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Biomedical subjects

Sanjay Saint

Publications and source records attributed to Sanjay Saint.

At least 37 records · Page 2Linked to original sources
PubMed2006

Risk factors for nosocomial urinary tract-related bacteremia: a case-control study.

BACKGROUND: Risk factors for bacteremia in patients with hospital-acquired bacteriuria are largely unknown. Given the morbidity and costs associated with nosocomial bacteremia, determining risk factors could enhance the safety of hospitalized patients. METHODS: We conducted a case-control study within the Veterans Affairs Puget Sound Health Care System. A patient hospitalized between 1984 and 1999 from whom a urine culture and a blood culture grew the same organism > or =48 hours after admission was considered a case. Control patients were those with significant bacteriuria detected > or =48 hours after admission who did not have a positive blood culture. We used logistic regression to determine independent risk factors for bacteremia. RESULTS: There were 95 cases and 142 controls. Independent, statistically significant predictors of bacteremia included immunosuppressant therapy within 14 days of bacteriuria (odds ratio [OR], 8.13); history of malignancy (OR, 1.94); male sex (OR, 1.88); cigarette use in the past 5 years (OR, 1.26); number of hospital days before bacteriuria (OR, 1.03); and antibiotic use within 3 days of bacteriuria (OR, 0.76). Corticosteroid use within 7 days of bacteriuria predicted bacteremia in patients <70 years old (OR, 14.24). Similarly, patients <70 years old were more likely to develop bacteremia if they had diabetes mellitus (OR, 6.19). CONCLUSION: Delineating risk factors for nosocomial urinary tract-related bacteremia can help target appropriate preventive practices at the highest risk patients.

Adult↗
PubMed2006

Reading habits of infection control coordinators in the United States: peer-reviewed or non-peer-reviewed evidence?

BACKGROUND: Because evidence-based health care is taking on increasing importance, we surveyed a national sample of infection control coordinators on their reading habits to discern which and how often various media are utilized. METHODS: Infection control coordinators at 797 hospitals in the United States were mailed a survey asking which peer-reviewed journals and other publications they subscribe to, their perception of the quality of the infection control articles provided by each, and the extent to which they use various resources for their work. RESULTS: The survey response rate was 74%. Infection control coordinators spend a mean of 3.6 hours/week reading journals or periodicals. Resources identified as most useful included the Centers for Disease Control and Prevention (CDC) Web site (52%), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) text (11%), and the APIC e-mail list (8%). Proportion of subscribers was highest for the American Journal of Infection Control (84%) and Infection Control Today (72%). The top 3 journals ranked on a scale of 1 to 10 for quality of infection control articles were Infection Control & Hospital Epidemiology (8.0), the American Journal of Infection Control (7.5), and the New England Journal of Medicine (7.4). The American Journal of Infection Control (85%) and Infection Control & Hospital Epidemiology (72%) were the most frequently used peer-reviewed sources of information, whereas Morbidity and Mortality Weekly Report (85%) and Hospital Infection Control (63%) ranked at the top for non-peer-reviewed periodicals. CONCLUSION: Infection control coordinators devote limited time to reading and critically appraising published evidence and rely heavily on sources that provide rapid access to information or evidence summaries, suggesting a growing need for easy-to-read, reliable sources of information about evidence-based infection prevention and control practices.

Attitude of Health Personnel↗
PubMed2006

Improving the safety of intravenous admixtures: lessons learned from a Pentostam overdose.

CASE STUDY: Weaknesses in the multistep process of admixture preparation and administration resulted in a patient with cutaneous leishmaniasis (CL) receiving a 10-fold intravenous (IV) overdose of Pentostam (sodium stibogluconalte), a rarely used drug. LESSONS LEARNED: A review of this adverse event resulted in five recommendations: (1) Provide staffing continuity among pharmacists and pharmacy technicians preparing and nurses administering the admixture; (2) Take time to ensure thorough and deliberative consideration ofquestions or concerns about admixture preparation; (3) Use due diligence in performing double checks of admixture calculations; (4) Know the drug and seek clarification when appropriate; and (5) Examine label information carefully. PROGRESS UPDATE: Two changes were made to improve patientsafety. First, a form was developed to accompany the preparation of complex IV drugs, including chemoltherapy solutions and nonformulary IV admixtures; the form is consistently used. Second, the pharmacy service developed information sheets for 12 high-risk drugs frequently used in IV admixtures. DISCUSSION: The medical center had processes in place to prevent medication errors, yet an error occurred nonetheless. Weaknesses were identified in staff communication, quality assurance checks, and product labeling. Also, nurses and pharmacists had less than adequate information about new or unusually dosed medications.

Adult↗
PubMed2006

Brief report: incidence, etiology, risk factors, and outcome of hospital-acquired fever: a systematic, evidence-based review.

OBJECTIVES: Temperature is universally measured in the hospitalized patient, but the literature on hospital-acquired fever has not been systematically reviewed. This systematic review is intended to provide clinicians with an overview of the incidence, etiology, and outcome of hospital-acquired fever. DATA SOURCES: We searched MEDLINE (1970 to 2005), EMBASE (1988 to 2004), and Web of Knowledge. References of all included articles were reviewed. Articles that focused on children, fever in the developing world, classic fever of unknown origin, or specialized patient populations were excluded. REVIEW METHODS: Articles were reviewed independently by 2 authors before inclusion; a third author acted as arbiter. RESULTS: Of over 1,000 studies reviewed, 7 met the criteria for inclusion. The incidence of hospital-acquired fever ranged from 2% to 17%. The etiology of fever was infection in 37% to 74%. Rates of antibiotic use for patients with a noninfectious cause of fever ranged from 29% to 55% for a mean duration of 6.6 to 9.6 days. Studies varied widely in their methodology and the patient population studied. CONCLUSIONS: Limited information is available to guide an evidence-based approach to hospital-acquired fever. We propose criteria to help standardize future studies of this important clinical situation.

Cohort Studies↗
PubMed2006

Condom versus indwelling urinary catheters: a randomized trial.

OBJECTIVES: To compare condom and indwelling urinary catheters in terms of infection risk and patient satisfaction. DESIGN: A prospective, randomized, unblinded, controlled trial. SETTING: An academically affiliated Veterans Affairs Medical Center. PARTICIPANTS: Hospitalized men aged 40 and older who required a urinary collection device. MEASUREMENTS: The incidence of adverse outcomes (bacteriuria, symptomatic urinary tract infection (UTI), or death) and patient device-related satisfaction as determined according to a questionnaire. Dementia status was recorded to assess effect modification by the presence of dementia. RESULTS: Seventy-five subjects were randomized: 41 receiving an indwelling catheter and 34 a condom catheter. The incidence of an adverse outcome was 131/1,000 patient-days with an indwelling catheter and 70/1,000 patient-days with a condom catheter (P=.07). The median time to an adverse event was 7 days in the indwelling group and 11 days in the condom group. After adjusting for other risk factors, it was found that condom catheter use reduced adverse outcomes (P=.04). Patients without dementia who had an indwelling catheter were approximately five times as likely to develop bacteriuria or symptomatic UTI or to die (hazard ratio=4.84, 95% confidence interval=1.46-16.02) as those with a condom catheter (P=.01). Patients reported that condom catheters were more comfortable (P=.02) and less painful (P=.02) than indwelling catheters. CONCLUSION: The use of condom catheters is less likely to lead to bacteriuria, symptomatic UTI, or death than the use of indwelling catheters. This protection is especially apparent in men without dementia.

Adult↗
PubMed2005

Effects of work hour reduction on residents' lives: a systematic review.

CONTEXT: The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents. OBJECTIVE: To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life. DATA SOURCES: We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings. STUDY SELECTION: Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States. DATA EXTRACTION: For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form. DATA SYNTHESIS: Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct. CONCLUSIONS: Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.

Education, Medical↗
PubMed2005

Impact of patient risk on the hospital volume-outcome relationship in coronary artery bypass grafting.

BACKGROUND: The impact of surgical risk on the relationship between hospital volume and outcomes in coronary artery bypass grafting (CABG) is uncertain. We assessed (1) whether in-hospital mortality rates differ across lower- and higher-volume hospitals by expected surgical risk and (2) whether high-risk patients are more likely to undergo CABG at low-volume centers. METHODS: We used clinical data on 27,355 adults who underwent CABG at 68 hospitals in California between 1997 and 1998. Hospitals were divided into low-volume (n=44), medium-volume (n=19), and high-volume (n=5) categories on the basis of tertiles of annual CABG volume. Using hierarchical logistic regression and log-binomial regression models, we assessed for differences in in-hospital mortality rates across hospital volume categories and the likelihood of CABG being performed in each hospital volume category after adjusting for expected surgical risk. RESULTS: Differences in adjusted in-hospital mortality rates between low- and high-volume centers rose as the expected risk of in-hospital death increased: 0.8% vs 0.4% at the 20th risk percentile and 3.8% vs 2.5% at the 80th risk percentile (P<.001 for all comparisons). While a similar trend was seen between medium- and high-volume centers, absolute differences were substantially smaller. The likelihood of patients having surgery at a low-volume center also rose significantly with expected surgical risk (relative risk of undergoing CABG at a low-volume center for patients at 80th vs 20th risk percentile, 1.29 [95% confidence interval, 1.14-1.51; P<.001]). CONCLUSION: High-risk patients are more likely to undergo CABG at low-volume facilities where their risk of dying is higher.

Aged↗
PubMed2005

Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.

BACKGROUND: Studies on adherence to infection control policies in nursing homes (NHs) are limited. This pilot study explores the use of various infection control practices and the role of infection control practitioners in southeast Michigan NHs. METHODS: A 43-item self-administered questionnaire and explanatory cover letter were mailed to 105 licensed NHs in southeast Michigan. A second mailing was sent to the nonresponders 4 weeks later. RESULTS: Significant variability existed in adoption of various infection control measures with respect to time spent in infection control activities (50% of facilities having a full-time infection control practitioner), definitions used in monitoring infections, and immunization rates (influenza: range, 0%-100%; mean, 73.2%; pneumococcal: range, 0%-100%; mean, 38.5%). CONCLUSION: Although strides have been made in infection control research in NHs, significant variations exist in implementation of infection control methods and guidelines. Future research should focus on identifying barriers to infection control in NHs.

Cross Infection↗
PubMed2005

Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis.

PURPOSE: To assess the efficacy of subglottic secretion drainage in preventing ventilator-associated pneumonia. METHODS: We performed a comprehensive, systematic meta-analysis of randomized trials that have compared subglottic secretion drainage with standard endotracheal tube care in mechanically ventilated patients. Studies were identified by a computerized database search, review of bibliographies, and expert consultation. Summary risk ratios or weighted mean differences with 95% confidence intervals were calculated for each outcome using a fixed-effects model. RESULTS: Of 110 studies retrieved, five met the inclusion criteria and enrolled 896 patients. Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia by nearly half (risk ratio [RR] = 0.51; 95% confidence interval [CI]: 0.37 to 0.71), primarily by reducing early-onset pneumonia (pneumonia occurring within 5 to 7 days after intubation). Although significant heterogeneity was found for several endpoints, this was largely resolved by excluding a single outlying study. In the remaining four studies, which recruited patients expected to require >72 hours of mechanical ventilation, secretion drainage shortened the duration of mechanical ventilation by 2 days (95% CI: 1.7 to 2.3 days) and the length of stay in the intensive care unit by 3 days (95% CI: 2.1 to 3.9 days), and delayed the onset of pneumonia by 6.8 days (95% CI: 5.5 to 8.1 days). CONCLUSION: Subglottic secretion drainage appears effective in preventing early-onset ventilator-associated pneumonia among patients expected to require >72 hours of mechanical ventilation.

Confidence Intervals↗