Early detection, prevention and management of bacterial infections in the intensive care unit

Bacterial infections occur frequently in intensive care units (ICU) across the world. Their prevalence has relevant impacts on diagnostic approaches, patient treatment concepts and subsequent patient outcomes. In this habilitation, the role and manifestation of bacterial surface and device contamination potentially affecting critically ill patients with coronavirus disease 2019 (COVID-19) as well as appropriate diagnostic and management strategies with hospital epidemiological consequences during a novel pandemic are discussed. The work demonstrates that bacterial superinfections in critically ill COVID-19 patients with acute respiratory distress syndrome are frequent and commonly associated with longer duration of invasive mechanical ventilation. It highlights the substantial potential of structured microbiological sampling procedures and thorough antibiotic stewardship, in order to prevent the spread of multidrug resistant bacteria. Furthermore, potential benefits of the application of intravenous immunoglobulins as an early management strategy to treat necrotizing soft tissue infections (NSTI) are analyzed in a structured ICU patient cohort with a rare bacterial disease. To analyze a further specific management and prevention approach, this work characterizes the visual behaviour of critical care nurses while identifying drug labels of relevant ICU medications in a setting where performing under time pressure and the avoidance of medication errors - such as in patients with bacterial infections - are key. Together, the results of the presented work demonstrate the importance of accurate diagnostic, prevention and treatment strategies in the vulnerable collective of ICU patients with bacterial infections

Visual Behaviour Strategies of Operators during Catheter-Based Cardiovascular Interventions

The aim was to gain insights into the visual behaviour and the perceptual skills of operators during catheter-based cardiovascular interventions (CBCVIs). A total of 33 CBCVIs were performed at the University Hospital Zurich by five operators, two experts and three novices, while wearing eye tracking glasses. The visual attention distribution on three areas of interest (AOIs) the "Echo screen", "Fluoro screen" and "Patient" was analysed for the transseptal puncture procedure. Clear visual behaviour patterns were observable in all cases. There is a significant differences in visual attention distribution of the experts compared to the novices. Experts spent 79% of dwell time on the Echo screen and 17% on the Fluoro screen, novices spent 52% on the Echo screen and 40% on the Fluoro screen. Additionally, results showed that experts focused their gaze on smaller areas than novices during critical interventional actions. Operators seem to exhibit identifiable visual behaviour patterns for CBCVIs. These identifiable patterns were significantly different between the expert and the novice operators. This indicates that the visual behaviour of operators could be employed to assist transfer of experts' perceptual skills to novices and to develop tools for objective performance assessment