The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals.

BACKGROUND: Each year, nearly 250,000 cases of central line-associated bloodstream infections (CLABs) occur in hospitals in the United States. In 2005, the Greater New York Hospital Association and the United Hospital Fund launched a collaborative initiative to eliminate CLABs in hospital intensive care units (ICUs). COLLABORATIVE DESIGN: Hospital leadership at 36 hospitals committed to support their staffs' participation in specific activities, including three learning sessions. An infectious disease physician consultant served as an on-call consultant to provide the necessary clinical guidance, real-time feedback, and support. Most hospitals' interdisciplinary CLABs teams met weekly to implement evidence-based practices known collectively as the central line bundle, determine areas for additional focus, and to reassess strategies using the Plan-Do-Study-Act (PDSA) model. RESULTS: There was a statistically significant decrease of 54% (p < .001) between the mean CLABs rate during the intervention period (2.24 infections per 1,000 central line days) compared with the mean baseline rate (4.85 infections per 1,000 central line days). By March 2008, the rate had dropped by 70% (1.44 infections per 1,000 central line days) compared with baseline. At the hospital level, decreases in CLABs rates up to 88% were observed between the baseline period and the intervention period, with 56% of hospitals achieving at least a 50% decrease in their CLABs rate. The hospitals beginning above the national rate decreased their CLABs rates by almost twice as much as hospitals that began below the national average. SUMMARY AND CONCLUSIONS: Each participating hospital sustained implementation of the central line bundle throughout the 33-month intervention, which, along with standardized line maintenance procedures, resulted in reduction in, and sometimes elimination of, CLABs.

Development of a word recognition instrument to test health literacy in dentistry: the REALD-30--a brief communication.

OBJECTIVE: This study aims to develop and pilot test a dental word recognition instrument. METHODS: The development of our instrument was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), an efficient word recognition instrument used to assess health literacy in the medical arena. Our instrument, Rapid Estimate of Adult Literacy in Dentistry (REALD-30), consisted of 30 common dental words with various degrees of difficulty. It was administered to 202 English-speaking adults recruited from outpatient medical clinics. We examined the instrument's internal reliability using Cronbach's alpha and its validity by correlating the REALD-30 score to two dental outcomes (perceived dental health status and oral health-related quality of life) and medical health literacy. RESULTS: REALD-30 scores were significantly correlated with REALM scores. REALD-30 was significantly related to perceived dental health status in the bivariate analysis. It also was significantly related to oral health-related quality of life in a multivariate analysis. In contrast, medical health literacy was not related to either of the dental outcome measures. CONCLUSIONS: The new REALD-30 instrument displays good reliability but only partial validity. Results suggest that dental health literacy may be distinct from medical health literacy and may have an independent effect on dental health outcomes.

Development of an easy-to-use Spanish Health Literacy test.

OBJECTIVE: The study was intended to develop and validate a health literacy test, termed the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA), for the Spanish-speaking population. STUDY DESIGN: The design of SAHLSA was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English. In addition to the word recognition test in REALM, SAHLSA incorporates a comprehension test using multiple-choice questions designed by an expert panel. DATA COLLECTION: Validation of SAHLSA involved testing and comparing the tool with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at UNC Health Care. PRINCIPAL FINDINGS: With only the word recognition test, REALM could not differentiate the level of health literacy in Spanish. The SAHLSA significantly improved the differentiation. Item response theory analysis was performed to calibrate the SAHLSA and reduce the instrument to 50 items. The resulting instrument, SAHLSA-50, was correlated with the Test of Functional Health Literacy in Adults, another health literacy instrument, at r=0.65. The SAHLSA-50 score was significantly and positively associated with the physical health status of Spanish-speaking subjects (p<.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach's alpha=0.92) and test-retest reliability (Pearson's r=0.86). CONCLUSIONS: The new instrument, SAHLSA-50, has good reliability and validity. It could be used in the clinical or community setting to screen for low health literacy among Spanish speakers.

Prevention of hospital-onset Clostridium difficile infection in the New York metropolitan region using a collaborative intervention model.

The incidence, severity, and associated costs of Clostridium difficile (C. difficile) infection (CDI) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of C. difficile. This article describes a multifaceted collaborative approach to reduce hospital-onset CDI rates in 35 acute care hospitals in the New York metropolitan region. Hospitals participated in a comprehensive CDI reduction intervention and formed interdisciplinary teams to coordinate their efforts. Standardized clinical infection prevention and environmental cleaning protocols were implemented and monitored using checklists. Monthly data reports were provided to hospitals for facility-specific performance evaluation and comparison to aggregate data from all participants. Hospitals also participated in monthly teleconferences to review data and highlight successes, challenges, and strategies to reduce CDI. Incidence of hospital-onset CDI per 10,000 patient days was the primary outcome measure. Additionally, the incidence of nonhospital-associated, community-onset, hospital-associated, and recurrent CDIs were measured. The use of a collaborative model to implement a multifaceted infection prevention strategy was temporally associated with a significant reduction in hospital-onset CDI rates in participating New York metropolitan regional hospitals.

Síndrome de apnea/hipopnea obstructiva del sueño y su asociación con las enfermedades cardiovasculares / Obstructive Sleep Apnea Hypopnea Syndrome and its association with cardiovascular disease

Introducción:El síndrome de apnea/hipopnea obstructiva del sueño, es una entidad que ha cobrado importancia en los últimos años, con una prevalencia estimada en adultos de edad media cercana al 4 y al 2% en hombres y mujeres, respectivamente, y que por su frecuencia constituye un problema de salud pública. Objetivo:Exponer, tras un análisis exhaustivo de la literatura disponible, la asociación entre el síndrome de apnea/hipopnea obstructiva del sueño y las enfermedades cardiovasculares. Método: Se hizo una revisión narrativa a partir de la literatura encontrada en las bases de datos más reconocidas. Se incluyeron 59 estudios publicados en los últimos treinta años y se excluyeron reportes y series de casos. Conclusiones: El síndrome de apnea/hipopnea obstructiva del sueño se reconoce hoy en día como un problema de salud pública mundial. En Latinoamérica, más específicamente en Colombia, se requieren estudios prospectivos de cohorte que sirvan de pauta para la población del continente e indiquen posibles diferencias respecto a la comunidad internacional en cuanto a su tratamiento y diagnóstico oportunos, así como acerca del impacto de estos en lo concerniente a los desenlaces cardiovasculares de los pacientes.

Introduction: The Obstructive Sleep Apnea Hypopnea Syndrome has gained importance has gained importance in recent years, with an estimated prevalence in population of middle-aged adults around 4 and 2% in men and women respectively, and that given its frequency constitutes a public health problem. Objective: To show, after a thorough analysis of the available literature, the association between the Obstructive Sleep Apnea Hypopnea Syndrome and cardiovascular diseases. Method: A narrative review was made from the literature found at the most recognized databases. Fifty nine studies published in the last thirty years were included and reports and case series were excluded. Conclusions: The Obstructive Sleep Apnea Hypopnea Syndrome is recognized today as a global public health problem. Latin America, specifically Colombia, requires prospective cohort studies that serve as a guideline for the continent's population and that could indicate possible differences compared to the international community regarding early diagnosis and treatment, and its impact in cardiovascular outcomes of these patients.