Feeding innovation – Update on the feed innovation toolkit and where we are with FEAST and Techfit

<p>All cost thresholds represent nationwide implementation costs over an 18mth period. Costs per ICU can be obtained by dividing each figure by 46 e.g. given RR  = 0.34 the cost threshold per ICU for the bundle relative to no intervention equals $4,349,730/46 =$94,559.</p><p>It is important to note that when both CH/SSD and MR catheters are being considered, the MR catheters are the preferred option where the bundle is dominated for all scenarios except where health benefits are valued at zero and bed-days only at the value of variable costs. Under this scenario where the bundle is dominated the MR catheters are not cost-effective as the cost per QALY exceeds $64,000 and it is the CH/SSD catheters that are preferred, hence the shift in the threshold seen in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0012815#pone-0012815-g003" target="_blank">Figure 3c</a>.</p

Cost and effectiveness thresholds for a catheter care bundle versus alternative infection control interventions.

<p>Cost and effectiveness thresholds for a catheter care bundle versus alternative infection control interventions.</p

Resources potentially required to implement a catheter care bundle.

<p>*Keystone funded to $15 million to undertake multiple projects not just a catheter care bundle.</p><p>Resources were identified based on the following publications:</p><p>Pronovost PJ, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C: Improving communication in the ICU using daily goals. J Crit Care 2003, 18:71–75.</p><p>Pronovost PJ, Weast B, Bishop K, Paine L, Griffith R, Rosenstein B, Kidwell RP, Haller KB, Davis R: Senior executive adopt-a-work unit: a model for safety improvement. Jt Comm J Qual Patient Saf 2004, 30:59–68.</p><p>Pronovost PJ, Goeschel C: Improving ICU care: it takes a team. Healthc Exec 2005, 20:15–22.</p><p>Pronovost PJ, Weast B, Rosenstein B, Sexton B, Holzmueller CG, Paine L, Davis R, Rubin HR: Implementing and validating a comprehensive unit-based safety program. Journal of Patient Safety 2005, 1:33–40.</p><p>Pronovost PJ, Needham DM, Berenholtz S, Sinopoli D, Chu H, Cosgrove SE, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725–2732.</p><p>Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM: Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004, 32:2014–2020.</p

Multivariate analysis of risk factors associated with overall 30 day mortality in <i>Staphylococcus Aureus</i> blood stream infection episodes.

1<p>Reference group composed of all principle diagnoses with similar 30 day mortality.</p>2<p>The effect of vancomycin MIC determined by E-test on mortality for patients treated with vancomycin. Similar results were obtained for the total group and when MIC was determined by broth microdilution.</p>3<p>Heteroresistant vancomycin intermediate (hVISA) <i>Staphylococcus aureus</i> phenotype determined using population analysis profiling area under the curve method.</p

Microbiological characteristics of <i>Staphylococcus aureus</i> blood stream infection episodes classified by population analysis profiling (PAP-AUC).

<p>*Pulse field gel electrophoresis (PFGE) with <i>Sma</i>I restriction. Isolates were classified based on band characteristics compared to known multilocus sequence typed isolates.</p><p>The proportion of vancomycin susceptible and heteroresistant isolates by method of minimum inhibitory concentration determination and Pulse Field Gel Electrophoresis (PFGE) typing.</p

Demographic and clinical features of <i>Staphylococcus Aureus</i> bacteraemia associated with heteroresistance compared to vancomycin susceptible episodes.

<p>2 VISA episodes excluded.</p><p>NOTE: Data are no. (%) of episodes, unless otherwise indicated.</p>1<p>There was a significant difference between the two groups with respect to the principal diagnosis distribution. This difference was due to haemodialysis access device (p<0.001) with all other diagnoses similar between the 2 groups (p = 0.23).</p><p>*Only 18 hVISA and 134 VSSA bacteraemia episodes had repeat blood cultures performed, 5 days after the initial isolate.</p

Proportion of Bacterial Genus/Family detected on all peripheral intravenous catheter (PIVC) tips and associated skin swab at PIVC insertion sites.

<p>PIVC tip and skin swab are represented by black and gray bar respectively.</p

Bacterial Genus/Family detected on peripheral intravenous catheter (PIVC) tips and associated skin swabs at PIVC insertion sites.

<p>C represents PIVC tip and S represents skin swab.</p

Relationship of the bacterial communities between PIVC tips and skin swabs at PIVC insertion sites.

<p>Pearson correlation showing the association of bacterial communities between PIVC tips and skin swabs at PIVC catheter sites were highly significant (correlation coefficient = 0.7; <i>p</i><0.001).</p

Weighted average of the standardized monthly incidence of <i>C</i>. <i>difficile</i> infection by Northern Hemisphere continents.

<p>Weighted average of the standardized monthly incidence of <i>C</i>. <i>difficile</i> infection by Northern Hemisphere continents.</p