[Reducing the Incidence of Medical Adhesive-Related Skin Injuries in Surgical Intensive Care Unit].

BACKGROUND & PROBLEMS: Patients with critical illnesses face an elevated risk of medical adhesive relation skin injuries (MARSI), which have negative, subsequent impacts on recovery and quality of healthcare. PURPOSE: The aim of this project was to decrease the incidence of MARSI in the surgical intensive care unit and to improve the accuracy of MARSI preventive care implementation. RESOLUTIONS: The intervention included the implementation of product-use cards, high-risk warning slogans, education programs, experience workshops, and a standard prevention-care protocol for MARSI. RESULTS: After project implementation, the incidence rate of MARSI decreased from 18.2% to 0%-9.3%, and the accuracy rate of preventive care increased from 38.6% to 95.5%. CONCLUSIONS: This project effectively reduced the incidence of skin injury and improved the quality of critical care. The skills related to the care and prevention of MARSI have been implemented throughout the hospital.

[The effect of bundle care on central line associated bloodstream infection in a medical intensive care unit].

BACKGROUND & PROBLEMS: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of .47%. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate. PURPOSE: We designed a project to reduce the CLABSI rate below .3% in our ICU. RESOLUTION: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care. RESULTS: The CLABSI rate reduced to .24% after project implementation. This result was below the target of .30%. CONCLUSIONS: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.

[Project to reduce the central venous catheter-related bloodstream infection rate].

BACKGROUND: Central venous catheter-related bloodstream infection (CRBSI) is an important indicator of care quality. The average CRBSI rate in our unit was 1.027% in 2009. Causes of infection included inadequate CRBSI prevention practices and outdated standard procedures. PURPOSE: We designed a project to reduce the CRBSI rate below 0.5% in our intensive care unit. RESOLUTION: Improvement plans included providing in-service education, establishing a central venous catheter (CVC) care checklist, and updating CRBSI clinical management standards. RESULTS: The CRBSI rate fell to 1.43‰ after implementation. This was significantly below the reduction target of 0.5%. CONCLUSIONS: This project effectively reduced CRBSI. We want to share this experience to help other hospitals and units improve critical care quality and reduce healthcare costs.

Material-driven differentiation of induced pluripotent stem cells in neuron growth factor-grafted poly(ε-caprolactone)-poly(ß-hydroxybutyrate) scaffolds.

The potential of constructs comprising induced pluripotent stem (iPS) cells and biopolymers can be high for neurological surgery practice, if the systematic activity of neuronal regeneration is clarified. This study shows a guided differentiation of iPS cells toward neurons in neuron growth factor (NGF)-grafted poly(ε-caprolactone) (PCL)-poly(ß-hydroxybutyrate) (PHB) scaffolds. The porosity of PCL-PHB scaffolds enhanced with increasing the concentration of salt particles (porogen) and the weight percentage of PCL. An increase in the graft concentration of NGF elevated the atomic ratios of N/C and O/C on the surface of NGF-grafted PCL-PHB scaffolds. In addition, incorporating heparin and NGF promoted the adhesion and viability of iPS cells in constructs. When the weight percentage of PCL increased, the viability of iPS cells reduced; however, more PCL in constructs benefited the adhesion of iPS cells. Under the influence of heparin and NGF, a high weight percentage of PCL and a long inductive period improved iPS cells to differentiate into neuron-like cells carrying ßIII tubulin and inhibited other differentiation(s). The material-driven differentiation in NGF-grafted PCL-PHB constructs can be promising in guiding iPS cells to produce neurons for nerve tissue engineering.