The Importance of Continued Quality Improvement Efforts in Monitoring Hospital-Acquired Infection Rates: A Cardiac Surgery Experience

Mocanu, Valentin; Buth, Karen J.; Johnston, Lynn; Davis, Ian; Hirsch, Gregory M.; Légaré, Jean‐François

doi:10.1016/j.athoracsur.2014.12.075

Cited by 22 publications

(43 citation statements)

References 10 publications

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“…We selected six types of infections based on recently published work by our group and due to their high relevance for our study population [3]. These included: 1) urinary tract infection (UTI), 2) pneumonia, 3) harvest site infections, 4) superficial sternal site infection (sSSI), 5) sepsis, and 6) deep sternal site infection (dSSI).…”

Section: Methodsmentioning

confidence: 99%

“…In the present study, we extended our previously published findings to conduct a detailed chart review from a 2-month sample period of patients that underwent cardiac surgery at tertiary cardiac care center [3]. Patients acquiring at least one type of infection postoperatively were identified and further analyzed to better assess current physician practices.…”

Section: Introductionmentioning

confidence: 97%

“…We have recently published observations on the prevalence of HAIs in adult post-cardiac surgery patients at one Canadian cardiac surgery center, showing an increased prevalence over an 18-year period from 8% in 1995 to 20% in 2013 [3]. Furthermore, this occurred despite advances in infection control practices that have been implemented to allow the institution to receive national accreditation.…”

Section: Introductionmentioning

confidence: 99%

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Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study

2017

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BackgroundThe management of hospital-acquired infections (HAIs) with respect to physician practices remains largely unexplored despite increasing efforts to standardize care. In the present study, we report findings from a 2-month audit of all patients that have undergone cardiac surgery at a large referral center in Atlantic Canada.MethodsAll patients who underwent cardiac surgical procedures during May and June 2013 at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia were identified. The prevalence of urinary tract infections (UTIs), pneumonia, leg harvest site infections, superficial sternal wound infections, deep sternal wound infections, and sepsis was examined to determine physician approaches in terms of verification rates (microbiology), time of diagnosis and duration of treatment. Continuous variables were compared using Student’s t-test and categorical variables were analyzed using Fischer’s exact test.ResultsA total of 185 consecutive patients underwent cardiac surgical procedures, of which 39 (21%) developed at least one postoperative infection. The overall prevalence of infection types, from highest to lowest, was UTI (8%), pneumonia (7%), leg harvest site infection (5%), superficial surgical site infection (4%), and sepsis (2%). There were no deep sternal wound infections. The overall in-hospital mortality rate was 3.8% with a median length of stay (LOS) of 8 days. The overall infection verification rate was 50% (ranged from 100% in sepsis to 10% in leg harvest site infections). In all cases, a full course of antibiotics was administered despite negative microbiology cultures or limited evidence of an actual infection.ConclusionsHAIs are commonly treated without being verified and treatment is often not discontinued after negative cultures are received. Our findings highlight the fact that antibiotic treatment is not always supported by evidence, and the effect of this could contribute to increased selective pressure for antimicrobial resistant bacteria.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study

2017

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“…Malnutrition results in longer length of stay and other negative health outcomes [3–5]. Staying longer in hospital may also perpetuate malnutrition due to dissatisfaction with food [6], exposure to infectious agents [7], and decreased mobility and function [8]. Despite the recognition of the importance of nutrition to the recovery of patients, relatively little intervention research, outside of nutritional supplementation, has been conducted [9].…”

Section: Introductionmentioning

confidence: 99%

The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

Keller

McCullough

Davidson

et al. 2015

Nutr J

110

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BackgroundMalnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation.MethodsA modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel.Results80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators.ConclusionsThis evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.

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“…The highest number of deaths occurred in patients who had treatment of cardiovascular disease as the main diagnosis for admission. The occurrence of nosocomial infection in the postoperative period of cardiac surgeries presents a variable incidence (between 5% and 25%), and there is no consensus on the actual death rates (29)(30) . In general terms, factors associated with hospital infection in the elderly in the ICU should be identified and treated early, as they may influence not only patients' stay in this environment, but also their clinical outcome (discharge).…”

Section: Discussionmentioning

confidence: 99%

Deaths among the elderly with ICU infections

et al. 2017

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Objective: to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the fi ndings with sociodemographic and clinical variables. Method: descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed. Results: a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on. Conclusion: the clinical outcome of the elderly who acquire infection in the intensive care unit is infl uenced by sociodemographic and clinical variables that increase mortality rates. Descriptors: Infection; Elderly; Clinical Outcome; Death; Intensive Care Units. RESUMO Objetivo: avaliar o desfecho clínico de idosos que adquiriram infecção hospitalar hospitalizados em Unidades de Terapia Intensiva, correlacionando os achados com variáveis sociodemográfi cas e clínicas. Método: pesquisa descritiva, realizada com 308 pacientes idosos. A coleta deu-se em prontuários e contempla os anos de 2012 a 2015. Realizaram-se análises uni-/bivariadas. Resultados: registrou-se associação estatística entre os tipos de desfechos clínicos e as variáveis: faixa etária, tempo de internação, presença de comorbidades prévias, diagnóstico principal, infecção do trato respiratório e urinário, uso de cateteres vesical de demora e venoso central, ventilação mecânica e traqueostomia. A curva de sobrevivência evidenciou maior mortalidade entre idosos a partir de 80 anos. Conclusão: o desfecho clínico de idosos que adquirem infecção na Unidade de Terapia Intensiva é infl uenciado por variáveis sociodemográfi cas e clínicas, que incrementam as taxas de mortalidade. Descritores: Infecção; Idoso; Desfecho clínico; Óbito; Unidades de Terapia Intensiva. RESUMENObjetivo: evaluar el desenlace clínico de ancianos que adquirieron infección intrahospitalaria durante internación en Unidades de Terapia Intensiva, correlacionando los hallazgos con variables sociodemográfi cas y clínicas. Método: investigación descriptiva, realizada con 308 pacientes ancianos. Datos recolectados de historias clínicas, considerando los años de 2012 a 2015. Se realizaron análisis uni/bivariados. Resultados: se registró asociación estadística entre los tipos de desenlace clínico y las variables: faja etaria, tiempo de internación, presencia de comorbilidades previas, diagnóstico principal, infección del tracto respiratorio y urinario, uso de catéteres vesicales de demora y venoso central, ventilación mecánica y traqueotomía. La curva de supervivencia evidenció mayor mortalidad entre ancianos a partir de los 80 años. Conclusión: el desenlace clínico de ancianos que adquieren infecciones en Unidades...

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The Importance of Continued Quality Improvement Efforts in Monitoring Hospital-Acquired Infection Rates: A Cardiac Surgery Experience

Cited by 22 publications

References 10 publications

Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study

Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study

The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

Deaths among the elderly with ICU infections

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