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We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU).
A single center observational quasi-experimental study.
A regional BICU in Maryland serving 300–400 burn patients annually.
In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes.
The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54–22.48).
CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm.
Operational medical support is the provision of field medical care during high-risk, extended-duration, and mission-driven law enforcement operations, often rendered under functionally austere conditions. The goals of tactical medicine are to facilitate the success and the safety of law enforcement missions during all phases of a tactical or Special Weapons And Tactics (SWAT) operation through the delivery of preventative, urgent, and emergency medical care. The role of protective medicine is the similarly broad medical support of protective operations in which security and law enforcement personnel and resources are dedicated to the safety and physical well-being of an individual or group of individuals. There exists significant overlap both in the approach to and implementation of tactical and protective medicine. Both tactical and protective medicine methodologies intend to provide the best possible outcome for both the personnel and the mission and recognize that medical challenges emerging during a law enforcement operation present to commanders both a medical problem and a tactical problem.
The principles employed by tactical medicine providers were initially developed by the military for small unit operations and continued to gain widespread acceptance in the civilian law enforcement community. The emerging need for tactical medical support followed closely the development and expansion of SWAT teams now commonly deployed by police departments and law enforcement agencies in the United States.
The need for these specialized tactical teams arose in response to the changing patterns of crime and violence in society and the need to provide an effective response to the criminal use of military-style weapons, the taking of hostages, and terrorist activities involving explosive, chemical, and biological agents.
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