The closed intensive care unit (ICU) model, whereby a patient is evaluated and admitted under an intensivist and orders involving patient care are written by the ICU team, is associate with a reduction in certain types of hospital acquire infections, according to a study present at the American Thoracic Society 2019 International Conference, held from May 17 to 22 in Dallas.
The care of physician
Most intensive care units (ICUs) around the world, with the general exception of the USA, now operate according to a “closed” model, i.e., patients are admit under the full responsibility of a train intensivist, as oppose to the “open” format in which patients are admit under the care of another attending physician and intensivists are just available for consultation.
Of 111 ICUs across nine Canadian provinces; 94 (85 %) report a close format model of care in 2015. In Asia, Arabi. report that 216 of 335 (65 %) ICUs survey in 2013 were close format and in the UK; so all ICUs analyze as part of the ICNARC project in 2010/2011 report that their unit model was close.
Similar to the situation in the UK, also in Australia and New Zealand the vast majority of ICUs; are runs in close format. Ahmad M. Sharayah, M.D., from the Monmouth Medical Center in Long Branch, New Jersey, and colleagues conduct a retrospective data analysis on the rates of central line associate blood stream infection; so catheter associate urinary tract infection and ventilator associate pneumonia (VAP) in a community medical center under two different ICU models.
The blood infections
There is good evidence that intensivist led patient management is associate with better patient outcomes; so than are achieve in units without intensivist cover. Moreover, an ICU team led by an experience intensivist in a closed-format unit provides quality care more efficiently than in an open unit where no one; which including the patient and relatives, is quite sure who has final responsibility for patient management.
Infection rates were compare for July 2014 to June 2016 and for July 2016 to June 2018; so when the ICU was under the open and close models, respectively. The researchers find that with the close model; hence there was a 19.3% reduction in the CLABSI rate; so 100% reduction in CAUTI rate (2.1 to 0/1,000 catheter days), and a 100% reduction in VAP (1.9 to 0/1,000 ventilator days). No significant change was see in the rate of C. diff infections or in MRSA blood infections. It can be speculate that with systematic delivery of care under a single, centralize leadership; also infectious complications can be prevented,” the authors write.