Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit.

Introduction: Central-venous-catheter (CVC)-related bloodstream infection (CRBSI) is a complication of intensive care stay which can have important adverse consequences for both patient and institution. There are a number of evidence-based interventions that reduce CRBSI, but it is recognised that consistently applying the best evidence every time is a challenge.

Methods: The authors set out to reduce CRBSI and introduced interventions in our intensive care unit (ICU) over a 4-year period using a quality improvement approach.

Reduction of ventilator-associated pneumonia: active versus passive guideline implementation.

Purpose: Ventilator-associated pneumonia (VAP) is associated with increased morbidity, mortality and costs. We describe an active, multifaceted implementation of a VAP prevention bundle designed to improve staff compliance with evidence-based actions and reduce the incidence of VAP.

Method: A 'VAP prevention bundle' was designed then implemented, first passively, then actively, as defined by a multimodal programme incorporating staff education, process measurement and outcome measurement and feedback to staff and organisational change.

Management of hyperthermia in traumatic brain injury.

Recently there has been much interest in the use of hypothermia in the management of the brain-injured patient and its effect on outcome. Most of these studies examine the use of hypothermia compared with normothermia of 37 degrees C and have failed to demonstrate a benefit in the treatment groups, but what is normothermia in the brain-injured patient? Good epidemiologic evidence suggests that the vast majority of patients admitted to an ICU environment will develop a fever. The development of fever is clearly associated with a worse prognosis.