Medical and surgical asepsis ...

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2J, the surgical intensive care unit (SICU) /

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Factors surgical team members perceive influence choices of wearing or not wearing personal protective equipment during operative /invasive procedures

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

Circadian rhythm disruption and post-surgical recovery

Circadian rhythms, patterns of each twenty-four hour period, are found in most bodily functions. The biological cycles of between 20 and 28 hours have a profound effect on an individual's mood, level of performance, and physical well being. Loss of synchrony of these biological rhythms occurs with hospitalization, surgery and anesthesia. The purpose of this comparative, correlational study was to determine the effects of circadian rhythm disruption in post-surgical recovery. Data were collected during the pre-operative and post-operative periods in the following indices: body temperature, blood pressure, heart rate, urine cortisol level and locomotor activity. The data were analyzed by cosinor analysis for evidence of circadian rhythmicity and disruptions throughout the six day study period which encompassed two days pre-operatively, two days post-operatively, and two days after hospital discharge. The sample consisted of five men and five women who served as their own pre-surgical control. The surgical procedures were varied. Findings showed evidence of circadian disruptions in all subjects post-operatively, lending support for the hypotheses.

Nursing Activities Score: avaliação da carga de trabalho de enfermagem em unidade de terapia intensiva adulto

The sizing of nursing human resources is an essential management tool to meet the needs of the patients and the institution. Regarding to the Intensive Care Unit, where the most critical patients are treated and the most advanced life-support equipments are used, requiring a high number of skilled workers, the use of specific indicators to measure the workload of the team becomes necessary. The Nursing Activities Score is a validated instrument for measuring nursing workload in the Intensive Care Unit that has demonstrated effectiveness. It is a cross-sectional study with the primary objective of assessing the workload of nursing staff in an adult Intensive Care Unit through the application of the Nursing Activities Score. The study was conducted in a private hospital specialized in the treatment of patients with cancer, which is located in the city of Natal (Rio Grande do Norte – Brazil). The study was approved by the Research Ethics Committee of the hospital (Protocol number 558.799; CAAE 24966013.7.0000.5293). For data collection, a form of sociodemographic characteristics of the patients was used; the Nursing Activities Score was used to identify the workload of nursing staff; and the instrument of Perroca, which classifies patients and provides data related to the their need for nursing care, was also used. The collected data were analyzed using a statistical package. The categorical variables were described by absolute and relative frequency, while the number by median and interquartile range. Considering the inferential approach, the Spearman test, the Wald chi-square, Kruskal Wallis and Mann-Whitney test were used. The statistically significant variables were those with p values <0.05. The evaluation of the overall averages of NAS, considering the first 15 days of hospitalization, was performed by the analysis of Generalized Estimating Equations (GEE), with adjust for the variable length of hospitalization. The sample consisted of 40 patients, in the period of June to August 2014. The results showed a mean age of 62,1 years (±23,4) with a female predominance (57,5%). The most frequent type of treatment was clinical (60,0%), observing an average stay of 6,9 days (±6,5). Considering the origin, most patients (35%) came from the Surgical Center. There was a mortality rate of 27,5%. 277 measures of NAS score and Perroca were performed, and the averages of 69,8% (±24,1) and 22,7% (±4.2) were obtained, respectively. There was an association between clinical outcome and value of the Nursing Activities Score in 24 hours (p <0.001), and between the degree of dependency of patients and nursing workload (rp 0,653, p<0,001). The achieved workload of the nursing staff, in the analyzed period, was presented high, showing that hospitalized patients required a high demand for care. These findings create subsidies for sizing of staff and allocation of human resources in the sector, in order to achieve greater safety and patient satisfaction as a result of intensive care, as well as an environment conducive to quality of life for the professionals

Prevalence of surgical wound infection after surgery for breast cancer: systematic review

One of the known risk factors for abuse and neglect of the elderly is the decrease in functionat capacity, contributíng to self care dependency of instrumental actívities of daily living and basic activities of daily Itving (OMS, 2015). Methods: Cross-sectional study with non probabilistíc sample of 333 elderly, performed in a hospital, homes and day centers for the elderly. The data collectíon protocol tncluded socio-demographic data, Questíons to elicit Elder Abuse (Carney, Kahan B Paris, 2003 adap. By Ferreira Alves & Sousa, 2005), scale of instrumental actívi - ties of daily living Lawton and Brody and Katz index to assess the levei of independence in actívities of daily living. Objectives: To evaluate the assodation between abuse and neglect in the elderly, instrumental actívitíes of daily living and levei of independence in actívitíes of daily living. Results: Emotional abuse is signifícantty correlated with the levei of independence in activities of daity Uving (p = 0. 000), older peopie with less independence tend to have higher leveis of emotional abuse. The total abuse is signtficantly correlated with the leveis of independence in activittes of daily living (p = 0. 002), less independent elderty tend to suffer greater abuse and neglect. There were no statistically significant associations between abuse and neglect and instrumental activities of daily l1v1ng. Conclusions: The less independent elderly are more vulnerable to situatíons of abuse and neglect, being more exposed to emotional abuse. These results point to the need for health professionals/ nurses develop prevention interventions, including strategies to support carers and early screentng tn less independent elderly. Keywords: Elder abuse. Negligence. Nursing care. Frail elderly. PREVALENCE OF SURGICAL WOUND INFECTION AFTER SURGERY FOR BREAST CÂNCER: SYSTEMATIC REVIEW C. Amaral3, C. Teixeira"'1', F. Sousa'', C. Antãoa "Polythecnic Institute o f Bragança, Bragança, Portugal; bEPI Unit, Public Health Institute, University of Porto, Portugal. Contact details: catarinaisabeln.amaraliSsmaU.com Introduction: Breast câncer is one of the most common mahgnant pathology in European countries, as Portugal, where annual inddence is around 90 new cases per 100,000 women. Breast surgery is the usual treatment for this pathology, however such procedure can be complicated by the infection of surgical site. Objectives: To know the prevalence and determtnants of surgtcal wound infection after breast surgery. Methods: We conducted a systematic review by searching of the Web of Sdence electronic database for articles published over the last s1x years 1n developed countries. Over three hundred dtatíons were obtained and after excludtng citations with reasons, fíve artícles met our inclusion criteria and were included in the present review. Results: Prevalence of surgical wound infection varied across studies between 0. 1% and 12. 5%. Bilateral mastectomy is assodated with higher prevalence of wound infectíon than unilateral mastectomy (3. 6% vs 3, 3%), lumpectomy with immediate breast reconstruction (IBR) is related with higher frequency of wound infectíon than surgery with no IBR (0, 5% vs 0, 1%), also, mastectomy with IBR is associated with higher prevalence of wound infectíon than mastectomy wtth no IBR (1, 5% vs 0, 3%) and breast surgery followed by axiltary lymph nade dissectíon is related with higher prevalence of wound infection than surgical procedures wtth no axillary lymph node dissection (2, 82% vs 1, 66%). Conclusions: Nurses that provide post-operatíve care to women after breast surgery should be aware about risk of wound tnfectíon, partícularly after more invasive procedures.

End of life clinician-family communication in ICU: a retrospective observational study - implications for nursing

Objective: The objective of this study was to identify practice issues that influence end of life communication and care of patients and families in the intensive care unit (ICU).

Design: This study used a retrospective observational approach utilising a medical record review. Setting: An Australian metropolitan mixed medical/surgical ICU. Subjects: There are two parts to this study. The first part related to all of the patients who died in the ICU in one calendar year, a total of 97. The second part of this study related to a random selection of 25% of these patients, a total of 24.

Results: This study showed that death in the ICU was often anticipated, and that whilst communication between family and medical personnel was evident in the medical record, the involvement or occurrence of communication between the nurse and the family was not recorded, and that nurses were included in only 25% of formal family meetings.

Conclusion: Whilst this study confirmed that death is often predicted for critically ill patients, and opportunities for communication with the family or next of kin assists to achieve consensus on end of life decisions, the involvement of nurses, as primary care-givers is not well represented in the medical record, thus undermining the importance of the nurses role in direct patient care that extends to the family in the ICU.

Correcting for bias when estimating the cost of hospital-acquired infection : an analysis of lower respiratory tract infections in non-surgical patients

Hospital acquired infections (HAI) are costly but many are avoidable. Evaluating prevention programmes requires data on their costs and benefits. Estimating the actual costs of HAI (a measure of the cost savings due to prevention) is difficult as HAI changes cost by extending patient length of stay, yet, length of stay is a major risk factor for HAI. This endogeneity bias can confound attempts to measure accurately the cost of HAI. We propose a two-stage instrumental variables estimation strategy that explicitly controls for the endogeneity between risk of HAI and length of stay. We find that a 10% reduction in ex ante risk of HAI results in an expected savings of £693 ($US 984).

Advanced nursing practice : a global perspective

Aim: To review the titles, roles and scope of practice of Advanced Practice Nurses internationally.----- Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context.----- Method: CINAHL, Medline, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant.----- Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles.----- Conclusion: Advanced Practice Nurses are critical for the future, provide cost-effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.