The PDCA (Plan-Do-Check-Act) cycle is a four-step process used for continuous quality improvement. The PDCA process has been applied for HAI prevention in various healthcare settings, resulting in reduction of HAI risks by improving adherence to evidence-based infection prevention practices, such as hand hygiene. The role of HAI surveillance in the PDCA cycle is to "Check" the processes and outcomes of HAI prevention activities. The collection and timely feedback of surveillance data turns the cycle by promoting competition among hospital employees to "Act" to improve adherence to recommended HAI prevention practices. The use of major HAI process and outcome indicators essential to keep the PDCA cycle turning will be discussed in this review.
As a method of amikacin sulfate (AMK) administration to elderly patients once daily, a reduction in the dose/body weight (mg/kg) according to the renal function is recommended. However, the possibility that a reduced dose cannot exhibit adequate antibacterial activity has been shown. Therefore, we administered AMK once daily to elderly patients and evaluated factors affecting clinical effects.
The subjects consisted of 330 patients with bacterial pneumonia (age, ≥65 years) who were treated with AMK. They were classified into responder and non-responder groups, and the dose, somatometry values, general blood examination values, and blood biochemical examination values were compared between the two groups.
Significant differences between the two groups were observed in Alb, RBC, Hb, and body weight. AMK dose did not differ between the two groups. Regarding Alb, RBC, and Hb that showed a difference between the responder and non-responder groups, a difference was observed in patients with a Cpeak < 41 μg/mL but not in those with a Cpeak ≥ 41 μg/mL. The incidence of renal function impairment did not differ between the groups with a Cpeak < 41 μg/mL or ≥ 41 μg/mL but was significantly higher in the group with a trough ≥ 4 μg/mL.
AMK administration to elderly patients once daily requires administration planning with consideration of a Cpeak ≥ 41 μg/mL even when the dose is reduced according to Ccr. Adequate antibacterial activity may not be achieved in patients with a low Alb, TP, RBC, Hb, or body weight.
It is important for an infection control team to detect patients with severe infection and promote physicians in prompt adequate therapy. The aim of this study was to identify short-term prognostic factors in patients with fever and elevated serum procalcitonin. A total of 425 patients (investigation group, n = 217 and validation group, n = 208) who had fever of more than 38°C and elevated procalcitonin of more than 2.0 ng/mL were included. Four factors, including C-reactive protein ≥ 22.57 mg/dL, serum albumin < 2.8 g/dL, blood urea nitrogen ≥ 32 mg/dL, and red cell distribution width ≥ 15.3, were significant independent prognostic factors for 30-day survival in multivariate analysis of the investigation group. Four variables, which were assigned 1 point each, were used to create a prognostic score (PS). 30-day survival was significantly worse in the elevated PS: 100%, 85%, and 64% in PS: 0, PS: 1/2, and PS: 3/4, respectively (p = 0.0010). The 30-day survival of validation group was well stratified by PS: 90%, 81%, and 52% in PS: 0, PS: 1/2, and PS: 3/4, respectively (p = 0.0001). Among patients with fever and elevated serum procalcitonin, a proposed scoring system may identify patients most likely to benefit from ICT assistance.
This study was performed to clarify how specific methods of perineal care and caregivers' distinctive hand movements affect the degree of spreading and sticking of pseudo-muddy stool. Fifteen nurses and care workers were enrolled in the study. The subjects performed the following four methods of perineal care on a male manikin with pseudo-muddy stool: general irrigation care (GI) based on a national survey, appropriate irrigation care (AI) based on medical literature, wipe care (WC) using a foam cleanser, and water-repellent treatment (WRT) before WC without a foam cleanser. The number of subjects in each group who experienced spreading and sticking of the pseudo-muddy stool and the size of the areas onto which the pseudo-muddy stool spread and stuck to the caregivers, manikins, surroundings, and care equipment were statistically analyzed.
Subjects in all groups experienced the spreading of stool to the caregivers' gloves. Significantly more subjects in the GI and AI groups experienced the spreading of stool to the greater trochanter of the manikin (GI, 8 [AR, 2.3]; AI, 8 [AR, 2.3]; WC, 1; WRT, 1; p = 0.001). Significantly more subjects in the GI than in the WRT group experienced the spreading of stool to the bed sheet (GI, 12 [AR, 4.0]; WRT, 1 [AR, -2.8]; p < 0.001). Significantly more subjects in the GI than in the AI group experienced the spreading of stool to the washing bottles (GI 7, AI 0, p = 0.016). Significantly more subjects in the WRT group experienced wiping stool off easily (WRT, 14 [AR, 3.9]; GI, 7; AI, 5; WC, 4; p < 0.001).
The findings of this study suggest that WRT before WC without a foam cleanser prevents spreading and sticking of stool in a more effective way than irrigation using tap water.