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Damon, Amy L., Carmen D. Parrotta, Lindsey A. Wallace, and William Riley. "The effectiveness of providing evidenced-based perinatal practice to low-income populations providing perinatal care: Does patient income influence the delivery of quality care?" Journal of Hospital Administration 2, no. 4 (June 8, 2013): 82. http://dx.doi.org/10.5430/jha.v2n4p82.
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Background: This study examines a national perinatal quality improvement collaborative designed to create high reliability through the use of evidence-based perinatal care bundles. The objective of this study is to determine whether hospitals serving low-income patient populations experienced lower compliance with perinatal care bundles than hospitals serving higher-income patient populations Objective: We investigated the relationship between the rate of perinatal bundle compliance within a hospital and the economic characteristics of the patients and surrounding community. We hypothesized a negative relationship between poverty and care bundle compliance. Methods: Using prospective data from 131,847 births over 34 months within 16 hospitals located in cities across the United States, we examined the relationship between compliance with evidence-based obstetrical care bundles and three measures of the poverty status of the patient population served and the hospital service area: 1) proportion of the obstetrical patients with Medicaid as the primary payer, 2) median income in the hospital service area, and 3) poverty rate in the hospital’s service area. Results: The findings indicate no difference in bundle compliance rates in relation to the economic characteristics of the participating hospitals and their patients. Conclusions: While previous research has indicated that patients of lower socioeconomic status are less likely to receive high quality care, the findings in this study indicate that hospital compliance with evidence-based perinatal care bundles did not differ by economic characteristics of the hospital service area. These results indicate uniformity of care across hospitals irrespective of patient economic characteristics.
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Gómez-Angelats, Elisenda, and Carolina Sánchez. "Care Bundles after Discharging Patients with Chronic Obstructive Pulmonary Disease Exacerbation from the Emergency Department." Medical Sciences 6, no. 3 (August 7, 2018): 63. http://dx.doi.org/10.3390/medsci6030063.
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Chronic obstructive pulmonary disease (COPD) is the second leading cause of emergency department (ED) admissions to hospital, and nearly a third of patients with acute exacerbation (AE) of COPD are re-admitted to hospital within 28 days after discharge. It has been suggested that nearly a third of COPD admissions could be avoided through the implementation of evidence-based care interventions. A COPD discharge bundle is a set of evidence-based practices, aimed at improving patient outcomes after discharge from AE COPD; body of evidence supports the usefulness of discharge care bundles after AE of COPD, although there is a lack of consensus of what interventions should be implemented. On the other hand, the implementation of those interventions also involves different challenges. Important care gaps remain regarding discharge care bundles for patients with acute exacerbation of COPD discharged from EDs There is an urgent need for investigations to guide future implementation of care bundles for those patients discharged from EDs.
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Shaw, Ali, Katherine Morton, Anna King, Melanie Chalder, James Calvert, Sue Jenkins, and Sarah Purdy. "Using and implementing care bundles for patients with acute admission for COPD: qualitative study of healthcare professionals’ experience in four hospitals in England." BMJ Open Respiratory Research 7, no. 1 (March 2020): e000515. http://dx.doi.org/10.1136/bmjresp-2019-000515.
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BackgroundCare bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.MethodsWithin the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.ResultsHealthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.ConclusionCare bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.
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Fulbrook, Paul, and Sharon Mooney. "Care bundles in critical care: a practical approach to evidence-based practice." Nursing in Critical Care 8, no. 6 (December 2003): 249–55. http://dx.doi.org/10.1111/j.1362-1017.2003.00039.x.
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Plata-Menchaca, Erika P., Juan Carlos Ruiz-Rodríguez, and Ricard Ferrer. "Evidence for the Application of Sepsis Bundles in 2021." Seminars in Respiratory and Critical Care Medicine 42, no. 05 (September 20, 2021): 706–16. http://dx.doi.org/10.1055/s-0041-1733899.
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AbstractSepsis represents a severe condition that predisposes patients to a high risk of death if its progression is not ended. As with other time-dependent conditions, the performance of determinant interventions has led to significant survival benefits and quality-of-care improvements in acute emergency care. Thus, the initial interventions in sepsis are a cornerstone for prognosis in most patients. Even though the evidence supporting the hour-1 bundle is perfectible, real-life application of thoughtful and organized sepsis care has improved survival and quality of care in settings promoting compliance to evidence-based treatments. Current evidence for implementing the Surviving Sepsis Campaign bundles for early sepsis management is moving forward to better approaches as more substantial evidence evolves.
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Weavind, Liza M., Nahel Saied, J. D. Hall, and Pratik P. Pandharipande. "Care Bundles in the Adult ICU: Is It Evidence-Based Medicine?" Current Anesthesiology Reports 3, no. 2 (March 26, 2013): 79–88. http://dx.doi.org/10.1007/s40140-013-0017-6.
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Dixon, Padraig, William Hollingworth, Jonathan Benger, James Calvert, Melanie Chalder, Anna King, Stephanie MacNeill, Katherine Morton, Emily Sanderson, and Sarah Purdy. "Observational Cost-Effectiveness Analysis Using Routine Data: Admission and Discharge Care Bundles for Patients with Chronic Obstructive Pulmonary Disease." PharmacoEconomics - Open 4, no. 4 (March 25, 2020): 657–67. http://dx.doi.org/10.1007/s41669-020-00207-w.
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Abstract Background Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease, and accounts for a substantial proportion of unplanned hospital admissions. Care bundles for COPD are a set of standardised, evidence-based interventions that may improve outcomes in hospitalised COPD patients. We estimated the cost effectiveness of care bundles for acute exacerbations of COPD using routinely collected observational data. Methods Data were collected from implementation (n = 7) and comparator (n = 7) acute hospitals located in England and Wales. We conducted a difference-in-difference cost-effectiveness analysis using a secondary care (i.e. hospital) perspective to examine the effect on National Health Service (NHS) costs and 90-day mortality of implementing care bundles compared with usual care for patients admitted to hospital with an acute exacerbation of COPD. Adjusted models included as covariates patient age, sex, deprivation, ethnicity and seasonal effects and mixed effects for site. Results Outcomes and baseline characteristics of up to 12,532 patients were analysed using both complete case and multiply imputed models. Implementation of bundles varied. COPD care bundles were associated with slightly lower secondary care costs, but there was no evidence that they improved outcomes once adjustments were made for site and baseline covariates. Care bundles were unlikely to be cost effective for the NHS with an estimated net monetary benefit per 90-day death avoided from an adjusted multiply imputed model of −£1231 (95% confidence interval − £2428 to − £35) at a high cost-effectiveness threshold of £50,000 per 90-day death avoided. Conclusion and Recommendations Care bundles for COPD did not appear to be cost effective, although this finding may have been influenced by unmeasured variations in bundle implementation and other potential confounding factors.
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Borgert, Marjon, Jan Binnekade, Frederique Paulus, Astrid Goossens, and Dave Dongelmans. "A flowchart for building evidence-based care bundles in intensive care: based on a systematic review." International Journal for Quality in Health Care 29, no. 2 (February 2, 2017): 163–75. http://dx.doi.org/10.1093/intqhc/mzx009.
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Siau, Keith, Sarah Hearnshaw, Adrian J. Stanley, Lise Estcourt, Ashraf Rasheed, Andrew Walden, Mo Thoufeeq, et al. "British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding." Frontline Gastroenterology 11, no. 4 (March 27, 2020): 311–23. http://dx.doi.org/10.1136/flgastro-2019-101395.
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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.
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Yamada, Koji, Hiroaki Abe, Akiro Higashikawa, Juichi Tonosu, Takashi Kuniya, Koji Nakajima, Haruko Fujii, et al. "Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery." SPINE 43, no. 24 (December 2018): 1765–73. http://dx.doi.org/10.1097/brs.0000000000002709.
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Kilpatrick, C., H. Murdoch, and A. Paterson. "O079: The rapid delivery of national evidence based recommendations for HAI care bundles." Antimicrobial Resistance and Infection Control 2, Suppl 1 (2013): O79. http://dx.doi.org/10.1186/2047-2994-2-s1-o79.
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Floyd, Natalie A., Karen A. Dominguez-Cancino, Linda G. Butler, Oriana Rivera-Lozada, Juan M. Leyva-Moral, and Patrick A. Palmieri. "The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review." Open Nursing Journal 15, no. 1 (April 20, 2021): 74–84. http://dx.doi.org/10.2174/1874434602115010074.
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Background: Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage. Objective: The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs. Methods: This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence. Results: The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs. Conclusion: Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
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Fitz, Sarah, Lauren Diegel-Vacek, and Erin Mahoney. "A Performance Improvement Initiative for Implementing an Evidence-Based Discharge Bundle for Lung Transplant Recipients." Progress in Transplantation 30, no. 3 (June 18, 2020): 281–85. http://dx.doi.org/10.1177/1526924820933832.
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Background: Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates. Local Problem: A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population. Methods: A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team. Interventions: The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge. Results: The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle. Conclusions: Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.
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Mullins, Sydney, Sarah Bernardy, Marianne MacLachlan, Maureen Evans, Anna Olszewski, Kara N. Kidd, Angela Maroon, et al. "807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S241—S242. http://dx.doi.org/10.1093/jbcr/iraa024.384.
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Abstract Introduction Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections. Methods A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year. Results Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups. Conclusions Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences. Applicability of Research to Practice Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.
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Gupta, Poonam, Mincy Thomas, Ashfaq Patel, Reeba George, Leena Mathews, Seenu Alex, Siji John, et al. "Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit." BMJ Open Quality 10, no. 1 (February 2021): e001200. http://dx.doi.org/10.1136/bmjoq-2020-001200.
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BackgroundCentral venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.MethodsIn collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.ResultsThe CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.ConclusionsImplementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.
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Veronese, Giacomo, Manlio Cipriani, Maurizio Bottiroli, Andrea Garascia, Michele Mondino, Patrizia Pedrotti, Daniela Pini, et al. "Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles." Journal of Cardiovascular Medicine 21, no. 7 (June 1, 2020): 529–31. http://dx.doi.org/10.2459/jcm.0000000000000989.
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Kurutkan, Mehmet. "An Application of Patient Safety in the Context of Evidence Based Practice: Care Bundles." Health Care Academician Journal 1, no. 2 (2014): 83. http://dx.doi.org/10.5455/sad.201401028388.
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Abdallah, Ayman Bahjat, and Rasha Zuhair Alkhaldi. "Lean bundles in health care: a scoping review." Journal of Health Organization and Management 33, no. 4 (June 28, 2019): 488–510. http://dx.doi.org/10.1108/jhom-09-2018-0263.
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Purpose The purpose of this paper is to review original research on lean management (LM) in health care to identify potential research gaps and present recommendations for future research. The paper also discusses the current state of implementing LM practices in health care. In addition, it presents and highlights “lean bundles” imported from manufacturing, namely, total quality management (TQM), human resource management, just-in-time and total productive maintenance, as a potential implementation strategy of LM in hospitals to optimize overall health care performance. Design/methodology/approach The scoping review was conducted based on the guidelines specified by Arksey and O’Malley (2005). Relevant included studies were retrieved by searching various electronic databases. The PRISMA guidelines were applied to identify and select eligible studies. Findings The majority of previous studies used selected practices to measure LM in health care. In most cases, these practices reflected a narrow and biased view of LM. Lean bundles which comprehensively view LM and reflect all its aspects have rarely been discussed in the health care literature. Evidence about the contribution of lean bundles to hospital performance needs to be addressed in future studies. Practical implications This paper demonstrates the implementation of the four lean bundles in hospitals. It argues that, instead of adopting one dimension or selected practices of LM, hospitals viewing LM as a comprehensive multi-dimensional approach through the adoption of the four lean bundles are expected to maximize their performances. Originality/value This is one of the first works to comprehensively review and discuss lean bundles in the context of health care. It argues that the adoption of the four lean bundles by hospitals will enable them to yield the maximum LM performance benefits. In addition, a proposed survey questionnaire based on the literature review is provided to assist researchers in conducting future empirical studies.
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Zirges, Christine, and Stephen Rusbarsky. "Care Bundles for Preventing Device Related Infections: Just Focus on These 6 Things." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s152. http://dx.doi.org/10.1017/ice.2020.671.
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Background: Centralizing healthcare associated infection (HAI) data for 21 hospitals across several states facilitates a big picture assessment of monthly enterprise performance along with evaluation of practice, policy, and products. Variation in prevention practices has made it difficult to identify areas of focus and created confusion when attempting to standardize prevention tactics for central-line and urinary catheter care. Lack of consistent practice audits have made it difficult to evaluate actual practice. For these reasons, we performed a gap analysis to understand the current state. Methods: Gap assessment tools were developed to assess infection prevention practices for central lines and indwelling urinary catheters. Survey questions were developed with a comment option to collect qualitative data. The 2014 Compendium of Strategies to Prevent Healthcare-Associated Infection in Acute-care Hospitals was utilized as the reference point. This document facilitates the translation of essential information into clinical practice, thus providing the rationale and level of evidence needed for discussion groups. Completion occurred with various key stakeholders within each hospital. One survey per hospital was compiled. Results: All hospitals completed the survey with key themes emerging and supported by observational data. Findings included variation with education, chlorhexidine bathing, types of dressings, and compliance with alcohol port protectors. Gaps identified with urinary catheter care included confusion surrounding catheter care, breaches in seals, and optimizing alternatives to catheterization. Rather than segment solutions for identified gaps, care bundles were developed to provide focus, to facilitate evidence-based practice, and to create standard work-around clinical audits that consisted of going to the patient rather than the electronic health record. Care bundles provided the 6 items to focus on and for which to create policy and standardize products. Conclusions: Care-bundle implementation initially created resistance from clinicians and many questions regarding actual practice. The design of the tool was deliberate in that audit language, the metric, and the “why” were included and served as a medium to discuss the evidence and immediate feedback for practice. Pareto charts were posted on unit performance boards. It became evident that compliance with prevention tactics was not consistent. Although number of infections or outcome data did not appreciably decrease, standardized utilization ratio was reduced by 11% for each device after 3 quarters. Process measures from bundle audits continue to improve, as do observational data, and these are part of focused discussions at quality forums. A culture change has occurred as process measures and evidence-based practice has become a priority.Funding: NoneDisclosures: None
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Hollesen, Rikke von Benzon, Rie Laurine Rosenthal Johansen, Christina Rørbye, Louise Munk, Pierre Barker, and Anette Kjaerbye-Thygesen. "Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control." BMJ Quality & Safety 27, no. 8 (February 3, 2018): 633–42. http://dx.doi.org/10.1136/bmjqs-2017-006599.
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BackgroundA safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.MethodsThe change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a ‘delivery bundle’, an ‘oxytocin bundle’ and a ‘vacuum extraction bundle’; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming’s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar <7 after 5 min or pH <7) were analysed using statistical process control.ResultsCompliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH <7 and Apgar <7 after 5 min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.ConclusionThis QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.
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Telfer, Michelle, Jessica Illuzzi, and Diana Jolles. "Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative." Journal of Doctoral Nursing Practice 14, no. 2 (May 18, 2021): 130–38. http://dx.doi.org/10.1891/jdnp-d-20-00026.
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BackgroundAt many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth.MethodsChart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks.ResultsThe bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.ConclusionsImplementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.Implications for NursingImplementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.
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Goffman, Dena, Cande V. Ananth, Adiel Fleischer, Mary D'Alton, Jessica A. Lavery, Richard Smiley, Kristin Zielinski, and Cynthia Chazotte. "The New York State Safe Motherhood Initiative: Early Impact of Obstetric Hemorrhage Bundle Implementation." American Journal of Perinatology 36, no. 13 (January 4, 2019): 1344–50. http://dx.doi.org/10.1055/s-0038-1676976.
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Objective To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS). Study Design In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status. Results Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status. Conclusion Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required.
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Teague, Amanda H., Amy J. Jnah, and Desi Newberry. "Intraprofessional Excellence in Nursing: Collaborative Strategies for Neonatal Abstinence Syndrome." Neonatal Network 34, no. 6 (2015): 320–28. http://dx.doi.org/10.1891/0730-0832.34.6.320.
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AbstractNeonatal abstinence syndrome (NAS) is a growing public health concern, one that costs the health care system $190–$720 million each year. Recently, state-level perinatal quality collaborative groups have disseminated NAS action plans: customizable frameworks aimed to assist health care systems in identifying, evaluating, treating, and coordinating discharge services for neonates with NAS. Hospital-based neonatal nursing quality improvement teams, including neonatal nurse practitioners (NNPs), neonatal clinical nurse specialists (CNSs), and clinical neonatal nurses, by virtue of their collective academic, administrative, and practical years of experience, are ideally positioned to develop, implement, and evaluate NAS care bundles. The article’s purpose is to discuss key elements of an NAS care bundle using the framework of the Perinatal Quality Collaborative of North Carolina NAS action plan as an exemplar. Discussion of evidence-based and nursing-driven metrics will be followed by a discussion of the emerging concept of an inpatient-to-outpatient transitional care NAS management model.
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Grigonis, Antony M., Amanda M. Dawson, Mary Burkett, Arthur Dylag, Matthew Sears, Betty Helber, and Lisa K. Snyder. "Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals." American Journal of Critical Care 25, no. 2 (March 1, 2016): 165–72. http://dx.doi.org/10.4037/ajcc2016894.
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Objective Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). Methods A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. Results The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η2 = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85–7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (−0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. Conclusion The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.
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Johnny, Jace D., Zachary Drury, Tracey Ly, and Janel Scholine. "Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review." Critical Care Nurse 41, no. 4 (August 1, 2021): 66–70. http://dx.doi.org/10.4037/ccn2021330.
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Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.
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Resende, Daiane Silva, Jacqueline Moreira do Ó, Denise von Dolinger de Brito, Vânia Olivetti Steffen Abdallah, and Paulo Pinto Gontijo Filho. "Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil." Revista da Sociedade Brasileira de Medicina Tropical 44, no. 6 (December 2011): 731–34. http://dx.doi.org/10.1590/s0037-86822011000600015.
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INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.
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Atia, Gehan A. F. "Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients." Evidence-Based Nursing Research 2, no. 1 (January 15, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i1.93.
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Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records.
Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups.
Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.
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Cotoia, Antonella, Savino Spadaro, Guido Gambetti, Despoina Koulenti, and Gilda Cinnella. "Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review." Microorganisms 8, no. 6 (May 30, 2020): 821. http://dx.doi.org/10.3390/microorganisms8060821.
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Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.
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Koyner, Jay L., Alexander Zarbock, Rajit K. Basu, and Claudio Ronco. "The impact of biomarkers of acute kidney injury on individual patient care." Nephrology Dialysis Transplantation 35, no. 8 (November 14, 2019): 1295–305. http://dx.doi.org/10.1093/ndt/gfz188.
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Abstract Acute kidney injury (AKI) remains a common clinical syndrome associated with increased morbidity and mortality. In the last several years there have been several advances in the identification of patients at increased risk for AKI through the use of traditional and newer functional and damage biomarkers of AKI. This article will specifically focus on the impact of biomarkers of AKI on individual patient care, focusing predominantly on the markers with the most expansive breadth of study in patients and reported literature evidence. Several studies have demonstrated that close monitoring of widely available biomarkers such as serum creatinine and urine output is strongly associated with improved patient outcomes. An integrated approach to these biomarkers used in context with patient risk factors (identifiable using electronic health record monitoring) and with tests of renal reserve may guide implementation and targeting of care bundles to optimize patient care. Besides traditional functional markers, biochemical injury biomarkers have been increasingly utilized in clinical trials both as a measure of kidney injury as well as a trigger to initiate other treatment options (e.g. care bundles and novel therapies). As the novel measures are becoming globally available, the clinical implementation of hospital-based real-time biomarker measurements involves a multidisciplinary approach. This literature review discusses the data evidence supporting both the strengths and limitations in the clinical implementation of biomarkers based on the authors’ collective clinical experiences and opinions.
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Conner, Janet, and Joan Ivaska. "Direct Data Mining from the Electronic Medical Record to Assess and Improve Compliance With Infection Prevention Bundles." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s32—s33. http://dx.doi.org/10.1017/ice.2020.511.
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Background: Bundles have been proven to reduce the risk of healthcare-associated infections and to provide for rapid recognition and response for the best outcome in patients with sepsis. Each element alone does not provide the statistical significance that all elements together allow. Providing near real-time compliance with bundle measures to clinical staff can drive performance improvement with the bundle during the patient’s hospital stay, resulting in improved clinical care and prevention of infection. Methods: In 2019, 3 clinical initiatives were chartered that applied evidence-based bundles for early identification and treatment of sepsis, prevention of healthcare-associated pneumonia (HAP), and prevention of surgical site infection. The bundle included the following elements: assessment of sepsis, measurement of lactic acid, collection of blood culture, timely administration of antibiotics. The HAP bundle included the following elements: assessment of aspiration risk, elevation of the head of the bed, oral care twice daily and preoperatively, and incentive spirometry postoperatively. And the SSI bundle included the following elements: preoperative CHG bath, appropriate preoperative antibiotic, perioperative glucose control, and perioperative temperature control. A multidisciplinary team developed and implemented dashboards that extracted bundle elements from the electronic medical record (EMR) nightly. Bundle compliance was calculated at the individual element level as well as the aggregate. Bundle failure data were available at the patient level as well as in aggregate by care location and provider, allowing for real-time feedback to staff and creation of improvement plans. An unanticipated benefit was the identification and correction of charting inconsistencies. Results: Collection, aggregation, and analysis of bundle compliance data were displayed in a system dashboard, and data were refreshed nightly. This approach allowed us to display overall bundle compliance at the facility and system level, including a heat map showing each facility’s compliance with the bundle and each associated element. Utilization of an EMR dashboard allowed for performance review on 100% of eligible patients rather than a sample, as occurs with manual review and abstraction processes. Routine review of performance via the dashboards with frontline staff, clinical leaders, medical staff, and executives has resulted in month-by- month improvement in bundle compliance. Conclusions: Direct data mining, data aggregation and analysis, followed by direct feedback to frontline staff, has resulted in steady improvement in overall bundle compliance, compliance with individual bundle components, and standardization of charting in the EMR. This approach has ultimately resulted in better outcomes for sepsis patients, reduction in healthcare-associated pneumonia, and reduction in surgical site infections.Funding: NoneDisclosures: None
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Linder, Lauri A., Cheryl Gerdy, Rouett Abouzelof, and Andrew Wilson. "Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line–Associated Bloodstream Infections in a Pediatric Oncology Unit." Journal of Pediatric Oncology Nursing 34, no. 3 (November 18, 2016): 185–95. http://dx.doi.org/10.1177/1043454216676838.
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Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line–associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line–associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.
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Stallsmith, Jena, Regina Won, Christopher M. Lopez, Forrest Orme, R. Brigg Turner, and Dominic Chan. "294. Interim Analysis of an Evidence-Based Bundle Intervention for Uncomplicated Enterobacterales Bacteremia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S146. http://dx.doi.org/10.1093/ofid/ofaa439.337.
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Abstract Background Use of evidence-based process bundles for Staphylococcus aureus bacteremia benefit patient outcomes. No studies exist assessing the value of an evidence-based bundle (EBB) in Enterobacterales bacteremia. Recent studies show shorter durations of therapy (DOT) (~ 7 days) result in similar outcomes as longer DOT when treating uncomplicated gram-negative bacteremia. An internal study showed 87% of treatment course durations were > 7 days. This study seeks to determine the impact of an education-based EBB for uncomplicated Enterobacterales bacteremia on patient length of stay (LOS) and DOT. Methods This is a quasi-experimental pre- post- analysis conducted across six medical centers. The pre-intervention cohort (n=546) consisted of patients treated for uncomplicated Enterobacterales bacteremia between Jan 1 2016 and Dec 31 2017. The post-EBB education cohort (n=49) consisted of patients treated with the bundle from Jan 1 2020 through Apr 4 2020. Exclusion criteria included immunocompromised state, multiple infection sites, lack of source control, polymicrobial bacteremia, death within 48 hours of treatment, receiving end of life care, < 6 days or > 16 days of therapy, and failure to receive at least one antibiotic with in vitro activity against the organism. The primary outcome was the proportion of patients receiving 6–10 days of therapy. Secondary outcomes included LOS, 30-day readmission rate, 30-day all-cause mortality, time to intravenous to oral conversion, and EBB adherence. Descriptive statistics were used for the baseline characteristics and primary and secondary outcomes. Multiple regression analysis was performed to assess patient covariates. Results There was no difference in the proportion of patients receiving 6–10 days of therapy between the pre- and the post-EBB groups (43.4% vs 53.1%; p = 0.19). There was no association between DOT and covariates. The pre- and post-intervention group had average total DOT of 11.7 ± 2.6 days and 10.6 ± 2.7 days (p = 0.0047), respectively. Conclusion This interim analysis suggests an education-based EBB for Enterobacterales does not increase the proportion of patients receiving DOT of 6–10 days. Education alone may be insufficient. Disclosures All Authors: No reported disclosures
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Poh, Kok Wei, Cheng Huong Ngan, Ji Yin Wong, Tiang Koi Ng, and Nadiah Mohd Noor. "Reduction of central-line-associated bloodstream infection (CLABSI) in resource limited, nonintensive care unit (ICU) settings." International Journal of Health Care Quality Assurance 33, no. 2 (February 25, 2020): 210–20. http://dx.doi.org/10.1108/ijhcqa-11-2019-0195.
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PurposeThere was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban.Design/methodology/approachPreinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care.FindingsThere was a significant overall reduction of CLABSI rate between preintervention and postintervention period [incidence rate ratio (IRR) of 0.06 (95 percent CI, 0.01–0.33; P = 0.001)].Practical implicationsCLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI.Originality/valueThis study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.
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El Sayed, Mazen J. "Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators." Emergency Medicine International 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/161630.
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Measuring quality in Emergency Medical Services (EMSs) systems is challenging. This paper reviews the current approaches to measuring quality in health care and EMS with a focus on currently used clinical performance indicators in EMS systems (US and international systems). The different types of performance indicators, the advantages and limitations of each type, and the evidence-based prehospital clinical bundles are discussed. This paper aims at introducing emergency physicians and health care providers to quality initiatives in EMS and serves as a reference for tools that EMS medical directors can use to launch new or modify existing quality control programs in their systems.
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Henry, Michelle. "Evaluation of evidence-based practice of catheter associated urinary tract infections prevention in a critical care setting: An integrative review." Journal of Nursing Education and Practice 8, no. 7 (January 28, 2018): 22. http://dx.doi.org/10.5430/jnep.v8n7p22.
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Background and objective: An estimated 449,300 catheter-associated tract urinary infection (CAUTI) incidents affecting Americans and 13,000 CAUTI-related deaths in the United States every year. The purpose of the review was the appraisal and integration of the best evidence practice for preventing CAUTI interventions and strategies to guide safety and quality initiatives in order to improve patient care.Methods: A total of 20 articles complied with the exclusion and inclusion criteria. The articles were studied, and the chosen articles were categorized in two areas of study: CAUTI prevention, and nurse education and knowledge improvement.Results: The articles selected were reviewed to encompass a review on the articles offering the most applicable corresponding information involving catheter-associated urinary tract infections and competency-based education.Conclusions: Analysis of the data from the literature search indicates the potential lack of compliance of CAUTI infection control practices is an issue for CAUTI problem. So implementing the best evidence to enforce CAUTI bundles compliance for CAUTI prevention is a key to reduce CAUTI rates.
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Huffines, Meredith, Karen L. Johnson, Linda L. Smitz Naranjo, Matthew E. Lissauer, Marmie Ann-Michelle Fishel, Susan M. D’Angelo Howes, Diane Pannullo, Mindy Ralls, and Ruth Smith. "Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit." Critical Care Nurse 33, no. 5 (October 1, 2013): 56–69. http://dx.doi.org/10.4037/ccn2013354.
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Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.
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Salm, Florian, Frank Schwab, Christine Geffers, Petra Gastmeier, and Brar Piening. "The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety." Infection Control & Hospital Epidemiology 37, no. 7 (April 5, 2016): 798–804. http://dx.doi.org/10.1017/ice.2016.72.
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OBJECTIVETo improve the patient safety of very-low-birthweight infants in neonatal departments in Germany.DESIGNMulticenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis.STUDY POPULATIONVery-low-birthweight patients from 32 neonatal departments in Germany.METHODSNeonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries.RESULTSThirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17–7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76–0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70–0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001).CONCLUSIONThe implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments.Infect Control Hosp Epidemiol 2016;37:798–804
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Anand, Tanya, Santa Ponce, Andrea Pakula, Cindy Norville, David Kallish, Maureen Martin, and Ruby Skinner. "Results from a Quality Improvement Project to Decrease Infection-Related Ventilator Events in Trauma Patients at a Community Teaching Hospital." American Surgeon 84, no. 10 (October 2018): 1701–4. http://dx.doi.org/10.1177/000313481808401033.
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Ventilator-associated pneumonia (VAP) is linked to increased morbidity and mortality and clinical protocols (VAP bundles) have evolved to minimize VAP. In 2009, a quality improvement project was implemented at our institution to decrease VAP rates in adult trauma patients. AVAP prevention committee was developed, and formal evidence-based education for the nursing and physician staff was introduced. During the study period (2009–2016), 2380 patients required ICU admission to our Level II trauma center. The mean Injury Severity Score was 33 1 12, and there were 17 per cent penetrating and 83 per cent blunt injuries. The early compliance (2010) with the VAP bundle was 65 per cent. Within one year of the implementation of VAP prevention, the compliance increased to >90 per cent. Compliance has been carefully trended and has remained at 100 per cent. All of the aforementioned interventions have resulted in a sustained dramatic decline in VAP, from 12 per cent in 2009 to 0 per cent in 2016. Ongoing education and ICU policy development has become the mainstay of our trauma ICU program. The introduction of evidence-based care education imparted a culture of excellence resulting in favorable outcomes in high-risk trauma patients related to VAP prevention. Ongoing monitoring and education is required to sustain these promising outcomes.
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Bannatyne, Molly, Judith Smith, Malavika Panda, Mohamed E. Abdel-Latif, and Tejasvi Chaudhari. "Retrospective Cohort Analysis of Central Line Associated Blood Stream Infection following Introduction of a Central Line Bundle in a Neonatal Intensive Care Unit." International Journal of Pediatrics 2018 (September 2, 2018): 1–8. http://dx.doi.org/10.1155/2018/4658181.
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Background. Central Line Associated Bloodstream Infections (CLABSI) constitute a leading cause of morbidity and mortality in neonatal populations. There has been an overwhelming increase in the use of evidence-based care practices, also known as bundles, in the reduction of these infections. In this report, rates of CLABSI and central line utilisation were examined following the introduction of a central line bundle in our Neonatal Intensive Care Unit (NICU) at the Canberra Hospital. Methods. The research undertaken was a retrospective cohort study in which newborn infants admitted to the Canberra Hospital NICU between January 2011 and December 2016 and had a central line inserted were included in the study. Data regarding central line days, bed days, infection rates, and patient demographics were collected before and after the introduction of an intervention bundle. CLABSI rates were calculated per 1,000 central line days for before (2011-2013) and after (2014-2016) the introduction of the bundle. The postintervention period was retrospectively analysed for compliance, with data regarding the completion of maintenance forms and insertion forms collected. Results. Overall, the results showed a significant decrease in CLABSI rates from 8.8 per 1,000 central line days to 4.9 per 1,000 central line days in the intervention period (p<0.001). Central line utilisation ratio (CLUR: ratio of central line days to bed days) was also reduced between pre- and postintervention periods, from 0.177 (4414/25013) to 0.13 (3633/27384; p<0.001). Compliance to insertion forms and maintenance forms was observed to increase within the intervention period. Conclusion. The implementation of a central line bundle was effective in reducing both CLABSI rates and dwell time (CLUR) for central venous catheters.
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Lenherr Ramos, Laura, Rainer Weber, Hugo Sax, Pietro Giovanoli, and Stefan P. Kuster. "A comprehensive unit-based safety program for the reduction of surgical site infections in plastic surgery and hand surgery." Infection Control & Hospital Epidemiology 40, no. 12 (October 14, 2019): 1367–73. http://dx.doi.org/10.1017/ice.2019.279.
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AbstractObjective:To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery.Design:Uncontrolled before-and-after study.Setting:Department of plastic surgery and hand surgery of a tertiary-care teaching hospital.Patients:Patients undergoing surgery between January 2016 and April 2018.Intervention:A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis.Results:Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%–65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31–5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed.Conclusions:This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.
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Linam, Matthew, Jessica Wright, Kum Kim, Cara Van Treek, and Patrick Spafford. "584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S275—S276. http://dx.doi.org/10.1093/ofid/ofz360.653.
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Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.
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Pinho, Rafaela, Luciana Tanure, Jussara Pessoa, Leonardo Santos, Braulio Couto, and Carlos Starling. "Impact of Each Component of a Ventilator Bundle on Preventing Ventilator-Associated Pneumonia and Lower Respiratory Infection." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s259—s260. http://dx.doi.org/10.1017/ice.2020.824.
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Background: Ventilator-associated lower respiratory infections (LRIs) and pneumonia (VAP) are important healthcare-associated infections and are among the leading causes of death worldwide. Prevention of these infections are often based on care bundles. We investigated the incidence of VAP+LRI and the preventive efficacy of each component of our ventilator bundle. Methods: Our ventilator bundle includes 6 components that are daily checked by an infection control practitioner. These 6 evidence-based practices were implemented in 3 ICUs from a general tertiary-care private hospital in Belo Horizonte City (Brazil): (1) daily oral care with chlorhexidine; (2) elevate the head of the bed to between 30 and 45; (3) avoid scheduled ventilator circuit change; (4) monitor cuff pressure; (5) use subglottic secretion drainage; and (6) daily sedation interruption and daily assessment of readiness to extubate. VAP and ventilator-LRI definitions were obtained from the CDC NHSN. The impact of adherence rate to items in the ventilator bundle (%) on the incidence rate of VAP+LRI was assessed using linear regression and scatterplot analyses. Results: Between January 2018 and April 2019, 1,888 ventilator days were observed in the 3 ICUs, with 42 VAP and LRI events, an overall incidence rate of 22.2 cases per 1,000 ventilator days. After September 2018, the infection control service started a campaign to increase the ventilator bundle compliance (Fig. 1). Adherence rates to all 6 bundle components increased between January–August 2018 and September 2018–April 2019 from 25% to 55% for daily oral care, from 34% to 79% for elevating the head of the bed, 28% to 86% for avoiding scheduled ventilator circuit change, from 32% to 83% for cuff pressure monitoring, from 32% to 83% for subglottic secretion drainage, and from 33% to 85% for daily sedation interruption. PAV and LRI incidence decreased from 41 to 16 in ICU A, from 22 to 14 in ICU B and from 24 to 18 in ICU C. The impact of each bundle component was identified by linear regression, calculating the percentage of PAV+LRI incidence rate that is explained by bundle item adherence (r2) and correlation coefficient (r): daily sedation interruption (r2 = 48%; r = 0.69; P = .004) (Fig. 2), cuff pressure monitorization (r2 = 0.3721; r = 0.61; P = .016), subglottic secretion drainage (r2 = 36%; r = 0.60; P = .017), avoidance of scheduled ventilator circuit change (r2 = 34%; r = 0.58; P = .023), daily oral care (r2 = 25%; r = 0.50; P = .050), and elevate the head of the bed (r2 = 25%; r = 0.48; P = .067). Conclusions: The impact of each bundle component on preventing PAV+LRI was identified by the study. An educational intervention performed by the infection control service increased the adherence to the ventilator bundle, and the PAV and LRI incidence decreased.Funding: NoneDisclosures: None
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Katzenberg, Gideon, Andrew Deacon, Joshua Aigbirior, and Jørgen Vestbo. "Management of chronic obstructive pulmonary disease." British Journal of Hospital Medicine 82, no. 7 (July 2, 2021): 1–10. http://dx.doi.org/10.12968/hmed.2020.0561.
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Chronic obstructive pulmonary disease is a prevalent condition in the UK, associated with high morbidity and mortality. Hospital physicians manage a significant portion of acute chronic obstructive pulmonary disease admissions to hospital and readmissions after discharge. Optimal management of exacerbations requires controlled oxygen therapy and ventilatory support where necessary, and careful administration of bronchodilators, steroids and antibiotics. Holistic care for these patients includes nutritional supplementation and palliative support for those with advanced disease. To reduce the chance of readmission, chronic obstructive pulmonary disease care bundles can be used, along with a review of inhaled and oral therapies. Where available, hospital-at-home discharge schemes can safely facilitate early discharge. Most importantly, high quality evidence-based smoking cessation support must be offered to smokers. Exercise improves the physiological and psychological condition of people with chronic obstructive pulmonary disease and should be encouraged, with referral to a pulmonary rehabilitation service if available.
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Bhatia, Kaku Singh, Oommen K. George, and Anoop George Alex. "Clinical, hemodynamic, echocardiographic, angiographic profiles and post-operative outcomes among DCRV patients from a tertiary care referral center in India." International Journal of Research in Medical Sciences 7, no. 7 (June 28, 2019): 2558. http://dx.doi.org/10.18203/2320-6012.ijrms20192628.
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Background: This retrospective study of data from 2006 to 2018 at a tertiary care referral center in India aims to document the contemporary clinical and hemodynamic profile of patients who were diagnosed with double chamber right ventricle (DCRV) based on echocardiography and cardiac catheterization. Patients were followed up and their outcomes were studied to document their short and long term outcomes.Methods: It is a retrospective observational study of patients diagnosed with DCRV in a tertiary care hospital in India. The diagnosis of DCRV was based on the following criteria: an echocardiographic diagnosis of DCRV with doppler evidence of a mid ventricular gradient; cardiac catheterization revealing a systolic pressure gradient between right ventricular inflow and outflow tracts; a right ventricular angiogram demonstrating an anomalous muscle bundle causing obstruction well below the infundibulum. All the patients were followed up for their long term outcomes.Results: All the patients underwent echocardiography and cardiac catheterization for confirmation of the diagnosis. Sixty percent of our patients presented during adulthood, which is very unusual presentation of this disease entity. Median age of our patient cohort was 23.5 years. Patients presenting during adulthood have atypical symptoms. Dyspnea was the most common presenting symptom in this study. Right ventricular hypertrophy (73.3%)and right bundle branch pattern (26.6%) were the common electrocardiographic findings in our patients. DCRV is commonly associated with other anomalies. Ventricular septal defect (VSD) was the commonest associated anomaly, which was seen in 80% of our patients. Mean gradient cross the anomalous muscle bundle was 67.5 mmHg. Three of our patients (20%) had no associated anomaly, which is very rare in DCRV. Eight patients underwent surgical correction with significant reduction in gradients in all and no perioperative mortality. Median follow up of 8 years showed no adverse outcomes and no progression of gradients.Conclusions: This study describes in detail the clinical profile, echocardiographic and angiographic identification of anomalous muscle bundles in DCRV patients, which will help the young readers in identifying this often missed diagnosis. It highlights the unusual presentation during adulthood with atypical symptoms in DCRV patients with excellent long-term outcomes on follow up.
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Formalejo, Cordella, Dan Meynard Mantaring, Cybele L. Abad, and Karl Evans Henson. "Assessment of Knowledge and Implementation Practices of the Ventilator-Acquired Pneumonia Bundle in a Private Hospital." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s132. http://dx.doi.org/10.1017/ice.2020.643.
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Background: Ventilator-acquired pneumonia (VAP) is estimated to occur in 9%–27% of patients intubated for >48 hours, and despite advances in antibiotic therapy, it remains a significant cause of morbidity and mortality. Several studies have shown that a VAP bundle significantly decreases VAP rates. In 2017, VAP rates in our institution peaked at 7.92 per 1,000 ventilator days despite perceived good adherence to the bundles of care. Methods: We performed a prospective, descriptive cross-sectional study using both quantitative (eg, validated questionnaires) and qualitative methods (eg, small group discussion and direct observation of practices) to assess the knowledge, attitudes and practices of infection control preventionists (ICPs) and intensive care unit (ICU) nurses regarding VAP prevention and the VAP bundle. Results: Of the 89 ICU nurses and 5 ICPs, we included 60 respondents, of whom 56 were ICU nurses, and 4 were ICPs. Median experience for nurses was 6 years (range, 0.67–16) and was 2 years (range, 2–4) for ICPs. Only 1 ICP had formal training on the VAP bundle, and only 1 ICU nurse had a master’s degree in nursing. Only 23 of 56 nurses (41%) reported that they had had formal training regarding the VAP bundle. Mean knowledge score regarding evidence-based VAP guidelines was 5 of 10 points (range, 3–8). Questions regarding mechanical ventilator operations had the lowest scores. Self-reported adherence to the VAP bundle ranged from 38.5% to 100%, with perfect compliance to head of bed elevation and poorest compliance with readiness to extubate and DVT prophylaxis. Overall VAP bundle compliance was 84.6%. Direct observation of nurses validated self-adherence to the VAP bundle and the institution’s compliance rates. Barriers to bundle adherence included lack of formal training, perceived lack of guidelines, inadequate resources, and fear of adverse events. Conclusions: Knowledge regarding specific components of VAP prevention is lacking. Compliance to the VAP bundle can be improved. Regular training, education, and direct feedback to assess the competency of both the medical and nursing staff are needed to improve adherence to the bundle, and ultimately decrease incidence of VAP in the ICU. Despite limitations, this is the first study to determine baseline knowledge, adherence, and implementation practices of key personnel directly involved with implementation of the VAP bundle.Disclosures: NoneFunding: None
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Billett, Amy, Aditya H. Gaur, Eric J. Werner, Cindi Winkle, Jeffery D. Hord, Richard Brown, David Bundy, and Marlene R. Miller. "Moving prevention of central line associated bloodstream infection efforts beyond the hospital walls: A multicenter pediatric hematology/oncology collaborative." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 86. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.86.
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86 Background: Elimination of central-line (CL) associated blood stream infections (BSI) (CLABSI) in the inpatient setting has been a focus for many healthcare organizations. Little is known about the rate of CLABSI in the ambulatory setting or the optimal improvement strategies. We systematically expanded CLABSI prevention efforts for children with underlying pediatric hematology/oncology (PHO) disease from inpatient to ambulatory settings and describe the related process (definitions, improvement change packages, compliance assessment) and outcome measures (CLABSI and other BSI rates). Methods: The evidence-based CL care and maintenance bundles developed for the Children’s Hospital Association Quality Transformation Network PHO inpatient multisite collaborative were adapted for the ambulatory setting. Teams self-reported compliance with bundle elements (daily goals, line entry/dressing/ port needle/ tubing change processes) and submitted total CL days for the PHO cohort in their care. National Healthcare Safety Network (NHSN) defined CLABSI, secondary BSI (as per NHSN definitions), and single positive blood cultures (SPBC) (currently not captured by NHSN) were tracked. All process and outcome measures were collected using an online data entry system. Results: Prospective data collection and ambulatory bundle implementation began in Nov. 2011; to date 24 of 36 hospitals participating in the inpatient PHO CLABSI prevention collaborative have successfully implemented the ambulatory component to their program. As of May 2012, accrued data from the ambulatory setting exists for 214 ambulatory CLABSI, 30 secondary BSI, and 72 SPBC in patients with 719,637 CL in situ (not CL accessed) line days. To date self-reported compliance with bundle elements is > 80%. Conclusions: We demonstrate a successful multisite expansion of CLABSI prevention efforts to the ambulatory setting in PHO patients. Given the limitations of the current NHSN CLABSI definitions in the PHO population and the goal to reduce all BSI, not just CLABSI, we also propose tracking of secondary BSI and SPBC and discuss how this contextual information can be helpful.
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Kukla, Mary, Shannon Hunger, Tacia Bullard, Kristen Van Scoyoc, Mary Beth Hovda-Davis, Margarida Silverman, Kelly Petrulavich, et al. "Impact of an Enhanced Prevention Bundle on Central-Line–Associated Bloodstream Infection Incidence in Adult Oncology Units." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s256—s258. http://dx.doi.org/10.1017/ice.2020.821.
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Background: Central-line–associated bloodstream infection (CLABSI) rates have steadily decreased as evidence-based prevention bundles were implemented. Bone marrow transplant (BMT) patients are at increased risk for CLABSI due to immunosuppression, prolonged central-line utilization, and frequent central-line accesses. We assessed the impact of an enhanced prevention bundle on BMT nonmucosal barrier injury CLABSI rates. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that houses the only BMT program in Iowa. During October 2018, we added 3 interventions to the ongoing CLABSI prevention bundle in our BMT inpatient unit: (1) a standardized 2-person dressing change team, (2) enhanced quality daily chlorhexidine treatments, and (3) staff and patient line-care stewardship. The bundle included training of nurse champions to execute a team approach to changing central-line dressings. Standard process description and supplies are contained in a cart. In addition, 2 sets of sterile hands and a second person to monitor for breaches in sterile procedure are available. Site disinfection with chlorhexidine scrub and dry time are monitored. Training on quality chlorhexidine bathing includes evaluation of preferred product, application per product instructions for use and protection of the central-line site with a waterproof shoulder length glove. In addition to routine BMT education, staff and patients are instructed on device stewardship during dressing changes. CLABSIs are monitored using NHSN definitions. We performed an interrupted time-series analysis to determine the impact of our enhanced prevention bundle on CLABSI rates in the BMT unit. We used monthly CLABSI rates since January 2017 until the intervention (October 2018) as baseline. Because the BMT changed locations in December 2018, we included both time points in our analysis. For a sensitivity analysis, we assessed the impact of the enhanced prevention bundle in a hematology-oncology unit (March 2019) that did not change locations. Results: During the period preceding bundle implementation, the CLABSI rate was 2.2 per 1,000 central-line days. After the intervention, the rate decreased to 0.6 CLABSI per 1,000 central-line days (P = .03). The move in unit location did not have a significant impact on CLABSI rates (P = .85). CLABSI rates also decreased from 1.6 per 1,000 central-line days to 0 per 1,000 central-line days (P < .01) in the hematology-oncology unit. Conclusions: An enhanced CLABSI prevention bundle was associated with significant decreases in CLABSI rates in 2 high-risk units. Novel infection prevention bundle elements should be considered for special populations when all other evidence-based recommendations have been implemented.Funding: NoneDisclosures: None
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Chang, Bickey H., Yea-Jen Hsu, Michael A. Rosen, Ayse P. Gurses, Shu Huang, Anping Xie, Kathleen Speck, Jill A. Marsteller, and David A. Thompson. "Reducing Three Infections Across Cardiac Surgery Programs: A Multisite Cross-Unit Collaboration." American Journal of Medical Quality 35, no. 1 (May 3, 2019): 37–45. http://dx.doi.org/10.1177/1062860619845494.
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Using a pre–post design, this study examined the impact of a multifaceted program to simultaneously improve 3 health care–associated infections and patient safety culture throughout the cardiac surgery service line in 11 hospitals. Interventions included the Comprehensive Unit-based Safety Program to improve safety culture and evidence-based bundles to prevent central line–associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP). CLABSIs and SSIs showed a downward trend over 2 years, then the rates returned to levels similar to baseline in the third year. VAP rate changes were difficult to interpret because of the VAP definition change. Patient safety culture domain “hospital management support” showed significant improvement, but feedback and communication about errors and staffing declined. Simultaneous implementation of multiple interventions across units is challenging. The findings highlight the importance of sustainment efforts and suggest future work should anticipate both positive and negative change in safety culture dimensions.
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Lo, Alvin HY, Adrian CL Kee, Andrew Li, and Francesca Rubulotta. "Controversies in Sepsis Management—What is the Way Forward?" Annals of the Academy of Medicine, Singapore 49, no. 9 (September 30, 2020): 661–68. http://dx.doi.org/10.47102/annals-acadmedsg.202090.
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Sepsis is life-threatening and might potentially progress from dysregulation to severe organ dysfunction. It is recognised by the World Health Organisation as a global health priority. The mortality rate for sepsis has decreased in many countries, and this is credited to the earlier recognition and treatment of this complex syndrome. In 2002, the Surviving Sepsis Campaign was launched, and there have been several revisions to the sepsis recommendations therefrom. The latest sepsis guidelines focus on viral as well as bacterial infections, and advise that initiating resuscitation and management should take place within one hour from when sepsis is initially suspected. Numerous studies and guidelines pertaining to sepsis management have been published over the past 2 decades. The use of novel therapies and alternative adjunctive therapies has tremendous potential in sepsis management. Debates amongst intensivists exist with the creation of updated sepsis guidelines and advances in treatment. The present review article provides both a summary and recommendations based on the latest clinical evidence and controversies around sepsis management. Key words: Critical Care Medicine, Intensive Care Medicine, Respiratory Medicine, Sepsis, Sepsis Bundles, Sepsis Management
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Jeffries, Howard E., Wilbert Mason, Melanie Brewer, Katie L. Oakes, Esther I. Mufioz, Wendi Gornick, Lee D. Flowers, et al. "Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative." Infection Control & Hospital Epidemiology 30, no. 7 (July 2009): 645–51. http://dx.doi.org/10.1086/598341.
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Objective.The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.