The effect of increased mobility on morbidity in the neurointensive care unit

2012 ◽  
Vol 116 (6) ◽  
pp. 1379-1388 ◽  
Author(s):  
W. Lee Titsworth ◽  
Jeannette Hester ◽  
Tom Correia ◽  
Richard Reed ◽  
Peggy Guin ◽  
...  
Keyword(s):  
Unit Length ◽  
Care Center ◽  
Tertiary Care ◽  
Neurointensive Care ◽  
Neurointensive Care Unit ◽  
Hospital Acquired Infections ◽  
Medical Icus ◽  
Hospital Acquired ◽  
Observation Period

Object The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients. Methods All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus. Results Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections. Conclusions Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

scholarly journals Epidemiology of hospital-acquired infections at a tertiary care center in Lebanon

2011 ◽  
Vol 5 (S6) ◽  
Author(s):  
S Kanj ◽  
G Kamel ◽  
L Alamuddin ◽  
N Zahreddine ◽  
N Sidani ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

scholarly journals Outbreak of NDM-1-Producing Escherichia coli in a Coronavirus Disease 2019 Intensive Care Unit in a Mexican Tertiary Care Center

2022 ◽  
Author(s):  
Oscar A. Fernández-García ◽  
María F. González-Lara ◽  
Marco Villanueva-Reza ◽  
Nereyda de-León-Cividanes ◽  
Luis F. Xancal-Salvador ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Collateral Damage ◽  
Surge Capacity ◽  
Hospital Acquired Infections ◽  
High Workload ◽  
Pandemic Response ◽  
Hospital Acquired

The SARS-CoV-2 pandemic has resulted in a surge of critically ill patients. Hospitals have had to adapt to the demand by repurposing areas as intensive care units. This has resulted in high workload and disruption of usual hospital workflows. Surge capacity guidelines and pandemic response plans do not contemplate how to limit collateral damage from issues like hospital-acquired infections. It is vital to ensure quality of care in surge scenarios.

scholarly journals Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 182
Author(s):  
Bernardo A. Martinez-Guerra ◽  
Maria F. Gonzalez-Lara ◽  
Nereyda A. de-Leon-Cividanes ◽  
Karla M. Tamez-Torres ◽  
Carla M. Roman-Montes ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Infections ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment ◽  
Hospital Acquired ◽  
Antimicrobial Prescription

Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

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

2000 ◽  
Vol 28 (7) ◽  
pp. 2626-2630 ◽  
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

scholarly journals Correlation between Antibiotic Consumption and Hand Hygiene Compliance Among Anesthesia and Intensive Care Healthcare Professionals

2020 ◽  
Vol 14 (1) ◽  
pp. 42-48
Author(s):  
Emanuela Santoro ◽  
Marco Fiore ◽  
Sebastiano Leone ◽  
Armando Masucci ◽  
Roberta Manente ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Healthcare Professionals ◽  
Tertiary Care ◽  
Antibiotic Consumption ◽  
Alcoholic Solution ◽  
Hand Washing ◽  
Hospital Acquired Infections ◽  
Consumption Data ◽  
Hospital Acquired

Aims: The aim of this study was to investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals working in the Department of Anesthesia and Intensive Care of a tertiary care University Hospital. Background: Two centuries have passed since the discovery of Semmelweis that the “puerperal fever” was due to an infection transmitted by the hands. Currently the hand hygiene is still not well performed, rather it is often replaced by the improper use of gloves. Microbial transmission is estimated to occur in one-fifth of all contact cases. Objective: To investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals. Furthermore, to correlate the consumption data of the hydroalcoholic solution and the amount of antibiotics used for the treatment of hospital-acquired infections. Method: The study was conducted over six months period (from January to June 2018); during this period, 20 monitoring sessions were performed. The following indicators were evaluated: a) Non-adherence to hand hygiene with concomitant use of gloves; b) Adhesion to alcoholic friction of hands; c) Hand-washing adhesion. Instead, the consumption data, provided by the hospital ward itself, were used for the evaluation of d) The antibiotics used in the treatment of hospital-acquired infections; e) The hydro-alcoholic solution used by the healthcare professionals for hand hygiene. Results: The frequency of non-adherence to hand hygiene was very high at the beginning of the study, subsequently it decreased to about a half percent to that at the initial stage. The adhesion to alcoholic friction of hands increased during the study period. Otherwise, the hand-washing adhesion slightly reduced, especially in March probably due to the recruitment of new inadequately trained nursing staff. The trend of antibiotic consumption was similar to handwashing. The consumption of hydro-alcoholic solution was very low, however over time, it increased considerably until the end of the study. Conclusion: In light of the findings from this work, it is necessary to make the hospital staff increasingly aware of the correct practice of hand hygiene and to organize training and informative sessions to promote the health of the individual and the community.

Predictive Value of Combination of D-dimer and Fibrinogen in Diagnosing Acute CVST

2021 ◽  
pp. 097275312110631
Author(s):  
Abhishek Pathak ◽  
Varun Kumar Singh ◽  
Anand Kumar ◽  
Vijaya Nath Mishra ◽  
Deepika Joshi ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Predictive Value ◽  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebral Venous Sinus Thrombosis ◽  
Latex Agglutination ◽  
D Dimer ◽  
Latex Agglutination Assay

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke, and the role of D-dimer and fibrinogen in early diagnosis of CVST has been studied with varying results. The present study aims to study the role of the combination of D-dimer and fibrinogen in early diagnosis of acute CVST. Methods: Forty consecutive confirmed acute CVST cases admitted at a tertiary care center were recruited for the study. D-dimer and fibrinogen were assessed by a rapid semiquantitative latex agglutination assay. Results: Out of the 40 CVST patients, 21 (52.50%) were females. The mean age of the patients was 37.58 years ± 19.17 years. Common clinical features were headache ( N = 38 [95%]), papilloedema ( N = 15 [37.5%]), and seizures ( N = 12 [30%]). Although the sensitivity (75%) of the combination of D-dimer and fibrinogen assay was lower than that of D-dimer or fibrinogen alone, the specificity and positive predictive value (75% each) was higher. Conclusions: The combination of D-dimer and fibrinogen testing may aid in an early diagnosis of acute CVST and in better management.

Role of Office-Based Vaginoscopy in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul S. Patel ◽  
Alana L. Christie ◽  
Philippe E. Zimmern
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashwat Dhillon ◽  
Kanhaiya Poddar ◽  
Murat Tuzcu ◽  
Eric Roselli ◽  
Lars Svensson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Troponin T ◽  
Coronary Revascularization ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

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