Publications (5)10.49 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Background Antimicrobial resistance is an urgent public health problem. There is very limited information regarding nurse practitioners' attitudes, perceptions, and knowledge about antibiotic use and resistance.Methods Web-based anonymous survey in a university-affiliated hospital.ResultsMost respondents agreed that antimicrobial resistance is a problem locally and nationally, were concerned about resistance in the community when prescribing antibiotics, and agreed that more appropriate use of antibiotics would decrease resistance. There is a paucity of knowledge in the management of anaerobic infections and resistant gram-negative bacteremia.Conclusion Incorporating nurse practitioners into antimicrobial stewardship programs could improve evidence-based practices and antimicrobial use.
- [Show abstract] [Hide abstract] ABSTRACT: Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections. Quasi-experimental study. Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area. All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department. Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist. The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time. We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.
- [Show abstract] [Hide abstract] ABSTRACT: We describe the investigation and control of a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae outbreak in a 20-bed surgical intensive care unit during the period from January 1, 2009 through January 1, 2010. Nine patients were either colonized or infected with a monoclonal strain of K. pneumoniae. The implementation of a bundle of interventions on July 2009 successfully controlled the further horizontal spread of this organism. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against most beta-lactams. Despite having been identified worldwide, studies describing successful control of KPC outbreaks are few. Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak. Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in the Miami metro area. Using the Microbiology database, all ertapenem resistant K. pneumoniae obtained from clinical specimens from January 1, 2009 to November 1, 2009 were identified. Additionally, 2 point prevalence surveys (using rectal cultures) were performed. Environmental cultures were also obtained. Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution. Because all infections were identified in the SICU, a bundle intervention was enforced in this unit on 7/10/09 consisting of daily 2% chlorhexidine baths, point prevalence surveys and environmental cultures, enhanced environmental cleaning, contact precautions, and staff education. One-to-one ratio was implemented among all environmental, respiratory, and nursing personnel assigned to KPC rooms. Results: Between January 1 and November 1, 2009 a total of 9 patients (7 men) carrying KPC-producing K. pneumoniae were identified in the SICU. Six patients were identified prior to the bundle intervention. The last KPC was identified on August 11, 2009. Median age of patients was 60 yrs (range: 25-75). Length of stay ranged from 15 to 150 days (mean, 84.2). Seven of 9 pts (77.7%) underwent surgical intervention during their admission, and 5/9 (71.4%) had solid organ transplants (2 liver, 1 kidney, 1 pancreas, 1 multi-visceral). The mean Apache II score was 18.3 (range, 7-28) and the Charlson comorbidity index ranged between 1-7 (mean, 5.3). A total of 6 patients (67%) died during hospitalization; 1 is still hospitalized. Four of 9 patients died from sepsis. Subsequent rectal surveys done in 8/09 among all SICU patients failed to show colonization with KPC producing enteric Gram negative rods. KPC K. pneumoniae strains were isolated from the lungs (5), abdominal fluid (2), blood (1) and urine (1). These strains were also isolated from mattresses, bed rails, ventilator tubing, intravenous pole, vitals monitors and TV monitors. Nine clinical isolates underwent KPC PCR and PFGE. All K. pneumoniae were found to be monoclonal KPC-3 producers. Colistin susceptibilities were <=1, except in one isolate which had an MIC of 16. Additionally, an imipenem-resistant Pseudomonas aeruginosa found during one rectal survey was found to be KPC-3 producer. Conclusions: A monoclonal KPC-3 producing K. pneumoniae outbreak in a SICU was successfully controlled by a bundle intervention.
Conference Paper: Acute Care Nurse Practitioners (ACNP): The Intensivist Model[Show abstract] [Hide abstract] ABSTRACT: Purpose: The role of the nurse practitioner is evolving to meet the needs of health care systems and patients. The mandate to limit physician residency hours in the United States has limited the availability of skilled care providers within the acute and critical care settings. Significance: The critically chronically ill patients have increased acuity and require ongoing bedside management and intervention. This new complex patient has evolved from a few underlying conditions to a multidimensional patient with chronic conditions, and long term sequelae. Strategy and Implementation: In critical care units, this requires high quality, evidence-based bedside care. In the 40-bed SICU of a large academic medical center, the ACNP group has grown from a single nurse practitioner to a group of 16. The role is expansive and encompasses bedside management, education of nurses and resident physicians, and multiple dimensions of family centered care. This role has required increased procedural skills including bedside percutaneous tracheostomy, pulmonary artery catheter placement, intubations, chest tubes and multiple other procedures. The evolution of this program has advanced nursing practice at the bedside and has increased support for nurses in this intense critical care ICU setting. The ACNP service has facilitated a decrease in infection rates, research oriented programs and enhancement of a family centered care environment. This program has also developed an educational program for all ACNPs within an enhanced degree educational program. Evaluation: The ACNP's continuous bedside management has enhanced patient outcomes, changed the financial constraints, and decreased patient complications. The knowledge to facilitate the recovery of critically ill individuals is based on organized strategic activity and continuity of care. Implications for Practice: The goal of this clinical presentation is to bring to the forefront the advantages of expanding the role of nurse practitioners within acute and critical care settings highlighting the benefits this new role holds for improving outcomes. The discussion will include the development of a fellowship.
University of Miami
كورال غيبلز، فلوريدا, Florida, United States
- Department of Surgery
Jackson Memorial HospitalMiami, Florida, United States