Anwar Khedr, Bijoy M Mathew, Hisham Mushtaq, Courtney A Nelson, Jessica L Poehler, Abbas B Jama, Jeanine M Borge, Jennifer L von Lehe, Eric O Gomez Urena, Syed Anjum Khan
{"title":"减少ICU假单胞菌感染:一个成功的多学科质量改进项目。","authors":"Anwar Khedr, Bijoy M Mathew, Hisham Mushtaq, Courtney A Nelson, Jessica L Poehler, Abbas B Jama, Jeanine M Borge, Jennifer L von Lehe, Eric O Gomez Urena, Syed Anjum Khan","doi":"10.53854/liim-3004-13","DOIUrl":null,"url":null,"abstract":"<p><p><i>Pseudomonas aeruginosa</i> infection causes high morbidity and mortality, especially in immunocompromised patients. <i>Pseudomonas</i> can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the <i>P. aeruginosa</i>-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the <i>P. aeruginosa</i>-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the <i>P. aeruginosa</i>-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial <i>P. aeruginosa</i>-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU <i>P. aeruginosa</i> outbreak.</p>","PeriodicalId":52423,"journal":{"name":"Infezioni in Medicina","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714997/pdf/1124-9390_30_4_2022_577-586.pdf","citationCount":"0","resultStr":"{\"title\":\"<i>Pseudomonas</i> infection reduction in the ICU: a successful multidisciplinary quality improvement project.\",\"authors\":\"Anwar Khedr, Bijoy M Mathew, Hisham Mushtaq, Courtney A Nelson, Jessica L Poehler, Abbas B Jama, Jeanine M Borge, Jennifer L von Lehe, Eric O Gomez Urena, Syed Anjum Khan\",\"doi\":\"10.53854/liim-3004-13\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><i>Pseudomonas aeruginosa</i> infection causes high morbidity and mortality, especially in immunocompromised patients. <i>Pseudomonas</i> can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the <i>P. aeruginosa</i>-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the <i>P. aeruginosa</i>-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the <i>P. aeruginosa</i>-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial <i>P. aeruginosa</i>-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU <i>P. aeruginosa</i> outbreak.</p>\",\"PeriodicalId\":52423,\"journal\":{\"name\":\"Infezioni in Medicina\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714997/pdf/1124-9390_30_4_2022_577-586.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infezioni in Medicina\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.53854/liim-3004-13\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infezioni in Medicina","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.53854/liim-3004-13","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project.
Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.
期刊介绍:
The Journal publishes original papers, in Italian or in English, on topics concerning aetiopathogenesis, prevention, epidemiology, diagnosis, clinical features and therapy of infections, whose acceptance is subject to the referee’s assessment. The Journal is of interest not only to infectious disease specialists, microbiologists and pharmacologists, but also to internal medicine specialists, paediatricians, pneumologists, and to surgeons as well. The Editorial Board includes experts in each of the above mentioned fields.