Closed Endotracheal Suction Systems for COVID-19: Rapid Review.

BACKGROUND: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. OBJECTIVE: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. METHODS: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." RESULTS: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. CONCLUSIONS: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.

Perception of patient safety culture among nursing students: A cross-sectional study.

AIM: To analyse the perception of patient safety culture among nursing students and to compare patient safety outcomes between the different year nursing groups. DESIGN: A cross-sectional descriptive study was conducted with nursing students (n = 266) between first and fourth years from one university in Spain. METHODS: The project was conducted during the 2020/21 academic year. The data were collected using a translated and adapted version of the "Hospital Survey on Patient Safety" developed by the Agency of Healthcare Quality (AHQR). RESULTS: Significant differences were found between the year of study of the nursing degree and whether or not specific training in patient safety culture had been received. The nursing students who had received specific training gave scores lower than anyone else in all questionnaire items, but only the indicators of "good practice" (p = 0.00) and "frequency of reported events" (p = 0.0012) showed significant differences. In some cases, fourth-year students had lower significant mean scores in their "perception of patient safety within unit/sector," "indicators of good practice" and "total score." PUBLIC CONTRIBUTION: Adverse events related to clinical practice continue to be a global problem. Improvements in patient safety require an increase in the patient safety culture of professionals and the promotion of development facilitators. Clinical practice and specific theoretical training foster greater awareness and demand related to patient safety, which is of interest when it comes to the development of new programmes that combine both methodologies and improve their effectiveness. Patient safety will continue to be a focus for all healthcare systems. The patient safety culture of future healthcare professionals should be developed at the university level in order to avoid unnecessary adverse events.

Nursing interventions of choice for the prevention and treatment of suicidal behaviour: The umbrella review protocol.

AIM: To determine which interventions, from a nursing perspective, can be considered as the interventions of choice for the prevention and treatment of suicidal behaviour. In this way, the umbrella review attempts to identify nursing interventions from the Nursing Interventions Classification (NIC) taxonomy with evidence for this purpose. DESIGN: Descriptive study protocol. METHODS: This umbrella review will consist of an extensive, systematic search of published systematic reviews and meta-analyses of studies examining interventions of choice for the prevention and treatment of suicidal behaviour. A systematic search of papers indexed in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Scopus, ISI Web of Knowledge and the Joanna Briggs Institute databases will be carried out; the results will be evaluated for inclusion by two independent reviewers. In addition, the bibliographic references of the included reviews will be searched. The assessment of the methodological quality of the included systematic reviews and meta-analyses, and data extraction, will be performed by two independent reviewers. Conflicts between reviewers will be resolved by an independent third reviewer. Research Ethics Committee approval is not required for this umbrella review. RESULTS: We will determine which of the interventions identified as being of choice in the review are included in the Nursing Interventions Classification (NIC); they may be an effective therapeutic tool for nurses in the prevention and treatment of suicidal behaviour.

A Scoping Review of Strategies Used to Implement the Surgical Safety Checklist.

In 2007, the World Health Organization initiated the Surgical Safety Checklist (SSC) as part of an initiative to improve patient outcomes. After publication of the SSC, perioperative nurses identified challenges with implementing it and questioned its effectiveness. We desired to summarize the state of the science on the effectiveness of strategies that perioperative personnel have used to implement and assess the SSC; therefore, we conducted a scoping review. We searched several databases and identified 28 articles that described the three key stages of SSC implementation (ie, before, during, and after). Half of the identified articles addressed intervention strategies and most articles provided strategies for SSC implementation. The literature also indicated that effective implementation occurred when there was adequate planning. Perioperative leaders should work with nurses when implementing the SSC and monitor its use after implementation to verify compliance and help prevent negative patient outcomes.

[Assessment of the implementation of an unambiguous patient identification system in an acute care hospital]. / Evaluación de la implantación de un sistema de identificación inequívoca de pacientes en un hospital de agudos.

OBJECTIVE: To achieve implantation of unequivocal identification of all admitted patients, to ensure the identification of patients with an individual bracelet integrated into the clinical record, and to involve health professionals in this process. MATERIAL AND METHODS: A working group was created, which analyzed the current situation in the hospital, selected materials, and designed the patient identification procedure and support material for patients and health professionals. After the system was implemented, coverage was assessed through direct observation. Implementation and satisfaction among patients and health professionals was evaluated through specifically designed questionnaires. RESULTS: Coverage was 79.4%. Most (82.8%) professionals knew why the identification bracelet was used and 57.8% thought it helped to avoid patient identification errors. Twenty percent used the bracelet data when administering medication, 29.2% when taking blood samples and 25.6% on entry to the operating room. Nearly all (88.3%) patients reported that the bracelet was not uncomfortable and 62.8% reported they received no information when the bracelet was placed. CONCLUSIONS: Acceptable coverage of the patient identification bracelets was achieved. However, the involvement of health professionals in the identification process was low, since the bracelets were not routinely used in established procedures and patients were only infrequently provided with information when the bracelets were placed.