Physiologic Effects and Symptoms Associated with Extended-Use Medical Mask and N95 Respirators.

OBJECTIVES: Compliance and tolerance of facemasks for extended periods are legitimate concerns. The goal of this study was to identify the physiologic and symptomatic effects of extended-use N95 filtering facepiece respirator (N95) compared with medical masks. We hypothesized that hospital personnel wearing medical masks alone would report fewer subjective complaints compared with personnel wearing an N95 with or without overlying medical mask. METHODS: This was a nonrandomized cohort study of hospital-based healthcare personnel at a single tertiary center wearing a medical mask alone or N95 with or without overlying medical mask during routine clinical activity. Potential subjects were consented and asked to complete a structured survey, including a 10-point Likert scale for subjective symptoms: headache, lightheadedness, breathlessness, facial bruising, facial irritation, mental fatigue, physical fatigue, and yawning. Study investigators also obtained vital signs on the participants. Results between subjects wearing a medical mask and subjects wearing an N95 were compared. A sample of 144 subjects, 72 in each mask cohort, was needed to detect a 20% difference in a composite outcome of headache, shortness of breath, or lightheadedness between groups with an alpha of 0.05 and power of 0.8. RESULTS: We enrolled 72 subjects in each group. There were no differences in baseline demographics. Overall 77% of the cohort reported subjective symptoms while donning a mask. There was no difference in the composite outcome, no difference recorded symptoms except facial bruising, and no difference in physiologic measures between groups. CONCLUSIONS: Most medical mask and N95 users reported symptoms during mask use. However, there was no difference in the symptom proportion or severity in either user.

Methods for reducing sepsis mortality in emergency departments and inpatient units.

BACKGROUND: As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). METHODS: North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. RESULTS: North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. CONCLUSION: Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.

Modifying the risk: once-a-day bathing "at risk" patients in the intensive care unit with chlorhexidine gluconate.

Chlorhexidine gluconate (CHG) decreases hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) that can cause colonization and infection. A standard approach is the bathing of all patients with CHG to prevent MRSA transmission. To decrease CHG utilization, this study assessed selective daily administration of CHG bathing to intensive care unit patients who had an MRSA-positive result or a central venous catheter. This risk-based approach was associated with a 72% decrease in hospital-acquired MRSA transmission rate.

The journey to zero.

This column explores some of the strategies employed on a journey to zero central line infections.