Home' The Source : First Quarter 2016 Contents at every level of public health and healthcare to improve patient
safety and eliminate infections that commonly threaten hospital
patients,” the CDC noted.
“Research shows that when healthcare facilities, care teams and
individual doctors and nurses are aware of infection problems and
take specific steps to prevent them, rates of some targeted HAIs (e.g.,
CLABSIs) can decrease by more than 70 percent,” the report says.
‘Bundles’ Beat Bacteria
Fortunately, recent research has shown that consistently and
correctly using a “bundle” of simple pre-surgical interventions
can significantly reduce the incidence of staph HAIs and SSIs
due to Staphylococcus aureus (S. aureus)—and possibly others.
The study was reported in the June 2, 2015, issue of JAMA and
focused on patients who had heart surgery or hip or knee re-
placements. The interventions include:
> Early screening of patients for S. aureus in their noses
> Requiring patients who tested positive for S. aureus to apply
antibiotic ointment in their nostrils and take antimicrobial baths
starting as early as five days before surgery
> Patients who test negative receive antimicrobial baths the night
before and morning of their surgery
> Dosing patients with appropriate antibiotics shortly before
surgery—vancomycin and cefazolin or cefuroxime for patients
who test positive for MRSA, and either cefazolin or cefuroxime
for the others
Nearly a third of Americans have S. aureus bacteria in their noses.
The germs typically do no harm, but they can wreak havoc if they
enter a surgical site. Staph—and especially MRSA—infections are
potentially lethal, and difficult and expensive to treat.
“Patients undergoing total hip or knee replacements and cardiac
operations should be tested to see if they carry the staph bacteria
in their noses,” says Loreen Herwaldt, University of Iowa (UI)
professor of internal medicine, director of hospital epidemiology
at UI Hospitals and Clinics, and senior author of the study.
“If they do carry the staph bacteria, the protocol we describe in
the JAMA article can lower their risk of a serious staph infection
by about 40 percent,” she said in a press release about the study.
Herwaldt’s co-authors included four infection experts from HCA:
Jonathan B. Perlin, M.D., president, Clinical Services Group and
chief medical officer; Jason Hickok, AVP Research and Academic
Affairs, Infection Prevention and Lab; Edward Septimus, M.D.,
medical director, Infection Prevention and Epidemiology, Clinical
Services Group; and Julia Moody, director, Infection Prevention,
Clinical Services Group.
The University of Iowa study involved a meta-analysis of
39 studies of surgical site infection practices at U.S. hospitals. The
best practices were “bundled” into a single protocol that was tested
by 20 hospitals in nine states.
“We did this study in a hospital system that already had low rates
epsis is the body’s overwhelming and life-threatening re-
sponse to infection and can lead to tissue damage, organ
failure and death—it kills some 258,000 Americans each
year, according to the Sepsis Alliance.
Sepsis symptoms can include fever, hypothermia, edema,
confusion, coma, low blood oxygen levels, rapid heart and respiratory
rate, and organ failure.
Forty percent of patients who develop severe sepsis die, and
up to half of those who survive suffer from post-sepsis syndrome
with symptoms that include extreme fatigue, insomnia, nightmares,
panic attacks, muscle and joint pain, and decreased cognitive
There is no cure for sepsis, so early detection is the best way to
ensure survival, according to the Sepsis Alliance.
Changes in cardiac functions can signal the onset of sepsis, and
also help guide clinicians in combating the condition. In the past,
physicians used central line catheters to monitor hemodynamics,
such as stroke volume, but that procedure carries its own risk of
infection and other complications, explains Angie Mitchell, director
of Nursing Services for HealthTrust’s Clinical Operations team.
As a result, central line use is being discouraged except in certain
specific situations. Clinicians instead are turning to non-invasive
means to monitor stroke volume and other values that change
with infection. HealthTrust has contracts with suppliers that offer
different non-invasive approaches.
Cheetah Medical’s NICOM and Starling SV Monitor systems em-
ploy a technology called Bioreactance that uses four disposable
sensors—two above the heart and two below—that continuously
measure the time delay between a small electrical current ap-
plied to the thorax and a small voltage on the thorax. The delay is
proportional to the flow of blood from the heart, which Cheetah
says provides a high degree of accuracy in measuring cardiac
Cheetah’s systems differ from other devices because they mea-
sure dynamic parameters, including stroke volume, directly at the
source—the beating heart, says Daniel Draper, Cheetah Medicals’
strategic marketing manager. “By providing a measure of the vol-
ume of blood leaving the heart, Cheetah monitors are unaffected
by the limitations of pressure measurements, including CVP [central
venous pressure] and pulse pressure.”
The Cheetah NICOM system is easy and quick to use and has
become “a key component in managing our severe sepsis and septic
shock patients while improving their mortality,” says Carol Golas, ICU
RN, the sepsis coordinator at the Medical Center of Aurora, Colorado.
Edwards Lifesciences’ ClearSight system uses a small inflatable
finger cuff to measure blood pressure, cardiac output, stroke volume
and stroke volume variation, says Tim Patz, Edwards’ senior director,
U.S . Critical Care Marketing.
A single cuff can be used for up to eight hours before the system
alerts the user to switch fingers. Or clinicians may use two cuffs for
continuous monitoring for up to 72 hours.
With New Tools
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