The use of the reds noninvasive lung fluid monitoring system to assess readiness for discharge in patients hospitalized with acute heart failure: A pilot study.

BACKGROUND: Inadequate decongestion is common in hospitalized heart failure (HF) patients and may contribute to readmissions. Our purpose was to use remote dielectric sensing (ReDS) technology to measure lung congestion at discharge in patients admitted with acute HF and to see if a device-targeted intervention could reduce HF readmission rates. METHODS: We conducted a prospective pilot study of patients admitted with acute decompensated HF randomized to receive standard therapy or ReDS-guided therapy to determine the timing of hospital discharge based on the amount of lung congestion present after diuresis. ReDS measurement was performed for all patients once they were deemed ready for discharge. Patients in the treatment arm with residual lung congestion defined by ReDS ≥39% had HF consultation and further diuresis. RESULTS: Of 108 HF patients (50% male, age 73.6 ±â€¯12.6 years, BMI 29.3 ±â€¯4.3 kg/m2, EF 38.5 ±â€¯15.1%, BNP 1138 ±â€¯987 pg/mL), 32% demonstrated residual lung congestion at the time of proposed hospital discharge. ReDS guided therapy triggered additional diuresis in 30% (18/60) of the patients in the treatment arm (average weight loss 5.6 pounds, p = 0.02). 30-day HF readmission rates were similar in the treatment and the control arms (1.7% vs 4.2%; p = 0.44). Patients discharged as planned with residual lung congestion with ReDS ≥39% had higher 30-day readmission rate compared to patients who were adequately decongested at discharge with ReDS <39% (11.8% vs. 1.4%, p = 0.03). CONCLUSION: In our single-center cohort, ReDS testing demonstrated that 32% of HF patients deemed ready for discharge have clinically significant residual lung congestion which was associated with a higher risk of readmission. ReDS-guided management was associated with significant decongestion but not a reduction in HF readmissions in this sample.

Community hospital stethoscope cleaning practices and contamination rates.

BACKGROUND: In the United States, nosocomial infections are estimated to cause 72,000 annual deaths. The stethoscope, commonly used, is rarely reported as a potential vector. Our study aims to describe stethoscope contamination and the effect of self-reported cleaning practices among health care providers in a community hospital setting. METHODS: Stethoscopes were collected at random times from health care providers and cultured per standard techniques. Providers answered a structured questionnaire related to their cleaning practices. Differences in bacterial growth rates and the impact of profession, cleaning frequency, and prior sanitization were evaluated. RESULTS: Of 104 cultured stethoscopes, 44% were from residents and medical students, from which 76% had bacterial growth, and 56% were from attendings, nurses, and respiratory therapists who had 91.4% growth (95% = confidence interval 0.62-0.86 and 0.81-0.96, respectively). Overall, 86.5% of providers claimed disinfection frequency compliant with Center for Disease Control and Prevention guidelines but there were no statistical differences between self-reported cleaning frequency or methods, and the presence of bacteria. CONCLUSIONS: Most stethoscopes are contaminated with bacteria, the presence of which was not affected by reported cleaning strategies.