Prediction of impending central-line-associated bloodstream infections in hospitalized cardiac patients: development and testing of a machine-learning model.

BACKGROUND: While modelling of central-line-associated blood stream infection (CLABSI) risk factors is common, models that predict an impending CLABSI in real time are lacking. AIM: To build a prediction model which identifies patients who will develop a CLABSI in the ensuing 24 h. METHODS: We collected variables potentially related to infection identification in all patients admitted to the cardiac intensive care unit or cardiac ward at Boston Children's Hospital in whom a central venous catheter (CVC) was in place between January 2010 and August 2020, excluding those with a diagnosis of bacterial endocarditis. We created models predicting whether a patient would develop CLABSI in the ensuing 24 h. We assessed model performance based on area under the curve (AUC), sensitivity and false-positive rate (FPR) of models run on an independent testing set (40%). FINDINGS: A total of 104,035 patient-days and 139,662 line-days corresponding to 7468 unique patients were included in the analysis. There were 399 positive blood cultures (0.38%), most commonly with Staphylococcus aureus (23% of infections). Major predictors included a prior history of infection, elevated maximum heart rate, elevated maximum temperature, elevated C-reactive protein, exposure to parenteral nutrition and use of alteplase for CVC clearance. The model identified 25% of positive cultures with an FPR of 0.11% (AUC = 0.82). CONCLUSIONS: A machine-learning model can be used to predict 25% of patients with impending CLABSI with only 1.1/1000 of these predictions being incorrect. Once prospectively validated, this tool may allow for early treatment or prevention.

The quick confusion scale in the ED: comparison with the mini-mental state examination.

The Quick Confusion Scale (QCS) is a 6-item battery of questions focusing on orientation, memory, and concentration weighted to yield a top score of 15. Analysis of the QCS compared with the Mini-Mental State Examination (MMSE) is needed to determine if the QCS is a valid marker of cognitive mental status. The MMSE and the QCS were administered to a convenience sample of 205 patients presenting to the emergency department. Exclusions included head trauma, multisystem trauma, Glasgow Coma Scale less than 15, non-English speaking, education level less than 8 years, contact or droplet isolation, acute illness, or incomplete data for reasons such as restricted patient access. Mean scores were 24.8(SD = 4.7; range 2-30) on the MMSE and 11.89 (SD = 3.5; range 0-15) on the QCS. QCS scores were significantly correlated (r = .783) with MMSE scores. The QCS appears comparable with the MMSE and is quicker to administer.

Balcony collapse at the University of Virginia graduation: what hath Jefferson wrought?

The purpose of this report is to describe the emergency medical response to a disaster caused by the collapse of a balcony in Pavilion I on the Lawn of the University of Virginia during graduation. The emergency medical response to rescue of the injured was hindered by five major factors: (1) a metal linked chain blocked access of rescue vehicles, (2) inability to identify an emergency medical command officer, (3) failure to transfer injured patients with stable vital signs and secured to backboards to a triage area away from the scene of the accident, (4) ineffective crowd control, and (5) the failure to delay procession until completion of patient transport from the disaster site. Sixteen people were injured in the accident and one patient died. The cause of the accident was the absence of a redundant architectural support system for the balcony.

Ease of donning commercially available latex examination gloves.

There are a wide variety of latex examination gloves now available for use by health care providers. A prospective randomized trial was completed to quantify the forces required to don a sample of seven cornstarch-lubricated gloves and 13 powder-free latex examination gloves. The data collected was analyzed by a 20 x 2 general factorial ANOVA, as well as two 1-way ANOVAs using a least significance difference post hoc test. Some powder-free gloves can be easily donned with dry or wet hands without tearing with forces comparable to those encountered with powdered gloves. With the advent of these powder-free examination gloves, powdered gloves can now be abandoned, protecting health professionals and patients from the dangers of absorbable dusting powders. Despite the dangers of the absorbable dusting powders and the Food and Drug Administration's requirement for labeling examination glove boxes, some manufacturers of powdered examination gloves do not appropriately label their boxes with a warning to the health professional and patient of the presence of powder.

Polydimethylsiloxane for augmentation of the chin, malar, and nasal bones.

Polydimethylsiloxane (PDMS) is used for augmentation of the chin, malar and nasal bones and is available through three different manufacturers. PDMS has been widely accepted by surgeons for bone augmentation because of its variability in hardness, its ability to be easily molded and shaped, and its biological inertness. Wound repair around PDMS implants is achieved through capsule formation. Fibrous capsule formation can be interrupted by infection, immune reaction, implant migration, or extrusion. Recent studies have shown no correlation between silicone implants and connective tissue disease.

Studies of determinants of glove hole puncture during electrosurgery.

Holes in surgical gloves are considered to be an important source of transmission of pathogens between patient and surgeon. The purpose of this study was to determine if electrosurgery could alter the integrity of latex surgical gloves. The effects of electrosurgery on 11 brands of commercially available latex surgical gloves were tested through an in vitro study that simulated the conditions in the operating room. Glove hole puncture was encountered only with coagulation current operating at the highest setting. In addition, maximal surface area contact with the hemostat to the glove surface was required to produce glove puncture. The presence of powder and glove hydration were not significant determinants of glove hole puncture. On the basis of our study, we believe that all surgical gloves tested offered the surgeon adequate protection at commonly used levels of cutting and coagulation current, as long as no breach existed prior to the donning of gloves.

Ease of donning commercially available powder-free surgical gloves.

There are a wide variety of powder-free gloves that can now be used by surgeons. The purpose of this study was to quantify the forces required to don these powder-free surgical gloves. The lowest donning forces for wet hands was encountered with powder-free gloves coated with a hydrogel polymer. In addition, the hydrogel coated gloves exhibited the least increase in donning forces from dry hands to wet hands. While greater forces were encountered with the other commercially available powder-free gloves than the hydrogel coated gloves, they all could be safely donned on dry hands without tearing.