Results and lessons from a hospital-wide initiative incentivised by delivery system reform to improve infection prevention and sepsis care.

BACKGROUND: An academic safety-net hospital leveraged the federally funded state Delivery System Reform Incentive Payment programme to implement a hospital-wide initiative to reduce healthcare-associated infections (HAIs) and improve sepsis care. METHODS: The study period was from 2013 to 2017. The setting is a 770-bed urban hospital with six intensive care units and a large emergency department. Key interventions implemented were (1) awareness campaign and clinician engagement, (2) implementation of HAI and sepsis bundles, (3) education of clinical personnel using standardised curriculum on bundles, (4) training of key managers, leaders and personnel in quality improvement methods, and (5) electronic medical record-based clinical decision support. Throughout the 5-year period, staff received frequent, clear, visible and consistent messages from leadership regarding the importance of their participation in this initiative, performing hand hygiene and preventing potential regulatory failures. Several process measures including bundle compliance, hand hygiene and culture of safety were monitored. The primary outcomes were rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and sepsis mortality. RESULTS: From 2013 to 2017, the hospital-wide rates of HAI reduced: CLABSI from 1.6 to 0.8 per 1000 catheter-days (Poisson regression estimate: -0.19; 95% CI -0.29 to -0.09; p=0.0002), CAUTI from 4.7 to 1.3 per 1000 catheter-days (-0.34; -0.43 to -0.26; p<0.0001) and SSI after 18 types of procedures from 3.4% to 1.3% (-0.29; -0.34 to -0.24; p<0.0001). Mortality of patients presenting to emergency department with sepsis reduced from 9.4% to 2.9% (-0.42; -0.49 to -0.36; p<0.0001). Adherence to bundles of care and hand hygiene and the hospital culture of patient safety improved. Results were sustained through 2019. CONCLUSION: A hospital-wide initiative incentivised by the Delivery System Reform Incentive Payment programme succeeded in reducing HAI and sepsis mortality over 5 years in a sustainable manner.

Laboratory tests on mercury emission monitoring with resonating gold-coated silicon cantilevers.

To measure extremely low concentrations of mercury vapor in gases as encountered in flue gases of coal-fired power plants, accurate and reliable online and/or portable mercury detection systems are needed. As discussed in this communication, resonating silicon-based cantilevers coated with thin films of gold change their resonant frequency when exposed to mercury vapors and could serve as the basis for such sensing devices. Two different types of commercial AFM cantilevers, which differed by physical dimensions and surface finish, were coated with a 10 nm film of gold and were tested in streams of argon containing mercury. The argon flow rates ranged from 5.7 to 57.4 ml/min, carrying mercury vapors at concentrations between 37 and 700 microg/m3. The results show that smaller cantilevers (approximately 140 microm x 40 microm x 4 microm) with a resonant frequency of 270-275 kHz were sensitive to less than 10 picograms of mercury, whereas larger cantilevers (approximately 245 microm x 50 microm x 7 microm) with a resonant frequency of 155-165 kHz have a sensitivity about 10 times lower. The results indicate that the kinetics of mercury capture by the gold coating follows a simple power law-correlation with the mass change (delta m) being proportional to t(n), where t is the capture time and n depends strongly on the concentration of mercury in the gas. It is also demonstrated that the mercury can be stripped off the gold coating by heating to 350 degrees C, which would allowthe cantilevers to be regenerated and reused.