ◽  
Mechanical Ventilators ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Settings ◽  
High Acuity ◽  
Gastrostomy Tubes

Background:Candida auris and carbapenemase-producing organisms (CPO) are multidrug-resistant organisms that can colonize people for prolonged periods and can cause invasive infections and spread in healthcare settings, particularly in high-acuity long-term care facilities. Point-prevalence surveys (PPSs) conducted in long-term acute-care hospitals in the Chicago region identified median prevalence of colonization to be 31% for C. auris and 24% for CPO. Prevalence of C. auris colonization has not been described in pediatric populations in the United States, and limited data exist on CPO colonization in children outside intensive care units. The Chicago Department of Public Health (CDPH) conducted a PPS to assess C. auris and CPO colonization in a pediatric hospital serving high-acuity patients with extended lengths of stay (LOS). Methods: CDPH conducted a PPS in August 2019 in a pediatric hospital with extended LOS to screen for C. auris and CPO colonization. Medical devices (ie, gastrostomy tubes, tracheostomies, mechanical ventilators, and central venous catheters [CVC]) and LOS were documented. Screening specimens consisted of composite bilateral axillae and groin swabs for C. auris and rectal swabs for CPO testing. The Wisconsin State Laboratory of Hygiene tested all specimens. Real-time polymerase chain reaction (PCR) assays were used to detect C. auris DNA and carbapenemase genes: blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP (Xpert Carba-R Assay, Cepheid, Sunnyvale, CA). All axillae and groin swabs were processed by PCR and culture to identify C. auris. For CPO, culture was only performed on PCR-positive specimens. Results: Of the 29 patients hospitalized, 26 (90%) had gastrostomy tubes, 24 (83%) had tracheostomies, 20 (69%) required mechanical ventilation, and 3 (10%) had CVCs. Also, 25 (86%) were screened for C. auris and CPO; 4 (14%) lacked parental consent and were not swabbed. Two rectal specimens were unsatisfactory, producing invalid CPO test results. Median LOS was 35 days (range, 1–300 days). No patients were positive for C. auris. From CPO screening, blaOXA-48 was detected in 1 patient sample, yielding a CPO prevalence of 3.4% (1 of 29). No organism was recovered from the blaOXA-48 positive specimen. Conclusions: This is the first documented screening of C. auris colonization in a pediatric hospital with extended LOS. Despite a high prevalence of C. auris and CPOs in adult healthcare settings of similar acuity in the region, C. auris was not identified and CPOs were rare at this pediatric facility. Additional evaluations in pediatric hospitals should be conducted to further understand C. auris and CPO prevalence in this population.Funding: NoneDisclosures: None

scholarly journals Compensating for the Effect of Inlet Gas Temperature on Heated Humidifier Performance

2003 ◽  
Vol 31 (1) ◽  
pp. 54-57 ◽  
Author(s):  
B. G. Carter ◽  
T. Kemp ◽  
J. Mynard ◽  
M. Hochmann ◽  
A. Osborne
Keyword(s):  
Gravimetric Method ◽  
Heated Humidifier ◽  
Gas Temperature ◽  
Heated Humidifiers

The humidity output of heated humidifiers may be compromised by inlet gas temperatures exceeding approximately 26°C, with humidity dropping below the recommended levels for intubated patients. A new version of the Fisher & Paykel MR850 humidifier claims to deal with this problem by offering a humidity compensation option. The present study tested this feature by measuring humidity output using the gravimetric method and a hygrometer at different inlet gas temperatures (16.6°C to 40.0°C) with compensation on and off. It was found that the compensation is effective in maintaining humidity levels despite high inlet gas temperatures.

scholarly journals ‘Whatsapp’ Call For Help In Medical Emergencies? A Case Report

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Nurfatihah Alias ◽  
Nik Nurfatin Nik Mohamad Fad’lullah Suhaimi ◽  
Shahir Asraf Abdul Rahim ◽  
Muhammad Rasydan Abdul Ghani ◽  
Abdul Hadi Mohamed
Keyword(s):  
Case Report ◽  
Healthcare Workers ◽  
Local Anaesthetics ◽  
Good Alternative ◽  
Medical Field ◽  
Technological Advances ◽  
Care Workers ◽  
Major Mode ◽  
Life Threatening ◽  
Medical Emergencies

The ubiquity of smartphones means that it has become a major mode of communication to all including the healthcare workers. Messaging applications such as WhatsApp, Instagram, WeChat, Line and others have become the new platforms for communications in the medical field between health care workers for rapid relay of information and aid in diagnosis and management of patients. This case report describes the rare complications of local anaesthetics systemic toxicity (LAST) during regional anaesthesia. Immediate calling for help was done through Whatsapp messaging application to the group of anaesthetists and anaesthesiology medical officers as there was a poor network available for a telephone call to be made. Prompt response came from other medical colleagues within few seconds after the message was conveyed. Adequate helping hands were available immediately, thus, morbidity and mortality from the life-threatening complication was successfully avoided. Messaging applications may be one of the efficient mode of technology in the medical emergencies with the increasingly advanced smartphones in computing abilities and connectivity. In the future, developing technological advances specifically designed for communicating medical emergencies can be a good alternative in ensuring more effective and rapid communication.

scholarly journals Remotely controlled ventilators, it is time

2020 ◽  
Vol 1 (2) ◽  
pp. 55-56
Author(s):  
Ehab Daoud
Keyword(s):  
Infectious Virus ◽  
Daily Life ◽  
Wireless Technology ◽  
Patient Room ◽  
Mechanical Ventilators ◽  
Full Agreement ◽  
Technological Advances

In this issue we read with interest the article by Cabbat and Cho explaining the benefits of implementing wireless technology to control mechanical ventilators. In full agreement with them, especially in this unprecedented time where we are confronted in the ICU with a highly infectious virus, I think the time has come for us to be able to control the ventilator remotely, at least from the outside of the patient room. In this era of COVID-19 underscored by a shortage of clinicians and PPEs, this remotely controlled ventilator makes so much sense for all the reasons they highlighted. Additionally, in our current era of technological advances, almost any devices we use in our daily life has the option of being remotely controlled. Imagine purchasing a television and having to manually change and pick among channels much like we did 40 years ago.

A Chryseobacterium meningosepticum Outbreak in a Neonatal Ward

2003 ◽  
Vol 24 (8) ◽  
pp. 613-617 ◽  
Author(s):  
Serdal Güngör ◽  
Metehan Özen ◽  
Aysehan Akinci ◽  
Riza Durmaz
Keyword(s):  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Index Case ◽  
Environmental Surveillance ◽  
Mechanical Ventilators ◽  
Endotracheal Tubes ◽  
Multiple Samples ◽  
Neonatal Ward ◽  
Antiseptic Solutions

AbstractObjective:To report epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak.Design:Outbreak investigation.Setting:A neonatal intensive care unit (NICU) of a referral teaching hospital.Methods:During 2 weeks in September 2001, four neonates in the NICU developed sepsis and underwent laboratory investigation. Multiple samples were obtained for cultures from endotracheal tubes, mechanical ventilators and humidifier boxes, infant incubators, parenteral and antiseptic solutions, feeding bottles, sinks, faucets, doors, and healthcare workers.Results:C. meningosepticum was isolated from the blood cultures of four patients. The first isolate was identified 5 days after the death of the index case. Although all isolates were ciprofloxacin susceptible in vitro, the remaining three patients did not respond to ciprofloxacin therapy given for 6 or 7 days. Therapy was switched to vancomycin and rifampin and all three patients survived, with one having a complication (hydrocephalus). Environmental surveillance revealed C. meningosepticum in the stock lipid solution as the source of the epidemic. The outbreak was controlled after discontinuation of intravenous lipid solution, restriction of further neonatal admissions, and thorough disinfection of the unit and its equipment.Conclusion:Early identification of an epidemic and its source is important in avoiding morbidity and mortality. A contaminated lipid stock bottle was the source of this outbreak associated with multiple cases and one death.

scholarly journals Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients

2014 ◽  
Vol 22 (6) ◽  
pp. 1034-1040 ◽  
Author(s):  
Adriana Carla Bridi ◽  
Thiago Quinellato Louro ◽  
Roberto Carlos Lyra da Silva
Keyword(s):  
Intensive Care ◽  
Coronary Care Unit ◽  
Mechanical Ventilators ◽  
Infusion Pumps ◽  
Alarm Fatigue ◽  
Physiological Variables ◽  
Clinical Alarms ◽  
Sense Of Security ◽  
False Sense ◽  
Coronary Care

OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue.METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds.RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour.CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security.

scholarly journals The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maurizio Bottiroli ◽  
Angelo Calini ◽  
Riccardo Pinciroli ◽  
Ariel Mueller ◽  
Antonio Siragusa ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Northern Italy ◽  
Mechanical Ventilators ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Anesthesia Machines

Abstract Background The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice. Methods We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group. Results Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns. Conclusions Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic. Clinical trial number Not applicable.

scholarly journals COVID-19 in 2020 – a look back from NHS frontline

2021 ◽  
Author(s):  
Julie Smith ◽  
Toni Collier ◽  
Karen Dixon ◽  
Morenike Adebusuyi ◽  
Tonye Sikabofori ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Severe Acute Respiratory Syndrome ◽  
Healthcare Workers ◽  
Healthcare Systems ◽  
World Health ◽  
Technological Advances ◽  
Look Back ◽  
The World ◽  
Health Organization

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 defined our world in 2020. In over a year since the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic, on 11th March 2020, over 130 million people have contracted the virus worldwide, of whom 2.9 million have died. Healthcare systems have weathered unprecedented stresses, but the modern medical and technological advances have come up with vaccines within a year of the WHO declaration. Consequently, as healthcare workers look forward to more normal and less stressful times, some United Kingdom National Health Service (NHS) colleagues have had a retrospective look at their experiences at the beginning of the pandemic.

scholarly journals Evaluating Healthcare Worker Movements and Patient Interactions Within ICU Rooms

2020 ◽  
Vol 41 (S1) ◽  
pp. s222-s224
Author(s):  
Karim Khader ◽  
Molly Leecaster ◽  
William Ray ◽  
Candace Haroldsen ◽  
Lindsay Keegan ◽  
...  
Keyword(s):  
Healthcare Worker ◽  
Healthcare Workers ◽  
Innovative Technology ◽  
Antibiotic Resistant ◽  
Heat Maps ◽  
3 Dimensional ◽  
System A ◽  
Patient Interactions ◽  
High Acuity ◽  
Surgical Icu

Background: Contamination of healthcare workers and patient environments likely play a role in the spread of antibiotic-resistant organisms. The mechanisms that contribute to the distribution of organisms within and between patient rooms are not well understood, but they may include movement patterns and patient interactions of healthcare workers. We used an innovative technology for tracking healthcare worker movement and patient interactions in ICUs. Methods: The Kinect system, a device developed by Microsoft, was used to detect the location of a person’s hands and head over time, each represented with 3-dimensional coordinates. The Kinects were deployed in 2 intensive care units (ICUs), at 2 different hospitals, and they collected data from 5 rooms in a high-acuity 20-bed cardiovascular ICU (unit 1) and 3 rooms in a 10-bed medical-surgical ICU (unit 2). The length of the Kinect deployment varied by room (range, 15–48 days). The Kinect data were processed to included date, time, and location of head and hands for all individuals. Based on the coordinates of the bed, we defined events indicating bed touch, distance 30 cm (1 foot) from the bed, and distance 1 m (3 feet) from the bed. The processed Kinect data were then used to generate heat maps showing density of person locations within a room and summarizing bed touches and time spent in different locations within the room. Results: The Kinect systems captured In total, 2,090 hours of room occupancy by at least 1 person within ~1 m of the bed (Table 1). Approximately half of the time spent within ~1 m from the bed was at the bedside (within ~30 cm). The estimated number of bed touches per hour when within ~1 m was 13–23. Patients spent more time on one side of the bed, which varied by room and facility (Fig. 1A, 1B). Additionally, we observed temporal variation in intensity measured by person time in the room (Fig. 1C, 1D). Conclusions: High occupancy tends to be on the far side (away from the door) of the patient bed where the computers are, and the bed touch rate is relatively high. These results can be used to help us understand the potential for room contamination, which can contribute to both transmission and infection, and they highlight critical times and locations in the room, with a potential for focused deep cleaning.Funding: NoneDisclosures: None

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