scholarly journals Comparison of Automated Strategies for Surveillance of Nosocomial Bacteremia

2007 ◽  
Vol 28 (9) ◽  
pp. 1030-1035 ◽  
Author(s):  
Cristina Bellini ◽  
Christiane Petignat ◽  
Patrick Francioli ◽  
Aline Wenger ◽  
Jacques Bille ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Data ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Automated Surveillance ◽  
Contaminated Blood ◽  
Hospital Acquired

Objective.Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance.Methods.Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data.Setting.An 850-bed university hospital.Participants.All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years.Results.The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%.Conclusion.Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.

scholarly journals Transthoracic Echocardiography: Impact on Diagnosis and Management in Tertiary Care Intensive Care Units

2005 ◽  
Vol 33 (4) ◽  
pp. 492-496 ◽  
Author(s):  
L. K. Stanko ◽  
E. Jacobsohn ◽  
J. W. Tam ◽  
C. J. De Wet ◽  
M. Avidan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Data ◽  
Transthoracic Echocardiography ◽  
Clinical Information ◽  
Management Plan ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Diagnosis And Management ◽  
Referring Physicians

The purpose of this study was to evaluate the utility of transthoracic echocardiography (TTE) in an intensive care unit by determining its impact on diagnosis and management. Over a six-month time period, we performed a prospective observational study on all patients admitted to either the medical or the surgical intensive care unit. Structured interviews were conducted with referring physicians before and after the TTE to determine the referring physicians’ pre-TTE diagnosis, reasons for requesting the TTE, and whether the TTE resulted in a change in diagnosis and/or management. A total of 135 TTE examinations were done in 126 patients. The referring physicians deemed that clinical information was inadequate to make a definitive diagnosis and management plan in 36/135 (27%) of the requests. In 99/135 (73%) studies, physicians indicated that there was probably sufficient clinical information to formulate a diagnosis and management plan, but ordered a TTE to corroborate their clinical findings. Overall, a change in diagnosis occurred in 39/135 (29%) of studies, and a change in management in 55/135 (41%) of studies. Diagnosis was changed in 19/99 (19%) studies with adequate clinical data, and in 20/36 (56%) studies with inadequate clinical data (P<0.001). Management was changed in 34/99 (34%) of studies with adequate clinical data and in 21/36 (58%) of studies with inadequate clinical data (P=0.017). Of the 62 management changes, 57/62 (92%) changes were minor, and 5/62 (8%) were major. In conclusion we have found that TTE frequently resulted in a change in the diagnosis and management.

scholarly journals AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study

2020 ◽  
Author(s):  
Benedikt Zujalovic ◽  
Benjamin Mayer ◽  
Sebastian Hafner ◽  
Florian Balling ◽  
Eberhard Barth
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Acetylcholinesterase Activity ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Baseline Values

Abstract Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020

Classification of adverse events occurring in a surgical intensive care unit

2007 ◽  
Vol 194 (3) ◽  
pp. 328-332 ◽  
Author(s):  
Heidi Frankel ◽  
Jason Sperry ◽  
Lewis Kaplan ◽  
Andrea Foley ◽  
Reuven Rabinovici
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

scholarly journals Molecular epidemiology ofPseudomonas aeruginosain an intensive care unit

1993 ◽  
Vol 110 (3) ◽  
pp. 427-436 ◽  
Author(s):  
G. Döring ◽  
M. Hörz ◽  
J. Ortelt ◽  
H. Grupp ◽  
C. Wolz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Aerosol Generation ◽  
Air Sampler ◽  
Route Of Transmission ◽  
Hygienic Measures ◽  
Hospital Acquired

SUMMARYGenotyping was used to analysePseudomonas aeruginosaisolates from sink drains and 15 intubated patients as part of a 3-month prospective study of strain transmission in a medical-surgical intensive care unit. Ninety percent of all washbasin drains were persistently contaminated with severalP. aeruginosagenotypes. In 60% (9/15) of the patients,P. aeruginosacolonization or infection was hospital-acquired:P. aeruginosastrains isolated from these patients were present in hospital sinks or in other patients before their admission. Since all patients were immobile, personnel were the probable route of transmission ofP. aeruginosain the hospital. The mechanism of strain transmission from sinks to hands during hand washing was investigated in a children's hospital. WhenP. aeruginosawas present at densities of > 105/c.f.u. per ml in sink drains, hand washing resulted in hand contamination withP. aeruginosavia aerosol generation in the majority of experiments orP. aeruginosawas detected using an air sampler above the washing basin. HighP. aeruginosacfu were present at 4.30 h in the eight sinks (5.4 × 105−7.0 × 1010c.f.u./ml), whereas at 13.00 hP. aeruginosac.f.u. were significantly lower (3.1 × 102−8.0 × 105c.f.u. / ml). These data reveal that the danger of bacterial contamination of hands during hand washing is highest in the morning. The identified transmission routes demand more effective hygienic measures in hospital settings particularly concerning personnel hands and sink drains.

Opinions of nurses on the ethical problems encountered while working as a team in intensive care units

2018 ◽  
Vol 13 (3) ◽  
pp. 120-125
Author(s):  
Oya Ögenler ◽  
Ahmet Dağ ◽  
Havva Doğan ◽  
Talip Genç ◽  
Hürmüs Kuzgun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
University Graduates ◽  
Surgical Intensive Care ◽  
Ethical Problems ◽  
Item Data ◽  
Intensive Care Unit Nurses

Background The intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices. Objective To determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital. Method The descriptive research was conducted on nurses working in intensive care units (n = 96). A 56-item data collection form consisting of two parts developed by the researchers was used. Frequency (percent) and median were evaluated, and statistical calculations were used for group comparisons. Results Out of the 82 (85.4%) nurses who participated in the study, 65 (82.3%) were university graduates. About 52 (66.7%) of the participants were female with a mean age of 28.12 ± 5.84; 26 (31.6%) had intensive care certification, and 54 (65.1%) had ethical training. The internal intensive care unit nurses were less satisfied with their jobs, able to use tools, said that they had the right to refuse the patient compared to the surgical intensive care unit nurses. Discussion and conclusions: It is a positive situation for the participants to score low with ethical problems based on suggestion as the probability of meeting with their teammates. However, it is important that the problems that affect the motivation of the nurses are different according to the intensive care unit and the employees.

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