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Prevention of High Blood Pressure by the Beeta Vulgaris Root Solution Research Article iMedPub Journals Health Science Journal 2016 http://www.imedpub.com/ ISSN 1791-809X Vol. 10 No. 2: 5 A Multifaceted Intervention Program Maria Mitsogianni1, Ioannis Vasileiadis1, to Prevent Bloodstream Infection in an Maria Parisi1, IntensiveCare Unit Running Head: An Georgios Tzanis1, Intervention for the Reduction Efstathia Kampisiouli1, of Bacteraemia in ICU Zoi Psaroudaki2, Efstathia Perivolioti2, Kimon Fountoulis2, Christina Routsi1, 1 Abstract Serafeim Nanas and 3 Objective: Bloodstream infections (BSIs) are associated with increased Sotirios Tsiodras morbidity and mortality among critically ill patients. The aim of this prospective multifaceted interventional study is to investigate the effect of 1 First Critical Care Department, National a bundle of measures on BSI rates. and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece Methods: The study was divided in a baseline and an intervention 2 Department of Clinical Microbiology, period. The interventions initiated consisted of a central venous catheter Evangelismos Hospital, Athens, Greece (CVC) insertion and maintenance bundle, an educational program 3 Fourth Department of Internal Medicine, promoting hand hygiene among health-care workers as well as weekly National and Kapodistrian University performance feedback. Patient data collected included demographics, of Athens, Attikon University Hospital, days of antimicrobial therapy and CVC catheterizations and episodes of Athens, Greece bacteraemia. Altogether, 267 patients were enrolled in the study. Results: Bacteraemia occurred in 35 out of 143 patients in the baseline period (14.7 incidents per 1000 patient-days) and in 18 out of 124 patients Corresponding author: in the intervention period (8.8 incidents per 1000 patient-days). This Prof. Serafeim Nanas indicates a statistically significant lower BSI incidence after implementing the intervention (p < 0.05, OR 1.9). [email protected] Conclusions: An intervention program including modifying CVC insertion and maintenance as well as promoting hand hygiene seems to be an First Critical Care Department, National effective way of preventing BSI in intensive care units. and Kapodistrian University of Athens, Keywords: Bloodstream infection; Central venous catheter bundle; Hand Evangelismos Hospital, Ypsilantou 45-47, hygiene; Education intervention 106 75, Athens, Greece. Abbreviation: BSI: Blood Stream Infection; CVC: Central Venous Catheter; Tel: +306973036448 CLABSI: Central Line-Associated Blood Stream Infection; ICU: Intensive Fax: +302132043385 Care Unit; COPD: Chronic Obstructive Pulmonary Disease; APACHE II: Acute Physiology and Chronic Health Evaluation II; SAPS III: Simplified Acute Physiology Score III; SOFA: Sequential Organ Failure Assessment Received: November 23, 2015; Accepted: January 25, 2016; Published: January 31, 2016 Introduction Compared to the general hospital population, critically ill patients are at increased risk of BSI because of underlying Bloodstream infection (BSI) is a major cause of morbidity and comorbid conditions [5,6], prior receipt of antimicrobial therapy mortality worldwide and is associated with prolonged hospital and widespread use of invasive devices such as central venous stay and additional health care costs [1-4]. © Copyright iMedPub | This article is available in: www.hsj.gr/archive 1 ARCHIVOSHealth Science DE MEDICINA Journal 2016 ISSNISSN 1698-94651791-809X Vol. 10 No. 2: 5 catheters (CVCs). The presence of the latter is a common Full barrier precautions during the insertion including donning predisposing factor for BSI (central line associated bloodstream of sterile gloves, sterile gown, cap and mask by the physician infection - CLABSI) [7]. The risk varies depending on ward-type, inserting the catheter, large sterile draping of the patient, skin institution and geographical region [8]. antisepsis with 2 % chlorhexidine preparation and avoidance of the femoral site when possible. Compliance with best practices Specific strategies have been shown to significantly reduce the was ensured by a checklist which had to be filled by the physician rate of CLABSIs in intensive care units (ICUs) [9] and have been adopted in the Centers for Disease Control and Prevention at every new insertion. (CDC) and other guidelines [10-12]: full barrier technique during Regular inspection of the insertion site for signs of infection and CVC insertion, skin antisepsis with chlorhexidine, catheter site replace of the dressing when dump or soiled or routinely once selection with avoidance of the femoral vein, preinsertion hand per week. hygiene and early removal of unnecessary catheters. Behavioral Moreover, we implemented a series of measures in order to interventions that improve the compliance of the personnel promote hand hygiene among healthcare workers: also seem to play a significant role [13]. The efficacy of these measures has been confirmed in several large scale studies in the Indications for hand hygiene were posted at strategic locations recent years [14-18], whereas the goal of a zero CLABSI rate has throughout the ICU. not been achieved. Healthcare workers were informed about the necessity of hand Moreover, hand hygiene is generally regarded as an effective hygiene in a lecture. way to reduce health-care infection rates - and consequently BSI In order to further support our measures, a booklet of standards rates - caused by cross-transmission of pathogens [19]. Based on regarding central line care and hand hygiene according to the World Health Organization initiative [20], several campaigns recommended guidelines was distributed to the personnel. aiming at promoting hand hygiene in healthcare have been introduced in the last years [21]. However, compliance between Definitions healthcare workers still remains low [22]. A BSI was considered to be ICU-related if it was detected at least The objective of the present study is to evaluate the impact of 48 hours after admission. Both primary and secondary BSIs were a series of technical and educational interventions consisting considered in the analysis. Cultures of common skin contaminants of CLABSI prevention measures and a hand hygiene promotion were not included in the analysis, unless the microorganism program on the rates of BSI in an ICU. was isolated in two different samples. An antimicrobial day was defined as a day for which any amount of an antimicrobial agent Methods was administered to an individual patient. Study design Microbiological methods This prospective interventional study was conducted in the 30- bed intensive care unit (ICU) of Evangelismos hospital, a 1000- Blood cultures were obtained when indicated by the treating bed tertiary care hospital in Athens, over a 17-month period physician in case of clinical suspicion of infection. All specimens (October 2010 to February 2012). were processed using standard methods at the microbiological laboratory of the hospital. Detection of microorganisms was All adult patients admitted to the ICU for more than 48 hours TM were eligible to participate in the study. The exclusion criteria performed by the automatic blood culture system BD BACTEC were ICU hospitalization in the previous three months, brain 9000 Series. death, pregnancy and microbiologically confirmed sepsis at the admission point. Statistical analysis Data collected included demographics, preexisting medical The data analysis was performed using SPSS for Windows conditions, severity scores on admission, days of antimicrobial Version 19.0. Continuous variables are expressed as mean therapy, days of central venous catheterization as well as (standard deviation - SD) and categorical variables as counts and number of catheter-insertions during the ICU stay. All episodes percentages. of bacteraemia were recorded. The patients were followed until acquiring a BSI, until discharge from the ICU or for a maximum of Variables were compared using the independent-sample t-test 30 days. or Pearson chi square test, as appropriate. Risks were compared using odds ratios (OD) with corresponding 95 % confidence The study was divided in two periods: a baseline observation intervals (CI). All tests were two-tailed, and p-values less than period (October 2010 - April 2011) and an intervention period (May 2011 - February 2012). The study protocol was approved by 0.05 were considered to indicate statistical significance. the Ethical Committee of the hospital. Outcome measures Interventions The primary endpoint of the study was the acquisition of We introduced a CVC insertion and maintenance bundle bacteraemia. The BSI rate was expressed as the number of BSIs consisting of: per 1000 patient days. 2 This article is available in: www.hsj.gr/archive ARCHIVOSHealth Science DE MEDICINA Journal 2016 ISSNISSN 1698-94651791-809X Vol. 10 No. 2: 5 Figure 1 Flow chart of patients enrolled in the study. Results education and feedback on decreasing BSI rates. Our findings demonstrate that implementation of a CVC-care bundle and As shown in Figure 1, a total of 603 patients were admitted a program to improve hand hygiene was associated with a to the ICU during the study period, of which 267 were eligible significant reduction in BSIs. for enrolment in the study (143 in the baseline and 124 in the intervention period) and were included in further analysis. Our study was completed one year after an intervention regarding ventilator-associated pneumonia in the same ICU, which could Their main demographic and clinical characteristics are have already positively
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