Upload File

ssi: i hear the words, but are we talking about the same thing? safer healthcare now! western node...

  • Home
  • Documents
  • SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and
30
SSI: I hear the words, SSI: I hear the words, but are we talking about the same but are we talking about the same thing? thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Wendy Runge, RN, BScN, CIC Infection Prevention and Control, Infection Prevention and Control, Calgary Health Region Calgary Health Region Surgical Site Infections: Simply Complicated

Upload: joan-nicholson

Post on 30-Dec-2015

213 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

SSI: I hear the words, SSI: I hear the words, but are we talking about the same thing?but are we talking about the same thing?

Safer Healthcare Now! Western Node

Wendy Runge, RN, BScN, CICWendy Runge, RN, BScN, CIC

Infection Prevention and Control, Infection Prevention and Control,

Calgary Health RegionCalgary Health Region

Surgical Site Infections: Simply Complicated

Page 2: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and
Page 3: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

The SSI phenomena: The SSI phenomena: A simply complex problemA simply complex problem

Page 4: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Defining SSI:Defining SSI:Getting on the same Getting on the same

pagepage

Page 5: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

CDC/NNIS SYSTEMCDC/NNIS SYSTEM

Guideline for Prevention of Guideline for Prevention of Surgical Site Infection, 1999 Surgical Site Infection, 1999 includes:includes:– Definition criteria for inclusion Definition criteria for inclusion

(or not!)(or not!)– Classification of infection Classification of infection

depthdepth

Page 6: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

SSI depthSSI depth

CDC/NNIS SSI CDC/NNIS SSI CLASSIFACATION CLASSIFACATION SYSTEMSYSTEM

Page 7: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

SSI DefinitionsSSI Definitions

Each depth has a set of Each depth has a set of definition criteriadefinition criteria

Each case must meet the Each case must meet the definition criteria definition criteria EXACTLYEXACTLY

Extended surveillance period for Extended surveillance period for implant surgery (12 months)implant surgery (12 months)

Page 8: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

CDC/NNIS SYSTEMCDC/NNIS SYSTEM

NNIS reports:NNIS reports:– Criteria for risk stratificationCriteria for risk stratification– Provides risk adjusted Provides risk adjusted

‘Benchmark’ rates for specific ‘Benchmark’ rates for specific proceduresprocedures

Page 9: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

NNIS RatesNNIS Rates

Risk- adjusted NISS ‘Benchmark’ Risk- adjusted NISS ‘Benchmark’ infection rate for hip prosthesis:infection rate for hip prosthesis:

0 = 0.54%0 = 0.54%

1 = 1.24%1 = 1.24%

2, 3 = 2.05%2, 3 = 2.05%

(50(50thth percentile rates; taken from the percentile rates; taken from the 1992-2003 NNIS report)1992-2003 NNIS report)

Page 10: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

It all started here…It all started here…

Page 11: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Case Study: Mrs. DCase Study: Mrs. D

73 year old female with IDDM, CAD, 73 year old female with IDDM, CAD, COPD and osteoarthritisCOPD and osteoarthritis

Right total hip performed in Right total hip performed in March/2005March/2005

Operative Details:Operative Details:– Intra operative cultures negIntra operative cultures neg– Procedure took 2:30Procedure took 2:30– PatientPatient ASA score was ‘3’ ASA score was ‘3’

– Wound classification = CleanWound classification = Clean

Page 12: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Case Study: Mrs. DCase Study: Mrs. D

Is Mrs. D a high surgical risk Is Mrs. D a high surgical risk patient?patient?

What is her NNIS risk score?What is her NNIS risk score?

Page 13: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

Uneventful surgery and hospital Uneventful surgery and hospital recovery, with discharge on day recovery, with discharge on day 66

Wound was ‘well approximated’ Wound was ‘well approximated’ with ‘scant serous discharge’with ‘scant serous discharge’

Does the drainage indicate an Does the drainage indicate an infection?infection?

Page 14: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

At 14 days post op, Mrs. D At 14 days post op, Mrs. D presents to ER with R hip redness presents to ER with R hip redness and some localized edemaand some localized edema

No drainage noted, no culturesNo drainage noted, no cultures The ER doc diagnoses ‘Cellulitis’ The ER doc diagnoses ‘Cellulitis’

and starts her on a course of and starts her on a course of KeflexKeflex

Is this an infection? Is this an infection?

Page 15: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

4 weeks post op, Mrs. D presents 4 weeks post op, Mrs. D presents in ER again, this time with hip in ER again, this time with hip pain, fever and an elevated WBCpain, fever and an elevated WBC

She is admitted to hospital with She is admitted to hospital with the diagnosis “Query septic joint”the diagnosis “Query septic joint”

Joint aspirate cultures are Joint aspirate cultures are negativenegative

Is this an infection?Is this an infection?

Page 16: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

Mrs. D’s urine cultures grow Mrs. D’s urine cultures grow Pseudomonas aeruginosaPseudomonas aeruginosa

Right hip xrays report no Right hip xrays report no significant findingssignificant findings

Her UTI is treated and she is Her UTI is treated and she is dischargeddischarged

Page 17: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

3 months post op, Mrs. D again 3 months post op, Mrs. D again presents with hip pain, fever and presents with hip pain, fever and an elevated WBCan elevated WBC

R hip Xray reports areas of R hip Xray reports areas of lucidity and possible loosening lucidity and possible loosening of the prosthesisof the prosthesis

Is this an infection?Is this an infection?

Page 18: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.) Urine culture is negative, CXR Urine culture is negative, CXR

shows no acute changesshows no acute changes CT scan of her R hip reports a fluid CT scan of her R hip reports a fluid

collection in the subcuticular tissuecollection in the subcuticular tissue The collection is aspirated:The collection is aspirated:

– Straw-colored fluidStraw-colored fluid– Cultures = ‘no growth’Cultures = ‘no growth’

Is this an infection?Is this an infection?

Page 19: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

Joint aspirate grew Joint aspirate grew Coagulase Coagulase negative staphylococcusnegative staphylococcus

She is admitted for ‘I&D of R Hip’She is admitted for ‘I&D of R Hip’ Diagnosis: ‘Query Infected R Hip’Diagnosis: ‘Query Infected R Hip’

Is this an infection?Is this an infection?

Page 20: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

Surgical Procedure: Evacuation Surgical Procedure: Evacuation of seroma, debridement and of seroma, debridement and liner exchange R hipliner exchange R hip

Surgeon’s Operative report: Surgeon’s Operative report: Evacuation of Seroma, Evacuation of Seroma, devitalized tissue debrided, joint devitalized tissue debrided, joint irrigated and liner exchanged irrigated and liner exchanged (no pus seen)(no pus seen)

Page 21: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

2:4 intraoperative tissue 2:4 intraoperative tissue cultures grow cultures grow Coagulase Coagulase negative staphylococcusnegative staphylococcus

A PICC is inserted course of A PICC is inserted course of Vancomycin is startedVancomycin is started

Is this an infection?Is this an infection? If yes, then what depth?If yes, then what depth?

Page 22: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

What are some possible reasons What are some possible reasons that Mrs. D developed a surgical that Mrs. D developed a surgical site infection?site infection?

What is the probable source of What is the probable source of the infection?the infection?

Page 23: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Mrs. D Mrs. D (cont.)(cont.)

Possible outcomes:Possible outcomes:– Cure – no further problemsCure – no further problems– Premature loosening and early Premature loosening and early

revisionrevision– Excision arthroplasty with 2-Excision arthroplasty with 2-

stage revisionstage revision

Page 24: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

SurveillanceSurveillance

Safer Healthcare Now! Western Node

"the ongoing, systematic collection, analysis, and interpretation of

health data essential to the planning, implementation, and evaluation of public health practice, closely integrated

with the timely dissemination of these data to those who need to know (CDC )".

Dr. Peter Riben, Infection Control SpecialistBC Provincial Infection Control Network

Page 25: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Process of SurveillanceProcess of Surveillance

Determine an ObjectiveDetermine an Objective Identify variations in the rate within a Identify variations in the rate within a

clinically relevant time frame clinically relevant time frame

Page 26: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Process of SurveillanceProcess of Surveillance

Define the EventDefine the Event NNIS - superficial, deep, organ space NNIS - superficial, deep, organ space

Page 27: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Process of SurveillanceProcess of Surveillance

Identify the data sources, who Identify the data sources, who collects the data, how frequently, collects the data, how frequently, triggers and timing triggers and timing

Page 28: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Process SurveillanceProcess Surveillance

Data collection form Data collection form Numerator Numerator DenominatorDenominator

Page 29: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

Process of SurveillanceProcess of Surveillance

Analyze, interpret, disseminate the Analyze, interpret, disseminate the information information

Page 30: SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and

DiscussionDiscussion

Table discussion on how surveillance Table discussion on how surveillance is viewed at each team levelis viewed at each team level

Report outReport out


University of Windsor Collaborative BScN Nursing Student ... · U of W Collaborative BScN Clinical Placement Policies Page 1 of 32 University of Windsor Collaborative BScN Nursing

RUNGE-KUTTA METHODS FOR PARTIAL …€¦ · for partial differential equations and fractional orders of ... runge-kutta method. condition c ... runge-kutta methods for partial differential

Runge Kutta Method. 1

Runge&Ku(a*Methods* - Boston Universitypeople.bu.edu/andasari/courses/Fall2014/LectureNotes/Week4_Lecture8.pdf · HigherOrder* Runge&Ku(a*Methods* (2) Runge-Kutta-Fehlberg (RKF45)

Symplectic Runge-Kutta methods satisfying effective … · Symplectic Runge-Kutta methods satisfying ... Therefore for symplectic Runge–Kutta method the second order condition is

American College of Surgeons BSCN - CMS

Section 7.4 Runge-Kutta Methods - Temple University 7.4 Runge-Kutta Methods Key terms: • Taylor methods • Taylor series • Runge-Kutta; methods linear combinations of function

IPAC BRITISH COLUMBIA 2016 Executive · IPAC BRITISH COLUMBIA . 2016 Executive ... CIC . President-elect: Baljinder Sidhu RN BScN CIC . Secretary: Ron Morley RPN ADPN . Treasurer:

Arterial blood gases Rafiq Suleman BScN

Catalogo Grupo Volks-Ford-07 - CORRETO · 76 silencioso escapamento cic 42660 cic 42636 cic 141237 cic 7725 cic 32262 silencioso escapamento silencioso escapamento 13170-17210-16170-12170bt-14170bt-16200

Accelerated Runge-Kutta Methods

CONTENTSjohnbutler/NumericalAnalysis/Numerical_Methods_DE.pdf · 3.1.2 2nd Order Runge Kutta a 0 = 0.5: Heun’s method 28 3.2 Third Order Runge Kutta methods 29 3.3 Runge Kutta fourth

BScN Program Handbook 2018-2019

Design of optimal Runge-Kutta methods - FEniCS Project · Outline 1 High order Runge-Kutta methods 2 Linear properties of Runge-Kutta methods 3 Nonlinear properties of Runge-Kutta

Runge&Ku(a*Methods* - Boston Universitypeople.bu.edu/andasari/courses/Fall2015/LectureNotes/... · 2015-10-01 · SecondOrder* Runge&Ku(a*Methods* The 2nd order Runge-Kutta method

Runge kutta essay

Grainger, Senauer and Runge

Implementation of a Quality Improvement Initiative Reduces ......Ankica Djurcic–Jovan, MN, BScN, RN, CHPCN(C), Alexandra Eisener, MEd, BScN, RN, Sheryl McDiarmid, MEd, MBA, BScN,

Information Literacy Competencies Integrated Within a Nursing Curricula Nina Koniuch Nina Koniuch RN,BScN, MScT RN,BScN, MScT Karen Halliday Karen Halliday

Runge Software Tutorial Talpac

Electronic Documentation & Bedside Medication Verification System Katie McVicar, BScN L4 MoMac & Elizabeth Young, BScN L4 MoMac Liz Bonney Director, Medical

ReduktiondesKommunikationsaufwandsiterierter Runge-Kutta ... · rierte Runge-Kutta-Verfahren basieren auf ... AbbruchkriterienerfülltsindundspeichertdasErgebnisineinerbooleschenVariablesimics_mpi_stop_condition

Collaborative BScN Program Practicum Handbook · UOIT-DC COLLABORATIVE BScN NURSING PROGRAM ... 2.1 Assignment of Placements ... (Revised 2002), clinical agencies and the policies

Runge-Kutta Method for.ppt

Presentation by Eric Runge

Runge Kutta Colocacion EDOs

runge kutta.pptx

Generalized Runge Kutta Method

META-LEARNING RUNGE-KUTTA

MPH-RH,BSCN,KRPN/KRCHN Chief Nursing Officer

Generalisations oftheLaplace–Runge–LenzVector

Pseudo Runge-Kutta

Catalogo Grupo Volks-Ford-10 continuação · PDF file147 bucha barra estabilizadora traseira cic 19293 cic 19245 cic 2618 cic 20489 cic 29929 cic 15387 cic 69499 ci 23106 cic 16848

Staggered Runge-Kutta Introduction

Abdominal Assessment Lisa Pezik, RN, BScN Clinical Educator