ICU Department Research Articles

Clinical distribution and nursing management of multi-drug resistant bacteria infection

Objective To analyze the clinical distribution and incidence of multi-drug resistant bacteria infection and to investigate prevention and control measures. Methods During July 2010 to June 2013, the clinical distribution characteristics of 9 376 cases of multi-drug resistant bacteria infection were analyzed. Then the prevention and control nursing interventions were taken. Results The department of neurosurgery (include neuro-ICU) had highest incidence of multi-drug resistant bacteria infection, with 1 640 cases (17.5%). Then, the department of neurology and ICU had 1 507 cases (16.1%) and 1 493 cases (15.9%) of multi-drug resistant bacteria infection. Within the 9 376 cases, the most frequent bacteria was staphylococcus aureus, with 1 930 cases (20.6%); the escherichia coli was in the second place with 1 635 cases (17.4%); the baumanii was 1 607 cases (17.1%); the klebsiella pneumonia was 1 504 cases (16.0%); the pseudomonas aeruginosa was 1 103 cases (11.8%). Conclusions The key to prevent and control the multi-drug resistant bacteria infection is to improve the care interventions, develop the supervise and management of the infection control network, increase the degree of importance and emphasize the early warning system. Key words: Bacteria infection; Multi-drug resistant bacteria; Clinical characteristics; Nursing management

Predicting a complicated course of Clostridium difficile infection at the bedside

Clostridium difficile infections (CDIs) are a common cause of antibiotic-associated diarrhoea and associated with CDI-related mortality in c. 10%. To date, there is no prediction model in use that guides clinicians to identify patients at high risk for complicated CDI. From 2006 to 2009, nine Dutch hospitals included hospitalized CDI patients in a prospective cohort. Potential predictors of a complicated course (ICU admission, colectomy or death due to CDI) were evaluated in uni- and multivariate logistic regression. A score was constructed that was internally validated by bootstrapping. Furthermore, a pilot external validation was performed. Twelve per cent of 395 CDI patients had a complicated course within 30 days after diagnosis. Age (≥85 years, OR 4.96; 50–84 years, 1.83), admission due to diarrhoea (OR 3.27), diagnosis at the ICU department (OR 7.03), recent abdominal surgery (OR 0.23) and hypotension (OR 3.25) were independent predictors of a complicated course. These variables were used to construct a prediction model. A score subsequently classified patients into high risk (39% with a complicated course), intermediate (16%), low (5%) or virtually no risk of experiencing a complicated course. The score performed well after internal validation (AUC 0.78) and a pilot external validation among 139 patients showed similar good performance (AUC 0.73). We present an easy-to-use, clinically useful risk score that is capable of categorizing CDI patients according to their outcome. Because classification is available at diagnosis, it could have major implications for treatment choice.

Acute Respiratory Failure in Patients With Toxic Epidermal Necrolysis

Stevens-Johnson syndrome and toxic epidermal necrolysis are severe adverse cutaneous drug reactions characterized by widespread skin and mucous membrane detachments, including bronchial mucosa, which may be associated with respiratory failure requiring mechanical ventilation. The presentation and outcome of patients requiring mechanical ventilation and the characteristics of bronchial epithelial lesions among ventilated patients are reported. Predictors of mechanical ventilation available on hospital admission were identified using univariate and multivariate logistic regressions. Retrospective cohort study. Medical ICU and dermatology department of a tertiary care hospital, which hosts the French national referral center for toxic epidermal necrolysis. Patients admitted for Stevens-Johnson syndrome/toxic epidermal necrolysis over a 14-year period were included. None. Of the 221 patients included in the study, 56 patients (25.3%) required mechanical ventilation. None of the patients received noninvasive ventilation. Patients requiring mechanical ventilation had a larger baseline detached body surface area, higher Logistic Organ Dysfunction score, and Simplified Acute Physiology Score II, and they presented more often with shock, pulmonary infiltrates, and renal dysfunction (p < 0.0001 for all comparisons). Among patients receiving mechanical ventilation, 57% of the patients died; those having bronchial epithelial lesions (22 of 56) required intubation earlier than others (1 [1-4] vs 4 [1-6] d after hospital admission; p = 0.027). Variables associated with mechanical ventilation in multivariate analysis included serum bicarbonates less than 20 mM (odds ratio, 4.9 [95% CI, 1.1-22.7]; p = 0.041), serum urea greater than 10 mM (odds ratio, 7.0 [95% CI, 2.2-22.8]; p < 0.001), a detached body surface area between 10% and 29% (odds ratio, 3.7 [95% CI, 1.0-13.8]; p = 0.048) or greater than or equal to 30% (odds ratio, 19.7 [95% CI, 4.4-87.4]; p < 0.0001), WBCs more than 12,000/mm3 (odds ratio, 11.6 [95% CI, 2.8-48.1]; p < 0.001), blood hemoglobin less than 8 g/dL (odds ratio, 8.1 [95% CI, 1.2-55.2]; p = 0.032), and more extensive pulmonary infiltrates (odds ratio, 9.7 [95% CI, 3.6-25.9]; p < 0.0001). Mechanical ventilation is required in one of four Stevens-Johnson syndrome/toxic epidermal necrolysis patients and is associated with a poor outcome. Prompt identification of Stevens-Johnson syndrome/toxic epidermal necrolysis patients at higher risk of intubation could help guide their early management, particularly for those having bronchial epithelial lesions.

The Clumping factor B gene typing in discriminating the strains of nosocomial-acquired methicillin-resistant Staphylococcus aureus

To evaluate the clfB typing method in discriminating the ST239 methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients under nosocomial infection in Tianjin first central hospital so as to access the clinical risk factors and outcomes of the MRSA nosocomial infection from ICU and non-ICU departments. Forty-two stains of MRSA with known SCCmec type were chosen in both ICU (n = 35) and non-ICU (n = 7) wards, from 2006 to 2012, of which MLST genotype was ST239. Clinical risk factors and rates on drug resistant to MRSA were counted, respectively. All the isolates of MRSA belonged to the same lineage 3 and 6 haplotypes, based on clfB variable-number tandom repeats typing. Thirty-five isolates from ICU belonged to 6 haplotypes, among which clfB3-52, 3-52E, 3-50, 3-52C, 3-50A and 3-50E were accouted for 42.9%, 37.1%, 8.6%, 5.7%, 2.9% and 2.9%, respectively. Seven isolates from non-ICU belonged to 3 haplotypes, in which 3-52, 3-52E and 3-50 were accouted for 42.8%, 28.6%, 28.6%, respectively. When clfB typing was combined with SCCmec typing in use, results showed that the index of discrimination as 0.767, better than clfB (ID = 0.688) or SCCmec (ID = 0.303) used alone. SCCmec III -clfB3-52E seemed as the major clone among the 10 haplotypes of clfB/SCCmec typing, which was accounted for 40.4% . There were significant differences on the length of hospitalization (P < 0.005) and the duration of antibiotics use (P < 0.05) between ICU and non-ICU. The clfB typing method which was based on variable-numbers of tandom repeats showed powerful ability of resolution. It could also be combined with MLST and SCCmec typing to be used in local epidemiological investigations.

Prevalence of Methicillin Resistant Staphylococcus aureus isolates from Al-Khoms hospital medical staff, Libya

The risk for acquisition of MRSA in a hospital setting by personnel; including doctors and nurses who are in contact with patients is escalating. This study was conducted to screen, isolate and identify Staphylococcus aureus from nose and throat specimens obtained from medical and paramedical personnel in Al-Khoms Teaching Hospital, Libya. A total of 150 persons were included in this study. Two specimens (throat and nasal swabs) were collected from each individual. Specimens were collected from medical (doctors) and paramedical staffs (nurses, technicians, midwives, and medical students), comprising both males and females with age groups ranging from 21 to 65 years, and belonging to different nationalities, departments, and clinical activities. MRSA isolates were detected by disc-diffusion and Latex agglutination method. The study showed prevalence of MRSA positive was in nasal swabs at 14.7% and throat swabs at 9.3% of tested individuals. Libyan nurses carried the highest rate of positive MRSA cases, (75%). Doctors, regardless of nationality, showed a lower prevalence of 25% positive MRSA. The prevalence of MRSA according to departments was found to be 43.7% in emergency, 16.2% surgery, 15.7% medicine, 33.3% in paediatrics, obstetrics and gynaecology 27.7% and renal dialysis 42.8%. No recorded prevalence in ICU and physiotherapy departments, because of the small number.

Distribution characteristics and drug resistance of 352 strains of pseudomonas aeruginosa

Objective To provide some evidences for the rational use of antibiotics investigating the distribution characteristics and drug resistance of pseudomonas aeruginosa in the hospital infection.Methods The detection rate,distribution characteristics,and drug sensitivity test findings of 352 strains of pseudomonas aeruginosa isolated from different kinds of clinical specimens in our hospital from April 2012 to April 2013 were retrospectively and statistically analyzed.Results The detection rate of pseudomonas aeruginosa in sputum samples was the highest(149 strains,42.33％),and that in wound secretions(107 strains,30.40％)came the next.P.aeruginosa mainly distributed in burn unit(30.40％) and ICU department(13.35％).Polymyxin E against pseudomonas aeruginosa were the most sensitive,with a resistance rate of 0.62％.The resistance rates to Amikacin,Meropenem,and Ciprofloxacin were 32.56％,38.00％,and 37.04％,respectively.The resistance rates to other antimicrobial agents were all over 40％.Conclusions In our hospital,P.aeruginosa mainly distribute in the burn unit and ICU department.P.aeruginosa has the characteristics of high resistance rate and multidrug resistance.Therefore,the clinicians should choose the antibiotics reasonably according to the antimicrobial susceptibility test results and do well in disinfection and isolation. Key words: Pseudomonas aeruginosa; Distribution; Drug resistance; Rational use of drugs

Report on 3rd ASNACC Held at Bali (Indonesia)

*Department of Anesthesiology and ICU, School of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia †Department of Anaesthesia & Pain Medicine, Fortis Memorial Research Institute (FMRI), Gurgaon, India The authors have no funding or conflicts of interest to disclose. Reprints: Hari H. Dash, MD, Department of Anaesthesia & Pain Medicine, Fortis Memorial Research Institute (FMRI), Gurgaon, India (e-mail: [email protected]). Received May 4, 2013 Accepted May 7, 2013

Application of catheter risk assessment scale in the department of cardiology ICU

Objective To explore the application effect of catheter risk assessment scale on the prevention of catheter slippage in patients with catheterization in the department of cardiology.Methods A total of 276 patients with a variety of catheters were randomly divided into the control group with 136 patients and the observation group with 140 patients.The patients in the control group were given the routine nursing methods.The patients in the observation group were evaluated by using catheter risk assessment scale and given predictive nursing according to the risk classification.The incidences of catheter slippage and security events were compared between the two groups.Results The total incidences of catheter slippage in the observation group was 2.26％,and 11.73％ in the control group,there was statistically significant difference between the two groups (Z =-4.831,P =0.000) ; The incidences of security events in the observation group was 6.48％,and 25.23％ in the control group,there was statistically significant difference between the two groups (x2 =-49.632,P =0.000).Conclusions The application of catheter risk assessment scale can minimize the risk of catheter slippage,and improve the ability of risk identification and processing of nurses in department of cardiology. Key words: Catheter slippage; Pipeline risk assessment; Heart care unit with

Study on the application of critical laboratory values

Objective By analysing the historical data of critical laboratory values,the development of practicable critical values reporting system was investigated. Methods There were totally 63 794 critical values reported by the Department of Laboratory Medicine of the First Affiliated Hospital of Fujian Medical University from Nov,2008 to Oct,2012.We analysed the yearly incidence,the analytes and the distribution of critical values; we also compared the report timeliness and false rejection rate before and after the informationization and differential management of the critical values report; Meanwhile we compared the clinician response time before and after the implementation of the new out-patients critical values reporting flow. Results There were 15 000-18 000 critical values reports yearly accounting for 1.53% (63 794/4 166 267) of the total results.Most of the critical values reports were from in-patients (about 80%),and the top 3 analytes of critical values were PLT, K+ and APTT.The critical values reports were not uniformly distributed the ICU Department,Hematology Department,Emergence Department and Liver Center were concentrated distribution departments.It took 3-8 minutes (median:5 min) for staff in the Department of Laboratory Medicine to call the clinician/nurse after critical values were known and the false rejection rate was 7.53% (949/12 596).However,it just took 5-10 s to notify the clinician/nurse via the electronic alert system,and the false rejection rate was 0.There was a significant decrease of critical values reports about the in-patients in the Hematology Department and the Liver Center since the definition of critical values in these two departments was slightly modified,that was from 13.85% to 11.24% (the Hematology Department) and from 12.77% to 8.43% (the Liver Center),respectively.And since the new out-patients critical values reporting flow was adopted (different reporting flows during office hours and out of hours),the clinician response time decreased from 20 min to 7 min. Conclusions The informationization of the critical values report is helpful to improve work efficiency and the accuracy rate.And the hospital should make practicable critical values reporting system on the basis of individual institutional needs,especially the out-patient critical values reporting flow.(Chin J Lab Med,2013,36:565-568) Key words: Clinical laboratory information systems; Reference values; Reference standards; Hospital administration

Avaliação da qualidade de vida e vulnerabilidade ao estresse no contexto hospitalar

The concept of Quality of Life is used to measure the conditions of life of a human being, as the word vulnerability refers to the chance of being exposed to sick people. This study aimed to examine possible relationships between perceived quality of life and vulnerability to job stress in nurses, technicians and nursing assistants who work in the ICU and emergency department of a public hospital. We used the instrument of quality of life of the World Health Organization, WHOQOL-Bref and Scale Vulnerability to Stress at Work. Met in relation to the labor sector, a significant difference only for Quality of Life total. Therefore it can be said that the professionals who work in the ICU have a higher perception of quality of life when compared to the SUS. In the correlation between the two instruments, the environment domain of the WHOQOL-Bref correlated negatively and significantly with all factors EVENT, indicating that the perception of the person in relation to various aspects of the environment they live in is related to vulnerability to stress.

Influence of the Admission Pattern on the Outcome of Patients Admitted to a Respiratory Intensive Care Unit: Does a Step-Down Admission Differ From a Step-Up One?

The outcomes of patients admitted to a respiratory ICU (RICU) have been evaluated in the past, but no study has considered the influence of location prior to RICU admission. We analyzed prospectively collected data from 326 consecutive patients admitted to a 7-bed RICU. The primary end points were survival and severity of morbidity-related complications, evaluated according to the patient's location prior to RICU admission. Three admission pathways were considered: step-down for patients transferred from the ICUs of our hospital; step-up for patients coming from our respiratory wards or other medical wards; and directly for patients coming from the emergency department. The secondary end point was the potential influence of several risk factors for morbidity and mortality. Of the 326 subjects, 92 (28%) died. Overall, subjects admitted in a step-up process had a significantly higher mortality (P < .001) than subjects in the other groups. The mortality rate was 64% for subjects admitted from respiratory ward, 43% for those from medical wards, and 18% for subjects from both ICU and emergency department (respiratory ward vs medical ward P = .04, respiratory ward vs emergency department P < .001, respiratory ward vs ICU P < .001, medical ward vs emergency department P < .001, and medical ward vs ICU P < .001). Subjects admitted from a respiratory ward had a lower albumin level, and Simplified Acute Physiology Score II was significantly higher in subjects following a step-up admission. About 30% of the subjects admitted from a respiratory ward received noninvasive ventilation as a "ceiling treatment." The highest odds ratios related to survival were subject location prior to RICU admission and female sex. Lack of use of noninvasive ventilation, younger age, female sex, higher albumin level, lower Simplified Acute Physiology Score II, higher Barthel score, and absence of chronic heart failure were also statistically associated with a lower risk of death. The pathway of admission to a RICU is a determinant of outcome. Patients following a step-up pattern are more likely to die. Other major determinants of survival are age, nutritional status and female sex.

Routine chest radiographs in the surgical intensive care unit: Can we change clinical habits with no proven benefit?

Daily routine chest radiographs (CR) are commonly performed in surgical ICU. Unnecessary CR increase costs and expose the staff and the patients to radiation risk. The goal of our study was to estimate the value of daily routine CR in the ICU and to determine the correlation between CR and physical findings in surgical ICU patients. Prospective observational study was conducted during period of two months at the ICU department at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. It included 97 consecutive patients who underwent digestive surgery and stayed at the ICU for at least two days. During their ICU stay, CRs were obtained as a clinical routine or to monitor lung pathology. Patients were followed daily, and CRs (as the proportion of positive findings) were compared with physical examination and clinical presentation. A total of 717 CRs were obtained, median number per patient was 4.0 (2.0-7.0). Proportion of positive findings was significantly higher comparing to auscultation until the sixth day of ICU stay. There was no difference in CR findings from day to day after the sixth day. Therapeutic efficacy of CRs was low as only 56 (7.8%) resulted in a change of patient management. We conclude that daily routine CRs are justified in the first six days of ICU stay, and after that time they show no advantages over clinical examination.

成功救治妊娠合并脑炎继发多脏器功能障碍综合征一例

年轻女性，妊娠20周，因发热、寒战3天入院，入院后因血小板减少入我院血液科，次日出现抽搐，第3日出现意识障碍转入ICU，化验检查提示患者存在死胎、呼吸衰竭、休克、肝损伤、肾损伤、胃肠功能及凝血功能障碍等，诊断为：脑炎、多器官功能障碍综合征、休克、死胎，经机械通气，持续心电监护，CVP监测，抗休克、激素冲击、抗癫痫，亚低温治疗，纠正凝血功能，多器官功能支持及早期营养支持治疗，第5天诱导分娩出1女性死婴，经20余天治疗后，患者神志清楚，四肢肌力3~4级，可正常饮食各项化验指标基本恢复正常，痊愈出院。 A young pregnancy women suffered from fever for 3 days and came to our hospital. After admission to the hematology department because of thrombocytopenia, in the third day coma appears and she was deliveried to ICU department. Our lab finding suggests that the patient presented respiratory failure, shock, liver injury, renal injury, ga-strointestinal dysfunction and coagulation dysfunction. Consider of that, the diagnosis was encephalitis, multiple organ dysfunction syndrome, shock, and stillbirth. Then we give her the treatment including the mechanical ventilation, mon-itoring CVP, fluid resuscitation, large dose glucocorticoid injection, and mild hypothcrmia, sedation, coagulating, organ support and early nutrition support therapy. And on the 5th day, a dead female baby was delivered, after more than 20 days treatment, the patient was clear. Muscle power was 3-4 level in the four limbs, lab finding returns to normal, the patient was discharged.

Ensuring direct laryngoscopy will not become an extinct skill

Acta Anaesthesiologica ScandinavicaVolume 56, Issue 6 p. 803-803 LETTER TO THE EDITOR Ensuring direct laryngoscopy will not become an extinct skill R. A. Lee, R. A. LeeSearch for more papers by this authorA. A. J. van Zundert, A. A. J. van ZundertSearch for more papers by this author R. A. Lee, R. A. LeeSearch for more papers by this authorA. A. J. van Zundert, A. A. J. van ZundertSearch for more papers by this author First published: 10 May 2012 https://doi.org/10.1111/j.1399-6576.2012.02708.xCitations: 2 Address: André van Zundert Department of Anesthesiology, ICU & Pain Therapy Catharina Hospital-Brabant Medical School Michelangelolaan 2 NL-5623EJ Eindhoven The Netherlands e-mail: zundert@iae.nl Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume56, Issue6July 2012Pages 803-803 RelatedInformation

A prospective observational study on prevalence of poisoning cases – focus on vasmol poisoning (para-phenylenediamine(PPD) poisoning)

BackgroundThe intentional and accidental poisoning by various modes are common in India. Nearly 1 million people die each year globally due to poisoning. Vasmol is an external preparation that contains...

P418 Extraintestinal manifestations in inflammatory bowel disease; the prevalence in tertiary referral center

Background: CDI is the main cause of antibiotic associated infectious diarrhea. Incidence, severity and burden on the healthcare system related to CDI have increased in last decade in many industrialized countries. Epidemiological data of CDI are scarce in Southern Europe. Aims: To evaluate incidence and secular trend of nosocomial CDI between 2000 and 2009 in two Spanish referral hospitals. To analyze the highest incidence rates across specialties. Methods: Setting: Two referral hospitals in the Barcelona metropolitan area. Design: Retrospective surveillance study. Laboratory CDI diagnosis: Positive toxigenic culture and/or toxin detection in fecal samples using cell citoxicity neutralization assay. Patients: All in-patients from whom an appropriate fecal sample was submitted for CDI study between January 2000 and December 2009 were included. Nosocomial CDI case definition: A nosocomial CDI case was defined by the presence of either a positive stool test for C. difficile toxin or toxigenic C. difficile more than 48 hours after admission and that not have been diagnosed of CDI within the previous 28 days. Results: We identified 278 cases. Between 2000 and 2005 CDI incidence remained stable (0.52 and 0.54 cases/10.000 inpatient days in 2000 and 2005 respectively). During second half of this decade a four fold increase in incidence occurred (0.79, 1.48, 1.95 y 2.33 cases/10.000 in-patient days in 2006, 2007, 2008 y 2009 respectively). During de same period there was an increased hospitalary antibiotics consumption (from 56 to 67 defined daily doses/100 in-patient days between 2000 and 2009) that correlated with nosocomial CDI incidence (r = 0.98, p < 0.001). Hematology, ICU, Infectious Diseases and Gastroenterology Departments had the highest CDI incidence rates. Conclusions: CDI incidence has quadruplicate during second half of last decade coinciding with an increased use of antibiotics. Our results highlight the importance of CDI surveillance in hospitals, specially among high risk departments.

P417 Nosocomial Clostridium difficile infection (CDI) incidence in two Spanish referral hospitals. Secular trend during the last decade

Background: CDI is the main cause of antibiotic associated infectious diarrhea. Incidence, severity and burden on the healthcare system related to CDI have increased in last decade in many industrialized countries. Epidemiological data of CDI are scarce in Southern Europe. Aims: To evaluate incidence and secular trend of nosocomial CDI between 2000 and 2009 in two Spanish referral hospitals. To analyze the highest incidence rates across specialties. Methods: Setting: Two referral hospitals in the Barcelona metropolitan area. Design: Retrospective surveillance study. Laboratory CDI diagnosis: Positive toxigenic culture and/or toxin detection in fecal samples using cell citoxicity neutralization assay. Patients: All in-patients from whom an appropriate fecal sample was submitted for CDI study between January 2000 and December 2009 were included. Nosocomial CDI case definition: A nosocomial CDI case was defined by the presence of either a positive stool test for C. difficile toxin or toxigenic C. difficile more than 48 hours after admission and that not have been diagnosed of CDI within the previous 28 days. Results: We identified 278 cases. Between 2000 and 2005 CDI incidence remained stable (0.52 and 0.54 cases/10.000 inpatient days in 2000 and 2005 respectively). During second half of this decade a four fold increase in incidence occurred (0.79, 1.48, 1.95 y 2.33 cases/10.000 in-patient days in 2006, 2007, 2008 y 2009 respectively). During de same period there was an increased hospitalary antibiotics consumption (from 56 to 67 defined daily doses/100 in-patient days between 2000 and 2009) that correlated with nosocomial CDI incidence (r = 0.98, p < 0.001). Hematology, ICU, Infectious Diseases and Gastroenterology Departments had the highest CDI incidence rates. Conclusions: CDI incidence has quadruplicate during second half of last decade coinciding with an increased use of antibiotics. Our results highlight the importance of CDI surveillance in hospitals, specially among high risk departments.

Acute intestinal failure in surgical patients: an audit of incidence, management and outcomes in an irish hospital, and compliance with ASGBI guidelines

Acute intestinal failure (AIF) is defined as an inability to tolerate 80% of nutritional requirements delivered enterally for a minimum of 48 h. In surgical patients it commonly relates to abdominal sepsis, intestinal obstruction, or ileus. The prevalence of AIF in surgical units in Ireland has not previously been studied. We retrospectively audited the general surgical and ICU departments in St James's Hospital over a 3-month period to identify patients with AIF and followed their management and outcomes focusing on the need for artificial nutrition and surgical intervention. Fifty-four surgical patients (11.4% of surgical emergency admissions) were diagnosed with AIF over the 3-month period. Of these, 30 (55.6%) required nutritional support; 26 (48.2%) had surgical ± radiological intervention and 6 (11.1%) had radiological intervention alone. Abdominal sepsis was present in 17 (31.5%) patients, a group that required significantly longer parenteral (14.6 vs. 6.7 days, p 0.029) and enteral (13.9 vs. 2.2 days, p 0.005) nutrition than AIF patients without abdominal sepsis. AIF also took longer to resolve in (5.8 vs. 4.2 days, p 0.024) in sepsis versus nonsepsis patients. The majority of patients (n = 43, 80%) were referred to clinical nutrition teams early after having symptoms for 3.77 days (range 1-21) and 72% had complete nutritional assessment clearly documented. AIF is common, and can often be treated conservatively. Early linkage with nutrition services is recommended. Early diagnosis of abdominal sepsis is important as this cohort of patients can be particularly difficult to manage.

Evaluación del cumplimiento de cabeceros elevados entre 30–45 o en pacientes intubados

Aims To determine compliance of the standard “semirecumbent position between 30–45 o in patients with artificial airway (AA)”. To know the opinion of the professionals on this issue. Material and methods An observational, prospective study was carried out in December 2009 in the ICU department of a tertiary hospital that excluded the limitation of therapeutic effort, prone position and antitrendelemburg. Data collected: headrest angle, professional experience of the nurse, shift, perception of the auditor, diagnostic, type of AA (tracheostomy or endotracheal tube), mechanical ventilation (MV) (yes/no) and enteral nutrition (EN). Nurses were surveyed to verify if they knew the standard, if they complied with it, the method used and their suggestions. We used the Student's t test and ANOVA for multivariable analysis, and Fisher's χ 2; p < 0.05 = significant. Results A total of 546 valid measurements were obtained from 53 patients, of which 40.9% had the correct semirecumbent position (30–45 o). Professionals with < 1 year of experience were those who raised the headrest the least, with only 26.4% of these measurements over 30 o. The standard was met in only 34.8% of the neurocritical patients (NC) vs non NC (46.7%) (p < 0.05). It was < 30 o in 29.2% of patients with tracheostomy vs 44% measurements performed on patients with TOT (p < 0.05). There were no differences between shifts, the use of MV or EN. Diagnostic accuracy of the auditor: sensitivity: 91.6%; specificity: 72.5%; positive predictive value: 70.2%; negative predictive value (NPV): 92.4%. 97.9% of responders know the standard. Visual judgment was used in 97.2% of the cases. Conclusions Measured compliance was less than 50% although the standard is well known by the nursing team. Even though the subjective perception has a high NPV, it does not achieve the standard.

Arenavirus outbreak with nosocomial transmission: infection control and the lessons learned

Anaesthesiology is generally practised in operating theatres, under controlled circumstances and with some degree of foresight. However, this expertise is frequently being sought in areas like the ICU and emergency department and during emergency medical evacuation. As such, a more than rudimentary knowledge of infection control principles is required.