Specialty Linens and Pressure Injuries in High-Risk Patients in the Intensive Care Unit.

BACKGROUND: The cardiovascular and surgical intensive care units had the highest unit-acquired pressure injury rates at an institution. Patients in these units had multiple risk factors for pressure injuries. Various interventions had been used to minimize pressure injuries, with limited results. OBJECTIVES: To evaluate the effect of specialty linens on the rate of pressure injuries in high-risk patients. The specialty linen was a synthetic silklike fabric that addressed the microclimate surrounding the patient, with the purpose of minimizing friction, shear, moisture, and heat. METHODS: The specialty linen was tried on 24 beds in the cardiovascular intensive care unit and 20 beds in the surgical intensive care unit, including sheets, underpads, gowns, and pillow cases. Data obtained from a retrospective review of electronic health records were compared for 9 months before and 10 months after specialty linens were implemented. RESULTS: Total unit-acquired pressure injury rates for both units combined declined from 7.7% (n = 166) before to 5.3% (n = 95) after the intervention. The intervention was associated with a significant reduction in posterior (coccyx, sacrum, back, buttock, heel, and spine) pressure injury rates, from 5.2% (n = 113) before to 2.8% (n = 51) after specialty linens were implemented (P < .001). CONCLUSION: Addressing the microclimate, friction, and shear by using specialty linens reduces the number of posterior pressure injuries. The use of specialty linens in addition to standard techniques for preventing pressure injuries can help prevent pressure injuries from developing in high-risk patients in intensive care units.

Setting Up a Patient Care Call Center After Potential HCV Exposure.

OBJECTIVES: Notify patients of a potential exposure to hepatitis C virus, coordinate testing, and provide follow-up counseling. METHODS: A team was convened to identify various needs in developing a patient care call center. The areas addressed included the following: location, hours, and duration; telephone accessibility; tracking calls and test results; billing; staffing; notification; and potential issues requiring additional evaluation. RESULTS: Disclosure letters were sent to 1275 patients; 57 letters were not deliverable. There were 245 calls to the helpline from October 25 through November 15. Lessons learned centered on hours of availability, staffing, use of an automated phone system and email communication, tracking results, and billing issues. CONCLUSIONS: A successful patient notification and follow-up effort requires a multidisciplinary team, internal and external communication, collection of data over an extended period, and coordination of patient information.

Efficacy of surveillance for 2009 H1N1 pandemic within a healthcare system.

In the fall of 2009, our hospital introduced a surveillance system to monitor the increase in cases of H1N1 pandemic influenza A virus infection. The system involved tracking cases of influenza-like illness in the emergency department, the outpatient clinics, and the inpatient wards as well as specimens with positive polymerase chain reaction results reported by the microbiology laboratory. Our data correlated well with national and regional data.

Ventilator-associated pneumonia in the home care setting.

OBJECTIVE: To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home. DESIGN: Retrospective cohort study. SETTING: University-affiliated home care service. PATIENTS: Patients receiving mechanical ventilation at home from June 1995 through December 2001. RESULTS: Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean +/- SD, 890.6 +/- 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (+/-SD) of 245 +/- 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia. CONCLUSIONS: Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.