scholarly journals The long-term impact of a program to prevent central line-associated bloodstream infections in a surgical intensive care unit

Clinics ◽  
2012 ◽  
Vol 67 (8) ◽  
pp. 969-970 ◽  
Author(s):  
AP Paula ◽  
PR Oliveira ◽  
EP Miranda ◽  
CS Felix ◽  
CB Lorigados ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Long Term Impact

Probabilistic Measurement of Central Line–Associated Bloodstream Infections

2015 ◽  
Vol 37 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Bala Hota ◽  
Paul Malpiedi ◽  
Scott K. Fridkin ◽  
John Martin ◽  
William Trick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Probabilistic Method ◽  
Bloodstream Infections ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Equal Distribution ◽  
Final Model ◽  
C Statistic

OBJECTIVETo develop a probabilistic method for measuring central line–associated bloodstream infection (CLABSI) rates that reduces the variability associated with traditional, manual methods of applying CLABSI surveillance definitions.DESIGNMulticenter retrospective cohort study of bacteremia episodes among patients hospitalized in adult patient-care units; the study evaluated presence of CLABSI.SETTINGHospitals that used SafetySurveillor software system (Premier) and who also reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN).PATIENTSPatients were identified from a stratified sample from all eligible blood culture isolates from all eligible hospital units to generate a final set with an equal distribution (ie, 20%) from each unit type. Units were divided a priori into 5 major groups: medical intensive care unit, surgical intensive care unit, medical-surgical intensive care unit, hematology unit, or general medical wards.INTERVENTIONSEpisodes were reviewed by 2 experts, and a selection of discordant reviews were re-reviewed. Data were joined with NHSN data for hospitals for in-plan months. A predictive model was created; model performance was assessed using the c statistic in a validation set and comparison with NHSN reported rates for in-plan months.RESULTSA final model was created with predictors of CLABSI. The c statistic for the final model was 0.75 (0.68–0.80). Rates from regression modeling correlated better with expert review than NHSN-reported rates.CONCLUSIONSThe use of a regression model based on the clinical characteristics of the bacteremia outperformed traditional infection preventionist surveillance compared with an expert-derived reference standard.Infect. Control Hosp. Epidemiol. 2016;37(2):149–155

Survey of Central Line–Associated Bloodstream Infection Prevention Practices across American Burn Association–Certified Adult Burn Units

2013 ◽  
Vol 34 (4) ◽  
pp. 439-440 ◽  
Author(s):  
Geetika Sood ◽  
Doris Heath ◽  
Kerri Adams ◽  
Charlotte Radu ◽  
Judy Bauernfeind ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Severe Burns ◽  
Institutional Review ◽  
Burn Units ◽  
Considerable Impact

Central line–associated bloodstream infections (CLABSIs) have a considerable impact on morbidity, length of stay, and potential mortality. The estimated per-case cost of CLABSIs is $11,000–$56,167, and there is consensus that most are preventable. Publicly reported CLABSI data are also now used as a metric to compare hospitals.There are published guidelines for the prevention of central line–associated infections, but these practices have not been studied in burn patients. Patients with severe burns pose unique and specific challenges and differ substantially from the typical medical or surgical intensive care unit (ICU) patient. Our objective was to assess CLABSI prevention practices in burn units.We identified all American Burn Association (ABA)–certified adult burn centers through the ABA website (http://www.ameriburn.org) and contacted nursing leadership of each burn intensive care unit to conduct a telephone survey of CLABSI prevention practices in March 2012. The survey project was approved by the Johns Hopkins institutional review board.We had 100% survey participation. There was substantial variation among burn units in the number of beds, the mix of patients, and the acuity of patients' illness. Bed size varied from 4 to 38. Eight units stated that their burn unit incorporated a step-down unit or floor-status beds in their bed count. Thirty (58.8%) of the 51 units defined themselves as mixed burn/surgical or trauma units. The percentage of burned patients seen in the burn units varied from 10% to 100%, with 8 (15.4%) of 51 units stating that their census consisted of fewer than 30% burned patients in their burn ICU.

Arterial catheter-related bloodstream infections: Results of an 8-year survey in a surgical intensive care unit*

2011 ◽  
Vol 39 (6) ◽  
pp. 1372-1376 ◽  
Author(s):  
Romain Pirracchio ◽  
Matthieu Legrand ◽  
Mathieu Resche Rigon ◽  
Joaquim Mateo ◽  
Anne Claire Lukaszewicz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Arterial Catheter ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Patients’ Characteristics Associated With Readmission to a Surgical Intensive Care Unit

2012 ◽  
Vol 21 (6) ◽  
pp. e120-e128 ◽  
Author(s):  
T. K. Timmers ◽  
M. H. J. Verhofstad ◽  
K. G. M. Moons ◽  
L. P. H. Leenen
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Severity Of Illness ◽  
Total Sample ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Term Survival

Background Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. Objective To investigate variables that might be associated with readmission to a surgical intensive care unit. Methods Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. Results Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. Conclusion The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.

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