scholarly journals Glucose management in the intensive care unit: are we looking for the right sweet spot?

2016 ◽  
Vol 4 (18) ◽  
pp. 347-347
Author(s):  
Sarah J. Beesley ◽  
Eliotte L. Hirshberg ◽  
Michael J. Lanspa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sweet Spot ◽  
The Right ◽  
Glucose Management

scholarly journals Contamination of Healthcare Worker Personal Protective Equipment with MRSA Outside the Intensive Care Unit Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s27-s28
Author(s):  
Gita Nadimpalli ◽  
Lisa Pineles ◽  
Karly Lebherz ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Direct Patient Care ◽  
Care Group ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Contact Precautions ◽  
Patient Interactions ◽  
The Right

Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.Funding: NoneDisclosures: None

Sweet Spot: Glucose Control in the Intensive Care Unit

2016 ◽  
Vol 37 (01) ◽  
pp. 057-067 ◽  
Author(s):  
Dieter Mesotten ◽  
James Krinsley ◽  
Marcus Schultz ◽  
Roosmarijn van Hooijdonk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glucose Control ◽  
Sweet Spot

scholarly journals Changes in muscle ultrasound for the diagnosis of intensive care unit acquired weakness in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Weiqing Zhang ◽  
Jun Wu ◽  
Qiuying Gu ◽  
Yanting Gu ◽  
Yujin Zhao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Diagnostic Accuracy ◽  
Biceps Brachii ◽  
Rectus Femoris ◽  
Apache Ii ◽  
Cross Sectional ◽  
Icu Admission ◽  
The Right ◽  
Muscle Ultrasound

AbstractTo test diagnostic accuracy of changes in thickness (TH) and cross-sectional area (CSA) of muscle ultrasound for diagnosis of intensive care unit acquired weakness (ICU-AW). Fully conscious patients were subjected to muscle ultrasonography including measuring the changes in TH and CSA of biceps brachii (BB) muscle, vastus intermedius (VI) muscle, and rectus femoris (RF) muscles over time. 37 patients underwent muscle ultrasonography on admission day, day 4, day 7, and day 10 after ICU admission, Among them, 24 were found to have ICW-AW. Changes in muscle TH and CSA of RF muscle on the right side showed remarkably higher ROC-AUC and the range was from 0.734 to 0.888. Changes in the TH of VI muscle had fair ROC-AUC values which were 0.785 on the left side and 0.779 on the right side on the 10th day after ICU admission. Additionally, Sequential Organ Failure Assessment (SOFA), Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores also showed good discriminative power on the day of admission (ROC-AUC 0.886 and 0.767, respectively). Ultrasonography of changes in muscles, especially in the TH of VI muscle on both sides and CSA of RF muscle on the right side, presented good diagnostic accuracy. However, SOFA and APACHE II scores are better options for early ICU-AW prediction due to their simplicity and time efficiency.

scholarly journals Case Report of an Injectional Anthrax in France, 2012

2020 ◽  
Vol 8 (7) ◽  
pp. 985
Author(s):  
Jean-Marc Thouret ◽  
Olivier Rogeaux ◽  
Emmanuel Beaudouin ◽  
Marion Levast ◽  
Vincent Ramisse ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Phylogenetic Analysis ◽  
Intensive Care ◽  
Bacillus Anthracis ◽  
Drug Users ◽  
Intravenous Drug Users ◽  
Drug Resistant ◽  
Positive Bacterium ◽  
Case Presentation ◽  
The Right

(1) Background: Bacillus anthracis is a spore-forming, Gram-positive bacterium causing anthrax, a zoonosis affecting mainly livestock. When occasionally infecting humans, B. anthracis provokes three different clinical forms: cutaneous, digestive and inhalational anthrax. More recently, an injectional anthrax form has been described in intravenous drug users. (2) Case presentation: We report here the clinical and microbiological features, as well as the strain phylogenetic analysis, of the only injectional anthrax case observed in France so far. A 27-year-old patient presented a massive dermohypodermatitis with an extensive edema of the right arm, and the development of drug-resistant shocks. After three weeks in an intensive care unit, the patient recovered, but the microbiological identification of B. anthracis was achieved after a long delay. (3) Conclusions: Anthrax diagnostic may be difficult clinically and microbiologically. The phylogenetic analysis of the Bacillus anthracis strain PF1 confirmed its relatedness to the injectional anthrax European outbreak group-II.

scholarly journals Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool

2020 ◽  
Vol 9 (1) ◽  
pp. e000753 ◽  
Author(s):  
Fatima Aldawood ◽  
Yasser Kazzaz ◽  
Ali AlShehri ◽  
Hamza Alali ◽  
Khaled Al-Surimi
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Open Communication ◽  
Frontline Staff ◽  
Safety Issues ◽  
Unit Level ◽  
The Right

BackgroundOpen communication between leadership and frontline staff at the unit level is vital in promoting safe hospital culture. Our hospital staff culture survey identified the failure to address safety issues as one of the areas where staff felt unable to express their concerns openly. Thus, this improvement project using the daily safety huddle tool has been developed to enhance teamwork communication and respond effectively to patient safety issues identified in a paediatric intensive care unit.MethodsWe used the TeamSTEPPS quality approach. TeamSTEPPS is an evidence-based set of teamwork tools developed by the US Agency of Healthcare Research and Quality to enhance teamwork and communication. We applied TeamSTEPPS using a tool called the Daily Safety Huddle, aiming at improving communication and interaction between healthcare workers and building trust by acting immediately when there is any patient safety issue or concern at the unit level.ResultsDuring the period from April to December 2017, the interaction between frontline staff and unit leadership increased through compliance with the daily safety huddle. Initially, compliance was at 73%, but it increased to 97%, with a total of 340 safety issues addressed. The majority of these safety issues pertained to infection control and medication errors (109; 32.05%), followed by communication (83; 24.41%), documentation (59; 17.35%), other issues (37; 10.88%), procedure (20; 5.88%), patient flow (16; 4.7%) and equipment and supplies (16; 4.7%).ConclusionsSystematic use of daily safety huddle is a powerful tool to create an equitable environment where frontline staff can speak up freely about daily patient safety concerns. The huddle leads to a more open and active discussion with unit leadership and to the ability to perform the right action at the right time.

scholarly journals Embolized Guidewire into Central Aorta: A Nightmare in the Pediatric Intensive Care Unit

2018 ◽  
Vol 07 (04) ◽  
pp. 210-212
Author(s):  
R.K. Nath ◽  
Manoj Sarowa ◽  
Neeraj Pandit ◽  
Richa Agrawal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventricular Septal Defect ◽  
Pediatric Intensive Care Unit ◽  
Septal Defect ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
Percutaneous Catheterization ◽  
The Right ◽  
Gooseneck Snare

AbstractA 4-month-old preterm, critically ill infant weighing 3.8 kg was admitted to our pediatric intensive care unit with congestive cardiac failure due to a large ventricular septal defect and its sequelae. During an attempt to insert a central line into the right subclavian vein at bedside, the guidewire inadvertently entered the subclavian artery and embolized distally. After multiple failed retrieval attempts, including surgical femoral cut-down to retrieve the wire, it was removed finally by fluoroscopic-guided percutaneous catheterization with the help of a cardiac bioptome and a gooseneck snare utilizing a novel maneuver.

scholarly journals Deprivation of liberty and intensive care: an update post Ferreira

2017 ◽  
Vol 19 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Behrad Baharlo ◽  
Daniele Bryden ◽  
Stephen J Brett
Keyword(s):  
Intensive Care Unit ◽  
Human Rights ◽  
Intensive Care ◽  
European Convention ◽  
Life Saving ◽  
Human Rights Act ◽  
Human Rights Act 1998 ◽  
The Right ◽  
Acid Test ◽  
Article 5

The right to liberty and security of the person is protected by Article 5 of the European Convention on Human Rights which has been incorporated into the Human Rights Act 1998. The 2014 Supreme Court judgment in the case commonly known as Cheshire West provided for an ‘acid test’ to be employed in establishing a deprivation of liberty. This ‘acid test’ of ‘continuous supervision and not free to leave’ led to concerns that patients lacking capacity being treated on an Intensive Care Unit could be at risk of a ‘deprivation of liberty’, if this authority was applicable to this setting. This article revisits the aftermath of Cheshire West before describing the recent legal developments around deprivation of liberty pertaining to intensive care by summarising the recent Ferreira judgments which appear for now to answer the question as to the applicability of Cheshire West in life-saving treatment.

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