Tag Archives: Incidence/Prevalence

What is the evidence on use of surgical counting systems to prevent errors?

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Stawicki SP, et al. Retained surgical items: a problem yet to be solved. J Am Coll. Surg. 2013;216(1):15-22.
This study analyzed 59 cases of retained surgical items (RSIs) as well as 118 matched controls. Incorrect counts during a procedure elevated the risk of RSI. An odds ratio of 20 for RSI risk was found for any incorrect surgical count.

Cima RR, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg. 2008;207(1):80-87.
Thirty-four cases of actual retained foreign objects (RFOs) in 21 patients occurred when the count had been reported as correct.

Jackson S, Brady S.  Counting difficulties:  retained instruments, sponges, and needles.  AORN.  2008;87(2): 513-21.
This review article discusses prevention of errors and references Association of Perioperative Registered Nurses (AORN) recommended practices.

Egorova NN, et al.  Managing the prevention of retained surgical instruments: what is the value of counting?  Ann Surg. 2008 Jan;247(1):13-8.
Reviews data on count prevalence of discrepancies in 153,263 operations. There were 1062 count discrepancies, and 1 in every 70 discrepancy cases had a retained item. Final count discrepancies prevented 54% of retained items. Due to the low incidence of retained foreign bodies, the positive predictive value of a count discrepancy for an actual retained foreign body was only 1.6.

Reviewed and updated 4/15/2014 ldt

Can a MRSA bundle prevent healthcare-associated MRSA infections in the ICU?

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Bottom line:  Use of a bundle decreased infection rates of healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) at Veterans Affairs (VA) hospitals.

Summary: Jain R, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections.  N Engl J Med. 2011 Apr 14;364(15):1419-30.

The study compared rates of healthcare-acquired MRSA infections at VA units before (October 2005 – March 2007) and after (October 2007 – June 2010) implementation of a care bundle that included universal nasal surveillance for MRSA, contact precautions for patients colonized or infected with MRSA, promotion of hand hygiene, and a change in the workplace culture that made infection control the responsibility of every staff member who had contact with patients. During the period there was a total of  8,318,675 patient days. Rates of MRSA infections in ICU units were reduced by 62% while the rates at units other than ICUs were reduced by 45% during the same period.

Huskins WC, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011 Apr 14;364(15):1407-18.

This study of 18 ICU units looked at infection rates of MRSA and vancomycin-resistant enterococcus (VRE) in adult ICUs. Units were randomized to receive an intervention (n=10)  of increased surveillance and expanded barriers or to remain the same as a control (n=8). Intervention group patients were assigned to contact precautions based on history of MRSA or VRE in the past 12 months or results of nasal and perianal swabs. Patients in control units had swabs, but contact precautions were instituted based on hospital procedures and were blinded to the swab results. As Figure 3 summarizes, there was no significant difference in change of infection rates between the two groups. Authors concluded that the intervention was unable to reduce the transmission of MRSA and VRE. The surveillance cultures identified a significant subgroup of colonized patients who would not have been recognized otherwise, but the healthcare providers who participated in the study failed to use clean gowns and gloves and perform hand hygiene as often as was required by the intervention.

Two studies of antibiotic care bundles for MRSA in ICUs can be found here.

Reviewed and updated 4/11/2014 ldt

For inpatients, is daily bathing with chlorhexidine gluconate (CHG) more effective than daily bathing with soap and water to reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enteroccocus (VRE) hospital-acquired infections (HAIs)?

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Bottom line: Use of CHG results in significant reductions in risks of central-line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and colonizations with VRE or MRSA but not reductions in infections.

Summary: Karki S, Cheng AC. “Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review.” J Hosp Infect. 2012;82(2):71-84.
This systematic review included sixteen published studies and four conference abstracts. Studies compared the use of CHG in washcloths with at least one of the following: soap and water bathing, routine advice, or no intervention.

Reviewed and updated 4/11/2014 ldt

 

What can happen if patients’ intake and output is not properly monitored after surgery?

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Bottom line: Monitoring and documenting intake and output after surgery is important for detecting conditions, such as postoperative urinary retention (POUR), which is associated with risk of overdistention and permanent detrusor muscle damage, leading to difficulties with urination.  Decreased output can also be an indicator of a urinary tract infection.

Summary:  Feliciano T, et al.  A retrospective, descriptive, exploratory study evaluating incidence of postoperative urinary retention after spinal anesthesia and its effect on PACU discharge.  J Perianesth Nursing.  2008; 23(6): 394-400.

Postoperative care.  In:  Lippincott’s Nursing Procedures and Skills.  Revised October 4, 2013.

Reviewed and updated 4/11/2014 ldt

Rates of central line-associated bloodstream infection (CLABSI) in 2001, 2008, and 2009 for ICU, inpatient, and hemodyalisis units

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Centers for Disease Control and Prevention (CDC).  Vital signs: central line–associated blood stream infections — United States, 2001, 2008, and 2009.  Morb Mortal Wkly Rep 2011 Mar 4; 60:243.

Includes incidence data comparing 2008-09 data to 2001, which was prior to the CDC’s 2002 guidelines for reducing CLABSIs.

Reviewed 4/11/2014 ldt

What is the reported incidence of central line blood stream infections based on central line device type (PICC, tunneled line, etc.)?

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Maki DG, et al.  The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.   Mayo Clin Proc. 2006 Sep;81(9):1159-71.

Included English-language articles of prospective studies of adults published between January 1, 1966, and July 1, 2005, identified in MEDLINE.

Tables 3 summarizes data for various types of catheters and reports incidence by infections per 1,000 catheter days.

AHRQ-sponsored intervention reduces rates of ventilator-associated pneumonia (VAP) in intensive care units (ICUs)

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Matar, Dany S, et al. “Achieving and sustaining ventilator-associated pneumonia-free time among intensive care units (ICUs): evidence from the Keystone ICU Quality Improvement Collaborative.” Infection control and hospital epidemiology 34.7 (2013):740-743.
This retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative showed that a zero rate of VAP could be attained and sustained for a considerable period of time in adult ICUs.

Berenholtz SM, et al. “Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infection control and hospital epidemiology 32.4 (2011):305-314.
Study of an intervention consisting of the Comprehensive Unit-Based Safety Program (CUSP) and a ventilator care bundle of five evidence-based practices from the Centers for Disease Control and Prevention. Reduced rates of VAP by up to 71% at 112 Michigan intensive care units (ICUs).

Reviewed and updated 4/24/2014 ldt