scholarly journals Simulation workshops as an adjunct to perioperative care bundles in the management of external ventricular drains: improving surgical technique and reducing infection

2019 ◽  
Vol 131 (5) ◽  
pp. 1620-1624
Author(s):  
Debayan Dasgupta ◽  
Linda D’Antona ◽  
Daniel Aimone Cat ◽  
Ahmed K. Toma ◽  
Carmel Curtis ◽  
...  
Keyword(s):  
Infection Rate ◽  
Perioperative Care ◽  
Best Practice ◽  
Simulation Training ◽  
External Ventricular Drain ◽  
Sampling Technique ◽  
Care Bundle ◽  
Infection Rates ◽  
Improvement Project ◽  
Csf Diversion

OBJECTIVETemporary CSF diversion through an external ventricular drain (EVD) comes with the risk of EVD-related infections (ERIs). The incidence of ERIs varies from 0.8% to 22%. ERIs increase mortality, morbidity, length of stay, and costs; require prolonged courses of antibiotics; and increase the need for subsequent permanent CSF diversion. The authors report the results of a quality improvement project designed to improve infection rates and EVD placement using simulation training in addition to a standardized perioperative care bundle. This project resulted not only in a decrease in ERIs, but also a significant improvement in surgical outcomes.METHODSA best-practice standardized perioperative approach and care bundle was approved by consensus among the senior neurosurgeons at the authors’ institution, and a standardized operative note was designed to encourage adherence to policy and improve documentation. This approach was adapted from the bundle previously described by Kubilay et al. Simulation workshops were introduced to teach safe sampling technique, administration of intrathecal drugs, and a standardized operative technique using the Rowena head surgical model. Effects of the interventions on placement, infection rates, and displacement were measured at two distinct time points over a 2-year period.RESULTSBaseline audits demonstrated satisfactory EVD placement in 74%, an infection rate of 8.5%, and displacement occurring in 20%. In the 2 years following the interventions, satisfactory placement improved to 96%, infection rate fell to 4.8%, and inadvertent displacement occurred in only 1.7%.CONCLUSIONSSimulation training and standardizing the perioperative care of patients requiring EVDs dramatically improved placement accuracy, reduced infection rates, and reduced EVD displacement rate.

scholarly journals A quality improvement project for delirium prevention and management over the Greater Manchester Critical Care Network

2020 ◽  
pp. 175114372091270
Author(s):  
Jessica Davis ◽  
Karen Berry ◽  
Rebecca McIntyre ◽  
Daniel Conway ◽  
Anthony Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Best Practice ◽  
Point Prevalence ◽  
Screening Tools ◽  
Care Bundle ◽  
Improvement Project ◽  
Care Network ◽  
Critical Care Units ◽  
Patient Morbidity ◽  
Delirium Prevention

Background Delirium is a common complication of critical illness with a significant impact on patient morbidity and mortality. The Greater Manchester Critical Care Network established the Delirium Reduction Working Group in 2015. This article describes a region-wide delirium improvement project launched by that group. Methods Multiple Plan-Do-Study-Act cycles were undertaken. Cycle 1: April 2015 demonstrated only 48% of patients had a formal delirium screen. Following this a network-wide event took place and the Delirium Standards for the Greater Manchester Critical Care Network were produced. Cycle 2: May 2016 quarterly audits across the network monitored compliance against the agreed standards. Group events involved implementation of a delirium care bundle, sharing best practice, educating staff and providing guidance on the management of delirium. Cycle 3: November 2016 quarterly audit continued and a regional delirium study day was rolled out across the region. Results We have 14 different units across our network, all of which have participated in the audit. The first audit showed a delirium point prevalence of 28%, subsequent point prevalence audits demonstrated rates as low as 13%. There has also been an improvement in the use of delirium screening tools. In the first audit 37% of patients had two delirium screens in 24 h, this has increased to 60% in the latest audit. Improvements were also made in availability of sensory aids and pain assessments. Conclusion The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.

Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution

2013 ◽  
Vol 118 (3) ◽  
pp. 514-520 ◽  
Author(s):  
Zeynep Kubilay ◽  
Shahram Amini ◽  
Loretta Litz Fauerbach ◽  
Lennox Archibald ◽  
William A. Friedman ◽  
...  
Keyword(s):  
Infection Rate ◽  
Best Practice ◽  
Situational Awareness ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
Skin Preparation ◽  
Sustained Reduction ◽  
Number Of Patients ◽  
Bundle Compliance ◽  
Critical Components

Object Ventricular infection after ventriculostomy placement carries a high mortality rate. Responding to ventriculostomy infection rates, a multidisciplinary performance improvement team was formed, a comprehensive protocol for ventriculostomy placement was developed, and the efficacy was evaluated. Methods A best-practice protocol was developed, including hand hygiene before the procedure; prophylactic antibiotics; sterile gloves changed between preparation, draping, and procedure; hair removal by clipping for dressing adherence; skin preparation using iodine povacrylex (0.7% available iodine) and isopropyl alcohol (74%); full body and head drape; full surgical attire for the surgeon and other bedside providers; and an antimicrobial-impregnated catheter. A checklist of critical components was used to confirm proper insertion and to monitor practice. Procedure-specific infection rates were calculated using the number of infections divided by the number of patients in whom an external ventricular drainage (EVD) device was inserted × 100 (%). Data were reported back to providers and to the committee. Bundle compliance was monitored over a 4-year period. Results At the authors' institution, 2928 ventriculostomies were performed between the beginning of the fourth quarter of 2006 and the end of the first quarter of 2012. Although the best-evidence bundle was applied to all patients, only 588 (20.1%) were checklist monitored (increasing from 7% to 23% over the study period). The infection rate for the 2 quarters before bundle implementation was 9.2%. During the study period, the rate decreased quarterly to 2.6% and then to 0%. Over a 4-year period, the rate was 1.06% (2007), 0.66% (2008), 0.15% (2009), and 0.34% (2010); it was 0% in 2011 and the first quarter of 2012. The overall EVD infection rate was 0.46% after bundle implementation. Conclusions Bundle implementation including an antimicrobial-impregnated catheter dramatically decreased EVD-related infections. Training and situational awareness of appropriate practice, assisted by the checklist, plus use of the antibiotic-impregnated catheter resulted in sustained reduction in ventriculitis.

The implementation of an external ventricular drain care bundle to reduce infection rates

2020 ◽  
Vol 34 (2) ◽  
pp. 181-186
Author(s):  
Sayed Samed Talibi ◽  
Adikarige HD Silva ◽  
Fardad T. Afshari ◽  
James Hodson ◽  
Stuart AG Roberts ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Care Bundle ◽  
Infection Rates

572 Integrating Shared Governance Principles with Real-time Technology to Improve Infection Rates in a Large Burn Center with Patients of Varying Acuity Levels

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S136-S137
Author(s):  
Jane Echols ◽  
Ashley Gamble ◽  
Lisa Berry ◽  
Lynn Dowling ◽  
Michael Wheeler
Keyword(s):  
Nursing Education ◽  
Real Time ◽  
Best Practice ◽  
Shared Governance ◽  
Central Line ◽  
Retention Rates ◽  
Infection Rates ◽  
Time Data ◽  
Improvement Project ◽  
Central Lines

Abstract Introduction Increased job satisfaction, and nursing retention are outcomes that have been related to nursing empowerment.1 Probably one of the most beneficial results of nursing empowerment is improved patient outcomes.1 Empowering nurses is not always an easy task, but the nursing best practice of shared governance through unit-based councils gives nurses the ability to mobilize resources within their own groups to get things done. Couple this mobilization of resources with real-time technology that provides a true clinical picture of outcomes, and this creates a template for success. Methods This is a nursing Quality Improvement project. Shared governance in the form of unit-based councils created within all of our patient care units has proven to be part of the equation for improved infection rates in all units. Our number of CAUTI AND CLABIS from 2018–2019 were reduced, we significantly reduced the number of device days (hospital-wide) for both foleys and central lines, which was also a goal. Through extensive nursing education, utilizing nurse driven protocol for foley removal, increased use of bladder scanning (each unit now has their own bladder scanner) and teaching about de-escalation of central lines/PICC lines as soon as possible, we have been able to reduce our device days overall. Alongside this nursing best practice, a new nursing data portal that allows for real time data collection to identify breaks in protocol with regards to central line and foley maintenance leading to CAUTIs and CLABSIs was also implemented, which allowed nursing to have direct impact on achieving success. Results Percent Change 2018 – 2019 CAUTI BU = 83% decrease, 3E burn = 100% decrease, 4W burn = 100% decrease Overall decrease = 90% CLABSI BU = 85%, 3E burn = 67% increase, 4W burn = no change Overall decrease = 78% Conclusions Implementation of nursing best practice efforts such as shared governance and unit-based councils, coupled with cutting edge technological resources directly contribute to improved infection rate outcomes. Another result of these efforts is the overall positivity fostered among nursing staff, boosting their sense of empowerment and creating better retention rates in all our units.

Ergonomic Process Improvement for Mapping Risk and Identifying Key Interventions for Eliminating Injuries from Needles and Sharps in the OR

2020 ◽  
Vol 64 (1) ◽  
pp. 716-720
Author(s):  
Pramila Kalaga ◽  
Barbara Wolford ◽  
Matthew Mormino ◽  
Timothy Kingston ◽  
Julie Fedderson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Process Improvement ◽  
Injury Risk ◽  
Best Practice ◽  
Physical Workload ◽  
Physical Factors ◽  
Improvement Project ◽  
Targeted Interventions ◽  
Effective Interventions ◽  
Sharps Injury

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

scholarly journals Toxoplasma gondii in Sheep and Goats from Central Iran

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Mojtaba Bahreh ◽  
Bahador Hajimohammadi ◽  
Gilda Eslami
Keyword(s):  
Toxoplasma Gondii ◽  
Dna Extraction ◽  
Infection Rate ◽  
Nested Pcr ◽  
Prevention Programs ◽  
Central Iran ◽  
Infection Rates ◽  
Sheep And Goats ◽  
One Year ◽  
Undercooked Meat

Abstract Objective Toxoplasmosis, caused by Toxoplasma gondii, infects humans by consuming infected raw or undercooked meat and foods harboring mature oocysts. In this study, we assessed the prevalence of T. gondii in sheep and goats coming from central Iran. After completing the questionnaire, about one gram of liver or diaphragm tissue was taken as a sample from 90 sheep and 90 goats slaughtered in Yazd Province and stored at – 20 ºC. DNA extraction was done, and then T. gondii was detected using nested PCR. Results This study indicated that the prevalence of T. gondii in all slaughtered animals was 11.6% (21 of 180), including 14.4% (13/90) in sheep and 8.8% (8/90) in goats. The infection rates in liver and diaphragm samples were 12.2% (11/90) and 11.1% (10/90), respectively (p = 0.8163). The infection rate in animals older than one was 16.3% (15/92), and it was 6.8% (6/88) in animals under one year of age. Therefore, no significant differences were found (p = 0.475). Infection rates were 19.5% (18/92) in males and 3.4% (3/88) in females (p = 0.0007). In conclusion, the infection rates of toxoplasmosis in livestock in this area are almost high, and therefore, it is necessary to design appropriate prevention programs to control the disease.

scholarly journals The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold

2021 ◽  
Vol 18 (14) ◽  
pp. 7491
Author(s):  
Yi-Tui Chen
Keyword(s):  
Infection Rate ◽  
Herd Immunity ◽  
The United States ◽  
Vaccination Rate ◽  
Infection Rates ◽  
Vaccination Rates ◽  
The United Kingdom ◽  
The World ◽  
Almost All ◽  
The Impact

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46–50.91 doses per 100 people.

Biological control of Fusarium wilt of cucumber with nonpathogenic isolates of Fusarium oxysporum

1987 ◽  
Vol 33 (5) ◽  
pp. 349-353 ◽  
Author(s):  
T. C. Paulitz ◽  
C. S. Park ◽  
R. Baker
Keyword(s):  
Biological Control ◽  
Fusarium Oxysporum ◽  
Infection Rate ◽  
Fusarium Wilt ◽  
Disease Incidence ◽  
Infection Rates ◽  
Control Activity ◽  
Significant Difference ◽  
Cucumber Roots ◽  
Linear Regressions

Nonpathogenic isolates of Fusarium oxysporum were obtained from surface-disinfested, symptomless cucumber roots grown in two raw (nonautoclaved) soils. These isolates were screened for pathogenicity and biological control activity against Fusarium wilt of cucumber in raw soil infested with Fusarium oxysporum f. sp. cucumerinum (F.o.c.). The influence of three isolates effective in inducing suppressiveness and three ineffective isolates on disease incidence over time was tested. The effective isolates reduced the infection rate (R), based on linear regressions of data transformed to loge (1/1 – y). Effective isolate C5 was added to raw soil infested with various inoculum densities of F.o.c. In treatments without C5, the increase in inoculum densities of F.o.c. decreased the incubation period of wilt disease, but there was no significant difference in infection rate among the inoculum density treatments. Isolate C5 reduced the infection rate at all inoculum densities of F.o.c. Various inoculum densities of C5 were added to raw soils infested with 1000 cfu/g of F.o.c. In the first trial, infection rates were reduced only in the treatment with 10 000 cfu/g of C5; in the second trial, infection rates were reduced in treatments with 10 000 and 30 000 cfu/g of C5.

External Ventricular Drain Infection

2007 ◽  
Vol 107 (1) ◽  
pp. 248 ◽  
Author(s):  
George K. C. Wong ◽  
Wayne W. S. Poon
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

Sign in / Sign up

Export Citation Format

Share Document