EPIQ Review.

BACKGROUND: A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE: To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS: A literature review was performed using methodology adapted from the American Heart Association's International Liaison Committee on Resuscitation. RESULTS: Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION: There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections.

HISTORIQUE: Une liste de vérification qui favorise le respect d'une technique aseptique pendant l'insertion d'un cathéter fait partie de nombreux « soins regroupés ¼ pour réduire les infections nosocomiales chez les patients à l'unité de soins intensifs. OBJECTIF: Déterminer si le recours à des interventions regroupées qui incluent une liste de vérification pendant l'insertion d'un cathéter central réduit les infections sanguines liées aux cathéters chez les patients à l'unité de soins intensifs. MÉTHODOLOGIE: Analyse bibliographique au moyen de la méthodologie adaptée du comité de liaison internationale sur la réanimation de l'American Heart Association. RÉSULTATS: Dix-sept études de cohorte ont été incluses. Treize étaient favorables à l'intervention et quatre étaient neutres. Le taux d'infection variait entre 1,6 et 10,8 cas sur 1 000 jours-cathéters centraux dans les groupes témoins, et entre 0,0 et 3,8 cas sur 1 000 jours-cathéters centraux dans les groupes d'intervention. CONCLUSION: Les preuves sont acceptables pour recommander l'utilisation de groupes de soins qui incluent une liste de vérification pendant l'insertion d'un cathéter central chez les patients de l'unité de soins intensifs pour réduire l'incidence d'infections sanguines liées aux cathéters.

Use of bundled interventions, including a checklist to promote compliance with aseptic technique, to reduce catheter-related bloodstream infections in the intensive care unit.

BACKGROUND: A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE: To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS: A literature review was performed using methodology adapted from the American Heart Association's International Liaison Committee on Resuscitation. RESULTS: Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION: There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections.

HISTORIQUE: Une liste de vérification qui favorise le respect d'une technique aseptique pendant l'insertion d'un cathéter fait partie de nombreux « soins regroupés ¼ pour réduire les infections nosocomiales chez les patients à l'unité de soins intensifs. OBJECTIF: Déterminer si le recours à des interventions regroupées, qui incluent une liste de vérification pendant l'insertion d'un cathéter central, réduit les infections sanguines liées aux cathéters chez les patients à l'unité de soins intensifs. MÉTHODOLOGIE: Analyse bibliographique au moyen de la méthodologie adaptée du comité de liaison internationale sur la réanimation de l'American Heart Association. RÉSULTATS: Dix-sept études de cohorte ont été incluses. Treize étaient favorables à l'intervention et quatre étaient neutres. Le taux d'infection variait entre 1,6 et 10,8 cas sur 1 000 jours-cathéters centraux dans les groupes témoins, et entre 0,0 et 3,8 cas sur 1 000 jourscathéters centraux dans les groupes d'intervention. CONCLUSION: Les preuves sont acceptables pour recommander l'utilisation de groupes de soins qui incluent une liste de vérification pendant l'insertion d'un cathéter central chez les patients de l'unité de soins intensifs pour réduire l'incidence d'infections sanguines liées aux cathéters.

A reference set of SNOMED terms for the structured representation of respiratory disorders of the newborn infant.

The SNOMED CT(R) July 2006 release was systematically examined using the CliniClue(R) terminology browser to identify SNOMED terms that might be relevant for the structured representation of respiratory disorders of the newborn infant. Three neonatologists evaluated 348 candidate terms for inclusion in a reference set. Two hundred and eighty-eight (83%) terms were selected for inclusion. Most of the terms (73%) are SNOMED terms that are very relevant for the specific domain of care for the newborn infant. Nearly half the terms are fully defined and a third have one or more synonyms. The estimated use for the RefSet terms was more than once per month for 9% of the SNOMED terms and less than once a year for 66% of the terms.

Representation of disorders of the newborn infant by SNOMED CT.

SNOMED CT is the most sophisticated reference terminology currently available for the representation of healthcare. An unforeseen consequence of the opportunistic evolutionary process for SNOMED CT may be that some terms for disorders of specialised clinical domains are not represented within the terminology. The SNOMED CT July 2006 release was systematically examined using the CliniClue terminology browser to determine whether 434 terms for disorders of the newborn infant are represented within the terminology. There was complete representation for 90.8% of the terms for disorders of the newborn infant, partial representation for 6.4% of the terms, and no representation for 2.8% of the terms. Complete representation is achieved with a single, pre-coordinated SNOMED expression for 96.2% of the terms for disorders of the newborn infant that have complete representation within SNOMED CT. Nearly ninety percent of the SNOMED CT concepts that completely represent these terms have the current Concept Status but less than 40% of these concepts are fully defined SNOMED concepts. Nearly 50% of these SNOMED CT concepts have one or more synonyms. SNOMED CT provides structured representation for the majority of this set of terms that are used for disorders of the newborn infant.

Real-time analysis for intensive care: development and deployment of the artemis analytic system.

The lives of many thousands of children born premature or ill at term around the world have been saved by those who work within neonatal intensive care units (NICUs). Modern-day neonatologists, together with nursing staff and other specialists within this domain, enjoy modern technologies for activities such as financial transactions, online purchasing, music, and video on demand. Yet, when they move into their workspace, in many cases, they are supported by nearly the same technology they used 20 years ago. Medical devices provide visual displays of vital signs through physiological streams such as electrocardiogram (ECG), heart rate, blood oxygen saturation (SpO(2)), and respiratory rate. Electronic health record initiatives around the world provide an environment for the electronic management of medical records, but they fail to support the high-frequency interpretation of streaming physiological data. We have taken a collaborative research approach to address this need to provide a flexible platform for the real-time online analysis of patients' data streams to detect medically significant conditions that precede the onset of medical complications. The platform supports automated or clinician-driven knowledge discovery to discover new relationships between physiological data stream events and latent medical conditions as well as to refine existing analytics. Patients benefit from the system because earlier detection of signs of the medical conditions may lead to earlier intervention that may potentially lead to improved patient outcomes and reduced length of stays. The clinician benefits from a decision support tool that provides insight into multiple streams of data that are too voluminous to assess with traditional methods. The remainder of this article summarizes the strengths of our research collaboration and the resulting environment known as Artemis, which is currently being piloted within the NICU of The Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada. Although the discussion in this article focuses on a NICU, the technologies can be applied to any intensive care environment.

SNOMED CT as the clinical terminology for the representation of the clinical care of the newborn infant.

Clinically relevant concepts of specialized clinical domains may not yet have been represented in SNOMED CT(R). The July 2006 release was examined with CliniClue browser to determine whether 881 terms for the clinical care of the newborn infant are represented in SNOMED CT. There was complete representation for 86.4% of terms drawn from the categories of diagnosis, intervention, drug or observation. There was partial representation for 10.2% and no representation for 3.4% of the terms.