Eliminating Infections in the ICU: CLABSI

Expert judgment based effort estimation techniques are widely used for estimating software effort. In the absence of process support, experts may overlook important factors during estimation, leading to inconsistent estimates. This might cause underestimation, which is a common problem in software projects. This multi-case study aims to improve expert estimation of software development effort. Our goal is twofold: 1) to propose a process to develop and evolve estimation checklists for agile teams, and 2) to evaluate the usefulness of the checklists in improving expert estimation processes. The use of checklists improved the accuracy of the estimates in two case companies. In particular, the underestimation bias was reduced to a large extent. For the third case, we could not perform a similar analysis, due to the unavailability of historical data. However, when checklist was used in two sprints, the estimates were quite accurate (median Balanced Relative Error (BRE) bias of-0.05). The study participants from the case companies observed several benefits of using the checklists during estimation, such as increased confidence in estimates, improved consistency due to help in recalling relevant factors, more objectivity in the process, improved understanding of the tasks being estimated, and reduced chances of missing tasks.

show abstract

“…Later, Dr. Pronovost's idea was adopted by all other states of the USA [20], and was also replicated at other places (cf. [21]).…”

Section: Checklists In Other Disciplinesmentioning

confidence: 99%

Developing and using checklists to improve software effort estimation: A multi-case study

Usman

Petersen

Börstler

et al. 2018

Journal of Systems and Software

View full text Add to dashboard Cite

show abstract

“…The internal jugular and subclavian veins may be at risk of thrombosis, or maybe inaccessible. Though femoral venous access is associated with a higher degree of infection[20], it has been used in several cases[17,18]. Whenever feasible, a subclavian central venous line is preferable, to reduce risk of infections in this group of patients receiving immunosuppressive therapy postoperatively.…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Face transplantation: Anesthetic challenges

Dalal

2016

WJT

View full text Add to dashboard Cite

Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products. A silicon face mask created from the facial impression is used to reconstruct the face and preserve the donor’s dignity. The recipient airway management most commonly used is primary intubation of an existing tracheostoma with a flexometallic endotracheal tube. The recipient surgery usually averages to 19-20 h. Since the face is a very vascular organ, there is usually massive bleeding, both in the dissection phase as well as in the reperfusion phase. Prior to reperfusion, often, after one sided anastomosis of the graft, the contralateral side is allowed to bleed to get rid of the preservation solution and other additives. Intraoperative product replacement should be guided by laboratory values and point of care testing for coagulation and hemostasis. In face transplantation, bolus doses of pressors or pressor infusions have been used intraoperatively in several patients to manage hypotension. This article reviews the anesthetic considerations for management for face transplantation, and some of the perioperative challenges faced.

show abstract

“…Central line-associated bloodstream infection (CLABSI) is one of serious healthcare-associated infections that cause increased medical costs, morbidity and mortality; however, CLABSIs have been prevented in many developed and developing countries using multifaceted approaches [ 1 – 5 ]. Several guidelines for the prevention of CLABSIs are available, but the core contents of the evidence-based recommendations are shared in common [ 6 , 7 ]. Although the objectives of the CLABSI prevention guidelines are evident and simple, the implementation of these guidelines in clinical practices requires many factors to be well-coordinated.…”

Section: Introductionmentioning

confidence: 99%

Implementation of central line-associated bloodstream infection prevention bundles in a surgical intensive care unit using peer tutoring

Park¹,

Ko²,

An³

et al. 2017

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

BackgroundCentral line-associated bloodstream infections (CLABSIs) can be prevented through well-coordinated, multifaceted programs. However, implementation of CLABSI prevention programs requires individualized strategies for different institutional situations, and the best strategy in resource-limited settings is uncertain. Peer tutoring may be an efficient and effective method that is applicable in such settings.MethodsA prospective intervention was performed to reduce CLABSIs in a surgical intensive care unit (SICU) at a tertiary hospital. The core interventions consisted of implementation of insertion and maintenance bundles for CLABSI prevention. The overall interventions were guided and coordinated by active educational programs using peer tutoring. The CLABSI rates were compared for 9 months pre-intervention, 6 months during the intervention and 9 months post-intervention. The CLABSI rate was further observed for three years after the intervention.ResultsThe rate of CLABSIs per 1000 catheter-days decreased from 6.9 infections in the pre-intervention period to 2.4 and 1.8 in the intervention (6 m; P = 0.102) and post-intervention (9 m; P = 0.036) periods, respectively. A regression model showed a significantly decreasing trend in the infection rate from the pre-intervention period (P < 0.001), with incidence-rate ratios of 0.348 (95% confidence interval [CI], 0.98–1.23) in the intervention period and 0.257 (95% CI, 0.07–0.91) in the post-intervention period. However, after the 9-month post-intervention period, the yearly CLABSI rates reverted to 3.0–5.4 infections per 1000 catheter-days over 3 years.ConclusionsImplementation of CLABSI prevention bundles using peer tutoring in a resource-limited setting was useful and effectively reduced CLABSIs. However, maintaining the reduced CLABSI rate will require further strategies.

show abstract

Eliminating Infections in the ICU: CLABSI

Cited by 30 publications

References 74 publications

Developing and using checklists to improve software effort estimation: A multi-case study

Developing and using checklists to improve software effort estimation: A multi-case study

Face transplantation: Anesthetic challenges

Implementation of central line-associated bloodstream infection prevention bundles in a surgical intensive care unit using peer tutoring

Contact Info

Product

Resources

About