Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Operating Room Information Systems”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources
PubMed2005

Pilot study of preoperative heart rate variability and adverse events in children emerging from anesthesia.

OBJECTIVE: To assess correlations between preoperative heart rate variability (a noninvasive measure of autonomic cardiac activity) and adverse respiratory events during anesthesia emergence in children. DESIGN: Case control study. SETTING: Tertiary care pediatric operating room. PATIENTS: Sixty-one children, aged 8 months to 13 yrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate power spectra were obtained from two 5-min immediate-preoperative electrocardiographs with an orthostatic posture change interposed and (n = 32) from a 24-hr preoperative Holter monitor. Observers recorded emergence from standardized anesthesia for coughing, laryngospasm, and desaturation. Low-frequency/high-frequency ratios (LF/HF) were derived from power spectra of heart rate variability. The orthostatic change in heart rate variability derived from brief preoperative recordings was significantly different if adverse events occurred during emergence from anesthesia (LF/HF standing/LF/HF supine = 1.3 vs. 2.8, p = .019). Holter-derived heart rate variability had no correlation with adverse events. Receiver operating characteristic analysis showed a sensitivity of 85% and specificity of 52% for predicting adverse events with preoperative recordings. CONCLUSIONS: This study provides new information regarding pathophysiology in children with upper respiratory infection. The magnitude of difference demonstrated is insufficient to propose this method as a preoperative screening test.

Adolescent↗
PubMed1999

The process of converting to a near filmless operation at the University of Utah, Department of Radiology.

The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a one-time change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed.

Diagnostic Imaging↗
PubMed2000

[An automated electronic anesthesia record using a hospital LAN (local area network)].

We have developed an automated electronic anesthesia record system using a hospital LAN. As the number of monitors we can use in the operating room is increasing, it is impossible to record all physiologic parameters in a handwritten anesthesia record. Physiologic parameters are recorded every 10 seconds from the anesthesia monitor. An operation ordering system by a hospital LAN has been completed and the patient's data are stored in a host computer, and we can use its data for the automated electronic anesthesia record preoperatively. The advantages of the automated electronic anesthesia record are continuous high quality, more data collection than the handwritten anesthesia record, and the electronic database. During a critical period, the anesthesiologist is too busy to plot physiologic parameters but the automated electronic anesthesia record is reliable and accurate. Disadvantage of the automated electronic anesthesia record is some practice required to input clinical events such as drug administration. The handwritten anesthesia record is easy to use and economical. Ergonomic problems still remain to be solved for wider acceptance of the automated electronic anesthesia record in clinical practice. At the end of the operation, intraoperative data are sent to a host computer and the anesthesia record is printed. We can use this database for clinical research and retrospective case reviews. The implementation of the automated electronic anesthesia record in anesthesia practice will improve quality of patient care.

Anesthesia↗
PubMed2006

INCOMING!--A web tracking application for PACU and post-surgical patients.

BACKGROUND: Capacity constraints necessitate improving hospital efficiency. An integrated real time system facilitating patient flow between the post-anesthesia care unit (PACU) and surgical ward would ease PACU workload by reducing the effort of discharging patients. METHODS: We developed INCOMING!, a web-based platform that monitors patient progress from the operating room to the PACU. INCOMING! integrates available data, automatically determining when a patient enters the PACU. An automated paging system alerts clinical unit managers to 'pull' their patients from the PACU after a set recovery period. General surgery patients were included in the INCOMING! system in late 2004 with paging added in mid-March 2005. Mean PACU length of stay was calculated for the intervention group (general surgery patients with INCOMING!) and compared to a control group (general surgery patients without INCOMING!) and an orthopedic surgery group before and after paging. RESULTS: The system successfully gathers data and generates automated pages when events occur. After paging, there was a significant difference between the orthopedic surgery control group and the general surgery intervention group (235 min versus 185 min, P = 0.001). The mean PACU LOS decreased in the INCOMING! intervention group by 26 min while the mean LOS increased by 28 min in the general surgery control group (P = 0.27). CONCLUSION: Pilot implementation demonstrates that INCOMING! performs the desired integration and automatic notification. Given the minimal cost and potential large gains from a wider deployment, we plan to implement the system for all PACU patients and all post-PACU care units.

Computer Systems↗
PubMed1994

Designing an anaesthesia data management system for a medium size country hospital. A report of four years experiences.

By the end of 1990 the anaesthesia department of the Offenburg hospital, a 500 bed hospital, started to install a data management system in the main operating theatres. In a first phase, 23 PCs were installed in 7 induction rooms and 7 theatres as well as in the 9-bed recovery-room. All PCs are connected via ethernet to a VAX-server. The main functions of the system may be summarized as follows: 1) On-line data acquisition from the patient monitor and from the anaesthesia machine (the ventilator); 2) Off-line data entry of other variables including drugs, fluids and postop. orders as well as demographic and administrative data; 3) Data transfer from induction room to theatre and from theatre to the recovery room; 4) Printout of an automatic anaesthesia record at the end of each case--a hand-written protocol no longer required; 5) Storage of data-files on the VAX-server with possibility of reviewing individual cases and also of performing all types of statistical analysis. The set-up of the whole system including 12 ICU beds and other workstations (total of 42 PC-stations) is described as well as hard- and software used. Problems encountered during installation of hardware and experiences during implementation of software are briefly discussed. A short overview is given concerning future development.

Anesthesiology↗
PubMed2002

Duplex selection facilitates single point-of-service endovascular and surgical management of aortoiliac occlusive disease.

We attempted to optimize management of aortoiliac occlusive disease by using duplex imaging to aid in selection of favorable lesions for percutaneous transluminal angioplasty (PTA)/stenting, by avoiding nontherapeutic arteriography, and by providing single point-of-service care in which endovascular and open surgical reconstruction were combined. One-hundred consecutive patients with symptomatic (91 claudication, 9 limb threat) inflow occlusive disease based on clinical examination and physiologic testing underwent physician-directed duplex scanning of the infrarenal aorta through the femoral bifurcation. Iliac lesions suited to endovascular intervention were defined as focal (length <5 CM), high-grade stenoses with a peak velocity >300 cm/sec and velocity ratio >2 by duplex and were differentiated from unfavorable (diffuse/long iliac stenosis, occlusions, aneurysms, femoral occlusive disease) inflow lesions. Patients with favorable iliac lesions according to duplex were considered candidates for PTA/stenting in an endo-capable operating room, without prior diagnostic angiography. On the basis of duplex imaging, 38 patients possessed endovascularly favorable iliac lesions, 58 patients had unfavorable aortoiliofemoral disease, and 4 obese patients had inadequate studies. Duplex interpretation correctly classified disease distribution/severity in 92% of 50 patients who subsequently underwent intraoperative or diagnostic arteriography. Thirty-one of the 45 (69%) total interventions performed in this patient group were based on duplex findings alone. Of 29 patients with favorable lesions by duplex scanning who had intervention, 25 (86%) received iliac PTA/stenting, while 4 patients required inflow surgical reconstruction for nonfocal iliac disease demonstrated on operative arteriography. Duplex imaging correctly identified the need for concomitant outflow reconstruction/bypass in 11 of the 25 (44%) patients treated by iliac PTA/stenting. Primary and assisted patency rates of iliac PTA/stenting were 83% and 100% at 24 months by life-table analysis. Duplex imaging in patients with symptomatic aortoiliac occlusive disease can provide sufficient information to permit endovascular and surgical intervention without formal diagnostic arteriography in most patients.

Aged↗
PubMed1975

Effect of reperfusion in acute ischemia and infarction.

Physiologic concepts relating to reperfusion of ischemic areas of myocardium may be applied both to acute coronary insuficiency, manifested by angina pectoris, and to restoration of coronary blood flow by coronary bypass procedures, currently employed both in acute myocardial infarction and in chronic myocardial ischemia for relief of angina pectoris. Of the information currently available from experimental studies, much may be applicable to the clinical situation. After acutr transient coronary occlusion mechanical and electrical properties of the ischemic area rapidly return to normal, but there is prolongation of tension development and occurrence of ventricular arrhythmias; implications of these phenomena for clinical coronary ischemia deserve exploration. Following more prolonged coronary ischemia, results of experimental reperfusion appear to be variable and, although restoration of function following several hours of ischemia is possible, certain deleterious effects are often observed in the form of myocardial edema and hemorrhage. Clinical use of bypass procedures in acute myocardial infarction suggests that results may be good, but that deleterious effects are occasionally observed; occurrence of the later requires definition and explanation. Restoration of myocardial blood flow in the presence of normal left ventricular function in chronic coronary artery disease, and failure to reverse functional abnormalities when left ventricular damage has already ensued in the clinical situation, appears to be well established; however, better methods to assess the potential for recovery of function following revascularization are needed in both acute and chronic coronary artery diseases. It is anticipated that more careful exploration of pathophysiology both in the catheterization laboratory and in the operating room may aid this process.

Acute Disease↗
PubMed2006

Personal dust exposures at a food processing facility.

A field study was performed to quantify personal dust exposures at a food processing facility. A review of the literature shows very little exposure information in the food processing industry. The processing area consisted of a series of four rooms, connected by a closed-loop ventilation system, housed within a larger warehouse-type facility. Workers were exposed to various fruit and vegetable dusts during the grinding, sieving, mixing and packaging of freeze-dried or air-dried products. Eight two-hour periods were monitored over two days. Personal total suspended particulate samples were collected on 37 mm PVC filters with 5 microm pore size according to National Institute for Occupational Safety and Health (NIOSH) Method 0500. The filters were analyzed gravimetrically. The two-hour task sampling personal dust exposures ranged from 0.33-103 mg/m3. For each worker, an eight-hour time weighted average (TWA) concentration was calculated, and these ranged from 3.08-59.8 mg/m3. Although there are no directly appropriate occupational exposure limits that may be used for comparison, we selected the Threshold Limit Value (TLV) for particulates not otherwise classified (PNOC) of 10 mg/m3 for inhalable particles. Neglecting the respiratory protection used, five out of eight of the worker time-weighted averages exceeded the TLV. It should be noted that the TLV is based on the inhalable fraction and in this study total suspended particulate was measured; additionally, the TLV is applicable for dusts that are insoluble or poorly soluble, and have low toxicity, which may have limited protective ability in this case due to the irritant nature of certain dusts (e.g., jalapeno peppers, aloe vera). Sieving resulted in significantly higher exposure than grinding and blending. Measuring area concentrations alone in this environment is not a sufficient method of estimating personal exposures due to work practices for some operations.

Dust↗
PubMed2005

Quality and operations of portable X-ray examination procedures in the emergency room: queuing theory at work.

The objective of this study was to evaluate the operation of the portable X-ray machine in relation to examinations ordered by the Emergency Department at the University of Medicine and Dentistry of New Jersey, as well as to identify any bottlenecks hindering the performance of the aforementioned system. To do so, the activity of the portable X-ray was monitored in the period from 8 June 2004 to 24 June 2004, as well as from 6 July 2004 to 12 July 2004, yielding 11 days of data and 116 individual X-ray examinations. During observation times was noted for various checkpoints in the procedure. Using the data gathered, the average input, output, processing times, and variance were calculated. In turn, these values were used to calculate the response times for the Ordering Phase (5.502 min), traveling (2.483 min), Examination Phase (4.453 min), returning (3.855 min), Order Processing Phase (2.962 min), and the Development Phase (3.437 min). These phases were combined for a total of 22.721 min from the time the examination was placed to the time the X-ray films were uploaded to the PACS computer network. Based on these calculations, the Ordering Phase was determined to be the single largest bottleneck in the portable X-ray system. The Examination Phase also represented the second largest bottleneck for a combined total of 44% of the total response time.

Computer Communication Networks↗
PubMed1992

Eight year's experience with automated anesthesia record keeping: lessons learned--new directions taken.

For the past eight years, an automated anesthesia record keeping system, COMANDAS (COMputerized ANesthesia Data Acquisition System) has been used in the cardiovascular operating rooms at Mayo Clinic. The automated anesthesia record is designed to match the traditional hand-written record and becomes part of the official medical record. COMANDAS is interfaced with the physiologic monitor and mass spectrometer in each OR, and a number of other computers within the Mayo Medical Center. Since the introduction of COMANDAS over 24,000 surgical procedures have been charted. The anesthesia record is more complete, consistent in organization, and legible when compared to a hand-written record. Recently, it was determined that the computers and peripherals that make up COMANDAS were wearing out and that the vendors would no longer support or replace the equipment. A process to find a replacement for COMANDAS was then begun. Although the cardiovascular anesthesia group was satisfied with the automated anesthesia record, there were a number of areas in which improvement was desired. A systematic evaluation of the system was begun with a survey of the users. The majority of those surveyed felt that COMANDAS was a useful system which made parts of their job easier. The user interface, method of manual data entry, time to produce the record and difficulty learning the system were the source of the greatest dissatisfaction. Artifacts, networking, interfacing with other devices and computers were also issues for the replacement system. Most commercial systems were found wanting in one or more areas of significance. The most practical solution appeared to be the modification of a currently available intensive care unit patient data management system.

Anesthesiology↗
PubMed2006

Rules, safety and the narrativisation of identity: a hospital operating theatre case study.

Patient safety has become a health policy priority around the world. Acknowledging that 'to err is human' has led to attempts to design systems and rules that limit the capacity for individual discretion and thereby reduce clinical errors. In addition, great emphasis is being placed on the need to eradicate cultures of blame, which are assumed to discourage clinicians from reporting errors, and to establish a 'safety culture', which encourages openness and honesty. These efforts are underpinned by cognitive psychological explanations of the way individuals process information, which leads them to make errors of judgement. This paper examines the attitudes of hospital doctors and managers to the implementation of rules in the context of patient safety. Our analysis, using interpretive research focused on narrative identity, provides an alternative perspective to that offered by the current safety orthodoxy. This leads us to suggest that the achievement of a 'safety culture' is a remote prospect. The failure to follow formal written rules relates not to a deficiency in the cognitive capacity of individuals acting in isolation, but to the identities which individuals occupy, create and negotiate and the social rules (as opposed to clinical guidelines or protocols) which correspond to those identities.

Attitude of Health Personnel↗
PubMedDate not supplied

Method and theory of monophasic action potential recording.

MAP recordings have been at the cradle of cardiac electrophysiology but only recently, through safer and simpler technology, have gained wider access to clinical electrophysiology. In contrast to conventional electrode catheter recordings, MAP recording devices provide precise information not only of the local activation time but of the entire local repolarization time course as well. Although the MAP does not reflect the absolute amplitude or upstroke velocity of transmembrane action potentials, it delivers highly accurate information on the action potential duration and configuration, including early afterdepolarizations as well as relative changes in transmembrane diastolic and systolic potential changes. Based on available data, the MAP probably reflects the transmembrane voltage of cells within a few millimeters of the exploring electrode. MAPs can be recorded by catheter technique from the endocardial surface and by special probes from the epicardium in the operating room. The contact electrode technique is preferable over suction electrodes because it is safer and simpler to use in patients and because it produces more stable, longer-lasting signals. A modified contact MAP catheter incorporates pacing electrodes and permits simultaneous assessment of action potential duration and refractoriness. This not only facilitates the use of MAP catheters in routine electrophysiological studies but also is important for assessing the voltage-independent effects of antiarrhythmic drugs on refractoriness. MAP recordings offer the opportunity to study, in the in situ heart, a variety of pertinent electrophysiological phenomena including, for example, effects of cycle length changes and antiarrhythmic drugs on action potential duration or the role of afterdepolarizations in the genesis of triggered arrhythmias. Due to vigorous heart beating, movement artifacts may occur and need to be distinguished from true abnormalities in the action potential time course. With these limitations in mind, MAP recordings are a valuable addition to clinical electrophysiological studies.

Action Potentials↗
PubMed1995

Critical care profiling for informed treatment of severely ill patients.

An important advance in critical care medicine is the availability of key biochemical test results at the patient's bedside within the brief period when they can be used to guide resuscitation and cardiovascular stabilization effectively. Frequently the menu of key tests, called a "critical care profile (CCP)," must be available to the attending clinician within 5 minutes to guide therapy in real time. Recent developments that make it possible to deliver a CCP with these 5 minutes include the ability to measure all of the analytes of the critical care profile on a whole-blood sample, and point-of-care testing. Today the results of a critical care profile can be available to the attending clinician within 5 minutes of his or her request by sampling approximately 200 microL of whole blood with a critical care instrument at or near a patient's bedside. Tests frequently recommended for a critical care profile include glucose, pO2, pCO2, pH, lactate, ionized calcium, potassium, sodium, ionized magnesium, and either hemoglobin concentration or hematocrit. Hospital areas that need critical care profile support include the emergency department, the operating room, and the intensive care unit.

Critical Care↗
PubMed1993

Predicting difficult laryngoscopy for tracheal intubation: an approach to airway assessment.

Tracheal intubation by direct laryngoscopy is an essential skill for physicians working in the operating room, emergency room or intensive care unit settings. While tracheal intubation can usually be accomplished with ease by direct laryngoscopy, it is sometimes difficult or impossible because of coexisting disease or abnormal physical features. When recognized before attempts at tracheal intubation, virtually all difficult airways can be secured by the selected use of specialized tracheal intubation techniques, although many of these methods require special training, experience, assistance and equipment. When a difficult airway is unrecognized before attempts at intubation the results can be catastrophic because the personnel and equipment necessary for utilizing the specialized tracheal intubation techniques may not be immediately available and the patient's spontaneous respiratory efforts may have been eliminated by anesthetics or muscle relaxants. Thus, identifying patients who are likely to harbor an airway that cannot reliably be secured by simple direct laryngoscopy is an important skill for all acute or critical care physicians. There is an extensive research data base describing historical information, physical examination findings and radiographic features that are associated with the difficult airway. Reviewed collectively, one of the most important underlying concepts suggested by this body of research literature is that the difficult airway is a product of many anatomic and pathologic variables. A surprisingly wide variety of historical, physical examination and radiographic features associated with difficult direct laryngoscopy have been described. A rational approach to airway assessment, therefore, naturally includes a detailed history, a careful physical examination and inspection of relevant x-rays whenever time permits. As outlined in Table 5, there are specific questions to address that may warn the physician about possible airway difficulty. A number of airway assessment schemes based on physical examination findings have been proposed and tested. These schemes vary in their complexity and their clinical convenience. The simpler schemes fail to address the multifactorial nature of the problem, while the more complex systems are clinically impractical. Schemes combining the distance of the thyromental space and the visibility of the oropharyngeal structures, such as that proposed by Frerk, are perhaps the most practical and reliable of the methods proposed to date. Clearly, no one scheme is ideal. At present, preintubation airway evaluation remains a poorly quantified gestalt estimate of the chances for difficulty based on a complex juxtaposition of historical information and physical findings.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1992

A fiber-optic broadband CT/MR video communication system.

Our department operates three magnetic resonance (MR) and three computed tomography (CT) scanners that are located in three different buildings up to 2 km apart. We have designed and implemented a multichannel, fiber-optic broadband video communication system as a remote scanner monitoring network. This system consists of baseband and broadband fiberoptic transmitters, receivers, and multiplexers. The structure of the video network is supported by two strategically located headends (distributors) connecting local/remote scanners and monitoring stations. The system is capable of serving up to 5 km from each headend. The video signal from each scanner is sent through a baseband fiber-optic link to a headend, where it is frequency modulated, multiplexed with other scanner video signals, and distributed over broadband fiber-optic links to monitoring stations. Each receiver consists of a demodulator, a channel selectable tuner, and a video monitor. The current design provides up to 16 scanner channels and 16 remote monitoring station connections. Monitoring stations are placed in 14 clinical locations including the following reading rooms: thoracic, neuro, abdomen, musculoskeletal, gastrointestinal, genitourinary, and pediatric radiology. A radiologist can use any of these 14 monitoring stations to view a patient's CT/MR images in real-time as they appear on any of the six scanner consoles. By selecting the proper channel assigned to a patient's scanner, the radiologist may monitor the examination while using the telephone to communicate with the technologist at the scanner site. This fiber-optic broadband video communication system has been integrated into daily clinical use for over 6 months.

Computer Communication Networks↗
PubMed1991

Indications and general techniques for lasers in advanced operative laparoscopy.

Lasers are but one of the several energy delivery systems used by the operative laparoscopist in the performance of advanced operative laparoscopy. Safety is a key factor in the selection of a laser because the tissue damage produced by this instrument is absolutely predictable. The surgeon must be totally familiar with the chosen wavelength and its tissue reaction if this safety factor is to be realized. Other instruments complement the use of lasers in advanced operative laparoscopy, and without thorough knowledge of all available techniques and instruments, the operative laparoscopist will not achieve the full potential of this specialty. It is beyond the scope of this issue on gynecologic laser surgery to present all of the useful nonlaser techniques. Suffice it to say that we often use laser, loop ligature, sutures, hemoclips, bipolar electricity, hydrodissection, and endocoagulation during the course of a day in the operating room and sometimes during one case. As enthusiasm for advanced operative laparoscopy grows and endoscopic capability increases, more complicated and prolonged surgical feats are reported. Radical hysterectomy and lymphadenectomy have been performed by the laparoscopic route, and endoscopic management of ovarian tumors also has been reported. At this moment, these must be viewed as "show and tell" procedures unsupported by statistics to demonstrate any advantage (or disadvantage) when compared with conventional surgical methods. The time required of advanced operative laparoscopy for any given procedure is certainly an important factor. Prolonged operative and anesthesia time certainly can negate the supposed benefit of small incisions and minimally invasive surgery. What goes on inside the abdomen is certainly the most important part of advanced operative laparoscopy. Good surgeons must recognize their own limitations and the limitations of available technology. The operative laparoscopist must know when to quit and institute a laparotomy. In general, when the magnitude of the operative laparoscopy greatly increases the time required to perform the surgery or exceeds the capability of the surgeon, laparotomy is necessary. Patients should never be promised that an operation will be done by laparoscopy. In advanced operative laparoscopy, informed consent means that the patient has had a reasonable explanation of the method, its benefits and its dangers, and has also been told that laparotomy is always a possibility. In our large series, the laparotomy rate is about 3%. It is also wise not to promise the patient that advanced operative laparoscopy will be done by the laser.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Terminals↗
PubMedDate not supplied

Increased productivity of a digital imaging system: one hospital's experience.

During peak hours of operation, it was not uncommon for the radiology department at St. Luke's Episcopal Hospital in Houston, Texas, to have a backlog of six to ten patients. While some of this was due to competing schedules from the emergency department (ED) and inpatients, the major problem was an inefficient workflow, especially for emergency department patients. Our staff in the radiology department worked with the hospital management to include plans for a new radiology room in an ED renovation project. In designing the new radiology room the most important issues under consideration were the physical location of the room and the type of radiography system to be installed. With plans to implement PACS, we evaluated computed radiography and digital radiography options. At St. Luke's, we had had our first experience with digital radiography after the purchase of a dedicated digital chest system. As a beta test site for the manufacturer, we had an opportunity to test--what was at the time--a new digital radiography system. The powerful impact of digital radiography became most evident by the decreased patient backlog. Even without PACS, workflow became dramatically more efficient. Images now are available for review within seconds after exposure, since there are no films to process. This has reduced our average exam time from ten minutes to one and a half minutes, not including patient transport time. The efficiency demonstrated with the digital chest system provided evidence that digital systems could handle significantly more patients than computed radiography or screen-film systems, without a compromise in image quality. Therefore, we decided to put a digital radiography system in the new ED radiology room. We estimate that the new unit will pay for itself in less than three years.

Efficiency, Organizational↗
PubMed2001

A European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004 study). European Study Group on Nosocomial Infection.

OBJECTIVES: To estimate the incidence of nosocomially acquired urinary tract infections (NAUTI) in Europe and provide information on the clinical characteristics, underlying conditions, etiology, management and outcome of patients. MATERIALS AND METHODS: We collected clinical information from NAUTI patients with a microbiology report on the named study day. RESULTS: A total of 141 hospitals from 25 European countries participated in the study. Written institutional bladder catheter guidelines were in place in 90.3% of EU hospitals and 55% of non-EU hospitals (P < 0.05). The total number of new NAUTI episodes on the day of the study was 298, representing an incidence of 3.55 episodes/1000 patient-days and an estimated prevalence of 10.65/1000. The five most commonly isolated micro-organisms were Escherichia coli, Enterococcus sp., Candida sp., Klebsiella sp. and Pseudomonas aeruginosa. Patients from non-EU countries were younger, with more severe underlying diseases with a higher incidence of obstructive uropathy/lithiasis. Overall, 22.8% of patients had no 'classic' UTI-predisposing factors. Catheter-associated UTI (CAUTI) was present in 187 patients (62.8%). A closed drainage system was used in only 78.5% of catheterised patients. The indication for bladder catheterisation was not considered adequate in 7.6% of cases and continuation of bladder catheterisation was considered unnecessary in 31.3%. Opening of the closed drainage system was the most frequent major error in catheter management (16.8%). Antimicrobial treatment was not considered adequate in 19.8% of all cases. CONCLUSIONS: The incidence of NAUTI in a large European population is 3.55/1000 patient-days. There is clearly room for improvement in the area of bladder catheterisation, catheter care and medical management of NAUTI. We recommend that European authorities draw up and implement practical and specific guidelines to reduce the incidence of this infection.

Age Factors↗