a.Venous thromboembolism (VTE)

This is a serious complication for patients in the intensive care unit (ICU) [17]. All ICU patients are at high risk for this complication given their predilection toward immobility. It includes upper and lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, all ICU patients should receive some form of prophylaxis against VTE.

A recent Systematic review and network meta-analysis of randomized clinical trials (RCTs) has concluded that LMWH reduces incidence of DVT, while UFH and mechanical compressive devices may reduce the risk of DVT. LMWH is probably more effective than UFH in reducing incidence of DVT. It should be considered the primary pharmacologic agent for thromboprophylaxis. The efficacy and safety of combination pharmacologic therapy and mechanical compressive devices is unclear [18].

*Prevention Strategies for Patient Safety in Hospitals: Methodical Paradigm, Managerial… DOI: http://dx.doi.org/10.5772/intechopen.106836*

#### b.Stress ulcers

Currently available data suggest that high-risk patients, such as those with coagulopathy, shock, or respiratory failure requiring mechanical ventilation, benefit from prophylactic treatment.

Prophylaxis against stress ulcers is frequently administered in most ICUs. Typically, histamine-2 antagonists are administered, and are preferred over proton pump inhibitors.

#### c.Prevention of pneumonia

Intensive care unit (ICU) acquired pneumonia is amongst the most common and morbid health care-associated infections.

Interventions reducing length of ICU stay reduces pneumonia incidence and should be prioritized. Other effective strategies are avoiding intubation, minimizing sedation, implementing early extubation strategies, and mobilizing patients. Dramatic decreases in Ventilator Associated Pneumonia rates occurs with implementation of ventilator bundles (**Table 1**). Best practices for implementation are engaging and educating staff and creating structures that facilitate bundle adherence. Regular feedback on process measure performance and outcome rates leads to improvements [19, 20].

#### *2.4.2 Nosocomial infections*

25–50% or more of nosocomial infections are due to the combined effect of the patient's own flora and invasive devices. There is a need for improvements in the use of such devices. Intensive education and "bundling" of evidence-based interventions (**Table 1**) can reduce infection rates through improved asepsis in handling and earlier removal of invasive devices. The maintenance of such gains requires ongoing efforts.

#### *2.4.3 Neonatal ICU*

Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units.

Preventive strategies are (i) hand hygiene practices (ii) central venous (CVC) related bloodstream infections prevention (iii) judicious use of antimicrobials for therapy (iv) enhancement of host defences with early enteral feeding with human milk (v) skin care.

#### *2.4.4 Surgical safety*

Adverse events have been estimated to affect 3–16% of all hospitalized patients. Surgical care contributes to half of these. More than half of such events are preventable [21].

One must be open to learning, embracing, and perfecting new surgical techniques of proven value. These include minimal tissue trauma, short operation times with brief ischemia periods, minimal blood loss etc [22]. Surgical progress with microsurgical techniques is leading the way for precision, perfection, and fewer complications [23].

Surgery has become more complex with more sophisticated technology and patients with more diverse and complex co-morbidities are being operated. Multiple


*Adapted from: www.cdc.gov/hicpac/pubs.html; www.cdc.gov/HAI/index.html.*

#### **Table 1.**

*Evidence based "Bundled Interventions" to prevent common health care–associated infections and other adverse events.*

team surgeries from diverse sub-specialties are becoming more common. These also entail risk of more errors. Dr. Atul Gawande, Professor of Surgery at Harvard Medical School, argues that using checklists can help surgeons to cope with increasing complexity. Use of a rigorous checklist in this rapidly changing environment will consolidate surgeons' aims to enhance both patient safety and clinical professionalism [24]. **Strategy for wrong-site, wrong-patient, wrong-procedure events**

Although, such events are rare but the consequences can be devastating. Hence prevention is of utmost importance.

Recent efforts made to address and prevent wrong-site surgery by a team at Naval Hospital, Cherry Point, NC (NHCP), have exemplified this [25]. Surgical verification checklist and its implementation provides for quality, safety, and a commitment to patient care.

*Prevention Strategies for Patient Safety in Hospitals: Methodical Paradigm, Managerial… DOI: http://dx.doi.org/10.5772/intechopen.106836*
