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Breast Surgery

Monday, 23 June 2008

Ventilator - associated pneumonia and new airway technologies

Author(s): Sarah Yarham
ISSUE: 2008 ; VOL 10 ; PART 2 (2008-April)
Journal Title: Trauma From Proquest NHS (01/1999 - 01/2008)
Page: 71 - 83
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Protecting health care workers: the critical role of airborne infection control.

Int J Tuberc Lung Dis. 2008 Jun;12(6):585. LinkOut
Friedland G.
Yale University School of Medicine, New Haven, Connecticut, USA.
PMID: 18492321 [PubMed - in process]

Intensive care unit outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infe

2: Infect Control Hosp Epidemiol. 2008 Jun;29(6):517-24. LinkOut
Laurent C, Rodriguez-Villalobos H, Rost F, Strale H, Vincent JL, Deplano A, Struelens MJ, Byl B.
Department of Infection Control and Epidemiology, Hopital Erasme, Universite Libre de Bruxelles, Brussels, Belgium.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in the intensive care units (ICUs) of a hospital and the impact of routine and reinforced infection control measures on interrupting nosocomial transmission.

DESIGN: Outbreak report.
SETTING: A 31-bed intensive care department (composed of 4 ICUs) in a university hospital in Belgium.
INTERVENTION: After routine infection control measures (based on biweekly surveillance cultures and contact precautions) failed to interrupt a 2-month outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures were implemented. The frequency of surveillance cultures was increased to daily sampling. Colonized patients were moved to a dedicated 6-bed ICU, where they received cohorted care with the support of additional nurses. Two beds were closed to new admissions in the intensive care department. Meetings between the ICU and infection control teams were held every day. Postdischarge disinfection of rooms was enforced. Broad-spectrum antibiotic use was discouraged.

RESULTS: Compared with a baseline rate of 0.44 cases per 1,000 patient-days for nosocomial transmission, the incidence peaked at 11.57 cases per 1,000 patient-days (October and November 2005; rate ratio for peak vs baseline, 25.46). The outbreak involved 30 patients, of whom 9 developed an infection. Bacterial genotyping disclosed that the outbreak was polyclonal, with 1 predominant genotype. Reinforced infection control measures lasted for 50 days. After the implementation of these measures, the incidence fell to 0.08 cases per 1,000 patient-days (rate ratio for after the outbreak vs during the outbreak, 0.11).
CONCLUSION: These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.
PMID: 18510461 [PubMed - in process]

Detection of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers.

Infect Control Hosp Epidemiol. 2008 Jun 12; [Epub ahead of print]
Snyder GM, Thom KA, Furuno JP, Perencevich EN, Roghmann MC, Strauss SM, Netzer G, Harris AD.

From the Departments of Epidemiology and Preventive Medicine (G.M.S., K.A.T., J.P.F., E.N.P., M.-C.R., S.M.S., A.D.H.) and Internal Medicine, Division of Pulmonary and Critical Care Medicine (G.N.) , University of Maryland School of Medicine , and the Veterans Affairs Maryland Health Care System (E.N.P., M.-C.R., A.D.H.) , Baltimore, Maryland .

Objective. To assess the rate of and the risk factors for the detection of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).
Methods. We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.
Results. Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%-24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P < .05), HCW contact with the head and/or neck of a patient (P < .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P < .05) were associated with an increased risk of acquiring these organisms. Conclusions. @nbsp; The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.
PMID: 18549314 [PubMed - as supplied by publisher]

The importance of critical care nurses' caring behaviours as perceived by nurses and relatives.

Click on author for link to article

O'Connell E, Landers M.
Related Articles, LinkOut

Intensive Crit Care Nurs. 2008
May 20; [Epub ahead of print] PMID: 18499460 [PubMed - as supplied by publisher]

Intensive care delirium monitoring and standardised treatment:

Van Eijk MM, Kesecioglu J, Slooter AJ.
Related Articles, LinkOut

A complete survey of Dutch Intensive Care Units.
Intensive Crit Care Nurs.
2008 Jun 2; [Epub ahead of print] PMID: 18524596 [PubMed - as supplied by publisher]

Journal of Critical Care articles June 2008, Volume 23, Issue 2

Assessing organizational performance in intensive care units: A French experience
Etienne Minvielle, PhD, MD; Philippe Aegerter, PhD, MD; Benoît Dervaux, et al

Quantifying the volume of documented clinical information in critical illness
Orit Manor-Shulman, MD; Joseph Beyene, PhD; Helena Frndova, MSc;et al

Teaching intensive care unit administration during critical care medicine training programs
James Gasperino, MD, PhD; Richard Brilli, MD, FCCM; Vladimir Kvetan, MD

Letter to the Editor 253–254
The blindfolded learner—A simple intervention to improve crisis resource management skills
Peter G. Brindley, MD, FRCPC; Darren Hudson, MD, FRCPC; Jason A. Lord, MD, FRCPC

Early loss of complexity is associated with ventilator-associated pneumonia in 2032 patients with trauma
Patrick R. Norris; Randy J. Carnevale; Randolph A. Miller; Bryan A. Cotton; Judith M. Jenkins;

Early detection of infection with continuous heart rate variability analysis in neutropenic patients
Saif Ahmad; Sarah Flanagan; Lauralyn McIntyre; et al

Relation of heart rate variability to serum levels of C-reactive protein in patients with severe sepsis and septic shock
Vasilios Papaioannou; Christos Dragoumanis; Ioannis Pneumatikos

Correlation between adiponectin and Acute Physiology and Chronic Health Evaluation II score in patients with intra-abdominal sepsis
Mustafa Kerem; Öge Taşcilar; Bülent Salman; Kürşat Dikmen;

Resistin is increased in intra-abdominal sepsis: Correlation with proinflammatory cytokines and Acute Physiology and Chronic Health Evaluation II scores
Tonguç Utku Yilmaz; Mustafa Kerem; Öge Taşcilar; et al

Natural history of disseminated intravascular coagulation diagnosed by the newly established diagnostic criteria for critically ill patients
Satoshi Gando; Daizoh Saitoh; Hiroshi Ogura; Toshihiko Mayumi; et al

Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

Mark Van Houdenhoven, MSc; Jeroen M. van Oostrum, MSc; Gerhard Wullink, PhD; Erwin Hans, PhD; Johann L. Hurink, PhD; Jan Bakker, MD, PhD; Geert Kazemier, MD, PhD

Improving patient safety in intensive care units in Michigan

Improving patient safety in intensive care units in Michigan

Peter J. Pronovost, MD, PhD, FCCM; Sean M. Berenholtz, MD, MHS; Christine Goeschel, RN, MPA, MPS; Irie Thom, RN, MSN; Sam R. Watson, MSA, MT(ASCP); Christine G. Holzmueller, BLA; Julie S. Lyon, PhD; Lisa H. Lubomski, PhD; David A. Thompson, DNSc, MSN; Dale Needham, MD, PhD, FRCPC; Robert Hyzy, MD; Robert Welsh, MD; Gary Roth, DO; Joseph Bander, MD; Laura Morlock, PhD; Bryan J. Sexton, PhD

Predictors of ventilator weaning in individuals with high cervical spinal cord injury

Predictors of ventilator weaning in individuals with high cervical spinal cord injury
Author(s): Chiodo AE ; Scelza W ; Forchheimer M
ISSUE: 2008 ; VOL 31 ; PART 1
Journal Title: American Rehabilitation From EBSCO ( CINAHL with Full Text ) - via Athens (01/1998 - 12/2004)

From Proquest NHS (04/1995 - 10/2004)
Page: 72
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Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis

Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis
Author(s): Christian J Wiedermann
ISSUE: 2008 ; VOL 8 (2008-01-24)
Journal Title: Bmc Emergency Medicine From BioMed Central [PDF] [Abstract] (/2001 - /)

From Free Medical Journals . com [PDF] [Abstract] (/2001 - /)

From UK PubMed Central (/2001 - /2008)
Page: 1
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Free Cortisol in Sepsis and Septic Shock

Free Cortisol in Sepsis and Septic Shock
Author(s): Bendel , S . ; Karlsson , S . ; Pettila , V . ; Loisa , P . ; Varpula , M . ; Ruokonen , E .
ISSUE: 2008 ; VOL 106 ; PART 6
Journal Title: Anesthesia and Analgesia ( Formerly : Current Researches in Anesthesia and Analgesia ) From Ovid ( Journals @ Ovid ) via Athens [Full Text] (01/1995 - /) Customer

Notes: 1997 v84/1 - Print Location: Macclesfield
Page: 1813-1819
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Delirium in Older Patients in Intensive Care Units

Archives of Internal Medicine From Free Medical Journals . com (/1998 - /Embargo: 1 year)

From HighWire article] [author(s)]

From NHS Innovations North West May 2008

Active Management of Critical Care Demand in Major Elective Surgery

The single most common reason for cancellation of major elective surgery is due to the lack of availability of High Dependency Unit (HDU) beds following surgery. The beds may have been used for emergency admissions and other planned admissions requiring post operative critical care. This service aims to actively manage the demand for High Dependency beds following
major elective surgery.

All patients requiring High Dependency Care following planned surgery are referred to the Critical Care Lead, who coordinates the availability of beds to meet these requests. (Surgeons complete a ‘Planned HDU Admission Registration Form’ to request a bed). The need for a High Dependency bed is reviewed by the Active Management Team. Activity is coordinated to ensure all elective surgery is managed in an efficient and equitable way. Prior to the introduction of this service in excess of 25% of planned major surgical procedures in this Trust were cancelled due
to a lack of HDU beds. A national audit in 2003 found that 17% of major vascular surgery was cancelled for this reason.

The introduction of this approach in this Trust has reduced the cancellation rate for major elective surgery to 7.3%. The financial savings due to a reduction in cancelled operating sessions over a 25 month period has been conservatively estimated to be £179,400.

North Cheshire Hospitals NHS Trust

2 articles from Critical care medicine

1. A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Bucknall-Tracey-K, Manias-Elizabeth, Presneill-Jeffrey-J.
Critical care medicine, {Crit-Care-Med}, May 2008, vol. 36, no. 5, p. 1444-50, ISSN: 1530-0293.

2. Patient and intensive care unit organizational factors associated with low tidal volume ventilation in acute lung injury. Umoh-Nsikak-J, Fan-Eddy, Mendez-Tellez-Pedro-A, Sevransky-Jonathan-E, Dennison-Cheryl-R, Shanholtz-Carl, Pronovost-Peter-J, Needham-Dale-M. Critical care medicine, {Crit-Care-Med}, May 2008, vol. 36, no. 5, p. 1463-8, ISSN: 1530-0293.

Intensive care unit staff nurses: predicting factors for career decisions

Intensive care unit staff nurses: predicting factors for career decisions
Hui-Ling Lai PhD, RN, MPH, MSN, Ya-Ping Lin RN, MSN, Hui-Kuan Chang Master Student, RN, Shu-Chen Wang RN, MSN, Yun-Ling Liu RN, Huei-Chen Lee RN, Tai-Chu Peng PhD, RN and Fwu-Mei Chang PhD, RN
pages 1886–1896