MICU includes our 68 beds over 6 pods and covered by 4 teams. Information updates include topics from our MICU Collaborative meeting (monthly involving MICU leadership and ancillary staff leads), Institutional Critical Care Committee (ICCC; monthly meeting for all adult ICUs at Henry Ford Hospital), and System Critical Care Committee (SCCC; monthly meeting for all Legacy ICUs at Henry Ford Health).
Clinical Updates
Candida auris update:
Candida auris is a multidrug-resistant fungal pathogen that can cause nosocomial outbreaks and severe invasive disease in hospitalized patients. Patients may be colonized with C. auris even though they are asymptomatic. By identifying patients who are colonized, we can take steps to limit the spread of C. auris within the hospital.
Who requires testing?
1. ED patients: All patients from a facility, including SNF, LTAC, or IPR who require admission
2. Inpatient transfers: All transfer patients from other hospitals, including other Henry Ford Health business units, or a facility (e.g., SNF, LTAC, IPR). The System Command Center (formerly ATMO) screens transfer patients for C. auris risk factors prior to bed placement. Those who screen positive for the following risk factors require testing and are placed in private rooms:
• Invasive/indwelling devices (tracheostomy, central venous catheters, indwelling urinary catheters, PEG tube, j-tube, cholecystostomy tube, other drains)
• Chronic or nonhealing wounds/ulcers
• MDRO or CRE colonization or infection
Note: Patients transferred from other EDs do not require testing if they present from home.
When testing is required, an OPA will fire prompting the provider to order Candida auris, PCR and Contact Isolation.
• If the OPA is dismissed, a hard stop will fire when orders are being signed, requiring the provider to order the test and isolation.
Announcements
There is a new infiltration/extravasation order set in EPIC. This was made after a sentinel event on P5 where infiltration of an IV was not noticed. The order set contains a Link to Tier 1 Guidelines for Extravasation Management, appropriate antidotes and warm or cold compress suggestions, nursing interventions (neurovascular checks and elevation are pre-selected), and antidotes and consults available to order if needed.