A critical care pandemic staffing framework in Australia.

BACKGROUND: Pandemics and the large-scale outbreak of infectious disease can significantly impact morbidity and mortality worldwide. The impact on intensive care resources can be significant and often require modification of service delivery, a key element which includes rapid expansion of the critical care workforce. Pandemics are also unpredictable, which necessitates rapid decision-making and action which, in the lack of experience and guidance, may be extremely challenging. Recognising the potential strain on intensive care units (ICUs), particularly on staffing, a working group was formed for the purpose of developing recommendations to support decision-making during rapid service expansion. METHODS: The Critical Care Pandemic Staffing Working Party (n = 21), representing nursing, allied health, and medical disciplines, has used a modified consensus approach to provide recommendations to inform multidisciplinary workforce capacity expansion planning in critical care. RESULTS: A total of 60 recommendations have been proposed which reflect general recommendations as well as those specific to maintaining the critical care workforce, expanding the critical care workforce, rostering and allocation of the critical care workforce, nurse-specific recommendations for staffing the ICU, education support and training during ICU surge situations, workforce support, models of care, and de-escalation. CONCLUSION: These recommendations are provided with the intent that they be used to guide interdisciplinary decision-making, and we suggest that careful consideration is given to the local context to determine which recommendations are most appropriate to implement and how they are prioritised. Ongoing evaluation of recommendation implementation and impact will be necessary, particularly in rapidly changing clinical contexts.

Development and Review of the Chest Tube High-Feedback Educational Simulation Trainer (CHEST).

INTRODUCTION: Emergency medicine physicians must receive training in chest tube placement. This life-saving skill must be completed quickly and competently to prevent morbidity and mortality. Training on live patients is no longer an appropriate or acceptable practice. Current training devices have been noted to be costly, may be difficult to store, or may require time-consuming cleanup or setup. METHODS: Fifteen Chest tube High-feedback Educational Simulation Trainers were created. Frames were made from wood and PVC, and soft tissue layers were designed using silicone and polyurethane foam. Nine training sites volunteered to test the model and provided feedback on the acceptability of the task trainer for skill training. RESULTS: Survey findings demonstrated that the model was realistic for teaching, portable, and was easy to use and maintain. In our model, the outer skin was noted to tear easily, thus limiting its use for suture training. Overall programs reported that they would use this model if it was available for the same or lower cost than current models. CONCLUSIONS: An inexpensive task trainer was created that was easy to store, quick to set up, durable, easy to clean, and rated as effective at training the skill of chest tube insertion.

Nosocomial infections acquired by patients treated with extracorporeal membrane oxygenation.

BACKGROUND: Infectious complications in patients treated with extracorporeal membrane oxygenation (ECMO) are a frequent contributor to morbidity and mortality in this group. Defining the characteristics of ECMO-related infections may inform treatment decisions, including antimicrobial therapy. METHODS: A retrospective observational study in an Australian intensive care unit, including adult patients treated with ECMO for at least 48 hours, over a 3-year period. Medical records were analysed for evidence of bloodstream infections (BSIs) and wound infections (WIs) at the ECMO cannulation site or the sternum. Demographic, ECMO-related and clinical data were collected, including inpatient antibiotic usage. RESULTS: We included 98 patients in the study. The median age was 50 years (IQR, 39-57 years). The median duration of ECMO treatment was 6.6 days (IQR, 4.0-12.8 days). Twenty-four infections were diagnosed in 21 patients; eight patients were diagnosed with BSIs on ECMO, 14 developed cannulation-site WIs, and two patients developed sternal wound infections. On multivariate analysis, we found that factors that increased infection risk included immunosuppression (OR, 2.9; P = 0.04) and treatment with venoarterial (VA) ECMO (OR, 14.7; P = 0.01). Infected patients had a significantly longer duration of hospital admission than patients without BSI or WI (55 days v 30 days; P = 0.03). Prior antibiotic use did not appear to be protective against subsequent infection. CONCLUSIONS: Infectious complications are common in ECMO patients and are associated with longer durations of hospital admission. Isolated pathogens were predominantly hospital-acquired Gram-negative bacteria and yeasts. Immunosuppression and treatment with VA ECMO were found to be specific risk factors for infection.