ABSTRACT: INTRODUCTION: As data from Clostridium difficile infection (CDI) in intensive care unit (ICU) are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI. METHODS: We compared patients with ICU-acquired CDI (watery or unformed stools occurring > 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring > 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea. RESULTS: Among 5260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25thQ ; 75thQ [0 ; 2] days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (Cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 - 1.35, p=0.3) nor the adjusted mortality to confounding variables (CSHR=0.81, 95% CI 0.4-1.64, p=0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR=0.64, 95% CI 0.34-1.21, p=0.17), nor the mortality adjusted to confounding variables (Cause specific hazard ratio (CSHR) =0.71, 95% confidence interval (CI) 0.38 - 1.35, p=0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days +/- 9.3 days, (p=0.4) in comparison to the diarrheic population, and 6.3 days +/- 4.3 (p=0.14) in comparison to the general ICU population. CONCLUSIONS: If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
Critical care (London, England) 11/2012; 16(6):R215. · 4.61 Impact Factor
ABSTRACT: To test the effects of three multifaceted safety programs designed to decrease insulin administration errors, anticoagulant prescription and administration errors, and errors leading to accidental removal of endotracheal tubes and central venous catheters, respectively. Medical errors and adverse events are associated with increased mortality in intensive care patients, indicating an urgent need for prevention programs.
Multicenter cluster-randomized study.
One medical intensive care unit in a university hospital and two medical-surgical intensive care units in community hospitals belonging to the Outcomerea Study Group.
Consecutive patients >18 yrs admitted from January 2007 to January 2008 to the intensive care units.
We tested three multifaceted safety programs vs. standard care in random order, each over 2.5 months, after a 1.5-month observation period.
Incidence rates of medical errors/1000 patient-days in the multifaceted safety program and standard-care groups were compared using adjusted hierarchical models. In 2117 patients with 15,014 patient-days, 8520 medical errors (567.5/1000 patient-days) were reported, including 1438 adverse events (16.9%, 95.8/1000 patient-days). The insulin multifaceted safety program significantly decreased errors during implementation (risk ratio 0.65; 95% confidence interval [CI] 0.52-0.82; p = .0003) and after implementation (risk ratio 0.51; 95% CI 0.35-0.73; p = .0004). A significant Hawthorne effect was found. The accidental tube/catheter removal multifaceted safety program decreased errors significantly during implementation (odds ratio [OR] 0.34; 95% CI 0.15-0.81; p = .01]) and nonsignificantly after implementation (OR 1.65; 95% CI 0.78-3.48). The anticoagulation multifaceted safety program was not significantly effective (OR 0.64; 95% CI 0.26-1.59) but produced a significant Hawthorne effect.
A multifaceted program was effective in preventing insulin errors and accidental tube/catheter removal. Significant Hawthorne effects occurred, emphasizing the need for appropriately designed studies before definitively implementing strategies.
clinicaltrails.gov Identifier: NCT00461461.
Critical care medicine 09/2011; 40(2):468-76. · 6.37 Impact Factor
ABSTRACT: The aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care.
Between days 3 and 5, perceptions by families and ICU staff of family involvement in care were collected prospectively at a single center. Family members completed the Hospital Anxiety and Depression Scale (HADS) and a satisfaction scale (Critical Care Family Needs Inventory). Nurses recorded care provided spontaneously by families. Characteristics of patient-relative pairs (n = 101) and ICU staff (n = 45) were collected. Patients described their perceptions of family participation in care during a telephone interview, 206 ± 147 days after hospital discharge.
The numbers of patient-relative pairs for whom ICU staff reported favorable perceptions were 101 (100%) of 101 for physicians, 91 (90%) for nurses, and 95 (94%) for nursing assistants. Only 4 (3.9%) of 101 families refused participation in care. Only 14 (13.8%) of 101 families provided care spontaneously. The HADS score showed symptoms of anxiety in 58 (58.5%) of 99 and of depression in 26 (26.2%) of 99 family members. The satisfaction score was high (11.0 ± 1.25). Among patients, 34 (77.2%) of 44 had a favorable perception of family participation in care.
Families and ICU staff were very supportive of family participation in care. Most patients were also favorable to care by family members.
Journal of critical care 04/2010; 25(4):634-40. · 2.13 Impact Factor