Staff nurses as antimicrobial stewards

An integrative literature review | American Journal of Infection Control

Background: Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

Methods: An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

Results: Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

Discussion: Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

Full reference: Monsees, E. et al. (2017) Staff nurses as antimicrobial stewards: An integrative literature review. American Journal of Infection Control. Vol. 45 (no. 8) pp. 917–922

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Oral care in ventilated intensive care unit patients

Diaz, T.L. et al. American Journal of Infection Control. Published online: 23 January 2017

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Highlights:

  • A quality improvement project was developed to evaluate the pre/post effects of standardized placement and supply of oral care equipment in patient rooms.
  • Daily audits were performed to assess nursing behavior related to the performance of oral care on intubated patients with components from a 24 hour kit.
  • Increasing supply and creating uniform placement of oral care tools in patient rooms contributes to increased performance of oral hygiene interventions by nurses.

Read the full abstract here

Central venous catheters: latest evidence for nursing practice

Chapman, S. Evidently Cochrane Blog. Published online: 15 September 2016

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Image source: Calleamanecer – Wikipedia // CC BY-SA 3.0

By Sarah Chapman

What are the things that you do to reduce the risk of catheter-related infection in patients with central venous catheters (CVCs)? Take a moment to run through them. Now think about each one and why you do it. I’ll give you some prompts; mentally tick off all that apply:

  1. It’s Trust policy
  2. NICE (or other) guidance recommends it
  3. There’s evidence that it’s effective
  4. I’ve always done it [this way]

That last one always made me (inwardly) howl with frustration whenever I heard it, but I know you evidence-seekers won’t have ticked that one. It would be great to tick the first three, but can you? There might be more howling over those. I was rather shocked (ok, call me naïve) to discover that reliable evidence supporting the replacement of peripheral venous catheters only when clinically indicated, duly recommended by the UK’s epic3 National Evidence-Based Guidelines as being both safe and cost-saving, had not translated into practice in some hospitals. This came to light in a lively #WeNurses tweetchat on the evidence and you can catch up with it in this blog.

Skin antisepsis

I’ve also blogged here about evidence from a number of Cochrane reviews on different aspects of infection prevention for people with CVCs but since then we’ve seen the publication of more reviews, including this one on skin antisepsis. Was that on your list? Here in the UK, NICE guidance (epic3 again) recommends cleansing with chlorhexidine gluconate in 70% alcohol, or povidone iodine in alcohol for patients sensitive to chlorhexidine (tick). Can we tick off evidence of effectiveness?

The review brought together data from 12 randomised studies with 3446 CVCs (number of patients unknown), comparing different skin antisepsis regimens with each other and with none. Whilst there is nothing here to overturn the guidance, the evidence is mostly low or very low quality and, beyond saying that chlorhexidine solution may be more effective than povidone iodine, any questions about which regimen is best or whether skin antisepsis benefits patients are left unanswered.

Read the full post here

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 3: paediatric care.

The article presents an interview with British nurse Jonathan Whitton of Nottingham Children’s Hospital. When asked about his experience of using a chlorhexidine gluconate (CHG) impregnated sponge dressing, Whitton says that he found it easy to apply and remove. He comments on the role infection prevention plays in his daily nursing activities. Whitton believes that all pediatric units should review the available literature about CHG dressings.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 3: paediatric care. Whitton J. Br J Nurs. 2014, vol 23 (14 Suppl):S22.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 2: paediatric intensive care.

The article presents an interview with nurse Norman Franklin of Freeman Hospital in Newcastle upon Tyne, England. When asked what made him decide to use a chlorhexidine gluconate (CHG) impregnated sponge dressing, he says the decision followed the publication of research on the prevention of catheter-related bloodstream infections. He comments on the role that infection prevention plays in his daily nursing activities. Franklin believes that using CHG sponge dressings will benefit patients.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 2: paediatric intensive care. Franklin N. Br J Nurs. 2014, vol 23(14 Suppl):S21.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 1: renal setting.

The article presents an interview with Mark Nicholls of East Kent Hospitals University National Health Service Foundation Trust in Kent, England. When asked what made him decide to use a chlorhexidine gluconate (CHG) impregnated sponge dressing in his workplace, Nicholls says that it was an audit of his facility. He comments on the role that infection prevention plays in his daily nursing activities. Nicholls believes that the use of CHG sponge dressings benefits patients.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 1: renal setting. Nicholls M. Br J Nurs. 2014, vol 23(14 Suppl):S20-1

Australian graduating nurses’ knowledge, intentions and beliefs on infection prevention and control: a cross-sectional study.

BACKGROUND: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts.

METHODS: A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored.

RESULTS: 349 students from six universities completed the study. 59.8% (95% CI 58.8-60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p < 0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional.

CONCLUSION: Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

Australian graduating nurses’ knowledge, intentions and beliefs on infection prevention and control: a cross-sectional study. Mitchell BG, Say R, Wells A, Wilson F, Cloete L, Matheson L. BMC Nurs. 2014 Dec 12, vol 13, no 1, p43