Integrating a data-driven monitor alarm discussion into safety huddles was a safe and effective approach to reducing alarms in low-acuity, highalarm PICU patients.
Background
Catheter-associated urinary tract infections are common health care–associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%.
Objective
To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections.
Methods
A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds.
Results
Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year.
Conclusion
Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.
It is not rare that extrapulmonary complications and not pneumonia dominate the clinical picture in infections with Mycoplasma pneumoniae, as is illustrated by three cases. In the first, a young woman developed an acute, but ultimately completely reversible, polyradiculitis after a Mycoplasma pneumonia. The second patient sustained a thoracic transverse myelitis which regressed rapidly and completely under treatment with erythromycin and prednisone. In the third one, the Mycoplasma pneumonia was complicated by a generalized hypersensitivity vasculitis affecting many organs. A largely reversible renal vasculitis was demonstrated angiographically.
Objective: Establish associations between a 40 month period of work of a public liver center unit and characteristics of liver transplant recipients before and after that period. Methods: Retrospective data was collected from the data base SINTRA/INCUCAI. Comparison between: 1e01/05/ 2009e31/12/2012 (before Hospital El Cruce/HEC) and 2e 01/01/2013e31/08/2016 (after HEC). The outcomes evaluated were: total transplants performed and divided by public/private centers, access to list, 24 h mortality, organ assignment order, waiting list time/WLT, donor per million habitants. Comparisons were performed by Wilcoxon Rank Sum test. Results: the median amount of transplant in Argentina during the last 6 years was 107 in each 4 month-period. In our center, 142 interventions were realized, with a median of 13 per 4 months; this represents 40% of the liver transplants/LT performed in public centers, and 11% across the country. There was statistical difference in the MELD score to access a LT (24 vs 26, p 0,0210), WLT (46 vs 72 days p 0,0012), donors per million (15 vs 13 p 0,0049), patients being transplanted in a public center (19 vs 30 p 0,0011). No difference was observed in the transplants performed across Argentina, at private centers, MELD/Emergency status, organ assignment order and 24 h mortality. Conclusion: MELD score and LTs performed in public centers increased; without impact in the global amount, and
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