The BMC Brief
August 15, 2012 Volume 1, Issue 29
The 8North Newton Pavilion (Cardiac Intensive Care Unit) team recently celebrated an impressive achievement – zero ventilator assisted pneumonias (VAP) and central line blood stream infections (CLBSI) for the past year.
“Very few hospitals reach zero percent for these infections,” said Cathy Korn, RN, Infection Prevention. “This is a huge accomplishment.”
It is estimated by the Centers for Disease Control that 80,000 CLBSI occur in U.S. hospital intensive care units (ICUs) each year, while VAP is the leading cause of morbidity and mortality in ICUs. Both are serious complications for patients and prolong hospital stays and increase costs.
“The key is standardized care and team work,” said Michael Ieong, MD, MICU Medical Director and Co-Chair of the Executive Critical Care Committee. “Frank Schembri, MD, Director of the Pulmonary Interventional Service, has spearheaded the standardization of training staff, fellows and attendings in the proper insertion of central lines, and the opening of the Simulation Center now affords he and his team the opportunity to further standardize and expand this training. Also, our nurses are vigilant about the care of the central line site and have the capacity to stop an insertion procedure if they feel it is not being done correctly. They also pay close attention to consistent maintenance of the sterile dressing at the insertion site while the central line is in place.”
VAP risk factors include length of time a patient is on a ventilator, level of sedation and the positioning of a patient in the bed.
“It is the collaborative effort of physicians, nurses, respiratory therapists and Infection Control to minimize the amount of time a patient is on the ventilator, as well as ensuring the head of the patient’s bed is raised above 30 degrees,” said Charlie O’Donnell, Director, Respiratory Care.
In addition to the support of the unit’s management in achieving this goal, Ieong credits the ongoing training led by Jan Eagan, RN, MS, Clinical Instructor, as central to sustaining successful infection control.
“Sustainability is the important thing. We have had zero CLBIs before at BMC and the fact that it is being replicated on this unit is a sign that we are doing something right,” he said.
The unit is also starting to use BMC’s new Solomont Clinical Simulation and Nursing Education Center to train staff in infection control procedures.
According to Patty Covelle, RN, Director of Nursing for Critical Care and Co-Chair of the Executive Critical Care Committee, standardization of care brings the team together to talk about each patient in a dedicated way.
"It makes everyone, every day, look at every line, every catheter, every ventilator to see how we can get patients off the devices that increase the risk of their acquiring infections,” she said.
“We have seen growth in our nurses embracing these practices," she continued. "They are extremely proactive about asking when we can remove a line or catheter from the patient or take the patient off a ventilator. It is validation of the good work we’ve put into achieving this goal.”
She notes that the Critical Care Committee collaborates with the Infection Control Committee on a regular basis to provide daily reports that alert staff to factors such as the number of patients with catheters in place.
“We also have one of the best housekeepers in the hospital, Ingrid Herrera, whose work impacts the environment for transmission of organisms from one patient to another,” Covelle added.
“Infection control has become part of our culture and the true credit goes to the team,” added Ieong.
"The great work so many have done to reduce the rate of VAPs and CLBSIs supports our overall goal to reduce preventable mortality and continually improve the quality of care we provide to our patients,” said Stan Hochberg, MD, Senior Vice President, Quality, Safety and Technology.
BMC researchers have found an association between childhood physical and sexual abuse and age at menarche (menstrual periods prior to age 11 years).
Renée Boynton-Jarrett, MD, ScD, Pediatric Primary Care, and corresponding author on the study published online in the Journal of Adolescent Health, found a 49 percent increase in risk for early onset menarche among women who reported childhood sexual abuse compared to those who were not abused. In addition, there was a 50 percent increase in risk for late onset menarche (menstrual periods after age 15 years) among women who reported severe physical abuse in childhood. The participants in the study included 68,505 women enrolled in the Nurses’ Health Study II, a prospective cohort study.
"In our study child abuse was associated with both accelerated and delayed age at menarche and importantly, these associations vary by type of abuse, which suggest that child abuse does not have a homogenous effect on health outcomes,” says Boynton-Jarrett. “There is a need for future research to explore characteristics of child abuse that may influence health outcomes including type, timing and severity of abuse, as well as the social context in which the abuse occurs.”
Child abuse is associated with a significant health burden over the life course. Early menarche has been associated with risks such as cardiovascular disease, metabolic dysfunction, cancer and depression, while late menarche has been associated with lower bone mineral density and depression.
“We need to work toward better understanding how child abuse influences health and translate these research findings into clinical practice and public health strategies to improve the well-being of survivors of child abuse,” adds Boynton-Jarrett.
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Patients share their BMC experience
I am writing to let you know of the amazing care that my mother received recently at Boston Medical Center.
My mother arrived by ambulance at BMC and the Emergency Department staff were wonderful. In particular, I would like to mention her nurse, Mike Baldasarre. He took wonderful care of mom in addition to keeping my family informed of everything that was going on. My mother was admitted to 8East, and the nursing staff and her team of doctors were great. When mom's health unexpectedly took a downward turn, the family was devastated, but the entire staff couldn't have been more caring and compassionate to us. Her nurse for three nights, Mary Bierne, was so caring and treated my mother with such kindness. She made sure my mom was comfortable, and that we, the family, were well taken care of.
Mom passed away on Tuesday morning, and although it is a sad time for my family, we wanted to stop and let you know that we all appreciate the care that she received while at Boston Medical Center.
BMC unveils Mayo Zone
Brian Jack named Chief of Family Medicine
Hiran Fernando named Chief of Thoracic Surgery
Timothy Osborn joins BMC
Osborn sees patients at BMC’s Shapiro Center, the Henry M. Goldman School of Dental Medicine, and the Commonwealth Ave Dental Health Center on BU’s Charles River Campus.
Thea James, MD, Emergency Medicine, and Director, Violence Intervention Advocacy Program (VIAP), has been named an outstanding physician by the Boston Business Journal for her and the VIAP team's work in violence intervention. James will receive the award at the Boston Business Journal’s annual Champions in Health Care event Aug. 23 at the Seaport Hotel, Boston. At the event, 14 individuals and two employers will be honored in seven categories including administrator, community outreach, employer, innovator, lifetime achievement, nurse and physician. Members of BMC’s VIAP team include Elizabeth Dugan, LICSW, Keith Gilliam, LMHC, Jumaane Kendrick, Donald Leonard, Andrea Malogon-Meagher, LCSW, Leroy Muhammad, and Kim Odum.
Richard Babayan, MD, BMC/BUSM Chief and Chair of Urology, was elected president of the Massachusetts Association of Practicing Urologists (MAPU) at the American Urological Association annual meeting in May. A director of the MAPU Executive Committee since 1990, Babayan served as president-elect from 2010-2012. He will serve as president for a two-year term and will assume responsibility for the association’s operations and activities, preside over the Board of Director’s meetings and serve as the society's chief spokesperson.
Gregory Antoine, MD, MBA, FACS, Chief, Plastic and Reconstructive Surgery, has been elected to the Board of Trustees of the National Medical Association (NMA). The mission of the NMA is to advance the art and science of medicine for people of African descent through education, advocacy, and health policy to promote health and wellness, eliminate health disparities, and sustain physician viability. The National Medical Association represents the interests of more than 30,000 African American physicians and the patients they serve, with nearly 129 affiliated societies throughout the nation and U.S. territories.
Pooja Mehta, MD, Obstetrics and Gynecology, has been selected as a 2013 Robert Wood Johnson Foundation Clinical Scholar, supported through the U.S. Department of Veterans Affairs. Mehta is one of 27 physicians chosen from across the country as a Scholar. Through the program, Mehta will learn to conduct innovative research and work with communities, organizations, practitioners and policymakers in order to take a leadership role in improving health and health care in the U.S. Mehta will begin her fellowship at the University of Pennsylvania in fall 2013.
BMC has received the American Heart Association/American Stroke Association’s Get With The Guidelines-Heart Failure Gold Achievement Award. The award recognizes BMC’s commitment and success in implementing excellent care for heart disease patients.