Malcolm Booth

Anthrax infection in drug users

www.thelancet.com Vol 375 April 17, 201

Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009–2010

Patients who died had an increased sequential organ failure assessment score and need for vasopressors.

Rehabilitation within Scottish intensive care units: a national survey

The National Institute for Health and Clinical Excellence (NICE) in Clinical Guideline 83: Rehabilitation after critical illness has set challenging recommendations regarding the routine evaluation for, and provision of, rehabilitation within critical care units. There is no published information regarding current practice in the UK. To establish current practice in Scotland we undertook a telephone survey of all 23 Scottish ICU lead clinicians and physiotherapists − 96% of lead clinicians and 100% of lead physiotherapists completed the survey. Routine assessment for physical (median two (IQR 1–3 [range 0–4])) and non-physical sequelae (median zero (IQR 0–2 [range 0–5])) is low. Aproximately half of ICUs (52%) provide an individualised, structured rehabilitation programme, 32% include activities of daily living and all provide low intensity rehabilitation (eg limb stretching and positioning exercises). There are significant differences (all p<0.05) in the number of units routinely providing more intensive rehabilitation (eg mobilising) while patients have an endotracheal tube versus once extubated.

Continuous decontamination of an intensive care isolation room during patient occupancy using 405 nm light technology

Environmental contamination within intensive care units (ICU) is recognised as a source of patient infection, and improved cleaning and disinfection methods are continually being sought. Visible light of 405 nm has been shown to have bactericidal properties, and this communication reports on the use of a ceiling-mounted 405 nm light system for continuous environmental disinfection of contact surfaces and air in an occupied ICU isolation room. Levels of bacterial contamination on a range of contact surfaces around the room were assessed before, during and after use of the system. For each study, the lighting units were operated continuously during daylight hours. Results demonstrate that the spatial distribution of bacterial contamination was reduced almost uniformly across all sampled contact surfaces during use of the 405 nm light system. Pooled data showed that significant reductions in overall bacterial contamination around the room were achieved, with bacterial counts reduced by up to 67% (p=0.0001) over and above that achieved with standard cleaning and infection control procedures alone. Use of 405 nm light significantly reduced environmental contamination across almost all sampled contact surfaces within the ICU isolation room. This has particular benefit in ICU where equipment and other ‘hand-touch’ sites make routine cleaning difficult, thus helping maintain a cleaner environment, and contributing to reducing cross-infection from environmental sources.

Oral Hygiene Practices in Scottish Intensive Care Units – a National Survey:

Ventilator-associated pneumonia (VAP) is associated with prolonged intensive care (ICU) stay, increased mortality and costs. Although oral hygiene may help prevent VAP, there is little data about practice in ICU. Therefore a telephone survey of oral hygiene practice in Scottish ICUs was undertaken. All 24 respondents (100% of units) thought that providing oral hygiene care was a worthwhile use of nursing time in the ventilated ICU patient. Fifty-four percent of respondents recognised the importance of oral hygiene in the prevention VAP. Other benefits of oral care cited were maintenance of patient comfort and dignity, and of tooth, gum and oral mucosal health. Most ICUs also felt that further training would be beneficial. Oral hygiene is recognised as having an important role in patient comfort. There is still a lack of evidence concerning the place of oral hygiene care in preventing nosocomial infection in mechanically ventilated patients, as highlighted in the recent NICE guidelines.

Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009-2010.

Differences between recipients and nonrecipients and the small number of higher risk patients confounded assessment.

Uptake of therapeutic hypothermia following out‐of‐hospital cardiac arrest in Scottish Intensive Care Units

hypothermia after cardiac arrestonce again. Critical Care and Resuscitation 2006; 8: 151–4. 7 Alderson P, Gadkary C, Signorini DF. Therapeutic hypothermia for head injury. Cochrane Database of Systematic Reviews 1999; 2: CD001048. DOI: 10.1002 ⁄ 14651858.CD001048.pub2 8 Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. Journal of the American Medical Association 1997; 277: 1127– 34.

Comorbidity and Intensive Care Outcome — A Multivariable Analysis:

Decisions regarding admission to intensive care are made considering both the physiological state of the patient and the burden of comorbidity. Despite many retrospective cohort studies looking at isolated comorbidities, there has been little work to study multiple comorbidities and their effect upon intensive care outcome. In this retrospective cohort analysis, detailed comorbidity and demographic data were gathered on 1,029 patients from the West of Scotland and matched to both unit and hospital mortality at 30 days. Logistic regression was performed to investigate the factors associated with death within 30 days at both hospital and unit level. Variables with a p-value <0.25 at the univariable level were considered in a multivariable model. Variable selection for the multivariable modelling was carried out using backward selection and then replicated using forward selection to check for model stability. A modelling tool was constructed for both unit and hospital mortality at 30 days. This modelling has shown significant odds ratios for hospital death for alcoholic liver disease (OR 4.83), age (1.03), rheumatological diseases (1.93) and functional exercise tolerance prior to admission (3.08). Results from this work may inform a national prospective study to validate the modelling tool on a wider population.

A pilot study of surveillance of intensive care unit associated infections in Scotland

Healthcare associated infections (HCAI) are a significant problem in healthcare settings worldwide. H The risk of HCAI is higher in patients undergoing multiple invasive procedures such as those requiring intensive care. A pilot study was undertaken to determine the incidence of intensive care unit (ICU) acquired infection in Scotland and to test the feasibility of the implementation of a surveillance system to measure ICU acquired infection in Scottish hospitals. The overall incidence of ICU acquired infection, namely pneumonia, bloodstream infection and central venous catheter related infection, was 30.5 infections per 1000 patient days with the majority being pneumonia. Implementation of the surveillance system was found to feasible and as such may have an important role in the monitoring of ICU acquired infection.

Survey of Family-Witnessed Brain Stem Death Testing in Intensive Care Units

It is not currently known how often relatives are present during brain stem death (BSD) testing. A telephone survey of a selection of UK intensive care units (ICUs) was therefore performed asking about their experience with family-witnessed BSD testing. Forty-eight ICUs participated. Relatives were allowed to witness BSD testing in 21 ICUs (44%). Despite initial concerns by some ICU staff, none had experienced any problems with the family being present during the testing procedure.