High risk of hospital-acquired infection in the ICU patient

Donowitz, Leigh G.; Wenzel, Richard P.; Hoyt, John W.

doi:10.1097/00003246-198206000-00001

Cited by 247 publications

(74 citation statements)

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“…Moreover, clinicians and managers are expected to meet four-hour targets, 1 where no patient would wait more than four hours in an emergency department (ED), from arrival to admission to a bed in the hospital or discharge, with zero tolerance for hospitalacquired infections (HAIs), 2 both of which are associated with patient average length of stay (ALoS). [3][4][5] High bed occupancy is associated with prolonged admission waits from the ED. 6 The latter can be reduced by availability of more empty beds, 7 which requires reducing ALoS that in turn requires increased, yet appropriate, discharges.…”

Section: Rationale For Interventionmentioning

confidence: 99%

The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

et al. 2011

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-Excess average length of stay (ALoS) not only results in an increased cost to hospitals but also increases the risk of hospital-acquired infection and thromboembolism. Various factors suggested to affect ALoS have yet to demonstrate a significant impact in clinical practice. Increased consultant input has been identified as an important factor influencing ALoS. As a result, a radical and innovative consultant job plan, replacing twice-weekly with twice-daily ward rounds (WRs) on a university teaching hospital's two medical wards has been designed. The number of discharges (NoDs) significantly increased (pϽ Ͻ0.01), ALoS reduced (pϽ Ͻ0.01), whereas, readmission rate and mortality remained unchanged (pϭ ϭNS) over 12 months following twice-daily WRs compared to two other wards with twice-weekly WRs. This innovative model resulted in almost doubling the NoDs and halving the ALoS. This study suggests that ALoS can be reduced and sustained with a cultural and behavioural shift in consultant working patterns, without affecting readmission rate or inpatient mortality.

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Section: Rationale For Interventionmentioning

confidence: 99%

The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

et al. 2011

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“…The human body enables survival of a wide variety of microorganisms with potential for causing infection (Burke, 1961). In circumstance where systemic host resistance is lowered, such as immunosuppression from medication, disruption of intact cutaneous or mucous membrane as a result of surgical procedures or trauma, patients' bacterial flora may become opportunistic and cause infection (Donowitz et al, 1982;Koontz, 2000).…”

Section: Introductionmentioning

confidence: 99%

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Niemogha¹,

Atoyebi²,

Ogunsola³

et al. 2011

Sierra Leone j. biomed. res.

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Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients, investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision, colon segments, scrapes, tissues, pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 37 0 C for 16-24 hours. Thereafter, isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75%) while those from colon segment was 30(37.6%), scrapes 8(16%) and pus 3(7.5%). Acinetobacter species found on incision was 15(7.5%) and pus 7(2.3%). Pseudomonas species was distributed on incision 5(2.5%), colon segment 4(5%), tissue 3(1.6%), scrapes 5(10%) and pus was 5(12.5%). Staphylococcus aureus which was isolated from incision was 2(1%), while scrapes and pus were 5(10%) and 7(17.5%) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7%), almost twice the rate of non-significant bacteriuria (35.3%); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt, Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound, showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery.

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“…Although in the UK most units are mixed with medical, surgical and trauma patients, other units are specialized, catering only for cardiac surgery or neurosurgery patients for example. In mixed ICU's infection has been reported in between 18 and 360% of patients [1,21], whereas in cardiac surgery ICU infection rates are much lower -in the order of 1-2 % [22].…”

Section: The Patientsmentioning

confidence: 99%

Selective decontamination of the digestive tract in intensive care

Boom

Ramsay

1992

Epidemiol. Infect.

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SUMMARYNosocomial infection in intensive care unit (ICU) practice is a common problem and is associated with abnormal carriage of Gram-negative aerobic bacilli in the gastrointestinal tract, resulting in endogenous infections. Selective decontamination of the digestive tract (SDD) is a regimen aimed at preventing or eradicating this abnormal carriage.A large number of trials examining SDD in ICU practice have been published, the vast majority showing a significant reduction in the incidence of nosocomial, Gram-negative infection. However, the impact on morbidity and mortality is much less certain. A recent meta-analysis has suggested a 10-20% reduction in mortality (3-6% absolute difference) with SDD. A discussion of these results is presented together with potential criticisms of SDD.

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High risk of hospital-acquired infection in the ICU patient

Cited by 247 publications

References 0 publications

The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Selective decontamination of the digestive tract in intensive care

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