Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections

Health care associated infections, the fourth leading cause of disease in industrialised countries, are a major health issue. One part of this condition is based on the increasing insertion and implantation of prosthetic medical devices, since presence of a foreign body significantly reduces the number of bacteria required to produce infection. The most significant hospital-acquired infections, based on frequency and potential severity, are those related to procedures e.g. surgical site infections and medical devices, including urinary tract infection in catheterized patients, pneumonia in patients intubated on a ventilator and bacteraemia related to intravascular catheter use. At least half of all cases of nosocomial infections are associated with medical devices

Detecting hospital-acquired infections: A document classification approach using support vector machines and gradient tree boosting

Peer reviewe

Portuguese hospitals’ main challenges in implementing Big Data projects for early detection of adverse events

Big Data has been creating much excitement and promises to solve many of the current health systems’ challenges. A specific application allows predicting adverse events, such as nosocomial infections, 24-48 hours earlier than traditional methods, by analysing in real-time physiological data allied with clinical information, and by extracting knowledge from this stored data. However, the implementation of this kind of projects is not without challenges. Hence, the objective of this thesis is to understand the main barriers in implementing Big Data projects for early detection of adverse events in the specific case of Portuguese hospitals. The collection of primary data, through surveys and interviews, allowed identifying three main barriers. Firstly, there is a generalized low knowledge regarding Big Data, which can hinder the consideration of these projects in the yearly budget and create difficulties in understanding how it can be applied and benefit the hospital. Secondly, a shortage of “Data Scientists” in Portuguese hospitals was reported, being this skilled labour crucial to creatively look at the data and understand how it generates value. Finally, an initial high investment with still undiscovered business value is a true barrier, reflecting the hospitals’ budget constraints. However, two initially identified obstacles were not validated by this analysis. Firstly, being an organizational change necessary to adapt to this new paradigm, resistance from managers and caregivers is not expected. Furthermore, data security and privacy were not considered true impediments but rather a requirement of the technology.“Big Data” tem vindo a despertar muita atenção e promete resolver os principais desafios que os sistemas de saúde hoje enfrentam. Uma aplicação específica permite prever intercorrências, como infeções adquiridas no hospital, 24-48 horas mais cedo do que os métodos tradicionais, através de uma análise em tempo real de fluxos fisiológicos e informação complementar, tal como da extração de novos algoritmos integrados nos dados armazenados. Contudo, a implementação destes projectos tem associada desafios e dificuldades. Assim, o objetivo desta tese é compreender quais as principais barreiras à implementação de projectos de “Big Data” para deteção precoce de intercorrências, no caso específico dos hospitais portugueses. Dados recolhidos através de inquéritos e entrevistas, permitiram identificar três barreiras principais. Primeiramente, o nível de conhecimento sobre “Big Data” é baixo, o que poderá impedir a inclusão deste tipo de projetos no orçamento e dificultar o entendimento relativamente à sua aplicação no meio hospitalar. Seguidamente, foi reportada uma carência generalizada de “Data Scientists”, sendo estes cruciais para olhar de forma criativa para os dados, compreendendo como podem gerar valor. Finalmente, a necessidade de existir um elevado investimento inicial, associada à falta de evidência relativamente aos benefícios, foi considerada uma barreira, refletida nas restrições orçamentais dos hospitais. Contudo, dois obstáculos inicialmente identificados, não foram validados pela análise. Primeiro, sendo necessária uma transformação organizacional, não é esperada resistência por parte dos gestores ou médicos e enfermeiros. Por outro lado, segurança e privacidade dos dados não foram consideradas uma barreira, mas algo que a tecnologia teria que garantir

Separator fluid volume requirements in multi-infusion settings

INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume