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Conference Highlights: CHEST 2011

New research presented at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, from October 22-26 in Honolulu addressed many important topics in pulmonary, critical care, and sleep medicine. The features below highlight just some of the studies that emerged from the meeting. » Pain Common for Pulmonologists Performing Bronchoscopy » Guideline Effects on CRBSI  » An Effective Computer Model for Smoking Cessation  Pain Common for Pulmonologists Performing Bronchoscopy The Particulars: Much attention has been paid to ergonomics and overuse injury in gastroenterology and surgery settings. However, little attention has been paid on other medical specialties, such as bronchoscopy. Data Breakdown: Researchers in New York gave an online questionnaire to 132 pulmonologists to assess pain and injury while performing bronchoscopy. Nearly 40% reported experiencing pain while operating a bronchoscope. Among this group, 22% reported recurring pain, which mostly occurred in the shoulder, back, wrist, neck, and thumb. This pain appeared to be associated with overuse and height less than 5’7″. Only 38% of pulmonologists who felt pain attempted to modify their workspace. Take Home Pearl: Interventions may be needed to prevent musculoskeletal injuries among pulmonologists who perform bronchoscopies. Guideline Effects on CRBSI [back to top] The Particulars: The Institute of Health Improvement Bundle was created in 2006 as a guideline to help hospitals reduce catheter-related bloodstream infection (CRBSI) rates. Whether this goal has been achieved remains uncertain. Data Breakdown: An investigation from researchers in Tampa retrospectively reviewed 895 patient charts for people admitted to two hospitals who required a central venous catheter (CVC) between 2007, when the guidelines were first released, and 2010. The rate of CRBSIs decreased from 4.38 per...

A Quality Improvement Strategy to Reduce Infection Rates

An estimated 80,000 patients each year experience catheter-related bloodstream infections during treatment in hospitals, about 31,000 of whom die, and the cost of treating these infections may be as high as $3 billion nationally. In 2009, the United States Department of Health and Human Services called for a 50% reduction in catheter-related infections nationwide by 2012. Institutions throughout the U.S. have initiated different interventions to accomplish this feat, but with varying degrees of success. Reducing Bloodstream Infection Rates Several years ago, the Keystone ICU Project was launched. Developed by Johns Hopkins University in partnership with the Michigan Hospital Association, the project utilizes a checklist for healthcare providers to follow when placing catheters. The checklist highlights five basic steps to decrease catheter-related bloodstream infection rates: 1. Promoting hand washing. 2. Full barrier precautions. 3. Skin antisepsis with chlorhexidine. 4. Avoiding the femoral site during catheter insertion. 5. Removing unnecessary catheters. Along with the checklist, the Keystone ICU Project promotes a culture of safety consisting of safety science education, training in the identification of potential safety problems, development of evidence-based solutions, and measurement of improvements. A key aspect of the program was to empower all caregivers—regardless of their level of experience—to question each other and stop procedures if safety is compromised. Profound New Data on Eliminating Infections In the January 31, 2011 issue of BMJ, my colleagues and I had a study published. It found that the virtual elimination of catheter-related bloodstream infections in ICUs throughout Michigan through the Keystone Project correlated with a 10% reduction in mortality rates in the state when compared to surrounding states. Using Medicare claims data, we...
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