scholarly journals Self-Extubation in the Surgical Intensive Care Unit and Restraint Policy Change: A Retrospective Study

2014 ◽  
Vol 1 (1) ◽  
pp. 10-14 ◽  
Author(s):  
John T. Denny ◽  
Enrique Pantin ◽  
Julia Denny ◽  
William Grubb ◽  
James Tse ◽  
...  
Keyword(s):  
Intensive Care ◽  
Policy Change ◽  
Initial Study ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Face To Face ◽  
Life Threatening ◽  
Recent Policy

Background:Self-extubation is a serious complication of mechanical ventilation. The incidence of self-extubation in a university hospital may be altered by a recent policy change, which requires daily written and face-to-face patient re-evaluations regarding the need for restraints in the intensive care units. There are many concerns and suspicions that this might result in less use of restraints and thereby increase the risk of self-extubation.Methods:The goal of this study was to describe the incidence of self-extubation (SE) over time and report any observed change with the change in restraint policy (RP).Results:The rate of self-extubation during the control year was 1.62% which increased to 2.33% during the initial study period and decreased to 1.30% in the following year. The distant follow-up period eight years after the initial change in restraint policy showed a rate of 1.14%. Apache scores did not differ significantly between the years compared.Conclusion:A new restraint policy, which requires frequent reordering by physicians, has the potential to be associated with increased self-extubation, at least temporarily. Staff education may help reduce this risk. Further research will be useful in clarifying which interventions can most reduce this potentially life-threatening complication.

scholarly journals Comparison of Automated Strategies for Surveillance of Nosocomial Bacteremia

2007 ◽  
Vol 28 (9) ◽  
pp. 1030-1035 ◽  
Author(s):  
Cristina Bellini ◽  
Christiane Petignat ◽  
Patrick Francioli ◽  
Aline Wenger ◽  
Jacques Bille ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Data ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Automated Surveillance ◽  
Contaminated Blood ◽  
Hospital Acquired

Objective.Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance.Methods.Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data.Setting.An 850-bed university hospital.Participants.All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years.Results.The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%.Conclusion.Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.

Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit

2002 ◽  
Vol 23 (3) ◽  
pp. 120-126 ◽  
Author(s):  
Marvin J. Bittner ◽  
Eugene C. Rich ◽  
Paul D. Turner ◽  
William H. Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Trial ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Surgical Intensive Care ◽  
Adult Intensive Care Unit ◽  
Paper Towel

Objective:To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.Design:Prospective trial with a nonequivalent control group.Setting:Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).Subjects:Unit staff.Intervention:Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.Results:Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r= -0.35 for the MICU,r= -0.46 for the SICU).Conclusions:Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.

The Journey to Zero Central Catheter–Associated Bloodstream Infections: Culture Change in an Intensive Care Unit

2012 ◽  
Vol 32 (2) ◽  
pp. 49-54 ◽  
Author(s):  
Sheri L. Southworth ◽  
Lita Jo Henman ◽  
Lisa A. Kinder ◽  
Jennifer L. Sell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Culture Change ◽  
Bloodstream Infections ◽  
Lessons Learned ◽  
Surgical Intensive Care Unit ◽  
Team Approach ◽  
Surgical Intensive Care ◽  
Life Threatening ◽  
Continuous Feedback

A process change with the goal of decreasing and ultimately eliminating bloodstream infections associated with central catheters in critical care patients was implemented at Riverside Methodist Hospital. This process of implementation resulted in a culture change in the hospital’s medical surgical intensive care unit. Keys to success included a multidisciplinary team approach, support from persons with a stake in the process, and provision of continuous feedback. The lessons learned in this journey at Riverside Methodist Hospital can help caregivers at other hospitals decrease the occurrence of these life-threatening infections.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Long-term follow-up of ICU patients

1992 ◽  
Vol 1 (2) ◽  
pp. 115-117 ◽  
Author(s):  
BC Friedman ◽  
W Boyce ◽  
CE Bekes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Practical Method ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Long Term Follow Up

Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.

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