title: Intensive care unit core measures improve infectious complications in burn patients.
abstract: There are no data on the effects of the Joint Commission on the Accreditation of Healthcare Organizations intensive care unit (ICU) core measures for outcomes in the burn population. The impact of the ICU core measures on patients admitted to burn center was studied. The prospective outcomes measured were hospital length of stay, ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (BSI) rates, and mortality for all burn patients admitted to the ICU. Protocols for the ICU core measures of deep venous thrombosis prophylaxis, stress ulcer prophylaxis, and daily weaning parameters, were in place before the start of the study period in 2005. Head-of-bed up at 30 degrees and glucose control, although variably practiced, were formally instituted in 2005. Enforcement of daily weaning parameters and sedation holidays were also implemented after 2005. The time period before institution of the core measures was 2003 to 2004 (pregroup), which was compared with the study time period of 2006 to 2008 (postgroup). There were no differences in the mean burn size, percent of inhalation injuries, or age between the two time periods. The VAP rate fell from 42/1000 to 13/1000 ventilator days, P = .0001. The BSI rate also declined from 12/1000 to 4/1000 line days, P = .05. Hospital and ICU lengths of stay and ventilator days did not change significantly between the periods. Risk-adjusted mortality for ICU patients improved from 13 to 7% (P = 0.01, odds ratio = 0.5 [0.29-0.85]). Although not specifically designed for the burn population, implementation of the proposed Joint Commission on the Accreditation of Healthcare Organizations ICU core measures for burn patients was associated with improvements in VAP and BSI rates, as well as a lower mortality.
authors.affiliation: Department of Surgery, Trauma Burn Center, University of Michigan Health System, Ann Arbor, MI 481099, USA.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wahl
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.forename: Christy
authors.initials: C
authors.lastname: Zalewski
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wang
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D002056:Burns / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002405:Catheterization, Central Venous; D002985:Clinical Protocols; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult