PubMed · 9535402
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G L Hortin, G Csako. 1998. Critical values, panic values, or alert values?. https://doi.org/10.1093/ajcp%2F109.4.496a
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BACKGROUND: Nosocomial infection is a leading complication in intensive care units. Although hand hygiene is the single most efficient preventive measure, compliance with this simple action remains low. OBJECTIVES: To assess the effect of an intervention to promote hand hygiene and to investigate risk factors for noncompliance in intensive care units. METHODS: We performed 7 observational surveys and implemented a promotional campaign after baseline in medical, surgical, and pediatric intensive care units of a teaching hospital. Health care workers were observed during routine patient care. The intervention consisted of a hospitalwide promotional campaign, including observation and performance feedback, posters display, and distribution of individual bottles of alcohol-based handrub. The main outcome measure was compliance with hand hygiene through handwashing or handrubbing. RESULTS: We observed 2743 opportunities for hand hygiene distributed over 248 periods. Overall compliance increased from 38.4% to 54.5% during the study (P<.001). Although recourse to handwashing remained stable at around 30%, handrubbing increased from 5.4% at baseline to 21.7% at the last survey (P<.001). Compliance increased among nurses and nursing assistants, but remained stable among physicians. Handwashing compliance decreased, on average, by 4.7% for an increase of 10 opportunities for hand hygiene per hour of patient care (P<.001), whereas no such association existed for handrubbing. CONCLUSIONS: Our intervention induced a marked and sustained increase in compliance with hand hygiene. In intensive care units, less time-consuming handrubbing might replace standard handwashing and overcome the barrier of time constraints.
INTRODUCTION: Performing early tracheostomy is a possible solution during prolonged ventilation in order to decrease late complications. Considering the duration of procedure and the hazards concerning the patient transport the risk of operation is high in the critically ill patients. Therefore bedside percutaneous tracheostomy (PCT) plays an increasing role in intensive therapy. AIMS: For emphasizing the widening role of PCT in intensive care the procedures were analysed in the mirror of international experiences. After introducing short history of the procedure the improvement of techniques is presented. METHODS: A description of the experiences with the three main techniques is presented based on early original publications. Analyzing the results of comparative studies the risks and benefits of different methods were investigated in focus of the early and late complications. RESULTS: Comparing the percutaneous and surgical techniques significantly lower number of late complications were observed in PCT groups by several studies but there is a debate concerning the early hemorrhagic complications. Among the percutaneous techniques there was no significant difference between the occurrence of complications. The greatest experience has been gathered with the sequential dilatation technique. The duration of procedure was the only significant difference between the sequential and forceps dilatational technique. CONCLUSIONS: According to the international literature the percutaneous tracheostomy is the procedure of choice for prolonged airway management for high-risk intensive care patients. Concerning the elevated risk of operation the percutaneous techniques have significantly shorter duration and lower rate of late complications. Among the different percutaneous techniques the only significant difference was the duration of the procedure. The shortest procedure was the forceps dilatational technique.
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