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To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.
A pre- and postintervention, quasi-experimental quality improvement study.
Setting and participants:
Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.
We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.
Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).
The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.
Nanoenergetic composites are of overwhelming interest to the Department of Defense because of the higher power output and the ability to finely tune the ignition thresholds of these composites. Recently, several variants of a nanoaluminum-poly(perfluorinated methacrylate) (AlFA) have been synthesized and optimized for a variety of applications including reactive warhead liners and bullet spotters. While conventional techniques such as thermal analysis and bomb calorimetry can be used to characterize the reaction mechanism and energy output of AlFA composites, characterizing their dynamic behaviour is more challenging. Bullet spotter applications require a material to be impact sensitive at very low velocities, yet be adequately insensitive. Several live-fire tests were conducted which revealed the AlFA50 material reacted consistently upon target impact at high velocities, but unreliably at very low velocities. In an effort to better understand the fundamental impact ignition mechanism and to determine the impact velocity threshold of AlFA50 a series of Taylor gas gun experiments were conducted. It was determined that the light-initiation mechanism was consistent with a pinch mechanism, and that the ignition velocity threshold was near 74 m/s. Based on these results, it was hypothesized that the addition of a filler material could be used to sensitize the AlFA50, and that Asay shear impact testing could be used to determine a more optimal shape of such inclusions. Experiments performed using the Asay shear impact test setup confirmed the pinch ignition mechanism, but observations also revealed that the size of the pinch point was important. Finally, it was shown that the addition of large glass beads (> 1mm in diameter) was effective at sensitizing the AlFA50 material at high and low velocities, with ignition observed at impact velocities as low as 35 m/s.
Outpatient hemodialysis bloodstream infection rates, now used for performance measurement and were significantly higher for manual compared with automated surveillance (P<.001), largely owing to the absence of blood culture data in the dialysis electronic health record. Improvement in data sharing between hospitals and outpatient dialysis centers is necessary.
Infect. Control Hosp. Epidemiol. 2016;37(4):472–474
Applied Anatomy for Anaesthesia and Intensive Care is an invaluable tool for trainee and practised anaesthetists and intensive care physicians seeking to learn, revise and develop their anatomical knowledge and procedural skills. Concise textual descriptions of anatomy are integrated with descriptions of procedures that are frequently performed in anaesthesia and intensive care, such as nerve blocks, focussed echo, lung ultrasound, vascular access procedures, front of neck airway access and chest drainage. The text is supported by over 200 high-quality, colour, anatomical illustrations, which are correlated with ultrasound, fibre optic and radiological images, allowing the reader to easily interpret nerve block sonoanatomy, airway fibre optic images and important features on CT and MRI scans. Useful mnemonics and easily reproducible sketch diagrams make this an essential resource for anyone studying towards postgraduate examinations in anaesthesia and intensive care medicine.