RESUMEN
OBJECTIVE: Use of non-invasive ventilation (NIV) in very low birthweight infants to decrease the incidence of bronchopulmonary dysplasia can also lead to pressure injuries (PI) caused by the respiratory device interface. We aimed to decrease our incidence of PIs related to the mask/prongs interface used for NIV (PI-NIV). STUDY DESIGN: We identified correct use of barriers and appropriate interface fit as key targets for intervention. Over several PDSA cycles, we developed custom 3D printed barrier templates to allow for barriers to be cut at the bedside and created concise educational documents to assist with interface fitting and troubleshooting. RESULTS: The incidence of all PI-NIV decreased from 5.64 to 2.27 per 1000 NIV patient-days and the incidence of reportable (stage 3-4 and unstageable) PI-NIV decreased from 1.13 to 0 per 1000 NIV patient-days during the study period. CONCLUSIONS: With appropriate barrier usage and targeted education, the risk of PI-NIV can be minimized.
RESUMEN
The pathogenicity of frog virus 3 (FV3)-like ranavirus varies in adult chelonian species at different environmental temperatures, but differences in pathogenicity at different temperatures has yet to be determined in juveniles. Our objective was to determine the susceptibility to FV3-like ranavirus in four species of juvenile chelonians: red-eared sliders (RES; Trachemys scripta elegans), Mississippi map turtles ( Graptemys pseudogeographica kohnii), false map turtles (FMT; Graptemys pseudogeographica), and eastern river cooters ( Pseudemys concinna concinna) at two environmental temperatures. Two simultaneous trials ( n=8 treatment and n=4 controls of each species) were conducted in separate temperature-controlled rooms with animals maintained at 22 C or 27 C. All of the inoculated animals of each species at each temperature died, but no mortality was observed in control animals. Median survival times varied between 8 d and 11 d, based on species and temperature, with RES in the 27 C trial surviving the shortest time and the FMT in the 22 C trial surviving the longest. Combining all species, turtles in the 27 C trial survived for fewer days than those housed at 22 C, despite all turtles in both trials having similar viral copies detected in postmortem tissues. Lesions in inoculated turtles resembled those noted in natural and experimental FV3-like ranavirus infections and included vasculitis, thrombosis, hemorrhage in multiple organs, renal tubular necrosis, and hepatic necrosis. Myositis was not present in any juvenile, infected turtles in this study. This study confirmed that juvenile chelonians have a high susceptibility to ranaviral disease.
