Biomedical subjects

Joan N Hebden

Publications and source records attributed to Joan N Hebden.

4 recordsLinked to original sources

PubMed2005

Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci co-colonization.

We assessed the prevalence, risk factors, and clinical outcomes of patients co-colonized with vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) upon admission to the medical and surgical intensive care units (ICUs) of a tertiary-care facility between January 1, 2002, and December 31, 2003. Co-colonization was defined as a VRE-positive perirectal surveillance culture with an MRSA-positive anterior nares surveillance culture collected concurrently. Among 2,440 patients, 65 (2.7%) were co-colonized. Independent risk factors included age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), admission to the medical ICU (OR 4.38, 95% CI 2.46-7.81), male sex (OR 1.93, 95% CI 1.14-3.30), and receiving antimicrobial drugs on a previous admission within 1 year (OR 3.06, 95% CI 1.85-5.07). None of the co-colonized patients would have been identified with clinical cultures alone. We report a high prevalence of VRE/MRSA co-colonization upon admission to ICUs at a tertiary-care hospital.

Aged↗

PubMed2004

Aggressive control measures for resistant Acinetobacter baumannii and the impact on acquisition of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a medical intensive care unit.

The medical ICU implemented aggressive control measures following an outbreak of multidrug-resistant, clonal Acinetobacter baumannii. Multivariable regression analyses comparing acquisition (6 months preceding to 6 months during or following the outbreak) revealed decreased VRE and MRSA acquisition. Aggressive control measures can reduce VRE, and perhaps MRSA, transmission.

Acinetobacter↗

PubMed2004

Preliminary assessment of an automated surveillance system for infection control.

BACKGROUND AND OBJECTIVE: Rapid identification and investigation of potential outbreaks is key to limiting transmission in the healthcare setting. Manual review of laboratory results remains a cumbersome, time-consuming task for infection control practitioners (ICPs). Computer-automated techniques have shown promise for improving the efficiency and accuracy of surveillance. We examined the use of automated control charts, provided by an automated surveillance system, for detection of potential outbreaks. SETTING: A 656-bed academic medical center. METHODS: We retrospectively reviewed 13 months (November 2001 through November 2002) of laboratory-patient data, comparing an automated surveillance application with standard infection control practices. We evaluated positive predictive value, sensitivity, and time required to investigate the alerts. An ICP created 75 control charts. A standardized case investigation form was developed to evaluate each alert for the likelihood of nosocomial transmission based on temporal and spatial overlap and culture results. RESULTS: The 75 control charts were created in 75 minutes and 18 alerts fired above the 3-sigma level. These were independently reviewed by an ICP and associate hospital epidemiologist. The review process required an average of 20 minutes per alert and the kappa score between the reviewers was 0.82. Eleven of the 18 alerts were determined to be potential outbreaks, yielding a positive predictive value of 0.61. Routine surveillance identified 5 of these 11 alerts during this time period. CONCLUSION: Automated surveillance with user-definable control charts for cluster identification was more sensitive than routine methods and is capable of operating with high specificity and positive predictive value in a time-efficient manner.

Cross Infection↗

PubMed2002

Preventing intravascular catheter-related bloodstream infections in the critical care setting.

Although intravascular catheters are indispensable for managing the care of critically ill patients, they can be associated with serious infection. Catheter-related bloodstream infections (CR-BSI) are a major cause of morbidity and mortality in the critical care setting. These infections are largely preventable. This article reviews the epidemiology and pathogenesis of these infections, the role of the critical care nurse in the diagnostic evaluation of CR-BSI, and strategies for their prevention.

Catheterization, Central Venous↗