patient safety in the icus - european...
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1. Overview
Objective:„Providing policymakers, managers and healthcare workers with theknowledge on the implementation of improvement measures (bundles) in patient care for the prevention and management of healthcare-associated infections (HAIs).“
Project mangement:• Barcelona, Spain• Brussels, Belgium• Freiburg, Germany• Msida, Malta• Nijmegen, Netherlands• Rome, Italy
2. Context/Public health problemHealthcare-associated infections (HAIs) are considered to be the
greatest risk for hospitalised patients, leading to a substantial increase in morbidity, mortality and costs in EU member states.
• Approx. 5-10% of hospitalised patients acquire HAIs while receivingtreatment for medical or surgical conditions.
• There are approximately 4.1 million HAIs and 30-50,000 attributabledeaths each year.
3. Key activities (1)Prevention of Catheter-Related Blood Stream Infections
• Survey of policies and practices for the prevention and management of catheter-related bloodstream infections (CRBSIs) in European hospitals
• Identification of implementation tools and momentous gaps in the adoption of the central venous line bundle (CVL-Bundle) for the prevention and control of CRBSIs
3. Key activities (2)Prevention of Ventilator-Associated Pneumonia (VAP)
• Survey of policies and practices for the prevention and management of ventilator-associated pneumonia (VAP) in European intensive care units (ICUs)
• Identification of the most powerful implementation tools and the momentous gaps in the adoption of the ventilator bundle(V-Bundle) for the prevention and control of VAP
3. Key activities (3)Implementation of strategies to increase patient safety in the ICU
• Bringing together pilot experiences from EU hospitals• Learning to improve complex systems of care• Providing an overview of evidenced-based organisational
strategies
3. Key activities (5)
Optimal Experimental Design for Future Studies• Providing a base for future testing of the clinical effectiveness
of implementation processes for bundled interventions in a diverse sample of European hospitals
• Identification of the optimal study design balanced betweenstatistical requirements and feasibility
A total of 1,730 replies from 77 countries; →1,281 replies from 16 countries used to compute weighted European estimates:
• Care for intubated patients, combined with measurement of compliance to guideline for hand hygiene:57% of the respondents (95% CI: 54–60)
• Systematic daily interruption of sedation and weaning protocol: Only 28% (95% CI: 24–33)
• Oral care protocol (e.g. with chlorhexidine): Only 27% (95%: 23–30)
• Provision of estimated outcome data (VAP rate) in the ICU: Only 20% (95% CI: 17–22)
• However, 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures will stimulatequality improvement and patient safety“.
4. Results (2)
The availability of VAP surveillancesystems + written standards formanagement of mechanically ventilatedpatients in the ICU are positively associatedwith → compliance with VAP preventionmeasures and, therefore, should befostered on a policy level.
4. Results (3)
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Written clinical guidelines for VAP prevention
• Forum on Quality and Safety in Healthcare, Nice, France, April 20-23, 2010. International conference with approximately 2.000 participants- Active workshop attendance
• ECCMID Vienna, Austria April 10-12, 2010. International conference with approximately 8.000 participants- Poster presentation at network corner
• ICAAC, Boston MA, September 11-15, 2010. International conference with approximately 10.000 participants - Presentation at network corner
• Forum on Quality and Safety in Healthcare, Amsterdam, NL, April 5-8, 2010. International conference with approximately 2.000 participants- Poster presentation at network corner
• ECCMID Milan, Italy, May 7-10, 2011 International conference with approximately 8.000 participants - Poster presentation at network corner
• ECCMID London, UK, April 1-3, 2012 International conference with approximately 8.000 participants - Poster presentation at network corner
- European epidemiology of MRSA bacteraemia: effective prevention requires more than just good hospital policies, M.A Borg, E. Scicluna, U. Frank on behalf of the Implement Project Group
- Evidence-based recommendations to increase the appropriate usage of antibiotics in ICU patients: a 5-day bundle. De Angelis*, P. De Santis, F. Di Muzio, C. Palazzolo, A. Brink-Huis, M. Hulscher, U. Frank, M. Antonelli, E. Tacconelli
• ECCMID Berlin, Germany, April 21013 International conference with approximately 8.000 participants- Poster presentation at network corner
Conference dissemination activities
5. Sustainability and Transferability
Gen
eral
izab
ilty There is a wide range of
potential study designs, however, to yield internallyvalid results, randomizationis needed.
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