Delirium and Associated Factors Among Older Patients in Coronary and Internal Medicine Intensive Care Units of a University Hospital

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

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Effect of applying nurses driven electrolyte repletion protocol on electrolyte disturbances control among critically ill patients

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n4p72 ◽

2020 ◽

Vol 10 (4) ◽

pp. 72

Author(s):

Mohamed E. Abdelgawad ◽

Nadia T. Ahmed ◽

Ahmed M. Elmenshawy

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Improve Patient Care ◽

University Hospital ◽

Treatment Modalities ◽

Control Group ◽

Electrolyte Disturbances ◽

Electrolyte Loss

Background and objective: Electrolyte disturbances remain a common lifesaving issue in the intensive care units. They are associated with increased morbidity and mortality. They are mostly resulted secondary to critical illness itself or associated treatment modalities. Therefore, electrolytes repletion should be done effectively and timely. This could be ensured using nurse driven protocols rather than traditional methods of repletion. These protocols are nurse initiated and collaboratively developed. They have been shown to improve patient care outcomes through the provision of high quality care. They are increasingly being used in the critical care setting. Objective: Determine the effect of applying nurses driven electrolytes repletion protocol on electrolytes disturbance control among critically ill patients.Methods: Quasi experimental research design was used. Sixty two critically ill patients with electrolytes loss were enrolled in the study at Alexandria Main University Hospital intensive care units, Egypt. All episodes of electrolyte loss were evaluated. Repletion of electrolyte loss was done according to unit routine for the control group and nurses driven electrolytes repletion protocol for the study group. Episodes of electrolyte disturbances, adverse events and timing of repletion were evaluated.Results: Neurological disorders represent the most encountered diagnosis. The most common cause of electrolyte loss in was the use of diuretics. Furthermore, there was a highly statistical difference between the two groups as regard electrolytes levels, effectiveness and timing of replacement.Conclusions: Application of nurses driven electrolyte repletion protocol resulted in improvements in the effectiveness and timeliness of electrolyte replacement.

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Antibiotic Consumption, Bacterial Resistance and their Correlation in a Swiss University Hospital and its Adult Intensive Care Units

Scandinavian Journal of Infectious Diseases ◽

10.1080/00365540310016646 ◽

2003 ◽

Vol 35 (11-12) ◽

pp. 843-850 ◽

Cited By ~ 53

Author(s):

Jutta M. Loeffler ◽

Jorge Garbino ◽

Daniel Lew ◽

Stephan Harbarth ◽

Peter Rohner

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Bacterial Resistance ◽

Antibiotic Consumption ◽

University Hospital

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Dissemination of Two Methicillin-Resistant Staphylococcus aureus Clones Exhibiting Negative Staphylase Reactions in Intensive Care Units

Journal of Clinical Microbiology ◽

10.1128/jcm.37.3.504-509.1999 ◽

1999 ◽

Vol 37 (3) ◽

pp. 504-509 ◽

Cited By ~ 14

Author(s):

Po-Ren Hsueh ◽

Lee-Jene Teng ◽

Pan-Chyr Yang ◽

Hui-Ju Pan ◽

Yu-Chi Chen ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Intensive Care ◽

Intensive Care Units ◽

Random Amplified Polymorphic Dna ◽

Cellular Fatty Acid ◽

University Hospital ◽

Methicillin Resistant ◽

Type Iv ◽

Routine Identification ◽

Arbitrarily Primed Pcr

From December 1997 to March 1998, 25 methicillin-resistantStaphylococcus aureus (MRSA) isolates exhibiting negative Staphylase (Oxoid Ltd., Basingstoke, England) reactions were identified from various clinical specimens from 13 patients in six intensive care units (ICUs) or in wards following a stay in an ICU at the National Taiwan University Hospital. The characteristics of these isolates have not been previously noted in other MRSA isolates from this hospital. Colonies of all these isolates were grown on Trypticase soy agar supplemented with 5% sheep blood and were nonhemolytic and unpigmented. Seven isolates, initially reported as Staphylococcus haemolyticus (5 isolates) and Staphylococcus epidermidis (2 isolates) by the routine identification scheme and with the Vitek GPI system (bioMerieux Vitek, Inc., Hazelwood, Mo.), were subsequently identified as S. aureus by positive tube coagulase tests, standard biochemical reactions, and characteristic cellular fatty acid chromatograms. The antibiotypes obtained by the E test, coagulase types, restriction fragment length polymorphism profiles of the staphylococcal coagulase gene, and random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates disclosed that two major clones disseminated in the ICUs. Clone 1 (16 isolates) was resistant to clindamycin and was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ) and was coagulase type II. Clone 2 (eight isolates) was resistant to clindamycin and TMP-SMZ and was coagulase type IV. These two epidemic clones from ICUs are unique and underline the need for caution in identifying MRSA strains with colonial morphologies not of the typical type and with negative Staphylase reactions.

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Pseudomonas aeruginosa-producing Metallo-β-lactamases (VIM, IMP, SME, and AIM) in the Clinical Isolates of Intensive Care Units, a University Hospital in Isfahan, Iran

Advanced Biomedical Research ◽

10.4103/2277-9175.219412 ◽

2017 ◽

Vol 6 (1) ◽

pp. 147 ◽

Cited By ~ 7

Author(s):

Mohammadreza Yazdani ◽

Farzin Khorvash ◽

Shiva Shabani ◽

Aliasghar Soudi

Keyword(s):

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Intensive Care Units ◽

Clinical Isolates ◽

University Hospital

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Transfusion profiles in intensive care units from a university hospital

Critical Care ◽

10.1186/cc5572 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P412

Author(s):

M Assuncao ◽

I Paula ◽

L Falcao ◽

B Mazza ◽

M Barros ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

University Hospital

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528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.597 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S254-S254

Author(s):

Min Ja Kim ◽

You Seung Chung ◽

Hojin Lee ◽

Jin Woong Suh ◽

Yoojung Cheong ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Clinical Laboratory ◽

Multidrug Resistant ◽

University Hospital ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Multidrug Resistant Organisms ◽

Before And After ◽

The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

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