Fall prevention and bathroom safety in the epilepsy monitoring unit.

Falls are one of the most common adverse events occurring in the epilepsy monitoring unit (EMU) and can result in significant injury. Protocols and procedures to reduce falls vary significantly between institutions as it is not yet known what interventions are effective in the EMU setting. This study retrospectively examined the frequency of falls and the impact of serial changes in fall prevention strategies utilized in the EMU between 2001 and 2014 at a single institution. Overall fall rate was 2.81 per 1000 patient days and varied annually from 0 to 9.02 per 1000 patient days. Both seizures and psychogenic nonepileptic events occurring in the bathroom were more likely to result in falls compared with events occurring elsewhere in the room. With initiation of increased patient education, hourly nurse rounding, nocturnal bed alarms, having two persons assisting for high fall risk patients when out of bed, and immediate postfall team review between 2001 and 2013, there was a trend of decreasing fall frequency; however, no specific intervention could be identified as having a particular high impact. In late 2013, a ceiling lift system extending into the bathroom was put in place for use in all EMU patients when out of bed. In the subsequent 15 months, there have been zero falls. The results reinforce both the need for diligent safety standards to prevent falls in the EMU as well as the challenges in identifying the most effective practices to achieve this goal

Biomaterials Associated Infection

Coagulase-negative staphylococci, mainly Staphylococcus epidermidis, are currently the most frequent cause of hospital acquired infections in the USA. Mostly, but not exclusively, S. epidermidis infections are linked to the use of implanted medical devices like central venous catheters, prosthetic joints and heart valves, pacemakers, cardiac assist devices, cerebrospinal fluid shunts, and intraocular lenses. As new molecular techniques reveal that S. epidermidis are by no means the most prominent bacteria of the skin and mucous membrane flora, the implication is that S. epidermidis has specific virulence factors, which transforms this commensal bacterial species into one of the most successful pathogens in modern medicine. A vast array of specific attachment factors for native and host protein-modified device surfaces and the ability to accumulate in adherent multilayered biofilms appear to be vital for the success of S. epidermidis as a pathogen. Biofilm formation contributes to the ability of the organism to withstand the host’s innate and acquired immune defense mechanisms and to resist antimicrobial therapy, so that device removal is a regular feature for the treatment of S. epidermidis biomaterial-associated infection. Recent developments in the understanding of S. epidermidis virulence are reviewed in this chapter