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Preventing infection in the trauma patient—Optimal infection control
S32
Abstracts Trauma Melbourne 2009 / Injury 41S (2010) S27–S48
ORAL-INVITED BREAKOUT 1-4 Established trauma systems – Victorian perspective P. Cameron 1,2,3 1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia 2 National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia 3 The Alfred Hospital, Melbourne, Victoria, Australia
Trauma systems have been promulgated internationally from the early seventies. What is meant by a trauma system has varied greatly over that time. Initially the focus was more on the “Trauma Centre” and the “Trauma Surgeon”, as systems have developed, emphasis has shifted to monitoring the system overall, including processes across the system. Despite this, there are no jurisdictions that routinely report processes and outcomes from roadside to rehabilitation and return to work. Victoria is attempting to create a Trauma System that is focussed on improving trauma outcomes, including prevention, prehospital care, trauma reception resuscitation, intensive care, surgery, rehabilitation, compensation systems and return to full capacity. There is an administrative structure, monitoring system and funding model which give Victoria a good chance of succeeding. doi:10.1016/j.injury.2010.01.026
Molecular typing tools can assist in defining the epidemiology of multi-resistant organisms. Clear policies and training are required to document the expectations and responsibilities of all staff. In intensive care, ongoing challenges include hand hygiene, environmental disinfection and antibiotic stewardship to prevent the generation and transmission of multi-resistant organisms. Interventions may address endemic problems or may be required in response to outbreaks. Successful interventions are based on local process and outcome data and require leadership from senior intensive care and unit staff in close collaboration with infection control. Implementation should consider not only the technical aspects, but also socio-cultural factors that may impact on compliance. An iterative approach, based on established principles of quality improvement, appears to be a useful model. However, the implementation of multiple cointerventions, using a multimodal (“bundled”) approach, together with an ethical and clinical imperative to act quickly, often results in a lack of evidence supporting individual components of infection control interventions. Improved study designs, such as stepped wedge interventions and cluster randomized controlled trials, and more rigorous methods of analysis, such as interrupted time series analysis, may help improve the quality of evidence. doi:10.1016/j.injury.2010.01.028 ORAL-INVITED BREAKOUT 2-2
ORAL-INVITED
Sepsis from central catheters-An important problem in the trauma patient
BREAKOUT 1-5
T. Leong
The future of trauma systems
Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
D. Cass
Central venous catheter sepsis remains a major cause of patient morbidity and mortality. ICU Trauma and Burns patients consistently report the highest incidence of central line associated blood stream infections in the ICU population. This complication is also associated with significant financial cost to the healthcare system. This presentation will briefly discuss definitions, aetiology and current evidence based strategies for reducing central line associated blood stream infections.
Children’s Hospital Westmead, Sydney, New South Wales, Australia No abstract. doi:10.1016/j.injury.2010.01.027 ORAL-INVITED
doi:10.1016/j.injury.2010.01.029
BREAKOUT 2-1 Preventing infection in the trauma patient—Optimal infection control A.C. Cheng 1,2 1
Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Nosocomial bacterial infections are one of the most common complications in intensive care. Common infections include central line-related bloodstream infection, urinary tract infection and ventilator associated pneumonia, and colonisation and infections with multi-resistant organisms. Surveillance using standardized epidemiological definitions is required to provide data to inform interventions. The use of standardized definitions of infection, which may be imperfect from a clinical perspective, is required to enable comparison with other centres. Trends over time, informed by appropriate statistical analysis, are the most important tools to assess success; risk adjustment, particularly for specialized units such as burns and trauma, is a significant unresolved issue.
ORAL-INVITED BREAKOUT 2-3 Understanding the local bugs in choosing which antibiotic to use A.A. Padiglione 1,2 1
Department of Infectious Diseases, The Alfred Hospital, Prahran, Victoria, Australia 2 Department of Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia Delayed administration of an effective antibiotic in sepsis kills. But overuse of overly broad therapy also kills (through side effects, or later when the patient evolves an infection from a resistant bacteria). At the Alfred ICU we attempt to reconcile these conflicting needs by: • early aggressive investigation of the potentially septic patient (esp. encouraging 2–3 sets of blood cultures before starting antibiotics);
Abstracts Trauma Melbourne 2009 / Injury 41S (2010) S27–S48
ORAL-INVITED BREAKOUT 1-4 Established trauma systems – Victorian perspective P. Cameron 1,2,3 1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia 2 National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia 3 The Alfred Hospital, Melbourne, Victoria, Australia
Trauma systems have been promulgated internationally from the early seventies. What is meant by a trauma system has varied greatly over that time. Initially the focus was more on the “Trauma Centre” and the “Trauma Surgeon”, as systems have developed, emphasis has shifted to monitoring the system overall, including processes across the system. Despite this, there are no jurisdictions that routinely report processes and outcomes from roadside to rehabilitation and return to work. Victoria is attempting to create a Trauma System that is focussed on improving trauma outcomes, including prevention, prehospital care, trauma reception resuscitation, intensive care, surgery, rehabilitation, compensation systems and return to full capacity. There is an administrative structure, monitoring system and funding model which give Victoria a good chance of succeeding. doi:10.1016/j.injury.2010.01.026
Molecular typing tools can assist in defining the epidemiology of multi-resistant organisms. Clear policies and training are required to document the expectations and responsibilities of all staff. In intensive care, ongoing challenges include hand hygiene, environmental disinfection and antibiotic stewardship to prevent the generation and transmission of multi-resistant organisms. Interventions may address endemic problems or may be required in response to outbreaks. Successful interventions are based on local process and outcome data and require leadership from senior intensive care and unit staff in close collaboration with infection control. Implementation should consider not only the technical aspects, but also socio-cultural factors that may impact on compliance. An iterative approach, based on established principles of quality improvement, appears to be a useful model. However, the implementation of multiple cointerventions, using a multimodal (“bundled”) approach, together with an ethical and clinical imperative to act quickly, often results in a lack of evidence supporting individual components of infection control interventions. Improved study designs, such as stepped wedge interventions and cluster randomized controlled trials, and more rigorous methods of analysis, such as interrupted time series analysis, may help improve the quality of evidence. doi:10.1016/j.injury.2010.01.028 ORAL-INVITED BREAKOUT 2-2
ORAL-INVITED
Sepsis from central catheters-An important problem in the trauma patient
BREAKOUT 1-5
T. Leong
The future of trauma systems
Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
D. Cass
Central venous catheter sepsis remains a major cause of patient morbidity and mortality. ICU Trauma and Burns patients consistently report the highest incidence of central line associated blood stream infections in the ICU population. This complication is also associated with significant financial cost to the healthcare system. This presentation will briefly discuss definitions, aetiology and current evidence based strategies for reducing central line associated blood stream infections.
Children’s Hospital Westmead, Sydney, New South Wales, Australia No abstract. doi:10.1016/j.injury.2010.01.027 ORAL-INVITED
doi:10.1016/j.injury.2010.01.029
BREAKOUT 2-1 Preventing infection in the trauma patient—Optimal infection control A.C. Cheng 1,2 1
Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Nosocomial bacterial infections are one of the most common complications in intensive care. Common infections include central line-related bloodstream infection, urinary tract infection and ventilator associated pneumonia, and colonisation and infections with multi-resistant organisms. Surveillance using standardized epidemiological definitions is required to provide data to inform interventions. The use of standardized definitions of infection, which may be imperfect from a clinical perspective, is required to enable comparison with other centres. Trends over time, informed by appropriate statistical analysis, are the most important tools to assess success; risk adjustment, particularly for specialized units such as burns and trauma, is a significant unresolved issue.
ORAL-INVITED BREAKOUT 2-3 Understanding the local bugs in choosing which antibiotic to use A.A. Padiglione 1,2 1
Department of Infectious Diseases, The Alfred Hospital, Prahran, Victoria, Australia 2 Department of Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia Delayed administration of an effective antibiotic in sepsis kills. But overuse of overly broad therapy also kills (through side effects, or later when the patient evolves an infection from a resistant bacteria). At the Alfred ICU we attempt to reconcile these conflicting needs by: • early aggressive investigation of the potentially septic patient (esp. encouraging 2–3 sets of blood cultures before starting antibiotics);