Training on the proper completion of the checklist must be provided to OR teams. The severity of the interventions influenced the number of items properly checked.
BackgroundInfection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings.MethodsIn the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record ‘order-set’ including AS and AP compliance indicators was designed. We compared the cost–benefit of the audits and the automated indicators for AS and AP compliance.ResultsCompliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested.ConclusionTraining ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
IntroductionPressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes.
MethodsPressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses.
ResultsA total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers.
Background Sepsis and septic shock are common causes of ICU admission with devastating outcomes. Adjunctive therapies are urgently needed, and the use of high dose of vitamin B1 and C have recently gained interest. However, on the basis of a perceived possible synergic effect, most trials have never tested the combination of thiamine and ascorbic acid, with a separate assessment of the effect of each individual component. In this context, while the association of thiamine and ascorbic acid was not found to improve survival rates, potentially harmful effects were found when administering ascorbic acid alone. We have conducted a retrospective cohort study, comparing ICU mortality of septic shock patients receiving standard treatment, thiamine alone or a combination of thiamine and ascorbic acid. Results A total of 1800 patients were included, 1260 receiving standard care, 436 receiving only thiamine and 104 patients receiving a thiamine / ascorbic acid combination. Using doubly robust estimation of the treatment effect, combining propensity score weighting and variables adjustment, we found thiamine alone to be associated with a decrease in ICU mortality compared to the use of a thiamine / ascorbic acid combination (Hazar Ratio equal to 0.60, 95% Confidence Interval [0.36;0.99], p=0.048). Conclusions In septic shock patients, administration of thiamine is associated with improved ICU mortality when used alone rather than when associated with ascorbic acid. This result strengthens the evidence showing a lack of effectiveness of the ascorbic acid / thiamine combination reported in recent randomized controlled trials. Furthermore, it argues in favor of the need for further trials investigating the effect of thiamine in septic ICU patients as an adjunctive therapy.
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