ABSTRACT
INTRODUCTION: First dose intravenous antimicrobial therapy should be administered within 1 hour of admission but this is achieved in a minority of patients. METHODS: We performed a retrospective analysis at the largest Oncology hospital in Europe. Nurse-led administration of initial antibiotic therapy was introduced to the admissions unit. RESULTS: The nurse led protocol increased compliance with the 1 hour target from 40% to 88.6%. There was a statistically significant decrease in the mean length of stay (p=0.045) which was more pronounced in the neutropenic population (p=0.006). There was a trend to improved 30 day mortality. CONCLUSIONS: A nurse led protocol can be effective in improving compliance with the 1 hour target. Early administration of intravenous antibiotics in cancer patients with sepsis is associated with a shorter length of inpatient stay and a trend to decreased mortality.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Neoplasms/complications , Nursing Assessment/methods , Sepsis , Time-to-Treatment , Administration, Intravenous , Early Medical Intervention , Emergency Service, Hospital/statistics & numerical data , England/epidemiology , Female , Guideline Adherence , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Neutropenia/etiology , Neutropenia/therapy , Outcome Assessment, Health Care , Program Evaluation , Quality Improvement , Retrospective Studies , Sepsis/drug therapy , Sepsis/etiology , Sepsis/mortality , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical dataABSTRACT
BACKGROUND: Rapid-release testing reduces the waiting period for administration of time-sensitive cell-therapy products. Current assay systems are labor intensive and time consuming. The Endosafe portable test system (PTS) is a chromogenic Limulus amebocyte lysate (LAL) portable endotoxin detection system that provides quantitative results in approximately 15 min. To evaluate Endosafe performance with cell-therapy products, side-by-side testing of traditional LAL systems and the Endosafe system was conducted at the Production Assistance for Cellular Therapies (PACT) facilities and the National Institutes of Health's Department of Transfusion Medicine, USA. METHODS: Charles River Laboratories provided each center with a PTS reader and two commercially prepared lyophilized reference standard endotoxin (RSE) vials. All samples tested with the Endosafe system used 0.05-5.0 endotoxin unit/mL (EU/mL) sensitivity cartridges provided by Charles River. Each vial was reconstituted with LAL water and tested in triplicate using the Endosafe and in-house LAL methods. Subsequently, each center tested the endotoxin content of standard dilutions of cell-therapy products, thus creating paired test results for each sample. Additionally, fabricated endotoxin-positive samples containing varying concentrations of endotoxin were prepared and shipped to all centers to perform blinded testing. RESULTS: Valid paired results, based on each center's LAL method and the Endosafe system criteria, were analyzed. Endotoxin detection between paired results was equivalent in most cases. DISCUSSION: The Endosafe system provided reliable results with products typically produced in cell-therapy manufacturing facilities, and would be an appropriate test on which to base the release of time-sensitive cell-therapy products.