...35, no. 3 original article Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units Veronique Nussenblatt, MD, MHS;1 Edina Avdic, PharmD, MBA;2 Sean Berenholtz, MD, MHS;3,4 Elizabeth Daugherty, MD, MPH;5 Eric Hadhazy, MS;1 Pamela A. Lipsett, MD, MHPE;3,4 Lisa L. Maragakis, MD, MPH;1 Trish M. Perl, MD, MSc;1 Kathleen Speck, MPH;3 Sandra M. Swoboda, RN, MS;3 Wendy Ziai, MD;3,6 Sara E. Cosgrove, MD, MS1 objective. Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. methods. Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team’s VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3. results. Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP by the committee. Antibiotics were continued for 120 (76%) of 158...
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...Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria Patrick D. Mauldin, Cassandra D. Salgado, Ida Solhøj Hansen, Darshana T. Durup and John A. Bosso Antimicrob. Agents Chemother. 2010, 54(1):109. DOI: 10.1128/AAC.01041-09. Published Ahead of Print 19 October 2009. Downloaded from http://aac.asm.org/ on January 1, 2012 by guest Updated information and services can be found at: http://aac.asm.org/content/54/1/109 These include: REFERENCES This article cites 43 articles, 12 of which can be accessed free at: http://aac.asm.org/content/54/1/109#ref-list-1 Receive: RSS Feeds, eTOCs, free email alerts (when new articles cite this article), more» CONTENT ALERTS Information about commercial reprint orders: http://aac.asm.org/site/misc/reprints.xhtml To subscribe to to another ASM Journal go to: http://journals.asm.org/site/subscriptions/ ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Jan. 2010, p. 109–115 0066-4804/10/$12.00 doi:10.1128/AAC.01041-09 Copyright © 2010, American Society for Microbiology. All Rights Reserved. Vol. 54, No. 1 Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria Patrick D. Mauldin,1,2 Cassandra D. Salgado,3 Ida Solhøj Hansen,1 Darshana T. Durup,1 and John A. Bosso1,3* Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy...
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..............................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...Ventilator Associated Pneumonia and Guidelines VAP: Definition • Pneumonia in patients receiving invasive mechanical ventilation for at least 48 hours • Early VAP: < 4 days in the ICU • Late VAP: > 4 days in the ICU VAP: Incidence US National Nosocomial Infection Surveillance Type of ICU Mean VAP Rate (Cases/1000 vent days) Trauma 15.1 Neurosurgical Surgical Burn Cardiothoracic 12.9 9.9 9.6 7.9 Data from January 2002 – June 2003 Reported as VAP rates/1000 vent days VAP: Burden of Illness • Incidence 10-20% of patients receiving mechanical ventilation > 48 hours • Increased ICU Mortality (2-4 times) • Increased ICU LOS (5-7 days) • Increased hospital costs (>$10,000 US in additional costs) Safdar et al, Crit Care Med, 2005; 33: 2184 VAP: Healthcare Cost Burden of Illness Canada (per year) (10.6 cases/1000 Vent days) Excess Vent days Excess Deaths1 16,000 days (55 ICU beds) 216 Excess Cost2 $46,000,000 1Based on attributable mortality of 5.8% cost cost methodology 2Ontario Clinical Criteria for Suspicion of VAP • New or persistent infiltrate on CXR without another cause • Plus any 2 of the following: • • • • Purulent endotracheal secretions Increasing oxygen requirements Core temperature > 38.0o C WBC < 3.5 or > 11.0 Adapted from N Engl J Med 2006;355:2619-30. Host Risk Factors for VAP • Underlying pulmonary disease (e.g. COPD) • • • • • Sepsis ARDS ...
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...com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-709077666.htm?categoryId=-1 If You Face Any Problem E- Mail Us At Contact.Hwnerd@Gmail.Com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before the study had begun, the Infection Control Department had meetings with nurses and doctors of the ICU, nurse educators, anesthesiologists, emergency room staff, Materials Management and the performance improvements departments...
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...com/EBT1-Evidence-Based-Practice-and-Applied-Nursing-Research-WGU-8906543.htm If You Face Any Problem E- Mail Us At JohnMate1122@gmail.com TASK 1 The research obtained in this particular study does support the conclusion. When all five area’s were studied, it verified that the incidence of ventilated associated pneumonia was decreased when oral care and dental care was performed onto these mechanically ventilated patients. The background information that was provided was direct, to the point and relevant to the impact of today’s heath care. Millions of dollars are being spent every year for incidences within hospitals that can be prevented and this study was set out to prove just that, that ventilator associated pneumonia can be prevented. The logic was simple. That logic was to clear the mouth and airway of any harboring microorganisms that can pool in the mouth and result into an infection. The test groups were relevantly the same size and the characteristics of age, sex, APACHE scores and reasons for admissions were comparable. The conclusion was predictable in verifying that strict oral cleaning did result in a lower incidence of ventilator associated pneumonia in patients. A.4. During the course of this research, ethics would be addressed. Before the study had begun, the Infection Control Department had meetings with nurses and doctors of the ICU, nurse educators, anesthesiologists, emergency room staff, Materials Management and the performance improvements departments...
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...Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter 27 -...
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...International Classification of Diseases Coding II Chapter 17 – 27 Chapter 17: 1. Which of the following anemias is caused by a failure of the bone marrow to produce red blood cells and may be congenital or acquired? A. Bone marrow deficiency anemia B. Sickle-cell anemia C. Aplastic anemia D. Thalassemia 2. Which of the following terms refers to either a reduction in the quantity of hemoglobin or a reduction in the volume of red blood cells? E. Anemia F. Coagulation defect G. Thrombocytopenia H. Leukocytosis 3. When a diagnostic statement of anemia is not qualified in any way, what should the coder do? I. Review the record for a surgical procedure; and if the patient had surgery, code as anemia due to acute blood loss. J. Review the medical record before assigning an unspecified type of anemia. K. Review the medical record to determine if the patient has been prescribed iron tablets, and code as iron-deficiency anemia. L. Review the medical record to determine if the patient has received chemotherapy, and assign the code for anemia due to antineoplastic chemotherapy. 4. Which of the following statements is true regarding a patient with documented sickle-cell trait? M. The patient has sickle-cell disease. N. Both of the patient’s parents carried the sickle-cell gene. O. The code for sickle-cell disease should be assigned. P. The patient received...
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... North Carolina Correspondence and requests for reprints should be addressed to Judith E. Nelson, M.D., J.D., Box 1232, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029. E-mail: Judith.nelson@mssm.edu Next SectionAbstract Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In this article, we describe the constellation of clinical features that characterize chronic critical illness. We discuss the outcomes of this condition including ventilator liberation, mortality, and physical and cognitive function, noting that comparisons among cohorts are complicated by variation in defining criteria and care settings. We also address burdens for families of the chronically...
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...An APIC Guide 2008 Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings About APIC APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 12,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC’s members are nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health professionals. APIC advances its mission through education, research, consultation, collaboration, public policy, practice guidance and credentialing. Look for other topics in APIC’s Elimination Guide Series, including: • • • • Catheter-Related Bloodstream Infections Clostridium difficile Mediastinitis MRSA in Long-Term Care Copyright © 2008 by APIC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. All inquires about this document or other APIC products and services may be addressed to: APIC Headquarters 1275 K Street, NW Suite 1000 Washington, DC 20005 Phone: 202.789.1890 Email: APICinfo@apic.org Web: www.apic.org ISBN: 1-933013-39-7 ...
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...A kid with Hepatitis A can return to school 1 week within the onset of jaundice. 2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine. 3. Hyperkalemia presents on an EKG as tall peaked T-waves 4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate 5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact. positive sweat test. indicative of cystic fibrosis 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity. 2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenitis, you will see nausea and vomiting first then pain. 3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches. 4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture. 5. Beta Blockers and ACEI are less effective in African Americans than Caucasians. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier bed flat. 2.autonomic dysreflexia- elevated bed first....then check foley...
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...Preface A well-developed knowledge of clinical microbiology is critical for the practicing physician in any medical field. Bacteria, viruses, and protozoans have no respect for the distinction between ophthalmology, pediatrics, trauma surgery, or geriatric medicine. As a physician you will be faced daily with the concepts of microbial disease and antimicrobial therapy. Microbiology is one of the few courses where much of the "minutia" is regularly used by the practicing physician. This book attempts to facilitate the learning of microbiology by presenting the information in a clear and entertaining manner brimming with memory aids. Our approach has been to: 4) Create a conceptual, organized approach to the organisms studied so the student relies less on memory and more on logical pathophysiology. The text has been updated to include current information on rapidly developing topics, such as HIV and AIDS (vaccine efforts and all the new anti-HIV medications), Ebola virus, Hantavirus, E. coli outbreaks, Mad Cow Disease, and brand-new antimicrobial antibiotics. The mnemonics and cartoons in this book do not intend disrespect for any particular patient population or racial or ethnic group but are solely presented as memory devices to assist in the learning of a complex and important medical subject. We welcome suggestions for future editions. 1) Write in a conversational style for rapid assimilation. 2) Include numerous figures serving as "visual memory tools" and summary charts...
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...and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia, palliative care Introduction Nutrients are introduced into the body in two ways: by enteral feeding through the digestive tract, and by parenteral feeding through a tube inserted in a vein in an arm or leg (peripheral line) or through the chest wall in...
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...NCSBN ON-LINE REVIEW 1.A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old...
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...00_078973706x_fm.qxd 1/14/08 2:42 PM Page i NCLEX-PN ® SECOND EDITION Wilda Rinehart Diann Sloan Clara Hurd 00_078973706x_fm.qxd 1/14/08 2:42 PM Page ii NCLEX-PN® Exam Cram, Second Edition Copyright © 2008 by Pearson Education All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. No patent liability is assumed with respect to the use of the information contained herein. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions. Nor is any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately...
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