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Integrating Evidence‐Based Practice With PDSA Methodology for the Reduction of Central Line Associated Blood Stream Infection in Intensive Care Unit

ABSTRACT

Background

Preventing central line associated bloodstream infections is feasible; although numerous hospitals continue to face challenges in achieving this important patient safety goal.

Aim

The aim of this project was to reduce the incidence of central line associated bloodstream infections in the intensive care unit.

Methods

This evidence-based practice quality improvement project was conducted in the general intensive care unit with 35 beds in King Abdullah Medical City in response to an increase in reported central line associated bloodstream infections cases. A searchable clinical question was formulated, and the relevant literature was reviewed and critically appraised to identify effective prevention strategies. Multimodal Interventions were then implemented and evaluated. The Plan, Do, Study, Act methodology was integrated with an evidence-based practice model to enhance the effectiveness, sustainability, and overall quality of the initiatives.

Results

Central line associated bloodstream infection rates decreased from 1.37 to 0.62 per 1000 central line days in the intensive care unit following implementation of the interventions. Moreover, the project generated a total cost savings of $244,201 USD (915,756 SAR), reflecting reduced costs associated with central line associated bloodstream infection cases over the subsequent 18 months.

Linking Evidence to Action

Implementation of multimodal interventions is essential to decrease central line associated bloodstream infection rate in intensive care units.

PUTRA-CV study protocol: a multicentre observational study of ethnic-specific genetic variants and dietary patterns in relation to lipoprotein(a) levels and their association with coronary artery disease severity in Malaysian adults

Por: Pannirselvam · S. · C Thambiah · S. · Appannah · G. · Ling · K. H. · Samsudin · I. N. · Hooper · A. J. · Yusoff · M. R. · Zakaria · A. F. · Razali · R. · Kiong · G. L. S. · Zahari Sham · S. Y. · Lai · Y. Y. · Abdul Rahman · T. H. · Zainal Abidin · I.
Introduction

Although low-density lipoprotein cholesterol (LDL-C) is established as the primary cardiovascular disease (CVD) risk factor, some individuals with LDL-C within desirable limits still develop coronary artery disease (CAD). Lipoprotein(a) (Lp(a)) has emerged as a genetically determined independent risk factor for CVD. This study aims to investigate Lp(a) by determining its association with coronary artery stenosis severity, identifying its ethnic-specific genetic determinants and assessing its relationship with an energy-dense dietary pattern.

Methods and analysis

The PUTRA-CV study is a 3-year, multicentre, case-control observational study involving adult patients who have undergone coronary angiography. The primary outcome is the association between Lp(a) levels and the severity of angiographic CAD (assessed by Gensini or Syntax score). Secondary outcomes include the frequencies of Lp(a)-associated single nucleotide polymorphisms (SNPs) (rs10455872 and rs3798220) and the association between dietary patterns and Lp(a) levels. Lp(a) will be measured using a particle-enhanced immunoturbidimetric method, and SNPs will be genotyped using high-resolution melting. Dietary intake will be assessed using a validated semiquantitative food frequency questionnaire. Data will be analysed using SPSS. Descriptive statistics will be used to summarise population characteristics. Bivariate analyses will use chi-square (2), independent t-tests or Mann-Whitney U tests as appropriate. The independent association between Lp(a) and coronary artery stenosis severity will be determined using multivariable logistic regression, adjusting for confounders. Empirically driven dietary patterns will be derived using reduced rank regression, and their association with Lp(a) will be assessed. For genetic analysis, allele frequencies of the LPA SNPs rs10455872 and rs3798220 will be calculated and compared between cases and controls.

Ethics and dissemination

Ethical approval has been obtained from the ethics committees of the Ministry of Health Malaysia (NMRR ID-24-00877-2ID-IIR), Universiti Putra Malaysia (JKEUPM-2024–246), Universiti Teknologi MARA (REC/07/2024-OT/FB/2) and Universiti Malaya Medical Centre (MREC ID NO: 2 02 453–13692). The findings will be disseminated via peer-reviewed journals and conferences.

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