Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality.

INTRODUCTION: Emergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality. METHODS: A retrospective chart review investigated all adult patients-admitted through either of 2 academic tertiary medical center emergency departments-who were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre- and post-protocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality. RESULTS: Serum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight (P < .05). There were no in-hospital mortality rate differences between the pre- and post-protocol implementation groups. DISCUSSION: Compliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets.

Chlorhexidine gluconate: to bathe or not to bathe?

Despite infection-prevention initiatives, hospital-acquired infections (HAIs) are still a common occurrence. Chlorhexidine gluconate (CHG) is an important antibacterial agent. Research indicates that the intervention of bathing with CHG can reduce the number of HAIs. Chlorhexidine gluconate is known to reduce the bioload of several bacteria, including multiple strains of methicillin-resistant Staphylococcus aureus. Research regarding the intervention of bathing with CHG was assessed and found to reduce central line-related blood stream infections, ventilator-associated pneumonia, and vancomycin-resistant enterococci. The reduction in HAIs was found to be greater as compared to bathing with soap and water. The reduction of these HAIs will allow for a saving of resources, finances and staff time, which may ultimately be passed on to the patient. While further research is indicated, a strong conclusion is drawn that bathing with CHG reduces the number of HAIs.

Positive Tuberculosis Blood Test as a Predictor of Health Status Among HIV-Infected Persons.

This cross-sectional study explored tuberculosis (TB) knowledge, attitudes, practice, and TB interferon-gamma release assay (IGRA) results as the predictor of self-reported poor mental and physical health among HIV-infected persons attending a sexually transmitted diseases clinic (N = 111). The participants correctly responded to only 56.6% of the TB knowledge questions. Most had positive attitudes and would not be ashamed of TB diagnosis. The TB practice was suboptimal with only half having been tested for TB within the past 2 years. Eight percent of the participants had positive IGRA (n = 9). Simultaneous multiple regression models showed that positive IGRA, an indicator of latent TB infection, was the only significant predictor of both poor mental health (p = .006) and physical health days (p = .016). IGRA screening and treatment of latent TB infection in HIV-infected persons could potentially improve their mental and physical health status in addition to reducing the TB reactivation rate.

Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses.

The primary purpose of this study was to examine the previously untested relationships between moral distress, compassion fatigue, perceptions about medication errors, and nurse characteristics in a national sample of 205 certified critical care nurses. In addition, this study included a qualitative exploration of the phenomenon of medication errors in a smaller subset of certified critical care nurses. Results revealed statistically significant correlations between moral distress, compassion fatigue, and perceptions about medication errors in this group. Implications for critical care nurses seeking to create work environments conducive to the reduction of medication errors are explored.