Continuous arteriovenous hemodiafiltration

As demonstrated by the above examples, in CAVHD blood access is usually obtained through femotal catheters, the blood flow rate is not routinely measured and the dialysate flow rate is arbitratily set to 1 to 2 L/hr. In this way, the treatment proved genetally effective. However, sometimes problems were encountered. In some patients frequent clotting of dialyzers occurred, probably because blood flow rate was too low. Sometimes plasma urea levels did not come down as quickly as we had expected or levels of phosphate were found to become too low. There was vinually no insight in the determinants of transpon rates and the dialysate flow rate that is necessary. It was not known to what extent CAVHD treatment had influence on the disappearance rate of drugs. Therefore, in 1989 a study was begun of the detenninams of blood flow rate, ultrafiltration and solute transpon rate in CAVHD, so as to be able to optimize CAVHD treatmentThe aims of this srudy can be sUllllilalized as follows: 1. Analysis of the determinants of blood flow rate. The resistance to flow rate of catheters and dialyzers was studied and the influence of blood viscosity was analyzed. A method was investigated for the determination of blood flow rate by using a probe outside the blood line. 2. Analysis of the determinants of ultrafiltration and convective rranspon rate. The transmembrane pressure difference and the hydraulic permeability of dialyzers were determined as well as the change in hydraulic permeability over time. Funhermore, the 'sieving coefficients' were determined for a number of clinically relevant solutes. 3. Analysis of the determinants of the diffusive transpon rate. A mathematical model of combined convection and diffusion was developed and used to determine the diffusive mass transfer coefficiem of a number

An analytical solution to solute transport in continuous arterio-venous hemodiafiltration (CAVHD)

In conventional intermittent hemodialysis, the overall mass transfer coefficient (Ko) of a dialyser is mostly calculated at zero ultrafiltration and at relatively high dialysate flow rates. In continuous arterio-venous hemodiafiltration (CAVHD), the dialysate flow rates are low as comparable to the rates of ultrafiltration flows, making the dialysis treatment as slow as possible. Therefore the overall mass transfer coefficient (Kd) of a CAVHD hemofilter has to be calculated in the presence of ultrafiltration. A mathematical model of CAVHD is presented in order to calculate the diffusive mass transfer coefficient (Kd) for a solute when blood, filtrate and dialysate flow rates and solute concentrations are known. The ultrafiltration volume flux (Jv) is assumed to vary linearly along the axial direction of the hemofilter. The calculated mass transfer coefficient Kd shows that at high values of dialysate flow and low values of ultrafiltration, the overall mass transfer coefficient (Kd) of a CAVHD hemofilter equals mass transfer coefficient (Ko) of a dialyser in conventional intermittent hemodialysis. Also, the calculated mass transfer coefficient Kd shows no significant differences when the ultrafiltration volume flux is assumed to be constant along the length of the hemofilter if no backfiltration occurs in the hemofilter

Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals

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Brengt ultraschone lucht op de OK meer veiligheid?

• Het ‘Beheersplan luchtbehandeling voor de operatieafdeling’ (2005) beschrijft het beheer en het onderhoud van de luchtbehandelingsinstallatie. • In dit Beheersplan wordt een norm voorgesteld voor luchtkwaliteit op operatieafdelingen type 1, die is aangenomen door de Nederlandse Orthopedische Vereniging, doch niet door andere wetenschappelijke verenigingen. • De Britse studie die ten grondslag ligt aan de voorgestelde norm voor luchtkwaliteit van operatieafdelingen type 1 is van 1982, en onvoldoende gecorrigeerd voor profylaxe met antibiotica. Die profylaxe leidt op zich namelijk ook al tot minder postoperatieve wondinfecties. • Recentere studies naar ultraschone lucht op de operatieafdeling laten geen infectiepreventief effect zien. • Er ligt een ta

Clinical and molecular epidemiology of extended-spectrum beta-lactamase- Producing klebsiella spp: A systematic review and meta-Analyses

Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-Analysis study. The random-effects meta-Analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-To-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp

Mortality associated with carbapenem-susceptible and Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa bacteremia

BACKGROUND: Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day in-hospital all-cause mortality in patients with Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) bacteremia compared to patients with VIM-negative, carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia. Second, we identified determinants for mortality and survival. METHODS: All patients with a positive blood culture with VIM-PA or CS-PA between January 2004 and January 2016 were included. Kaplan-Meier survival curves were constructed, and survivors and non-survivors were compared on relevant clinical parameters using univariate analyses, and multivariable analyses using a Cox-proportional hazard model. RESULTS: In total, 249 patients were included, of which 58 (23.3%) died. Seventeen out of 40 (42.5%) patients with VIM-PA died, compared to 41 out of 209 (19.6%) patients with CS-PA (difference = 22.9%, P-value = 0.001). Assumed acquisition of the bacterium at the intensive care unit was significantly associated with mortality (HR = 3.32, 95%CI = 1.60-6.87), and having had adequate antibiotic therapy in days 1-14 after the positive blood culture was identified as a determinant for survival (HR = 0.03, 95%CI = 0.01-0.06). VIM-PA vs CS-PA was not identified as an independent risk factor for mortality. CONCLUSIONS: The crude mortality rate was significantly higher in patients with a VIM-PA bacteremia compared to patients with a CS-PA bacteremia; however, when analyzing the data in a multivariable model this difference was non-significant. Awareness of the presence of P. aeruginosa in the hospital environment that may be transmitted to patients and rapid microbiological diagnostics are essential for timely administration of appropriate antibiotics. Acquisition of P. aeruginosa should be prevented, independent of resistance profile

VIM-positive Pseudomonas aeruginosa in a large tertiary care hospital: Matched case-control studies and a network analysis

Background: Emergence of multidrug-resistant Pseudomonas aeruginosa is of global concern. We aimed to identify epidemiological relationships, the most common way of transmission, and risk factors for presence of Verona Integron-encoded Metallo-β-lactamase (VIM)-positive P. aeruginosa (VIM-PA). Methods: We conducted a network analysis and matched case-control studies (1:2:2). Controls were hospital-based and matched with cases for ward, day of admission (control group 1 and 2) and time between admission and the identification of VIM-PA (control group 1). The network was visualized using Cytoscape, an

Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands

OBJECTIVES: To identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework. DESIGN: Cross-sectional survey assessing self-reported compliance and its behavioural correlates. SETTING: Internships of medical students in the Netherlands. PARTICIPANTS: 322 medical students of the Erasmus Medical Center were recruited over a period of 12 months during the Public Health internship, which is the final compulsory internship after an 18-month rotation schedule in all major specialities. PRIMARY AND SECONDARY OUTCOME MEASURES: Behavioural factors influencing compliance to hand hygiene guidelines were measured by means of a questionnaire based on the Theory of Planned Behaviour and Social Ecological Models. Multiple lin