Linda Goss

Get a grip on patient safety: outcomes in the palm of your hand.

Documentation of what nurses do and the consequential impact on the care and safety of the patient is essential for the optimal use of intravascular devices. The University of Louisville Hospital’s infection control department collaborated with the infusion therapy team on a project designed to provide an easier and more reliable way to quantify what the infusion therapy team did and the resultant patient outcomes. This project was based on software developed by the infection control department for use with the handheld personal digital assistant (PDA). This article will discuss how use of the PDA and software meet individual departmental needs and impact patient outcomes and patient safety by using evidence-based decision-making.

A Review of Documented Oral Care Practices in an Intensive Care Unit

Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients’ medical record.

Comparison of Risk Factors for Recovery of Acinetobacter baumannii During Outbreaks at Two Kentucky Hospitals, 2006

Objectives. Acinetobacter baumannii (A. baumannii) is a well-described cause of nosocomial outbreaks and can be highly resistant to antimicrobials. We investigated A. baumannii outbreaks at two Kentucky hospitals to find risk factors for Acinetobacter acquisition in hospitalized patients. Methods. We performed case-control studies at both hospitals. We defined a case as a clinical culture growing A. baumannii from a patient from August 1 to October 31, 2006 (Hospital A), or April 1 to October 31, 2006 (Hospital B). Results. Twenty-nine cases were identified at Hospital A and 72 cases were identified at Hospital B. The median case patient age was 42 years in Hospital A and 46 years in Hospital B. The majority of positive cultures were from sputum (Hospital A, 51.7%; Hospital B, 62.5%). The majority of case patients had multidrug-resistant A. baumannii (Hospital A, 75.9%; Hospital B, 70.8%). Using logistic regression, controlling for age and admitting location, mechanical ventilation (Hospital A odds ratio [OR] = 21.6; 95% confidence interval [CI] 3.5, 265.9; Hospital B OR=4.5, 95% CI 1.9, 11.1) was associated with A. baumannii recovery. Presence of a nonsurgical wound (OR=6.6, 95% CI 1.2, 50.8) was associated with recovery of A. baumannii at Hospital A. Conclusions. We identified similar patient characteristics and risk factors for A. baumannii acquisition at both hospitals. Our findings necessitate the importance of review of infection control procedures related to respiratory therapy and wound care.

Procedural and Educational Interventions to Reduce Ventilator-Associated Pneumonia Rate and Central Line-Associated Blood Stream Infection Rate

Background: Implementing best practice guidelines for ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLA-BSI) has variable success. Our institution was concerned with high rates of VAP and CLA-BSI. This retrospective study was undertaken to see whether implementation of the below practices would reduce the rates of VAP and CLA-BSI without resorting to more expensive interventions such as subglottic endotracheal (ET) tube suctioning or silver-impregnated ET tubes. We utilized easily collectable data (standardized infection ratios [SIRs]) to rapidly assess whether interventions already in place were successful. This avoided cumbersome data collection and review. Methods: Retrospective data review calculated SIRs using National Healthcare Safety Network benchmarks. Rates and SIRs were compared using z tests with P values <.05 considered statistically significant. This data review attempted to examine the impact of education campaigns, staff meetings, in-services, physician checklist, nurse checklist, charge nurse checklist implementation, and chlorhexidine gluconate oral care addition to the VAP bundle. Additionally, central line insertion required nursing supervision, a checklist, and physician signature. Results: The incidence rate of VAP went from 9.88 occurrences/1000 vent days in 2009 to 0 occurrences/1000 vent days in 2010 (P < .001). The CLA-BSI occurrences/1000 line days were 2.86 in 2009 and 0.97 in 2010 (P = .0187). The SIR for VAP was 4.12 in 2009 and 0 in 2010 (P < .001). For CLA-BSI, the SIR was 1.1 in 2009 and 0.37 in 2010 (P = .04). Conclusions: Efforts to improve physician, patient, and staff education, and checklist implementation resulted in a decrease in VAP and CLA-BSI. This study confirms the applicability of best practice guidelines and suggests a benefit to the use of checklists. We utilize a practical approach for examining the success of these changes.

Infection prevention and control and the refugee population: Experiences from the University of Louisville Global Health Center

Background: During 2016, approximately 140,000 individuals entered the United States as part of the federal government refugee resettlement program and established themselves in communities in virtually every state. No national database regarding refugee health currently exists; therefore, little is known about existing infectious diseases, conditions, and cultural practices that impact successful acculturation. The objective of this report is to identify what is currently known about refugees and circumstances important to infection prevention and control with respect to their roles as new community members, employees, and consumers of health care. Methods: Using data from the University of Louisville Global Health Centers Newly Arriving Refugee Surveillance System, health issues affecting refugees from the perspective of a community member, an employee, and a patient were explored. Results: Lack of immunity to vaccine‐preventable diseases is the most widespread issue impacting almost every adult, adolescent, and child refugee resettled in Kentucky. Health issues of concern from an infection prevention and control perspective include latent tuberculosis infection, HIV, hepatitis B, hepatitis C, syphilis, and parasites. Other health conditions that may also be important include anemia, obesity, oral health, diabetes, and cardiovascular disease. Conclusions: Refugee resettlement provides motivation for collaborative work among those responsible for infection prevention and control in all settings, their public health partners, and those responsible for and interested in community workforce concerns.

Postsplenectomy vaccination guideline adherence: Opportunities for improvement

BACKGROUND AND PURPOSE Patients undergoing splenectomy for trauma are at life-long risk for rapidly progressive septicemia. The purpose of this study was to investigate long-term patient understanding and follow-up with recommendations regarding their asplenia. METHODS Patients undergoing splenectomy for trauma January 2010-December 2014 were analyzed. Medical records were reviewed and telephone follow-up interviews were conducted in October-December 2015. Patients were asked a standard set of questions that included hospitalizations, awareness of infectious risks associated with asplenia, need for revaccination, and vaccines they had received since their index hospitalization. FINDINGS Two hundred forty-four patients underwent splenectomy during the study period. A total of 95 patients (39%) were included in the study. Thirty (32%) had been hospitalized since their trauma admission. Only 46% were aware of the risks for sepsis and the need to revaccinate. Only 7% reported having rapid access to antibiotics. CONCLUSIONS Despite uniform education prior to discharge, most patients undergoing splenectomy for trauma were unaware of the risks for sepsis and did not follow recommended guidelines for risk reduction. IMPLICATIONS FOR PRACTICE Improvements that have direct implications for advanced practice included the need to refer for vaccination, educate regarding infection risks, and facilitate rapid access to antibiotic treatment.

Antimicrobial resistance: a primer for the infusion specialist.

The development of resistance to antimicrobial agents continues to be a tremendous challenge to clinicians because of the negative patient outcomes that can result from this resistance. For clinicians to understand their individual responsibilities in reversing this trend, it is useful for them to understand how and why resistance develops. Armed with this knowledge, the infusion specialist can play an important role in the infection control and antimicrobial management processes that are essential in current healthcare settings.

The Impact of Zika Virus Education on Selection of Birth Control Methods Among Cuban Refugees Resettling in Louisville, Kentucky in 2016

Background: Cubans represented almost 40% of all refugees resettling in KY during 2015 and 2016. Their route to the United States included extended time in areas recognized as Zika endemic, making them vulnerable to Zika virus (ZV) exposure and infection. Early availability of birth control is one strategy stressed by the Centers for Disease Control and Prevention (CDC) to delay an unintended pregnancy after ZV exposure and prevent the catastrophic impact on a developing fetus. Objectives: The objectives were to determine: (a) awareness of ZV among Cuban refugees, and (b) the impact of education regarding ZV on their initial birth control decisions. Methods: During May–November 2016, 167 Cuban men and women aged 19–50 were seen by advanced practice nurses (APNs) in the University of Louisville Global Health Center (UL GHC). During the visit, awareness regarding ZV, current planned birth control method(s), and education about ZV was imparted using information developed by the CDC and provided by clinic personnel competent in delivery of culturally, socially, and linguistically appropriate messaging. Anticipated methods of birth control were then reassessed. Results: Condom use was the most prevalent contraceptive method used before and after ZV education (29% and 58% respectively, p < .001). The influence of education regarding ZV and ZV infection on selection of birth control methods (condom use) was significant (p < .001). Conclusions: Findings indicate education provided by APNs regarding ZV influence birth control selection among Cuban refugees.

Communicating Critical Surveillance Data for Improved Outcomes

1) How often do you utilize the “Vent Reviews” database? Never 0.00% Once a month 0.00% Once a week 50.00% Once a day 50.00% 2) Do you prefer the previous methods of communicating VAP details or the current database? I prefer the old way 0.00% I prefer the database 100.00% 3) Do you find the database to be user friendly? Yes 100.00% No 0.00% 4) Do you utilize the database to identify potential “at risk” ventilated patients? Yes 83.30% No 16.70% 5) Are interventions altered or increased based on information gathered from the database? Yes 83.30% No 16.70% Poster Abstracts / American Journal of Infection Control 40 (2012) e31-e176 e121