Adding value to daily chest X-rays in the ICU through education, restricted daily orders and indication-based prompting.

Background: Chest X-rays (CXRs) are traditionally obtained daily in all patients on invasive mechanical ventilation (IMV) in the intensive care unit (ICU). We sought to reduce overutilisation of CXRs obtained in the ICU, using a multifaceted intervention to eliminate automated daily studies.

Methods: We first educated ICU staff about the low diagnostic yield of automated daily CXRs, then removed the 'daily' option from the electronic health records-based ordering system, and added a query (CXR indicated or not indicated) to the ICU daily rounding checklist to prompt a CXR order when clinically warranted.

A multitiered strategy of simulation training, kit consolidation, and electronic documentation is associated with a reduction in central line-associated bloodstream infections.

Background: Simulation-based training has been associated with reduced central line-associated bloodstream infection (CLABSI) rates. We measured the combined effect of simulation training, electronic medical records (EMR)-based documentation, and standardized kits on CLABSI rates in our medical (MICU) and surgical (SICU) intensive care units (ICU).

Methods: CLABSI events and catheter-days were collected for 19 months prior to and 37 months following an intervention consisting of simulation training in central line insertion for all ICU residents, incorporation of standardized, all-inclusive catheter kits, and EMR-guided documentation.

Essential components of an infection prevention program for outpatient hemodialysis centers.

Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line-related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of hepatitis C continue to be reported. While established hospital-based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis facility is hospital-associated.