Effect of Implementing Safety-Engineered Devices on Percutaneous Injury Epidemiology

2004 ◽  
Vol 25 (7) ◽  
pp. 536-542 ◽  
Author(s):  
SeJean Sohn ◽  
Janet Eagan ◽  
Kent A. Sepkowitz ◽  
Gianna Zuccotti
Keyword(s):  
Tertiary Care ◽  
Pathogen Transmission ◽  
Blood Collection ◽  
Care Hospital ◽  
Full Time ◽  
Full Time Equivalent ◽  
Injury Rates ◽  
Injury Epidemiology ◽  
Before And After ◽  
Intervention Impact

AbstractObjective:To assess the effect of implementing safety-engineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood-borne pathogen exposure.Design:Before-and-after intervention trial comparing 3-year preintervention (1998–2000) and 1-year postintervention (2001–2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998.Setting:A 427-bed, tertiary-care hospital in Manhattan.Participants:All employees who reported percutaneous injuries during the study period.Intervention:A “safer-needle system,” composed of a variety of safety-engineered devices to allow for needle-safe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001.Results:The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full-time–equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low-risk (P < .01) and high-risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal-related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow-bore needles also decreased (70.6%, P < .001).Conclusions:The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.

Impact of a Rigid, Puncture Resistant Container System Upon Needlestick Injuries

1987 ◽  
Vol 8 (2) ◽  
pp. 63-66 ◽  
Author(s):  
Bruce S. Ribner ◽  
Martha N. Landry ◽  
Gail L. Gholson ◽  
Lisa A. Linden
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Full Time ◽  
Needlestick Injuries ◽  
Full Time Equivalent ◽  
Before And After

AbstractNeedlestick injuries in a 720-bed tertiary care hospital were analyzed before and after the introduction of a rigid, puncture resistant, needle disposal system. Following implementation of the system, disposal-related injuries decreased from 0.9 per 100 full-time equivalent employees/year to 0.3 per 100 full-time equivalent employees/year (p <.005). However, needlesticks associated with procedures (2.2 vs. 4.4 per 100 full-time equivalent employees/year, p <.0005), and those resulting from loose needles (0.5 vs. 1.9 per 100 full-time equivalent employees/year, p <.0005), increased. Injuries occurring during needle recapping or the carrying of needles were not significantly altered. Total needlestick injuries increased from 6.0 to 8.7 per 100 full-time equivalent employees/year (p <.0005).We concluded that a rigid, puncture resistant, needle disposal system can reduce disposal-related needlestick injuries, but must also be perceived as convenient to impact substantially upon needlesticks associated with other activities.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

Safety-Engineered Device Implementation: Does It Introduce Bias in Percutaneous Injury Reporting?

2004 ◽  
Vol 25 (7) ◽  
pp. 543-547 ◽  
Author(s):  
SeJean Sohn ◽  
Janet Eagan ◽  
Kent A. Sepkowitz
Keyword(s):  
Tertiary Care ◽  
Low Risk ◽  
Annual Rate ◽  
Blood Collection ◽  
Care Hospital ◽  
Mandated Training ◽  
Before And After ◽  
Injury Reporting ◽  
Intensive Education ◽  
Reporting Rates

AbstractObjective:To examine whether implementation of safety-engineered devices in 2001 had an effect on rates of percutaneous injury (PI) reported by HCWs.Design:Before-and-after intervention trial comparing 3-year preintervention (1998–2001) and 2-year postintervention (2001–2002) periods. PI data from anonymous, self-administered surveys were prospectively entered into CDC NaSH software.Setting:A 427-bed, tertiary-care hospital in Manhattan.Participants:HCWs who attended state-mandated training sessions and completed the survey (1,132 preintervention; 821 postintervention).Intervention:Implementation of a “safer-needle system” composed of various safety-engineered devices for needle-safe TV delivery-insertion, blood collection, and intramuscular-subcutaneous injection.Results:Preintervention, the overall annual rate of PIs self-reported on the survey was 36.5 per 100 respondents, compared with 13.9 per 100 respondents postintervention (P < .01). The annual rate of formally reported PIs decreased from 8.3 to 3.1 per 100 respondents (P < .01). Report rates varied by occupational group (P ≤ .02). The overall rate did not change between study periods (22.7% to 22.3%), although reporting improved among nurses (23.6% to 44.4%, P = .03) and worsened among building services staff (90.5% to 50%, P = .03). HCWs with greater numbers of Pis self-reported on the survey were less likely to formally report injuries (P < .01). The two most common reasons for nonreport (ie, thought injury was low risk or believed patient was low risk for blood-borne disease) did not vary from preintervention to postintervention.Conclusions:Safety-engineered device implementation decreased rates of Pis formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

Abstract 448: Impact of Novel Healthcare Facility First Responder Training on Resuscitation Task Self-Efficacy Measures

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Les R Becker ◽  
Cheryl Camacho ◽  
Sheryl J Titus ◽  
Janet L Thorne ◽  
Munish Goyal
Keyword(s):  
Ambulatory Care ◽  
Self Efficacy ◽  
Repeated Measures ◽  
Care Center ◽  
Tertiary Care ◽  
Sudden Cardiac Arrest ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Ambulatory Care Setting ◽  
Before And After

Introduction: When sudden cardiac arrest occurs in non-resuscitation focused care settings, bedside clinicians may not intervene prior to dedicated resuscitation team arrival. As perceived self-efficacy (SE) contributes to cognitive functioning, facilitating effective intervention, we developed and evaluated a mock code training approach, First Five (FF) , to enhance bedside responders’ resuscitation task SE using an entity’s defibrillator and manikin. Self-efficacy is knowing that one can perform actions in principle and envision performing the steps to reach a goal. Hypotheses: Participants’ resuscitation SE will improve after FF training; 2) Inpatient (IP) and Ambulatory Care Center (ACC) providers will differ in their pre-SE and post-SE in response to FF training. Methods: Participants enrolled from ACCs and medical-surgical IP units at a large, urban tertiary care hospital from May 2018 to April 2019 completed a de-identified 10-point Likert-scale SE survey before and after they were trained to perform initial bedside resuscitation tasks (Figure 1 x-axis labels). Matched, complete, pre/post data for 85 in-hospital and 107 ACC participants were analyzed via repeated measures multivariate analysis of variance. Results: Patterns of reported change in the seven resuscitation task SE measures of IP personnel differed significantly from those of ACC personnel [Pillai’s Trace = .222, F(7,184)=7.483, p=.0005, partial η 2 = .222]. In both settings, post-session SE measures increased significantly from pre-session SE measures [Pillai’s Trace = .588, F(7,184)=37.438, p=.0005, partial η 2 = .588]. Moreover, though ACC providers consistently reported lower pre-training SE resuscitation task scores, post-training scores from both settings were comparable (Figure 1). Conclusions: First Five training is effective in enhancing resuscitation task SE among inpatient and ambulatory care setting providers that are not resuscitation-focused.

The Effects of Ramadan Fasting on Heart Transplant Recipients

2021 ◽  
Author(s):  
Bandar Al-Ghamdi
Keyword(s):  
Heart Transplant ◽  
Tertiary Care ◽  
Case Report Form ◽  
Care Hospital ◽  
Transplant Recipients ◽  
Cross Sectional ◽  
Standard Case ◽  
Ramadan Fasting ◽  
Before And After ◽  
Heart Transplant Recipients

Background: Fasting during Ramadan is considered one of the most sacred Islamic rituals. To our knowledge, there is no data about Ramadan fasting in heart transplant recipients. Objectives: To assess the ability of heart transplant recipients to fast the month of Ramadan and to study the fasting effects on their clinical condition Design: A cross-sectional study of heart transplant recipients attending the heart transplant clinic in the three months following Ramadan in 1439 and 1440 Hijri (May-June 2018 and 2019). Setting: Heart transplant clinic in a tertiary care hospital in the Kingdom of Saudi Arabia. Patients and Methods: Heart transplant recipients attending the heart transplant clinic in the Heart Center at King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh. Data about Ramadan fasting was documented using standard case report form (CRF), and data were collected from the medical records about their clinical and laboratory findings before and after Ramadan. Main Outcome Measures: Ability of heart transplant receipts to fast during Ramadan and the effect of fasting on their medical condition. Sample Size: One hundred twenty heart transplant recipients were approached to participate in this study. Ninety-two patients agreed to participate in the study with seventy-eight patients fasted during Ramadan. Results: Seventy-eight patients were able to fast Ramadan (84.8%). In comparison to the months before and after Ramadan, 44 of the fasting patients (56.4%) reported no change in their overall health, 29 patients (37.2%) reported feeling better, and 5 patients (6.4%) reported feeling worse during fasting. Sixty patients (76.9%) reported no significant new symptoms, and 18 patients (23.08%) reported one or more new symptoms. Conclusions: It seems that the majority of heart transplant recipients beyond one year of transplantation can fast Ramadan without having significant medical issues Limitations: The small number of participants and the limitations of cross-sectional design.

Randomized Prospective Study of the Impact of Three Needleless Intravenous Systems on Needlestick Injury Rates

1996 ◽  
Vol 17 (12) ◽  
pp. 803-808
Author(s):  
Paul B. L'Ecuyer ◽  
Elizabeth Owens Schwab ◽  
Elizabeth Iademarco ◽  
Norma Barr ◽  
Elizabeth A. Aton ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Tertiary Care ◽  
Control Area ◽  
Needlestick Injury ◽  
Pathogen Transmission ◽  
Needlestick Injuries ◽  
Injury Rates ◽  
Rate Ratios ◽  
And Control ◽  
The Impact

AbstractObjective:To determine the impact of three needleless intravenous systems on needlestick injury rates.Design:Randomized controlled trial.Setting:1,000-bed tertiary-care Midwestern hospital.Participants:Nursing personnel from general medical, general surgical, and intensive-care units.Interventions:From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices.Results:24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95°% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61;P=.02 andP=.003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.010.69;P=.03 andP=.005, respectively) compared to controls.Conclusions:Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.

scholarly journals EVALUATION OF RATIONAL USE OF ANTIBIOTIC DRUGS IN SURGERY DEPARTMENT AT A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 145-149
Author(s):  
SREEJA NYAYAKAR ◽  
MANDARA MS ◽  
HEMALATHA M ◽  
LALLAWMAWMI ◽  
MOHAMMED SALAHUDDIN ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Rational Use ◽  
Post Surgery ◽  
Antibiotic Drugs ◽  
Before And After ◽  
Hospital Patients ◽  
Surgery Department

Objective: Antibiotics are the only drug where use in one patient can impact the effectiveness in another, so antibiotic misuse adversely impacts the patients and society. Improving antibiotic use improves patient outcomes and saves money. Antibiotic resistance has been identified as a major threat by the WHO due to the lack of development of new antibiotics and the increasing infections caused by multidrug resistance pathogens became untreatable. Methods: A prospective observational study was conducted for a period of 6 months. Data were collected from prescriptions and inpatient record files at the surgery department of the tertiary care hospital. Patients above age of 18 years of either gender whose prescription containing the antibiotics and patients who are willing to participate in the study were included in the study. Microsoft Excel was used for recording and analyzing the data of recruited subjects. Results: During our study period, we have collected 100 cases as per inclusion criteria, in total collected 100 cases, 52% are male and 48% are female. The mean age and standard deviation of the study population were found to be 46.61±16.12. The most commonly prescribed classification before and after the surgery is cephalosporin’s that is 57%. Results show that in pre-surgery, almost 93% of prescriptions have chosen the drugs as per ASHP guidelines, whereas in post-surgery, 95% of drugs have selected the drug as per ASHP guidelines. Conclusion: Our study has observed that some of the prescriptions are irrationally prescribed so the pharmacist has to take the responsibility to improve the awareness regarding rational prescribing of antibiotics. The national wide monitoring of antibiotics use, national schemes to obtain rational use of antibiotics, reassessing the prescriptions, education to practitioners, and surveys on antibiotics should be implemented.

scholarly journals Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

2019 ◽  
Vol 8 (8) ◽  
pp. 1902
Author(s):  
Sumit Kumar Gupta ◽  
Siddhartha Ghosh
Keyword(s):  
Tertiary Care ◽  
Relevant Information ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Care Hospital ◽  
Beta Lactam ◽  
Cross Sectional ◽  
Before And After ◽  
Surgery Department

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

scholarly journals Clinical evaluation of total abdominal hysterectomy - a prospective study in a tertiary care hospital

2015 ◽  
Vol 6 (2) ◽  
pp. 76-77
Author(s):  
Shirin Akhter ◽  
Rumana Nazneen
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Care Hospital ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Before And After ◽  
A Prospective Study

Total abdominal Hysterectomy are gradually rising in our country. This study has been designed to find out the common indications of abdominal hysterectomy in a tertiary care hospital,. to know the clinical characters of the patients and. o elucidate postoperative complication of abdominal hysterectomy.Methodology : Cross- sectional observational study was done during 1st October 2007 to 30th September 2008. Holy Family Red Crescent Medical College Hospital (HFRCMCH). Total 100 patients were selected following enclusion & exclusion criteria hyperposive sampling. Data were recorded before and after operation and analyzed by SPSS version 15.Result : In the present study patients with leiomyoma of uterus was found to be the major indication of hysterectomy followed by dys functional uterine bleeding (DUB) 18.0%, Pelvic inflammatory disease (PID) 14.0%, chronic cervicitis 10.0%, adenomyosis 10.0%, pelvic endometriosis 6.0%, cervical polyp 2.0%, ovarian cysts 1.0% and chriocarcinoma 1.0%. Mean duration of operation (hour) and hospital stay was 1.15 hours and 7.48 days respectively. Most common complication of present series was fever 20.0% followed by 13.0% had wound infection, 6.0% UTI and 2.0% wound dehiscence.Conclusion : Hysterectomy is now the most widely performed major operation in gynaecology. Indication and post operative complications of hysterectomy varies from region to region.Northern International Medical College Journal Vol.6(2) 2015: 76-77

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