Critical care clinics
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Critical care clinics · Jan 2013
ReviewPreventing clostridium difficile infection in the intensive care unit.
Clostridium difficile is a formidable problem in the twenty-first century. Because of injudicious use of antibiotics, the emergence of the hypervirulent epidemic strain of this organism has been difficult to contain. The NAP1/BI/027 strain causes more-severe disease than other widely prevalent strains and affects patients who were not traditionally thought to be at risk for Clostridium difficile infection. Critically ill patients remain at high risk for this pathogen, and preventive measures, such as meticulous contact precautions, hand hygiene, environmental disinfection, and, most importantly, antibiotic stewardship, are the cornerstones of mitigation in the intensive care unit.
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Critical care clinics · Jan 2013
ReviewAchieving zero central line-associated bloodstream infection rates in your intensive care unit.
Central line-associated bloodstream infection (CLABSI) is one of the most common health care-associated infections in the United States. The costs associated with CLABSIs include an estimated 28,000 deaths in the intensive care unit and up to $2.3 billion annually. Best practice guidelines, checklists, and establishing a culture of safety in hospitals are all initiatives designed to reduce the rate of CLABSI to zero.
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Critical care clinics · Jan 2013
ReviewDoes value-based purchasing enhance quality of care and patient outcomes in the ICU?
As health care expenditures increase, payers, including the Centers for Medicare and Medicaid Services, are moving away from reimbursement based on types and volume of services to an emphasis on quality of provided care, an approach called value-based purchasing (VBP). Because it is tied to reimbursement, VBP creates economic motivation to measure and improve care. VBP is proceeding without high-level evidence supporting its effectiveness in improving health care quality. Rising health care costs, however, make VBP an attractive approach for curtailing costs and emphasizing improved quality, and VBP is likely to become a more prevalent mechanism of reimbursement for providers and facilities.
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Critical care clinics · Jan 2013
ReviewPreventing catheter-associated urinary tract infections in the intensive care unit.
Urinary tract infection remains one of the most common healthcare-associated infections in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. Duration of catheterization is the most important risk factor for developing catheter-associated urinary tract infection (CAUTI). ⋯ Anti-infective catheters may be considered in some settings. Successful implementation of these measures has decreased urinary catheter use and CAUTI.
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A large fraction of intensive care unit (ICU) patients with respiratory failure who survive their critical illness leave the hospital with substantial neuromuscular weakness. In light of this reality, a shift in the approach to critical care management has begun. This viewpoint has broadened the perspective of ICU care providers beyond the narrow goal of leaving the ICU alive to a broader notion focused on minimizing the complications that accompany the inherent noxious nature of ICU care. Mobilization of mechanically ventilated patients is feasible, safe, and carries the potential for tremendous benefit for our patients.