Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive care unit using multifaceted intervention strategy

BACKGROUND/AIMS: We evaluated the effects of a multifaceted intervention for controlling a carbapenem-resistant Acinetobacter baumannii (CRAB) epidemic in an intensive care unit (ICU) with no restrictions on carbapenem use. METHODS: This study was conducted in a medical ICU between April 2012 and June 2016. The baseline infection control programs included surveillance cultures, contact precautions, and environmental cleaning. However, increases in the detection of CRAB isolates beginning in May 2013 led to the implementation of a new protocol, consisting of universal glove and gown use with daily chlorhexidine bathing for all patients in combination with baseline programs. The efficacy of the intervention was subjected to interrupted time series (ITS) analysis. RESULTS: The multifaceted intervention led to a decrease in the incidence of CRAB from 17.65 to 0.89 cases per 1,000 patient-days, during the study period (p < 0.001). ITS analysis revealed a significant change in the trend of CRAB incidence (–0.413, p < 0.001). Over this same period, mean monthly use of carbapenems increased from 143.54 ± 95.73 to 204.95 ± 78.43 doses per 1,000 patient-days (p = 0.018). CONCLUSIONS: Our multifaceted intervention reduced the incidence of CRAB acquisition in an ICU where carbapenem use was not restricted.

Effects of Telephone Follow-up on the Self-Care Performance for Cancer Patients Undergoing Chemotherapy and Role Stress of Family Caregivers / 기본간호학회지

PURPOSE: This study was conducted from January to March, 2004 to examine the effect of telephone follow-up on the performance of self-care in cancer patients undergoing chemotherapy and on role stress of family caregivers. METHOD: Research design was a nonequivalent control group non-synchronized design. Seventy-two participants were assigned to either the experimental group (18 cancer patients, 18 family caregivers) or the control group (18 cancer patients, 18 family caregivers). Data were collected before and after the intervention and were analyzed with paired t-test, t-test, Mann-Whitney U Test & Wilcoxon Signed Ranks Test. RESULTS: Performance of self-care in the experimental group undergoing telephone follow-up was significantly higher than that of the control group (t=8.016, p=0.000). Role stress of family members in the experimental group was also significantly higher than that of the control group (t=2.133, p=0.042). CONCLUSION: This results suggest that the telephone follow-up is effective for cancer patients undergoing chemotherapy and their family caregivers. Telephone follow-up can be recommended as an effective nursing intervention for self-care performance in cancer patients undergoing chemotherapy and to reduce role stress of family caregivers.