American journal of infection control
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Am J Infect Control · Dec 2008
Randomized Controlled TrialImpact of preoperative anxiolytic on surgical site infection in patients undergoing abdominal hysterectomy.
An increased anxiety may be associated with a higher risk of surgical site infection (SSI), but there is little objective data on the effect of preoperative anxiolytic interventions on SSI. To address this issue, we evaluated the effects of preoperative diazepam on postoperative SSI following abdominal hysterectomy. ⋯ Diazepam-treated patients showed lower postoperative anxiety and lower incidence of SSI up to 30 days after surgery compared with placebo in patients undergoing abdominal hysterectomy.
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Am J Infect Control · Dec 2008
Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project.
A quality improvement initiative that included rigorous measurement, feasible interventions, and cultural change was shown to nearly eliminate catheter-related bloodstream infections (CR-BSIs) in patients in a surgical intensive care unit (ICU). To build on this research, a statewide collaborative cohort study was conducted using the same evidence-based interventions. ⋯ Results suggest that this program model can be generalized and be implemented on a large scale in the United States or the world to significantly reduce the rate of CR-BSIs and their associated morbidities, mortalities, and costs of care.
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Patient characteristics and system-level factors place children at increased risk for catheter-related bloodstream infection (CR-BSI). National Healthcare Safety Network data from 36 pediatric intensive care units (PICUs) demonstrate a pooled mean of 5.3 CR-BSIs per 1000 catheter-days and a median of 3.5 CR-BSIs per 1000 catheter-days. Almost 60% of CR-BSIs in children are caused by gram-positive bacteria. In the PICU setting, arterial catheterization, increased duration of catheterization, use of extracorporeal life support, and presence of a genetic abnormality are independent risk factors for CR-BSIs. ECONOMICS: In children, cost estimates range from $36,000 to $50,000 per CR-BSI. ⋯ Based on limited data, antimicrobial lock therapy may be appropriate in certain clinical situations, and multifaceted interventions are effective in reducing CR-BSIs in children. In one center, maximum barrier precautions during insertion, antimicrobial-impregnated catheters, annual hospital-wide handwashing campaigns, physical barriers between beds, and use of 2% chlorhexidine skin disinfectant decreased CR-BSIs.
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Am J Infect Control · Dec 2008
Catheter-associated bloodstream infections: looking outside of the ICU.
Current recommendations for the prevention of central venous catheter-associated bloodstream infections (CA-BSIs) are mostly based on data from intensive care units (ICUs). The rates of CA-BSIs appear to be higher in non-ICU wards. Until this year, no published data were available on non-ICU CA-BSIs in the United States. This article is a summary of a talk given at an industry-sponsored conference on CA-BSIs. It summarizes an original article of ours previously published in a peer-reviewed journal. ⋯ Benchmark data for hospital infections in the non-ICU setting are starting to become available and efforts to improve care may have greater impact here than in the ICU. Upon patient transfer out of the ICU, it should be determined whether the catheter can be removed. Educational measures targeted at non-ICU wards are warranted. First results of computer-assisted methods to facilitate surveillance of larger number of patients are promising. The Healthcare Infection Control Practices Advisory Committee recommends that CA-BSIs be publicly reported. CA-BSIs in non-ICU patients could soon be part of a mandatory reporting.
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In 1992, the United States Food and Drug Administration required health care services to adopt needle-free devices to prevent health care workers' exposure to bloodborne pathogens resulting from needlestick injuries, and several systems of disinfectable needle-free connectors (DNC) were introduced. ⋯ Strategies focused in the implication of the nurse staff in CRBSI surveillance increase compliance with DNC handling recommendations and minimize the risk of developing a CR-BSI. DNCs can be used safely if staff complies with recommendations for use.