Preventing Central Line-Associated Bloodstream Infections
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
C-Reactive Protein and Albumin Kinetics Before Community-Acquired Bloodstream Infections – Cambridge.Org/Hyg a Danish Population-Based Cohort Study
Epidemiology and Infection C-reactive protein and albumin kinetics before community-acquired bloodstream infections – cambridge.org/hyg a Danish population-based cohort study 1 1,2,3 1 4 5 Original Paper O. S. Garvik , P. Póvoa , B. Magnussen , P. J. Vinholt , C. Pedersen , T. G. Jensen6, H. J. Kolmos6, A. T. Lassen7 and K. O. Gradel1 Cite this article: Garvik OS, Póvoa P, Magnussen B, Vinholt PJ, Pedersen C, Jensen 1Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, and Center TG, Kolmos HJ, Lassen AT, Gradel KO (2020). for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, ground floor, 5000 Odense C-reactive protein and albumin kinetics before 2 community-acquired bloodstream infections – C, Denmark; NOVA Medical School, New University of Lisbon, Campo Mártires da Pátria 130, 1169-056 Lisbon, 3 a Danish population-based cohort study. Portugal; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, CHLO, Estrada do Forte do Alto do Duque, 4 Epidemiology and Infection 148,e38,1–6. 1449-005 Lisbon, Portugal; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, https://doi.org/10.1017/S0950268820000291 Sdr. Boulevard 29, entrance 40, 5000 Odense C, Denmark; 5Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, entrance 20, 5000 Odense C, Denmark; 6Department of Clinical Microbiology, Odense Received: 30 October 2019 University Hospital, J.B. Winsløws Vej 21, 2nd floor, 5000 Odense C, Denmark and 7Department of Emergency Revised: 16 January 2020 Medicine, Odense University Hospital, Kløvervænget 25, entrance 63-65, 5000 Odense C, Denmark Accepted: 22 January 2020 Key words: Abstract Albumin; C-reactive protein; community acquired bloodstream infections Early changes in biomarker levels probably occur before bloodstream infection (BSI) is diag- nosed. -
BLOOD INFECTIONS INTRODUCTION TYPES Of
BLOOD INFECTIONS Please supplement and learn theory on the basis of the lecture, Mim’s book and supplementary materials before class!!! INTRODUCTION PRINCIPLE: UNDER NATURAL CONDITIONS BLOOD IS STERILE IMPORTANT TERMS: Nosocomial infection ……………………………………………………………………………………………………………….. Bacteremia ………………………………………………………………………………………………………………………………. Viremia …………………………………………………………………………………………………………………………………….. Fungemia ………………………………………………………………………………………………………………………………….. Sepsis …………………………………………………………………………………………………………………………………………. SIRS …………………………………………………………………………………………………………………………………………….. MODS …………………………………………………………………………………………………………………………………………. ARDS …………………………………………………………………………………………………………………………………………… DIC ………………………………………………………………………………………………………………………………………………. CRBI …………………………………………………………………………………………………………………………………………….. BSI ………………………………………………………………………………………………………………………………………………. TYPES of BACTEREMIA .------------------------------------ ---------------------------------- ---------------------------------- •Examples: •Examples: •Examples: •-------------------------------------- •------------------------------------- •------------------------------------ -------------------------------------- •-------------------------------------- •-------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -------------------------------------- -
Association Between Patient Outcomes and Accreditation in US Hospitals
RESEARCH Association between patient outcomes and accreditation in US BMJ: first published as 10.1136/bmj.k4011 on 18 October 2018. Downloaded from hospitals: observational study Miranda B Lam,1,2 Jose F Figueroa,3,4 Yevgeniy Feyman,2 Kimberly E Reimold,2 E John Orav,5 Ashish K Jha2,3,4 1Department of Radiation ABSTRACT RESULTS Oncology, Brigham and OBJECTIVES Patients treated at accredited hospitals had lower Women’s Hospital/Dana Farber 30 day mortality rates (although not statistically Cancer Institute, Boston, MA, To determine whether patients admitted to US USA hospitals that are accredited have better outcomes significant lower rates, based on the prespecified P 2Department of Health Policy than those admitted to hospitals reviewed through value threshold) than those at hospitals that were and Management, Harvard T H state surveys, and whether accreditation by The reviewed by a state survey agency (10.2% v 10.6%, Chan School of Public Health, Boston, MA 02115, USA Joint Commission (the largest and most well known difference 0.4% (95% confidence interval 0.1% to 3Department of Medicine, accrediting body with an international presence) 0.8%), P=0.03), but nearly identical rates of mortality Harvard Medical School, confers any additional benefits for patients for the six surgical conditions (2.4% v 2.4%, 0.0% Boston, MA, USA 4Department of Medicine, compared with other independent accrediting (−0.3% to 0.3%), P=0.99). Readmissions for the Division of General Internal organizations. 15 medical conditions at 30 days were significantly Medicine, Brigham and lower at accredited hospitals than at state survey Women’s Hospital, Boston, DESIGN MA, USA Observational study. -
Reinforcing the Immunocompromised Host Defense Against Fungi: Progress Beyond the Current State of the Art
Journal of Fungi Review Reinforcing the Immunocompromised Host Defense against Fungi: Progress beyond the Current State of the Art Georgios Karavalakis 1, Evangelia Yannaki 1,2 and Anastasia Papadopoulou 1,* 1 Hematology Department-Hematopoietic Cell Transplantation Unit, Gene and Cell Therapy Center, “George Papanikolaou” Hospital, 57010 Thessaloniki, Greece; [email protected] (G.K.); [email protected] (E.Y.) 2 Department of Medicine, University of Washington, Seattle, WA 98195, USA * Correspondence: [email protected]; Tel.: +30-2313-307-693; Fax: +30-2313-307-521 Abstract: Despite the availability of a variety of antifungal drugs, opportunistic fungal infections still remain life-threatening for immunocompromised patients, such as those undergoing allogeneic hematopoietic cell transplantation or solid organ transplantation. Suboptimal efficacy, toxicity, development of resistant variants and recurrent episodes are limitations associated with current antifungal drug therapy. Adjunctive immunotherapies reinforcing the host defense against fungi and aiding in clearance of opportunistic pathogens are continuously gaining ground in this battle. Here, we review alternative approaches for the management of fungal infections going beyond the state of the art and placing an emphasis on fungus-specific T cell immunotherapy. Harnessing the power of T cells in the form of adoptive immunotherapy represents the strenuous protagonist of the current immunotherapeutic approaches towards combating invasive fungal infections. The progress that has been made over the last years in this field and remaining challenges as well, will be discussed. Citation: Karavalakis, G.; Yannaki, E.; Papadopoulou, A. Reinforcing the Keywords: fungal infections; fungus-specific T cells; T cell immunotherapy Immunocompromised Host Defense against Fungi: Progress beyond the Current State of the Art. -
Bacterial Bloodstream Infections in HIV-Infected Adults Attending a Lagos Teaching Hospital
J HEALTH POPUL NUTR 2010 Aug;28(4):318-326 ©INTERNATIONAL CENTRE FOR DIARRHOEAL ISSN 1606-0997 | $ 5.00+0.20 DISEASE RESEARCH, BANGLADESH Bacterial Bloodstream Infections in HIV-infected Adults Attending a Lagos Teaching Hospital Adeleye I. Adeyemi1, Akanmu A. Sulaiman2, Bamiro B. Solomon3, Obosi A. Chinedu1, and Inem A. Victor4 1Department of Microbiology, Faculty of Science, University of Lagos, Akoka, Nigeria, 2Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Nigeria, 3Department of Obstetrics and Gynaecology, Bacteriology Research Laboratory, College of Medicine, University of Lagos, Lagos, Nigeria, and 4Institute of Child Health and Primary Care, Lagos University Teaching Hospital, Idi-Araba, Nigeria ABSTRACT An investigation was carried out during October 2005–September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients—86 males and 115 females—aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 °C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had <200 cells/µL of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. -
Pdfs/ Ommended That Initial Cultures Focus on Common Pathogens, Pscmanual/9Pscssicurrent.Pdf)
Clinical Infectious Diseases IDSA GUIDELINE A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiologya J. Michael Miller,1 Matthew J. Binnicker,2 Sheldon Campbell,3 Karen C. Carroll,4 Kimberle C. Chapin,5 Peter H. Gilligan,6 Mark D. Gonzalez,7 Robert C. Jerris,7 Sue C. Kehl,8 Robin Patel,2 Bobbi S. Pritt,2 Sandra S. Richter,9 Barbara Robinson-Dunn,10 Joseph D. Schwartzman,11 James W. Snyder,12 Sam Telford III,13 Elitza S. Theel,2 Richard B. Thomson Jr,14 Melvin P. Weinstein,15 and Joseph D. Yao2 1Microbiology Technical Services, LLC, Dunwoody, Georgia; 2Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; 3Yale University School of Medicine, New Haven, Connecticut; 4Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; 5Department of Pathology, Rhode Island Hospital, Providence; 6Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill; 7Department of Pathology, Children’s Healthcare of Atlanta, Georgia; 8Medical College of Wisconsin, Milwaukee; 9Department of Laboratory Medicine, Cleveland Clinic, Ohio; 10Department of Pathology and Laboratory Medicine, Beaumont Health, Royal Oak, Michigan; 11Dartmouth- Hitchcock Medical Center, Lebanon, New Hampshire; 12Department of Pathology and Laboratory Medicine, University of Louisville, Kentucky; 13Department of Infectious Disease and Global Health, Tufts University, North Grafton, Massachusetts; 14Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois; and 15Departments of Medicine and Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey Contents Introduction and Executive Summary I. -
Thejewish Thejewish
THE JEWISH VETERAN Volume 71 • Number 4 • 2017 JWV and Lack of Accountability at the Department of the VA Veterans Affairs Leaves Veterans Flabbergasted Page 14 By Lance Wang, Editor I had the opportunity to interact with limitation of their system, and share my NAZIS ARE NOT the Veterans’ Administration while in frustration. I don’t blame them. WELCOME IN AMERICA! uniform, much more so since retiring Why is it so difficult to bring the from the Army. As with any large or- problems in the VA to solution stages? Commentary By ganization I’ve encountered good and For years the VA has been neither fish PNC Dr. Robert Pickard bad. Certainly the good is the dedicated nor fowl – it did not have the account- functionaries who I encounter, many of ability nor true profit motive that civil- Page 4 whom are themselves veterans. I also ian medical agencies have, nor did it have been particularly pleased with the have the discipline to which a military service of a nearby VA Community- agency was subjected. It was designed Register Now! Based Outreach Clinic which provides to replace a 19th century system which responsiveness that I’ve never encoun- largely put the onus on charitable or- tered from a big city VA facility. They ganizations and local communities to have provided more continuity of care care for veterans. It was never fully re- than I encountered in the military or the sourced to perform its mission, result- The workload for the VA has only civilian world. However the “bad” side ing in fraud and scandals like we saw increased since the editorial was writ- has certainly made itself known. -
Chapter 2 Disease and Disease Transmission
DISEASE AND DISEASE TRANSMISSION Chapter 2 Disease and disease transmission An enormous variety of organisms exist, including some which can survive and even develop in the body of people or animals. If the organism can cause infection, it is an infectious agent. In this manual infectious agents which cause infection and illness are called pathogens. Diseases caused by pathogens, or the toxins they produce, are communicable or infectious diseases (45). In this manual these will be called disease and infection. This chapter presents the transmission cycle of disease with its different elements, and categorises the different infections related to WES. 2.1 Introduction to the transmission cycle of disease To be able to persist or live on, pathogens must be able to leave an infected host, survive transmission in the environment, enter a susceptible person or animal, and develop and/or multiply in the newly infected host. The transmission of pathogens from current to future host follows a repeating cycle. This cycle can be simple, with a direct transmission from current to future host, or complex, where transmission occurs through (multiple) intermediate hosts or vectors. This cycle is called the transmission cycle of disease, or transmission cycle. The transmission cycle has different elements: The pathogen: the organism causing the infection The host: the infected person or animal ‘carrying’ the pathogen The exit: the method the pathogen uses to leave the body of the host Transmission: how the pathogen is transferred from host to susceptible person or animal, which can include developmental stages in the environment, in intermediate hosts, or in vectors 7 CONTROLLING AND PREVENTING DISEASE The environment: the environment in which transmission of the pathogen takes place. -
Guidelines for Management of Opportunistic Infections and Anti Retroviral Treatment in Adolescents and Adults in Ethiopia
GUIDELINES FOR MANAGEMENT OF OPPORTUNISTIC INFECTIONS AND ANTI RETROVIRAL TREATMENT IN ADOLESCENTS AND ADULTS IN ETHIOPIA Federal HIV/AIDS Prevention and Control Office Federal Ministry of Health July 2007 PART I GUIDELINES FOR MANAGEMENT OF OPPORTUNISTIC INFECTIONS IN ADULTS AND ADOLESCENTS ii Table of Contents Foreword iv Acknowledgement v Acronyms and Abbreviations vi 1. Introduction 1 2. Objectives and Targets 2 2.1. Objectives 2 2.2. Targets 2 3. Management of Common Opportunistic Infections 2 4. Unit 1: Management of OI of the Respiratory System 3 1.1 Bacterial pneumonia 6 1.2 Pneumonia due to Pneumocystis jiroveci. 6 1.3 Pulmonary tuberculosis 7 1.4 Correlation of pulmonary diseases and CD4 count in HIV-infected patients 9 Unit 2: Management of GI Opportunistic Diseases 11 2.1. Dysphagia and odynophagia 11 2.2. Diarrhoea 12 2.3 Peri-anal problems 14 2.4. Peri-anal and/or genital herpes 15 Unit 3: Management of Opportunistic Diseases of the Nervous system 16 3.1. Peripheral neuropathies 17 3.2. Persistent headache with (+/-) neurological manifestations (+/-) seizure 18 3.3. Management of common CNS infections presenting with headache and/or seizure 19 3.3.1. Toxoplasmosis 19 3.3.2 Management of seizure associated with toxoplasmosis and other CNS OIs 21 3.3.3 Cryptococcosis 23 3.3.4 CNS Tuberculosis 25 Unit 4: Management of Skin Disorders 26 4.1 Aetiological Classification of Skin Disorders in HIV disease. 27 4.2 Selected skin conditions in patients with HIV infection 28 4.2.1 Seborrheic dermatitis 28 4.2.2 Pruritic Papular Eruption 29 4.2.3 Kaposi’s Sarcoma 29 Unit 5: Management of Fever 30 5.1 Selected causes of fever in AIDS patients 33 5.1.1 Malaria 33 5.1.2 Visceral Leishmaniasis 33 5.1.3 Sepsis 34 Unit 6: Some Special Conditions in OI Management 35 6.1 Initiating ART in context of an acute OI 35 6.2 When to initiate ART in context of an acute OI 36 iii Tables 1. -
Appendix I: Methodology and Origin of External Quality Review (Eqr) Protocol Development
2012 EXTERNAL QUALITY REVIEW (EQR) PROTOCOLS APPENDIX I: METHODOLOGY AND ORIGIN OF EXTERNAL QUALITY REVIEW (EQR) PROTOCOL DEVELOPMENT TABLE OF CONTENTS PURPOSE OF THE APPENDIX .......................................................................................................................................... 1 PERFORMANCE IMPROVEMENT PROTOCOLS DEVELOPMENT .............................................................. 2 PERFORMANCE MEASUREMENT PROTOCOLS DEVELOPMENT ............................................................. 6 INFORMATION SYSTEM CAPABILITIES ASSESSMENT DEVELOPMENT ................................................ 7 ADDITIONAL REFERENCES ................................................................................................................................. 9 PURPOSE OF THE APPENDIX The purpose of this Appendix is to describe how the protocols were developed and to document the references applied to them. As described in the introduction to the protocols, the original protocols were developed in 2001 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), working with consultants and representatives of private accrediting organizations, quality measurement experts, State Medicaid agencies, and advocates for Medicaid beneficiaries, under the direction of the Centers for Medicare & Medicaid Services (CMS). In 2010, CMS contracted with Provider Resources, Inc. (PRI) and their subcontractor, the National Committee for Quality Assurance (NCQA), to work with EQR stakeholders, including States, -
Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting a b,c, Alexander Lepak, MD , David Andes, MD * KEYWORDS Invasive candidiasis Pharmacokinetics-pharmacodynamics Therapy Source control Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit (ICU) are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Currently, candidemia represents the fourth most common health care–associated blood stream infection.1–3 With increasingly immunocompromised patient populations, other fungal species such as Aspergillus species, Pneumocystis jiroveci, Cryptococcus, Zygomycetes, Fusarium species, and Scedosporium species have emerged.4–9 However, this review focuses on invasive candidiasis (IC). Multiple retrospective studies have examined the crude mortality in patients with candidemia and identified rates ranging from 46% to 75%.3 In many instances, this is partly caused by severe underlying comorbidities. Carefully matched, retrospective cohort studies have been undertaken to estimate mortality attributable to candidemia and report rates ranging from 10% to 49%.10–15 Resource use associated with this infection is also significant. Estimates from numerous studies suggest the added hospital cost is as much as $40,000 per case.10–12,16–20 Overall attributable costs are difficult to calculate with precision, but have been estimated to be close to 1 billion dollars in the United States annually.21 a University of Wisconsin, MFCB, Room 5218, 1685 Highland Avenue, Madison, WI 53705-2281, USA b Department of Medicine, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA c Department of Microbiology and Immunology, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA * Corresponding author. -
Bloodstream Infections Surveillance Module for Rural Hospitals and Non-Acute Settings
TASMANIAN INFECTION PREVENTION AND CONTROL UNIT Bloodstream Infections Surveillance Module for rural hospitals and non-acute settings. Version 1 Department of Health and Human Services Bloodstream infection - surveillance module for rural hospitals and non-acute settings. Tasmanian Infection Prevention and Control Unit (TIPCU) Department of Health and Human Services, Tasmania Published 2013 Copyright—Department of Health and Human Services Editors • Anne Wells, TIPCU • Fiona Wilson, TIPCU Suggested citation: Wells A., Wilson F. (2013). Bloodstream infection – surveillance module for rural hospitals and non- acute settings. Hobart: Department of Health and Human Services. TASMANIAN INFECTION PREVENTION AND CONTROL UNIT Population Health Department of Health and Human Services GPO Box 125 Hobart 7001 Ph: 6222 7779 Fax: 6233 0553 www.dhhs.tas.gov.au/tipcu 1 Contents Blood stream infection surveillance ........................................................................................................ 3 Background ......................................................................................................................................... 3 Aims .................................................................................................................................................... 3 Inclusion criteria.................................................................................................................................. 3 Exclusion criteria................................................................................................................................