Central line-associated bloodstream infections (CLABSI) are a target of safety improvement initiatives, as they are common and harmful. This guideline provides an update on recommended steps for organizations to support the implementation of CLASBI reduction efforts.

This cohort study enrolled 18 sites across 12 countries to assess the validity of a newly developed classification system (ClassIntra v1.0) for assessing intraoperative adverse events. Results indicate that the tool has high criterion validity and can be incorporated into routine practice in perioperative surgical safety checklists or used as a monitoring/reporting tool.

“Serious games” are becoming more prevalent in health care. This article describes a "serious game" PlayDecide for use of multidisciplinary healthcare teams in which the teams are presented with real-world case stories of events and incidents, incorporating the perspectives of healthcare professionals and patients. Players are tasked with exchanging and discussing perspectives and information, then working towards a shared group policy position around error reporting and patient safety. This study evaluated the use of the PlayDecide framework in two large urban academic medical centers and noted a significant change in error reporting behavior among junior faculty post-intervention. 

Engaging patients in health care–acquired infection (HAI) prevention, such as asking providers about hand hygiene compliance, has shown promise. This commentary recommends providing patients with information about infection risks and hospital policies as additional areas to involve patients in reducing HAIs.

Antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VRE), are frequent sources of hospital-acquired infection (HAI) in the intensive care unit (ICU). Although the incidence of serious infections caused by MRSA has been decreasing, the optimal strategies to prevent spread of these bacteria remain unclear. In this cluster-randomized trial conducted in 18 ICUs, a protocol that involved universal surveillance and barrier precautions (gowns and gloves) for patients colonized with these bacteria was evaluated for effectiveness at preventing colonization and infection with MRSA or VRE. No reduction in colonization or infection was found, in part attributable to the fact that use of barrier precautions was suboptimal. Prior successful efforts to reduce HAI have emphasized the role of safety culture in addition to specific preventive interventions, an approach discussed in-depth in this analysis of the landmark Keystone ICU project.

Controversy exists regarding whether children should be required to undergo an electrocardiogram before participating in competitive sports. This study found a significant rate of diagnostic error among pediatric cardiologists in the interpretation of abnormal screening electrocardiograms.

This article discusses strategies to prevent catheter-related infections.

… outside the intensive care unit. … Kallen AJ, Patel PR, O'Grady NP. Clin Infect Dis. 2010;51:335-341.   …

This article contemplates the resident 80-hour work week, specifically in neurosurgical training, and posits that such limits will negatively impact the educational experience of surgical specialists.

Duty-hour regulations may have negatively impacted the educational experience of neurosurgical residents.

Measures that have been proposed to reduce the incidence of medication errors target prescribing safety (e.g., computerized provider order entry) or safety in administering medications (e.g., bar coding or automated dispensing). While each of these individual measures has been shown to decrease errors, as yet few systems "close the loop" by integrating safety measures for prescribing and administering medications. Utilizing an electronic system that incorporated CPOE, automated dispensing, bar coding, and an electronic medication record, this single-institution study demonstrated a significant reduction in both prescribing errors and administration errors. However, staff time spent on medication-related tasks increased. While the study results are promising, one caveat is that the system was not used for high-risk drugs such as anticoagulants or intravenous medications.

The project team implemented a web-based learning module to improve medication safety among unit nurses and found that, while it was well received and seemed to reduce non-intravenous (IV) medication errors, it had no broad effect on overall error rates.