Who safeguards mothers?

While routine screening for group B streptococcus is not recommended in the UK, women are sometimes coincidentally found to be carrying these bacteria during investigations of symptoms in pregnancy. If such women decide to decline intravenous antibiotics for themselves in labour, they can seek support from midwives in appropriate roles. But once the woman's baby is born, the situation changes somewhat, as the legal context changes and the issue of safeguarding may be raised. This article considers the issues that arise in such scenarios and raises questions about who is there to support women who experience pressure to consent to their healthy newborn baby having prophylactic intravenous antibiotics.

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations.

OBJECTIVE: To describe factors senior critical care nurses identify as being important to address when introducing selective digestive tract decontamination (SDD) in the clinical setting. BACKGROUND: Critically ill patients are at risk of developing ventilator-associated pneumonia (VAP). SDD is one strategy shown to prevent VAP and possibly improve survival in the critically ill. METHODS: We performed a secondary analysis of qualitative data obtained from 20 interviews. An inductive thematic analysis approach was applied to data obtained from senior critical care nurses during phase two of a multi-methods study. RESULTS: There were four primary considerations identified that should be addressed or considered prior to implementation of SDD. These considerations included education of health care professionals, patient comfort, compatibility of SDD with existing practices, and cost. CONCLUSIONS: Despite a lack of experience with, or knowledge of SDD, nurses were able to articulate factors that may influence its implementation and delivery. Organizations or researchers considering implementation of SDD should include nurses as key members of the implementation team.

The microbiota battle.

Antibiotic prophylaxis for laboring women with the intent of protecting newborns from group B strep (GBS) infection carries substantial risks and ethical shortcomings. GBS has been proven to be developing resistance to erythromycin and clindamycin. We are now seeing evidence of its resistance to penicillin, the recommended drug used in the prophylactic protocol. Bacterial resistance to antibiotics is linked to increased virulence of the bacteria. Considering the fact that robust bacterial flora throughout the body is essential to the health and well-being of new mothers and the bacterial colonization of their babies, perhaps the prophylactic use of antibiotics needs to be reconsidered.

A systematic review of prophylactic antimicrobials in PEG placement.

AIM: To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. BACKGROUND: Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. DESIGN: Systematic review. METHODS: We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. RESULTS: Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22-0.44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5.8 patients to prevent one infection - NNT. CONCLUSIONS: Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. RELEVANCE TO CLINICAL PRACTICE: The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.

Prótesis y paliación / Stents and palliation

El drenaje endoscópico de las neoplasias malignas de la vía biliar es el tratamiento paliativo de elección, con una baja morbilidad y mortalidad. Claramente se benefician del uso de prótesis metálicas auto-expansibles, aquellos pacientes que tienen una sobrevida estimada mayor a 6 meses, en especial quienes tienen obstrucciones distales y cuando existe una colangitis asociada a la obstrucción biliar inicial. En las obstrucciones proximales, hay que utilizar el medio de contraste mínimo y con baja presión de inyección, drenando en lo posible ambos lóbulos, siempre y cuando para lograr esto último, no se requiera de una manipulación excesiva, evitando así, la colangitis segmentaria. La complicación más frecuente es la colangitis aguda, en especial en pacientes con obstrucciones proximales. Se recomienda el uso de antibióticos profilácticos en todos los pacientes, ya que desconocemos en cuáles no vamos a lograr nuestro objetivo.

Current practice of antibiotic prophylaxis for catheter procedures.

The practice of giving prophylactic antibiotics to patients at the time of urinary catheter insertion, change or removal is variable since guidelines for their use have yet to be established. The use of prophylactic antibiotics to prevent urinary catheter-related infections and the possibility of bacteraemia and septicaemia, despite a lack of evidence for their efficacy, is a matter of concern in light of the reported overuse of, and increased resistance to, antibiotics. This article describes an audit of, and increased resistance to, antibiotics. This article describes an audit conducted in one trust to establish the current practice of antibiotic prophylaxis for urinary catheter procedures. The audit confirmed that in 60% of the recorded catheter procedures, patients were given antibiotics, usually gentamicin. Variations in gentamicin prophylaxis were revealed, including differences in the timing of administration relative to the catheter procedure. This audit revealed that intramuscular gentamicin was given simultaneously with the procedure or after the procedure in a number of cases, suggesting that on these occasions "prophylaxis" was suboptimal.

Group B strep: prevention is better than cure.

We believe that the key issue for prevention of EOGBS infection is knowledge-if a pregnant woman knows she carries GBS, or has other risk factors present that increase the risk of her baby developing EOGBS infection, she can be offered IAP to protect her baby from this potentially devastating condition. Of course, women don't have to accept the recommended intravenous antibiotics in labour (or an ECM test, either privately or if available on the NHS) if they choose not to. But surely they should have access to good-quality information so they can make an informed choice about what is right for them and for their unborn baby? And midwives are in the perfect position to ensure that pregnant women have such information, resulting in appropriate treatment, which will minimise the number of babies suffering needlessly from EOGBS infection.

Chemical and biological terrorism preparedness for staff development specialists.

Staff development specialists must adapt orientation and continuing/life-long learning educational programs to provide nursing staff with the knowledge and skills required to respond to a biological or chemical terrorist attack. The integration of accurate, reliable, and timely information into staff development programs will contribute to the advancement of a national nursing workforce adequately prepared to respond to a major public health event resulting from the intentional use of biological and chemical weapons.

Maximizing nurses' advocacy role to improve patient outcomes.

Perioperative nurses are eminently situated, academically prepared, and professionally qualified to positively affect patient outcomes. Increasing efficiency and justifying the need for an RN in the perioperative milieu revolve around nurses' role as patient advocates. Perioperative nurses can take many measures to maximize this role, including reducing surgical site infections by enabling the timely administration of antimicrobial prophylaxis and by ensuring that surgical staff members realize the documented risks of removing hair from the surgical site.