HAP/VAP care bundle interventions - a UK approach. Dr R G Masterton NHS Ayrshire & Arran
|
|
- Beryl Henderson
- 6 years ago
- Views:
Transcription
1 HAP/VAP care bundle interventions - a UK approach Dr R G Masterton NHS Ayrshire & Arran
2 How Hazardous Is Health Care? (Leape and Amalberti) Total lives lost per year 100,000 10,000 1, HAZARDOUS (>1/1000) Health Care Mountain Climbing Bungee Jumping REGULATED Driving Chemical Manufacturing Chartered Flights Scheduled Airlines ,000 10, ,000 1,000,00 0 Number of encounters for each fatality ULTRA-SAFE (<1/100K) European Railroads Nuclear Power 10,000,0 00
3 Healthcare Quality Strategy 3 Quality Ambitions Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.
4 Healthcare Quality Strategy 3 Quality Ambitions Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which Person respect centred individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. No avoidable injury or harm from the healthcare they receive, and that they are Harm cared for in an appropriate, clean and safe environment at all times. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation. Waste & Variation
5 Quality Measurement Framework Quality Outcome Measures HEAT Supporting local and national quality indicators
6 Healthcare Quality & Cost QUALITY INITIATIVES COST REDUCTION PROGRAMMES Costs more Cost neutral Improves quality Quality neutral Reduces quality reduces costs
7 To do things differently, we must see things differently. When we see things we haven t noticed before, we can ask questions we didn t know to ask before. John Kelsch, Xerox Quality Health care in America Project
8 Care Bundle
9
10 HAP Guideline Recommendations Grade Prevention Diagnosis Treatment A B C D GPP Masterton et al. J Antimicrob Chemother. 2008;62:5-34.
11 HAP Guideline Recommendations Grade Prevention Diagnosis Treatment A B C D GPP Masterton et al. J Antimicrob Chemother. 2008;62:5-34.
12 What is a Care Bundle? 1. Set of around 5 evidence-based interventions that apply to all patients with a common disease. 2. Ensure the delivery system means the interventions are delivered. 3. Compliance is all or nothing. 4. Measure outcomes to ascertain benefits. 5. Develop the will to deliver all the time every time. Masterton. Intensive Care Med. 2009;35:
13 Success of Care Bundles in Healthcare Environment Institute of Healthcare Improvement 100K Lives Campaign in USA has now become the 5 Million Lives Campaign Care Bundles demonstrated to be highly effective: Central Line Bundle has reduced bloodstream infections Ventilator Bundle has reduced ventilator associated pneumonia Care Bundles to prevent HCAI are advocated High Impact Interventions in the Department of Health Saving Lives delivery programme Seven Care Bundles published to date: Most for insertion/care of indwelling catheters/devices Care Bundle for prevention of spread of Clostridium Difficile includes an element for prudent antibiotic prescribing
14 Severe Sepsis Bundles Bundle use = consistent and significant improvement in survival Antibiotic administration, timing and appropriateness = maximum outcome benefit. Khan et al. Indian J Crit Care Med ;14: 8 13
15 The New Treatment Paradigm VAP Care Bundle Antimicrobial Care Bundle
16 THE NEW TREATMENT PARADIGM
17 The New Treatment Paradigm Start with the appropriate empiric antibiotic first in nosocomial infections If appropriate, change antibiotic dosage or therapy based on resistance and pathogen information Recognise that prior antimicrobial administration is a risk factor for the presence of resistant pathogens Know the unit s resistance profile and choose antibiotics accordingly Administer antibiotics at the right dose for the appropriate duration Masterton. Int J Antimicrob Agents ;33:
18 Getting it right Improved survival rate (%) Septic shock Severe shock Sepsis Rello et al. Crit Care Med 2003;31:
19 The Clock is ticking Survivial (%) Each hour off delay carries 7.6% reduction in survival Delay in treatment (hours) from hypotension onset Kumar et al. Crit Care Med 2006; 34:
20 The New Paradigm in a Care Bundle Secondary analysis of prospective before after study Intervention: emergency department sepsis bundle Bundle components Patient identification Fluid resuscitation Vasopressor administration Antibiotic recommendations Shorr, et al. Crit Care Med 2007;35:
21 The New Paradigm in a Care Bundle Total group Survivors Cost per patient (US $) p=0.009 Total cost (US $) Before Before After Group Mortality reduced with protocol from 48.3% to 30.0% (p=0.04) Group After Shorr, et al. Crit Care Med 2007;35:
22 The New Paradigm in a Care Bundle 2,000 Before After 1,600 Costs (US$ x 1000) 1, Total cost differential: $573, Total ICU Ward Pharmacy Lab Rad RT ED OR Misc Shorr, et al. Crit Care Med 2007;35:
23 The New Paradigm in a Care Bundle 1.0 Proportion of subjects remaining hospitalised Pre-intervention Post-intervention p= Median LOS Pre: 10 days Post: 7.5 days Length of stay (days) Shorr, et al. Crit Care Med 2007;35:
24 VAP CARE BUNDLE
25 The Care Bundle Approach VAP Care Bundle 5 simple, basic, universally accepted components Bed elevation Sedation vacation Daily weaning assessment Peptic ulcer prophylaxis DVT prophylaxis Craven. Chest;2006;130:
26 VAP Care Bundle The Top Ten Empiric therapy based on knowledge of local pathogens and assessment of risk factors Immediate treatment following microbiological sampling Oral care with chlorhexadine Non invasive ventilation preferred SD for mechanically ventilated patients greater than 48 hours Assess response within 72 hours Short duration of treatment therapy - 8 days if patient on appropriate regimen and not infected by MDR pathogen Sedation vacation and weaning protocol Monotherapy in preference to combination therapy in those not at risk for pseudomonas or MDR De-escalate in responding patients once culture results available Prevention Diagnosis Treatment Rello et al. J Crit Care May 26. [Epub ahead of print] & Intensive Care Med. 2010;36:
27 VAP Care Bundle Treatment Empiric therapy based on knowledge or local pathogens and assessment of risk factors Immediate treatment following microbiological sampling Assess response within 72 hours Short duration of treatment therapy - 8 days if patient on appropriate regimen and not infected by MDR pathogen Monotherapy in preference to combination therapy in those not at risk for pseudomonas or MDR De-escalate in responding patients once culture results are available Rello et al. J Crit Care May 26. [Epub ahead of print] & Intensive Care Med. 2010;36:
28 Impact of IHI VAP Improvement Bundle The key components of the Ventilator Bundle are: 1. Elevation of the Head of the Bed 2. Daily "Sedation Vacations" and Assessment of Readiness to Extubate 3. Peptic Ulcer Disease Prophylaxis 4. Deep Venous Thrombosis Prophylaxis 5. Daily Oral Care with Chlorhexidine Al-Tawfiq et al. Am J Infect Control Apr 17. [Epub ahead of print].
29 Impact of IHI VAP Improvement Bundle VAP prevention bundle resulted in reduction of VAP rates from (P <.001) : Mean of 9.3 cases/1000 ventilator-d in 2006 Mean of 2.3 cases/1000 ventilator-d in 2007 Mean of 2.2 cases/1000 ventilator-d in 2008 Each VAP case increased: attributable hospital LoS by 10 days mean hospital cost by $40,000. Al-Tawfiq et al. Am J Infect Control Apr 17. [Epub ahead of print].
30 VAP Care Bundle in The Ayr Hospital 1. Elevation of the Head of the Bed to Daily Sedation Break 3. Discussion of Extubation and Weaning 4. Daily x4 Oral Care with Chlorhexidine Al-Tawfiq et al. Am J Infect Control Apr 17. [Epub ahead of print].
31 VAP in The Ayr Hospital
32 VAP in The Ayr Hospital
33 ANTIMICROBIAL CARE BUNDLE
34 The Antimicrobial Care Bundle At initiation: Document clinical rationale for antibiotic initiation Appropriate specimens sent to diagnostic microbiology laboratory (according to local policy) Antibiotic selected according to local policy and risk group (exclude allergy) Consider removal of foreign body/drainage of pus/surgical intervention Cooke et al. Int J Antimicrob Agents. 2007;30:
35 The Antimicrobial Care Bundle For continuation: Daily consideration of: de-escalation intravenous oral switch stopping antibiotics (based on review of clinical picture and laboratory results) Antibiotic drug levels monitored as required by local policy Cooke et al. Int J Antimicrob Agents. 2007;30:
36 The Antimicrobial Stewardship Bundle Documentation of treatment rationale Collection of appropriate specimens Appropriate empirical selection of antibiotics according to local surveillance and formulary De-escalation Selection of appropriate agents for definitive therapy Toth et al. American Journal of Health-System Pharmacy, 2010;67:
37 The Antimicrobial Stewardship Bundle A total of 160 patients and 442 antibiotic orders were evaluated. 168 interventions were made, with an acceptance rate of 91%. De-escalation rose from 72% to 90% (p = 0.01). Compliance with all quality indicators rose from 16% to 43% (p < 0.001). Toth et al. American Journal of Health-System Pharmacy, 2010;67:
38
39 Success Through Education The Change Team Bloos et al. British Journal of Anaesthesia 2009;103:
40 Success Through Education The Change Team No difference in VAP frequency Audit I (33.1%) and Audit II (32.4%, P=0.68). Bloos et al. British Journal of Anaesthesia 2009;103:
41 Success Through Feedback The Electronic Dashboard Zaydfudim et al. Arch Surg. 2009;144(7):
42 Success Through Feedback The Electronic Dashboard Zaydfudim et al. Arch Surg. 2009;144(7):
43 Success Through Feedback The Electronic Dashboard Zaydfudim et al. Arch Surg. 2009;144(7):
44 Success Through MMP The Multimodal Programme VAP prevention bundle compliance increased after active implementation. VAP incidence fell significantly from 19.2 to 7.5 per 1,000 ventilator days. Rate difference (99% CI) = 11.6 ( ) per 1,000 ventilator days; Rate ratio (99% CI) = 0.39 (0.16, 0.96). Multimodal programme = staff education, process measurement, outcome measurement, feedback to staff and organisational change. Hawe et al. Intensive Care Med. 2009;35:
45 Success Through the IHI Tool The Model for Improvement When you combine the 3 questions with the What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? PDSA cycle, you get Act Study Plan Do the Model for Improvement
46
The Clinical Management of Hospital Acquired Pneumonia. NHS Ayrshire & Arran
The Clinical Management of Hospital Acquired Pneumonia Dr R G Masterton NHS Ayrshire & Arran What s new in HAP/VAP? Care bundles MRSA VAP Improving outcomes with current antimicrobial New antimicrobials
More informationGuess or get it right?
Guess or get it right? Antimicrobial prescribing in the 21 st century Robert Masterton Traditional Treatment Paradigm Conservative start with workhorse antibiotics Reserve more potent drugs for non-responders
More informationVAP Prevention bundles
VAP Prevention bundles Dr. Shafiq A.Alimad MD Head of medical department at USTH YICID workshop, 15-12-2014 Care Bundles What are they & why use them? What are Care Bundles? Types of Care Bundles available
More informationTargeted literature review:
Targeted literature review: What are the key infection prevention and control recommendations to inform a minimising ventilator associated pneumonia (VAP) quality improvement tool? Part of HAI Delivery
More informationSepsis. Reliability- can we achieve Dr Ron Daniels
Sepsis. Reliability- can we achieve it? @SepsisUK Dr Ron Daniels Chief Executive, Global Sepsis Alliance Fellow: NHS Improvement Faculty Chief Executive: United Kingdom Sepsis Trust & Chair, UK SSC RRAILS
More informationPotential Conflicts of Interests
Potential Conflicts of Interests Research Grants Agency for Healthcare Research and Quality Akers Bioscience, Inc. Pfizer, Inc. Scientific Advisory Boards Pfizer, Inc. Cadence Pharmaceuticals Kimberly
More informationMoving from VAP to VAC
Moving from VAP to VAC Cindy Munro, PhD, RN, ANP-BC, FAANP, FAAN Associate Dean of Research and Innovation Professor College of Nursing Conflict of interest: No relationships with pharmaceutical companies,
More informationVentilator Associated Pneumonia Vap
Ventilator Associated Pneumonia Vap 1 / 6 2 / 6 3 / 6 Ventilator Associated Pneumonia Vap Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator. A ventilator
More informationQuality Improvement: Why and How. Michael L. Rinke, MD March 9 th, 2013
Quality Improvement: Why and How Michael L. Rinke, MD March 9 th, 2013 Disclosures I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of
More informationQuality & Safety Committee Date: 22 June 2016 Agenda item: 4.4
SUMMARY REPORT ABM University Health Board Quality & Safety Committee Date: 22 June 20 Agenda item: 4.4 Subject Prepared by Approved by Infection Prevention & Control Delyth Davies, Head of Nursing, Infection
More informationconvey the clinical quality measure's title, number, owner/developer and contact
CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical
More informationVentilator Associated
Ventilator Associated Pneumonia: Key and Controversial Issues Christopher P. Michetti, MD, FACS Inova Fairfax Hospital, Falls Church, VA Forrest Dell Moore, MD, FACS Banner Healthcare System, Phoenix,
More informationSepsis: What Is It Really?
Sepsis: What Is It Really? Steven D. Burdette, MD, FIDSA, FACP Professor of Medicine Wright State University Boonshoft School of Medicine Director of Antimicrobial Stewardship for Premier Health and Miami
More informationAyrshire and Arran NHS Board
Paper 3 Ayrshire and Arran NHS Board Monday 19 Healthcare Associated Infection Position Report Author: Bob Wilson, Infection Control Manager Babs Gemmell, Business Manager Sponsoring Director: Fiona McQueen,
More informationImproving Prevention and Control of Infection Quarter 2 Report: April 2009 September 2009
Improving Prevention and Control of Infection Quarter 2 Report: April 2009 September 2009 1. Introduction This Quarter 2 updates the Health Board on infection prevention and control issues within the BCUHB.
More informationHEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION
HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health Care Medical
More informationBundle Therapy in Critical Care
14 : 3 Subhash Todi, Kolkata Introduction Institute for Health Care Improvement (IHI), USA has developed the concept of Bundle to help clinician deliver bedside care more reliably and effectively.each
More informationDiagnosis of Ventilator- Associated Pneumonia: Where are we now?
Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Gary French Guy s & St. Thomas Hospital & King s College, London BSAC Guideline 2008 Masterton R, Galloway A, French G, Street M, Armstrong
More informationSaving Lives: Focusing on Severe Sepsis and Septic Shock
Saving Lives: Focusing on Severe Sepsis and Septic Shock Deborah Cameron, RN, CPHQ Paul Pratt, RN Glenn Russ, RN Providence Little Company of Mary Medical Center San Pedro January 18, 2011 Objectives 1.
More informationSuperhero or Superzero? Vancomycin vs. Linezolid for MRSA Pneumonia
Superhero or Superzero? Vancomycin vs. Linezolid for MRSA Pneumonia Brandon Dionne, PharmD, BCPS, AAHIVP Assistant Clinical Professor Northeastern University Seth Housman, PharmD, MPA Clinical Assistant
More informationThe Infection Control Doctor and Clostridium difficile infection. Dr David R Jenkins University Hospitals of Leicester NHS Trust, England
The Infection Control Doctor and Clostridium difficile infection Dr David R Jenkins University Hospitals of Leicester NHS Trust, England 250 200 150 100 50 0 Monthly cases of Clostridium difficile (UHL
More informationIntroduction. Centers for Disease Control and Prevention (CDC),
When Prevention Fails: The Clinical and Economic Impact of Sepsis Introduction Healthcare-associated infections are one of the top 0 leading causes of death in the U.S. The US Centers for Disease Control
More informationAneurin Bevan Health Board. Quarterly Infection Control Report
Aneurin Bevan Health Board Wednesday 18 th November 2009 Agenda Item: 2.5 Aneurin Bevan Health Board Quarterly Infection Control Report 1 Introduction In line with Annual Operating Framework and Local
More informationNew Strategies in the Management of Patients with Severe Sepsis
New Strategies in the Management of Patients with Severe Sepsis Michael Zgoda, MD, MBA President, Medical Staff Medical Director, ICU CMC-University, Charlotte, NC Factors of increases in the dx. of severe
More informationMAKING SENSE OF IT ALL AUGUST 17
MAKING SENSE OF IT ALL AUGUST 17 @SepsisUK Dr Ron Daniels B.E.M. CEO, UK Sepsis Trust CEO, Global Sepsis Alliance Special Adviser to WHO SCALE AND BURDEN @sepsisuk Dr Ron Daniels B.E.M. CEO, UK Sepsis
More informationPrescribe appropriate immunizations for. Prescribe childhood immunization as per. Prescribe influenza vaccinations in high-risk
Supplemental Digital Appendix 1 46 Health Care Problems and the Corresponding 59 Practice Indicators Expected of All Physicians Entering or in Practice Infectious and parasitic diseases Avoidable complications/death
More informationNaeem Ali, MD Medical Director. The Ohio State University Wexner Medical Center
Update in Critical Care, 2012: Teamwork in the ICU Naeem Ali, MD Medical Director Medical Intensive Care Unit The Ohio State University Wexner Medical Center 1 Many developments in Critical Care Emergence
More informationLast frontier of infection in critically ill patients
Last frontier of infection in critically ill patients Nick Beeching Tropical & Infectious Disease Unit Royal Liverpool University Hospital Liverpool School of Tropical Medicine Liverpool School of Tropical
More informationAmerican College of Surgeons Critical Care Review Course 2012: Infection Control
American College of Surgeons Critical Care Review Course 2012: Infection Control Overview: I. Central line associated blood stream infection (CLABSI) II. Ventilator associated pneumonia (VAP) I. Central
More informationANWICU knowledge
ANWICU knowledge www.anwicu.org.uk This presenta=on is provided by ANWICU We are a collabora=ve associa=on of ICUs in the North West of England. Permission to provide this presenta=on has been granted
More informationNHS GRAMPIAN. Healthcare Associated Infection (HAI) Bimonthly Report January 2017
NHS GRAMPIAN Healthcare Associated Infection (HAI) Bimonthly Report uary 2017 1. Actions Recommended The Board is requested to note the content of this summary bimonthly HAI Report, as directed by the
More informationNothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
More information9/25/2017. Nothing to disclose
Nothing to disclose Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Explain
More informationStressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds November 8, 2016 2016 MFMER slide-1 Objectives Identify the significance
More informationGuidelines 2017 for the management of hospitalacquired pneumonia (HAP) and. ventilator-associated. pneumonia (VAP)
Guidelines 2017 for the management of hospitalacquired pneumonia (HAP) and ventilator-associated Modifiez le style des sous-titres du masque pneumonia (VAP) Filip Moerman Présentation pour les soins int
More informationJourney to Decreasing Clostridium Difficile and the Unexpected Twist. Jackie Morton, Infection Prevention Cortney Swiggart, Medication Safety Officer
Journey to Decreasing Clostridium Difficile and the Unexpected Twist Jackie Morton, Infection Prevention Cortney Swiggart, Medication Safety Officer 4/13/2018 Objectives Discuss the organism and clinical
More informationThe Sepsis Timebomb. James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals
The Sepsis Timebomb James Wigfull Critical Care and Anaesthesia Sheffield Teaching Hospitals Relationship of SIRS, Sepsis and Infection BACTEREMIA PANCREATITIS INFECTION FUNGEMIA PARASITEMIA VIREMIA SEPSIS
More informationCare Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT
Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: All MHS employed providers within Primary Care, Urgent Care, and In-Hospital Care. The secondary audience
More informationCURRENT GUIDELINES FOR SEPSIS MANAGEMENT
HELLENIC SEPSIS STUDY GROUP www.sepsis.gr CURRENT GUIDELINES FOR SEPSIS MANAGEMENT Evangelos J. Giamarellos-Bourboulis, MD, PhD Associate Professor of Medicine 4 th Department of Internal Medicine, National
More informationCurrent Concepts in VAP: Stress Ulcer Prophylaxis & Probiotics. Deborah Cook
Current Concepts in VAP: Stress Ulcer Prophylaxis & Probiotics Deborah Cook Objectives VAP The Old: Gastropulmonary route of infection The New: Microbiome modification Role of acid suppression Influence
More informationVenous Thromboembolism (VTE) Prevention and Treatment of VTE in Patients Admitted to Hospital
Please Note: This policy is currently under review and is still fit for purpose. Venous Thromboembolism (VTE) Prevention and Treatment of VTE in Patients Admitted to Hospital This procedural document supersedes
More informationPreventing Ventilator-Associated Pneumonia: Five Components of Care
Institute for Healthcare Improvement Preventing Ventilator-Associated Pneumonia: Five Components of Care 1. Elevation of the Head of the Bed Elevation of the head of the bed is an integral part of the
More informationCARE OF THE ADULT PNEUMONIA PATIENT
Care Guideline CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: The target audience for this Care Guideline is all MultiCare providers and staff, including those associated with our clinically integrated
More informationThink Globally: Strategies to Improve the Culture of Antibiotic Prescribing
Think Globally: Strategies to Improve the Culture of Antibiotic Prescribing October 11, 2017 Paul Lewis, PharmD, BCPS (AQ-ID) Johnson City Medical Center Johnson City, TN 1 Outline Introduction to stewardship
More informationEFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
More informationThe past. The evolving role of epidemiology in infection prevention and control: past present and future. Overview. Epidemiology
The evolving role of epidemiology in infection prevention and control: past present and future Professor Jacqui Reilly EM Cotterall Lecture IPS 2010 Overview Past: The historical contribution of epidemiology
More informationIntracheal antibiotics administration
Intracheal antibiotics administration Jean Chastre, M.D. www.reamedpitie.com Disclosure Conflicts of interest: Consulting or Lecture fees: Bayer, Pfizer, Cubist/Merck, Basilea, Kenta/Aridis, Roche, AstraZeneca/Medimmune
More informationNo conflicts of interest to disclose
No conflicts of interest to disclose Introduction Epidemiology Surviving sepsis guidelines 2012 Updates Resuscitation protocols Map Goals Transfusion Sepsis-3 Bundle Management Questions Sepsis is a systemic,
More informationA Snapshot of Colistin Use in South-East Europe and Particularly in Greece
A Snapshot of Colistin Use in South-East Europe and Particularly in Greece Helen Giamarellou 02.05.2013 When Greek Physicians Prescribe Colistin? It is mainly prescribed in the ICU for VAP, bacteremia
More informationRapid Response Teams. January 17, Safe Table Webinar
Rapid Response Teams January 17, 2017 Safe Table Webinar Christin Gordanier, MSN, RN, Inpatient Nursing Director at Virginia Mason Medical Center in Seattle, Washington. Alice Ferguson, BSN, RN, Project
More informationSepsis Update: Focus on Early Recognition and Intervention. Disclosures
Sepsis Update: Focus on Early Recognition and Intervention Jessie Roske, MD October 2017 Disclosures I have no actual or potential conflict of interest in relation to this program/presentation. I will
More informationUPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
More informationOutline. Pharmacists Improving Outcomes in the Management of. of Infectious Diseases. Threats Against Desired Outcomes 7/11/2010
Pharmacists Improving Outcomes in the Management of Infectious Diseases Christine Teng, MSc(Clin Pharm) BCPS Assistant Professor Dept of Pharmacy, National University of Singapore Principal Pharmacist
More informationSepsis 3.0: The Impact on Quality Improvement Programs
Sepsis 3.0: The Impact on Quality Improvement Programs Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School of Brown University
More informationOptimizing Antibiotic Therapy in the ICU For Pneumonia Current and Future Approaches
Optimizing Antibiotic Therapy in the ICU For Pneumonia Current and Future Approaches Andrew F. Shorr, MD, MPH Washington Hospital Center Georgetown Univ. Disclosures I have served as a consultant to, researcher/investigator
More informationPharmacologyonline 1: (2010) ewsletter Singh and Kochbar. Optimizing Pharmacokinetic/Pharmacodynamics Principles & Role of
Optimizing Pharmacokinetic/Pharmacodynamics Principles & Role of Cefoperazone Sulbactam Singh M*, Kochhar P* Medical & Research Division, Pfizer India. Summary Antimicrobial resistance is associated with
More informationMT Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS
MT-0913-2008 Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS 02 SmartCare /PS automates weaning The problem however is that no matter how good the written protocol is, physicians and
More informationHealthcare Associated Infection Report February 2016 data
Healthcare Associated Infection Report February 2016 data Section 1 Board Wide Issues Section 1 of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual
More informationAyrshire and Arran NHS Board
Paper 4 Ayrshire and Arran NHS Board Monday 11 ember Healthcare Associated Infection Reporting Template Report Author: Bob Wilson, Infection Control Manager Sponsoring Director: Professor Hazel Borland,
More informationMDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES
MDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES 1 Marin H. Kollef, MD Professor of Medicine Virginia E. and Sam J. Golman Chair in Respiratory Intensive Care Medicine Washington University School of
More informationImplementation and evaluation of the impact of a "ventilator-bundle at Kinshasa University Clinics: Before and after study.
Research Article http://www.alliedacademies.org/journal-infectious-diseases-medical-microbiology/ Implementation and evaluation of the impact of a "ventilator-bundle at Kinshasa University Clinics: Before
More informationLinezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin Shorr A F, Susla G M, Kollef M H
Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin Shorr A F, Susla G M, Kollef M H Record Status This is a critical abstract of an economic evaluation
More informationContinuous Infusion of Antibiotics In The ICU: What Is Proven? Professor of Medicine Vice-Chairman, Department of Medicine SUNY at Stony Brook
Continuous Infusion of Antibiotics In The ICU: What Is Proven? Michael S. Niederman, M.D. Chairman, Department of Medicine Winthrop-University Hospital Mineola, NY Professor of Medicine Vice-Chairman,
More informationSepsis in primary care. Sarah Bailey, Emma Evans, Nicola Shoebridge, Fiona Wells
Sepsis in primary care Sarah Bailey, Emma Evans, Nicola Shoebridge, Fiona Wells sepsisnurses@uhcw.nhs.uk Quiz!! OR Hands on your heads Hands on your hips Definition. The Third International Consensus Definition
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationSurveillance of Surgical Site Infection Annual Report For procedures carried out from: January December 2009
Surveillance of Surgical Site Infection Annual Report For procedures carried out from: January 2003 - December 2009 Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) Contents
More informationGUIDE TO INFECTION CONTROL IN THE HOSPITAL. Carbapenem-resistant Enterobacteriaceae
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 47: Carbapenem-resistant Enterobacteriaceae Authors E-B Kruse, MD H. Wisplinghoff, MD Chapter Editor Michelle Doll, MD, MPH) Topic Outline Key Issue Known
More informationCommunity Acquired Pneumonia. Background & Rationale to North American Guidelines. Lionel Mandell MD FRCPC Brussels Belgium
Community Acquired Pneumonia Background & Rationale to North American Guidelines Lionel Mandell MD FRCPC Brussels Belgium Consider Impact of the disease Issues to reflect upon Impact of the Disease 3-4
More informationMT Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS
MT-0913-2008 Custom Weaning Protocol for your Ventilator Patients SMARTCARE /PS 02 SmartCare /PS automates weaning The problem however is that no matter how good the written protocol is, physicians and
More informationENGLISH FOR PROFESSIONAL PURPOSES UNIT 3 HOW TO DEAL WITH CLOSTRIDIUM DIFFICILE
ENGLISH FOR PROFESSIONAL PURPOSES UNIT 3 HOW TO DEAL WITH CLOSTRIDIUM DIFFICILE The diagnosis of CDI should be based on a combination of clinical and laboratory findings. A case definition for the usual
More informationFurther information You can get more information and share your experience at
GS15 Surgery for Pilonidal Sinus Further information You can get more information and share your experience at www.aboutmyhealth.org Local information You can get information locally from: Taunton and
More informationDo PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis. Deborah Cook
Do PPIs Reduce Bleeding in ICU? Revisiting Stress Ulcer Prophylaxis Deborah Cook ICU-Acquired Upper GI Bleeding Case series of 300 ICU patients describing stressrelated erosive syndrome Frequent Fatal
More informationHEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY
HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health
More informationCardiology Department. Clinical Governance
Cardiology Department Clinical Governance Background Cardiology department has a high throughput of emergency and elective patients Two acute sites CAH and DHH Cardiac investigation department provides
More informationContraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley
Contraindications to time critical surgery; when not to proceed from the perspective of: The Physician A/Prof Peter Morley British Journal of Surgery 2013; 100: 1045 1049 The risk of 30 day mortality
More informationSepsis Management Update 2014
Sepsis Management Update 2014 Laura J. Moore, MD, FACS Associate Professor, Department of Surgery The University of Texas Health Science Center, Houston Medical Director, Shock Trauma ICU Texas Trauma
More informationKey Points. Angus DC: Crit Care Med 29:1303, 2001
Sepsis Key Points Sepsis is the combination of a known or suspected infection and an accompanying systemic inflammatory response (SIRS) Severe sepsis is sepsis with acute dysfunction of one or more organ
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationMALDI-TOF MS: Translating Microbiology Laboratory Alphabet Soup to Optimize Antibiotic Therapy
MALDI-TOF MS: Translating Microbiology Laboratory Alphabet Soup to Optimize Antibiotic Therapy September 8, 2017 Amy Carr, PharmD PGY-2 Infectious Diseases Pharmacy Resident Seton Healthcare Family amy.carr@ascension.org
More informationSkin and soft tissue (SSTI) sepsis (surgery, antimicrobial therapy and more)
Skin and soft tissue (SSTI) sepsis (surgery, antimicrobial therapy and more) Christian Eckmann Antibiotic Stewardship Expert ECDC Chief of Staff Department of General, Visceral and Thoracic Surgery Klinikum
More informationSurviving Sepsis Campaign Guidelines 2012 & Update for David E. Tannehill, DO Critical Care Medicine Mercy Hospital St.
Surviving Sepsis Campaign Guidelines 2012 & Update for 2015 David E. Tannehill, DO Critical Care Medicine Mercy Hospital St. Louis Be appropriately aggressive the longer one delays aggressive metabolic
More informationNO DISCLOSURES 5/9/2015
Annette Stralovich-Romani, RD, CNSC Adult Critical Care Nutritionist UCSF Medical Center NO DISCLOSURES Incidence & consequences of malnutrition Underfeeding in the ICU Causes/ consequences Nutrition intervention
More informationDoc: 1.9. Course: Patient Safety Solutions. Topic: Infection prevention and control. Summary
Course: Patient Safety Solutions Topic: Infection prevention and control Summary Health care-associated Infection (HCAI) is defined as an infection acquired in a hospital by a patient who was admitted
More informationEducational Workshop
Educational Workshop EW02: Management of severe sepsis and septic shock anno 2015 Arranged with ESGBIS & International Sepsis Forum (ISF) Convenors: W. Joost Wiersinga, Amsterdam, NL Tom van der Poll,
More informationESCMID Online Lecture Library. by author
Measuring antimicrobial consumption: why, what and how? ESCMID Postgraduate Education Course Antimicrobial Stewardship Developing, Implementing & Measuring Seva (Barcelona), Spain, 8 10 May 2014 Håkan
More informationFalls Prevention and Management in Scotland: the Impact of Local and National Policies
Falls Prevention and Management in Scotland: the Impact of Local and National Policies Falls prevention: Evidence into Practice European Seminar Glasgow, 19 November 2014 Ann Murray National Falls Programme
More informationSepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
More information2016 Sepsis Update: Pearls, Pitfalls, and Core Measure Quicksand
2016 Sepsis Update: Pearls, Pitfalls, and Core Measure Quicksand Jack Perkins, MD FACEP, FAAEM, FACP Assistant Professor of Emergency and Internal Medicine Virginia Tech Carilion School of Medicine Why
More informationThe Ever Changing World of Sepsis Management. Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital
The Ever Changing World of Sepsis Management Laura Evans MD MSc Medical Director of Critical Care Bellevue Hospital COI Disclosures No financial interests to disclose Learning Objectives Review the evolution
More informationA real journey. Using The Model For Improvement To Reduce Falls and Injury
A real journey Using The Model For Improvement To Reduce Falls and Injury Our Team Manager: Helen Delmonte, Coordinator: Catherine Heaney Falls Preceptors -Physiotherapist, Mobility Therapist, OT/Activities
More informationLAPAROSCOPIC RADICAL REMOVAL OF THE KIDNEY INFORMATION FOR PATIENTS
The British Association of Urological Surgeons 35-43 Lincoln s Inn Fields London WC2A 3PE Phone: Fax: Website: E-mail: +44 (0)20 7869 6950 +44 (0)20 7404 5048 www.baus.org.uk admin@baus.org.uk LAPAROSCOPIC
More informationHOSPITAL INFECTION CONTROL
HOSPITAL INFECTION CONTROL Objectives To be able to define hospital acquired infections discuss the sources and routes of transmission of infections in a hospital describe methods of prevention and control
More informationCPD Matrix for Intensive Care Medicine
CPD Matrix for Intensive Care Medicine Please note that Level 3 of the CPD Matrix below is for consultants practicing either solely in ICM or in ICM a dual specialty that is not anaesthesia. Anaesthetist
More informationAminoglycosides as an antibiotic class maintain
SURGICAL INFECTIONS Volume 17, Number 3, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/sur.2015.276 An Argument for the Use of Aminoglycosides in the Empiric Treatment of Ventilator-Associated Pneumonia Addison
More informationBC Sepsis Network Emergency Department Sepsis Guidelines
The provincial Sepsis Clinical Expert Group developed the BC, taking into account the most up-to-date literature (references below) and expert opinion. For more information about the guidelines, and to
More informationAndrea Blotsky MDCM FRCPC General Internal Medicine, McGill University Thursday, October 15, 2015
The TIMES Project: (Time to Initiation of Antibiotic Therapy in Medical Patients Presenting to the Emergency Department with Sepsis) - Preliminary Findings Andrea Blotsky MDCM FRCPC General Internal Medicine,
More informationKICU Spontaneous Awakening Trial (SAT) Questionnaire
KICU Spontaneous Awakening Trial (SAT) Questionnaire Please select your best answer(s): 1. What is your professional role? 1 Staff Nurse 2 Nurse Manager 3 Nurse Educator 4 Physician 5 Medical Director
More informationACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives
ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives Module 1 Critical Care Pharmacy Evolution and Validation, Practice Standards, Training, and Professional Development,
More informationGOVERNING BODY MEETING in Public 22 February 2017 Agenda Item 3.4
GOVERNING BODY MEETING in Public 22 February 2017 Paper Title Purpose of paper Redesign of Services for Frail Older People in Eastern Cheshire To seek approval from Governing Body for the redesign of services
More information