Examining the Root Cause of Surrogate Conflicts in the Intensive Care Unit and General Wards

2010 ◽  
Vol 29 (1) ◽  
pp. 38-48 ◽  
Author(s):  
Allison Neyhart Rubin ◽  
Katrina A. Bramstedt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Root Cause ◽  
General Wards

Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project

2018 ◽  
Vol 8 (5) ◽  
pp. 408-413 ◽  
Author(s):  
Arunava Biswas ◽  
Sangeeta Das Bhattacharya ◽  
Arun Kumarendu Singh ◽  
Mallika Saha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Conceptual Framework ◽  
Neonatal Intensive Care ◽  
Hand Hygiene Compliance ◽  
Hand Washing ◽  
Root Cause ◽  
Hygiene Compliance

Abstract Objective Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. Materials and Methods We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. Results A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. Conclusions Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.

scholarly journals Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

2020 ◽  
pp. 1-9
Author(s):  
Sean Wei Xiang Ong ◽  
Pei Hua Lee ◽  
Yian Kim Tan ◽  
Li Min Ling ◽  
Benjamin Choon Heng Ho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cell Culture ◽  
Intensive Care ◽  
Infection Control ◽  
Environmental Contamination ◽  
Transmission Risk ◽  
Common Area ◽  
The Common ◽  
General Wards ◽  
The Impact

Abstract Background: The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities. Methods: In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards. Results: In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture. Conclusion: Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.

Role of the intensive care unit

2018 ◽  
Author(s):  
Matt Wise ◽  
Paul Frost
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Failure ◽  
Radiology Department ◽  
Organ Support ◽  
Specific Patient ◽  
High Dependency ◽  
Operating Theatres ◽  
The Uk ◽  
General Wards

The intensive care unit (ICU) can be defined as an area reserved for patients with potential or established organ failure and has the facilities for the diagnosis, prevention, and treatment of multi-organ failure. Usually, the ICU is located in close proximity to A & E, the radiology department, and the operating theatres, as it is between these areas that patient flows are greatest. In large urban hospitals, there may be more than one ICU, some of which serve specific patient populations, such as paediatrics, neurosurgery, cardiothoracic surgery, liver failure, and burns. Many hospitals also have high-dependency units (HDUs) that offer higher nurse-to-patient ratios and more advanced monitoring than a general wards does, as well as limited organ support. In the UK, the distinctions between ICU, HDU, and general ward have been abandoned in favour of a classification based on the patient’s needs rather than their location.

scholarly journals Staphylococcal infection in an intensive-care unit, and its relation to infection in the remainder of the hospital

1973 ◽  
Vol 71 (2) ◽  
pp. 341-348 ◽  
Author(s):  
D. M. Harris
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Phage Type ◽  
Staphylococcal Infection ◽  
Benzyl Penicillin ◽  
Staphylococcal Infections ◽  
Resistant Strains ◽  
General Wards ◽  
Time Of Admission

SUMMARYA survey of the staphylococcal infections occurring in a general hospital over a period of four and a half years showed that multiple-resistant strains of phage type 77 were endemic in the medical and surgical wards. Strains of this phage type were uncommon among patients attending the casualty department, and those found were usually either fully sensitive to antibiotics or resistant to benzyl-penicillin only. Regular monitoring of patients admitted to the intensive-care unit showed that 58 % of staphylococcal infections in such patients were present at the time of admission to the unit. Although the wards thus constituted a significant reservoir of infection for the intensive-care unit, there was no evidence to suggest that the return of patients from the unit to the wards was responsible for the transfer of infection in the opposite direction. The possibility of reducing the numbers of multiple-resistant staphylococci in the general wards, by the screening of all new admissions for the presence of tetracycline-resistant strains, appears to be impracticable in this area.

scholarly journals The clinical implications of sinus tachycardia in mild COVID-19 infection: A retrospective cohort study

2021 ◽  
Vol 9 ◽  
pp. 205031212110549
Author(s):  
Jenny Yi Chen Hsieh ◽  
Juliana Yin Li Kan ◽  
Shaikh Abdul Matin Mattar ◽  
Yan Qin
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Sinus Tachycardia ◽  
High Dependency ◽  
General Wards

Objectives: This study aims to estimate the prevalence of sinus tachycardia in hospitalized patients with mild COVID-19 infection and to identify the clinical, radiological, and biological characteristics associated with sinus tachycardia. Methods: A retrospective cohort study was conducted on patients with mild COVID-19 infection and sinus tachycardia during hospitalization. Outcomes measured included incidences of venous thromboembolism, high-dependency/intensive care unit admission, laboratory parameters, and radiological findings. Results: A total of 236 COVID-19 positive patients admitted to Singapore General Hospital isolation general wards from 1 June 2020 to 30 June 2020 were included in this study. Ninety-seven (41.1%) patients had sinus tachycardia on or during their admission. All patients were monitored in general wards and discharged to community quarantine facilities. None required oxygen support or high-dependency/intensive care unit admission. Sinus tachycardia was associated with increased C-reactive protein level (odds ratio = 1.033, 95% confidence interval = 1.002–1.066), abnormal chest X-ray findings (odds ratio = 3.142, 95% confidence interval = 1.390–7.104), and longer hospitalization (odds ratio = 1.117, 95% confidence interval = 1.010–1.236). There was no significant statistical association between sinus tachycardia and incidences of venous thromboembolism. Conclusion: This study suggests that patients with mild COVID-19 infection and concurrent sinus tachycardia are more likely to have higher inflammatory marker levels, abnormal imaging, and prolonged hospitalization. However, no significant association between sinus tachycardia and thromboembolism is identified in mild COVID-19 infection.

828: RIGHT CARE AND FLOURISHING NURSES: A COMPARISON OF THE INTENSIVE CARE UNIT AND GENERAL WARDS

2016 ◽  
Vol 44 (12) ◽  
pp. 283-283
Author(s):  
Margo van Mol ◽  
Tchiyaban Said ◽  
Erwin Kompanje ◽  
Marjan Nijkamp
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Wards

scholarly journals Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1307-1315 ◽  
Author(s):  
Gili Regev-Yochay ◽  
Gill Smollan ◽  
Ilana Tal ◽  
Nani Pinas Zade ◽  
Yael Haviv ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tap Water ◽  
Medical Center ◽  
Common Factor ◽  
Control Measures ◽  
Root Cause ◽  
Infection Control Measures ◽  
Single Clone ◽  
Environmental Reservoir

AbstractBackgroundCarbapenemase-producing Enterobacteriaceae (CPE) outbreaks are mostly attributed to patient-to-patient transmission via healthcare workers.ObjectiveWe describe successful containment of a prolonged OXA-48–producing S. marcescens outbreak after recognizing the sink traps as the source of transmission.MethodsThe Sheba Medical Center intensive care unit (ICU), contains 16 single-bed, semi-closed rooms. Active CPE surveillance includes twice-weekly rectal screening of all patients. A case was defined as a patient detected with OXA-48 CPE >72 hours after admission. A root-cause analysis was used to investigate the outbreak. All samples were inoculated on chrom-agar CRE, and carbapenemase genes were detected using commercial molecular Xpert-Carba-R. Environmental and patient S. marcescens isolates were characterized using PFGE.ResultsFrom January 2016 to May 2017, 32 OXA-48 CPE cases were detected, and 81% of these were S. marcescens. A single clone was the cause of all but the first 2 cases. The common factor in all cases was the use of relatively large amounts of tap water. The outbreak clone was detected in 2 sink outlets and 16 sink traps. In addition to routine strict infection control measures, measures taken to contain the outbreak included (1) various sink decontamination efforts, which eliminated the bacteria from the sink drains only temporarily and (2) educational intervention that engaged the ICU team and lead to high adherence to ‘sink-contamination prevention guidelines.’ No additional cases were detected for 12 months.ConclusionsDespite persistence of the outbreak clones in the environmental reservoir for 1 year, the outbreak was rapidly and successfully contained. Addressing sink traps as hidden reservoirs played a major role in the intervention.

scholarly journals In hospital cardiac arrest in Intensive Care Unit versus non Intensive Care Unit patients with COVID 19. A systematic review and meta analysis

2021 ◽  
Author(s):  
Georgios Mavrovounis ◽  
Maria Mermiri ◽  
Athanasios Chalkias ◽  
Vishad Sheth ◽  
Vasiliki Tsolaki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Icu Patients ◽  
Pooled Prevalence ◽  
General Wards ◽  
Hospital Cardiac Arrest

Aim: To estimate the incidence of in hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID 19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non ICU patients with COVID 19. Methods: We systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. Results: Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID 19 patients was 7% [95% CI: 4, 11%; P < 0.0001] and 44% [95% CI: 30, 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42, 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow up was 59% [95% CI: 37, 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. Conclusion: The incidence of IHCA amongst hospitalized COVID 19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

Evaluation of the Safety of Rapid Administration of Undiluted High-Dose Intravenous Levetiracetam

2022 ◽  
pp. 194187442110679
Author(s):  
Brittany M. Kasturiarachi ◽  
Rashi Krishnan ◽  
Diana L. Alsbrook ◽  
Brittany Hudson ◽  
Hallie Kelly ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Intermittent Infusion ◽  
Infusion Reaction ◽  
Descriptive Statistics ◽  
High Dose ◽  
Adverse Side Effects ◽  
Hemodynamic Disturbance ◽  
General Wards

Background Intravenous (IV) levetiracetam (LEV) is an antiseizure medication traditionally given as an intermittent infusion to mitigate potential adverse effects given its acidic formulation. The process of compounding may lead to delays in treating status epilepticus, which is why administration of undiluted doses is of interest. Prior studies have shown safety of IV doses from 1000 mg to 4500 mg; however, assessments of adverse side effects outside IV site reactions have not been studied. Methods A retrospective analysis was completed with patients who received 1500 mg doses of undiluted IV LEV. We included patients ≥ 18 years old that received at least 1 dose of IV LEV 1500 mg from January 2018 to February 2021. Study end points included assessment of hemodynamic disturbance (bradycardia [HR less than 50 beats per minute] or hypotension [SBP less than 90 mmHg] within 1 hour or documented infusion reaction within 12 hours of LEV. Descriptive statistics were utilized. Results A total 213 doses of 1500 mg of IV LEV were administered to 107 patients. Peripheral lines were used for 85.9% of doses. Approximately half of doses (57) were administered to patients on the general wards, with the remainder in the intensive care unit or emergency department. Two patients (1.9%) experienced bradycardia; however, 1 patient had pre-existing bradycardia. Three patients (3.8%) experienced hypotension; however, those patients were receiving vasopressors prior to the dose. There were no cases of infusion reaction. Conclusion Undiluted, rapid administration of IV LEV 1500 mg was well tolerated and safe.

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