Community-associated MRSA among Indigenous children in remote settings: Best practices for NPs.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major public health concern for Indigenous pediatric populations worldwide. It is the leading cause of skin and soft tissue infections in this demographic. This article reviews the literature and presents an evidence-based algorithm for the assessment and management of CA-MRSA among Indigenous children in remote settings.

Acute kidney injury: Challenges and opportunities.

Community-acquired acute kidney injury (CA-AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses CA-AKI and its implications for APRNs.

Nursing Care in Healthcare-Associated Infections: A Scoping Review.

OBJECTIVE: To identify and map nursing care to the adult patient with Healthcare-Associated Infections admitted to the Intensive Care Unit. METHOD: Scoping Review, conducted in January 2018, through the search of studies in national and international databases, journals, catalogs of theses and dissertations, and websites of Brazilian health institutions. We included full surveys published in the Portuguese, Spanish or English language; which had as object of study the researched subject, besides manuals and protocols. We analyzed the type of material, year, country, population, method, Level of Evidence, and nursing care. The final sample consisted of 33 publications. RESULTS: Among the nursing care to the patient, hand hygiene was identified, general care in nursing procedures, use of protocols, effective communication and periodic training. CONCLUSION: Identifying patient care with infection was important in order to list methods and reorient nursing activities.

Nursing Care in Healthcare-Associated Infections: A Scoping Review / Cuidado de enfermería en las Infecciones Relacionadas con la Asistencia Sanitaria: Scoping review / Cuidado de enfermagem nas Infecções Relacionadas à Assistência à Saúde: Scoping review

ABSTRACT Objective: To identify and map nursing care to the adult patient with Healthcare-Associated Infections admitted to the Intensive Care Unit. Method: Scoping Review, conducted in January 2018, through the search of studies in national and international databases, journals, catalogs of theses and dissertations, and websites of Brazilian health institutions. We included full surveys published in the Portuguese, Spanish or English language; which had as object of study the researched subject, besides manuals and protocols. We analyzed the type of material, year, country, population, method, Level of Evidence, and nursing care. The final sample consisted of 33 publications. Results: Among the nursing care to the patient, hand hygiene was identified, general care in nursing procedures, use of protocols, effective communication and periodic training. Conclusion: Identifying patient care with infection was important in order to list methods and reorient nursing activities.

RESUMEN Objetivo: Identificar y asignar los cuidados de enfermería al paciente adulto con Infecciones Relacionadas a la Asistencia a la Salud internado en Unidad de Terapia Intensiva. Método: Scoping Review, realizado en enero de 2018, mediante la búsqueda de estudios en bases de datos, revistas, catálogos de tesis y disertaciones nacionales e internacionales, además de sitios de instituciones brasileñas de salud. Esto incluye la investigación publicada en su totalidad en portugués, español o Inglés; que tenían como objeto de estudio la temática investigada, además de manuales y protocolos. Se analizó el tipo de material, año, país, población, método, Nivel de evidencia, y cuidados de enfermería. La muestra final fue de 33 publicaciones. Resultados: Entre los cuidados de enfermería al paciente, se identificó la higienización de las manos, cuidados generales en los procedimientos de enfermería, utilización de protocolos, comunicación efectiva y entrenamientos periódicos. Conclusión: Identificar los cuidados al paciente con infección fue importante para elencar métodos y reorientar las actividades de la Enfermería.

RESUMO Objetivo: Identificar e mapear os cuidados de enfermagem ao paciente adulto com Infecções Relacionadas à Assistência à Saúde internado em Unidade de Terapia Intensiva. Método: Scoping Review, realizado em janeiro de 2018, mediante busca de estudos em bases de dados, revistas, catálogos de teses e dissertações nacionais e internacionais, além de sites de instituições brasileiras de saúde. Incluem-se pesquisas publicadas na íntegra na língua portuguesa, espanhola ou inglesa; que tinham como objeto de estudo a temática investigada, além de manuais e protocolos. Analisou-se o tipo de material, ano, país, população, método, Nível de Evidência, e cuidados de enfermagem. A amostra final foi de 33 publicações. Resultados: Dentre os cuidados de enfermagem ao paciente, identificou-se a higienização das mãos, cuidados gerais nos procedimentos de enfermagem, utilização de protocolos, comunicação efetiva e treinamentos periódicos. Conclusão: Identificar os cuidados ao paciente com infecção foi importante para elencar métodos e reorientar as atividades da Enfermagem.

Inadvertent overinfusion of norepinephrine using infusion pump loading dose.

Programming infusion pumps has been recognised as a high-risk step and a source of adverse events (Nuckols et al., 2008; Hyman, 2010). Literature describing infusion pump loading dose errors and NORepinephrine complications is scarce (Girard et al., 2010). This case study presents the first ever report of an inadvertent overinfusion of NORepinephrine due to the loading dose option on the infusion pump, and resulting cardiac arrest of the patient. A patient was admitted to the emergency room and started on a NORepinephrine infusion inadvertently as a loading dose rather than a primary infusion. Historical values for the loading dose volume to be infused (VTBI) and primary rate were not adjusted during the setup. Eight hours and 58minutes later, the loading dose VTBI reached 0mL and the pump reverted to the historical primary rate of 999mL/hour. The event log showed that 37.1mL of NORepinephrine was infused resulting in an equivalent calculated bolus dose of 1.8mg administered in two minutes. The patient suffered a cardiac arrest and the infusion was stopped. No faults were found with the pump. Herein, we discuss our analysis of the pump event logs and propose further safety strategies and interventions.

Lean methodology: an evidence-based practice approach for healthcare improvement.

Lean methodology, an evidence-based practice approach adopted from Toyota, is grounded on the pillars of respect for people and continuous improvement. This article describes the use of Lean methodology to improve healthcare outcomes for patients with community-acquired pneumonia. Nurse practitioners and other clinicians should be knowledgeable about this methodology and become leaders in Lean transformation.

Managing C difficile relapses in the community.

Nurses face several challenges in caring for patients with recurrent episodes of C difficile in the community. This article reports on the development of a clinical pathway to meet the needs of older patients and their families.

Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease.

Pneumonia affects millions of people every year in the United States. Hospital-acquired pneumonia is associated with a mortality rate as high as 50%. Pneumonia is classified according to where it was acquired or by the infecting organism. This article explores the similarities and differences in three types of pneumonia seen routinely in the intensive care unit: community-acquired pneumonia, ventilator-associated pneumonia, and health care-associated pneumonia.

Pneumonia part 2: signs, symptoms and vaccinations.

Streptococcus pneumoniae is a cause of significant morbidity and mortality worldwide. There are many different serotypes of the organism which may be carried by up to 50% of children under the age of 6 years, as well as many adults. The organism is associated with both pneumonia and invasive pneumococcal disease, which may result in septicemia or meningitis. It is also a principal cause of otits media and sinusitis, which are not life-threatening, but generate a lot of discomfort, loss of schooling or working days, and around 60 000 GP consultations per year in the UK. Vaccination is a safe and effective way to prevent this infection from causing significant ill health.

Pneumonia part 1: Pathology, presentation and prevention.

Pneumonia is a significant cause of morbidity and mortality and can affect all age groups although it is the very young and the very old who are most at risk. Pneumonia can be caused by many different organisms and can present as a primary condition or as a complication of other diseases or acute health problems. This article will give an overview of the disease, its symptoms and treatment and will focus primarily on community-acquired pneumonia. Two further articles will look at specific causative organisms, i.e. Streptococcus Pneumoniae and influenza, as well as the preventive strategies for these.

Devastating cerebral air embolism after central line removal.

BACKGROUND: Air embolism is a well-published complication arising from central venous catheter use. Literature and case studies provide information regarding clinical sequelae. Preventable mistakes still occur despite following what is considered appropriate protocol. This case report describes the neurological complications likely caused by a cerebral air embolism related to central venous catheter removal. CASE: An 84-year-old man was admitted to the neuroscience critical care unit with acute stroke symptoms and seizures after removal of a central venous catheter. CONCLUSION: There is an abundance of literature describing best practice, complications, and treatment of venous air embolism associated with central line catheter use. Utilization of central venous catheters is increasing. With increased utilization comes the responsibility to improve commonplace knowledge and ensure that practice guidelines and protocols are dependable and consistent.

Necrotizing community-acquired methicillin-resistant Staphylococcus aureus pneumonia: an emerging problem in correctional facilities.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections have been common in prisons for more than a decade. However, CA-MRSA as a cause of pneumonia has been reported infrequently. This infection can present with flu-like symptoms and rapidly progress, possibly leading to death in a matter of days. Two cases of MRSA community-acquired pneumonia (CAP) associated with influenza-like illness in correctional officers employed in two separate prisons within the California prison system are presented. Both individuals were previously healthy, but one died of this disease. MRSA is an uncommon, but now recognized, cause of CAP. These cases are notable for their unique presentation and occurrence in non-health care, occupational settings. Prompt diagnosis and intervention by occupational health nurses and physicians are critical to improving outcomes, especially in high-risk settings such as prisons. These worksites need an effective occupational health program to manage MRSA, with adequate training for both employees and inmates.

Performing an aseptic technique in a community setting: fact or fiction?

BACKGROUND: Maintaining the principles of asepsis when performing wound care and other invasive procedures is one of the fundamental approaches of preventing healthcare-acquired infection. Such an approach has been advocated for community practitioners. LITERATURE: The performance of an aseptic technique is an under-researched area. The few studies that have been conducted have identified how strict adherence to the technique is difficult and contamination of hands/gloves is common and that community nurses often have a fatalistic view about whether asepsis is possible in a community setting. AIM: The overall aim of this research project was to examine how experienced practitioners have adapted the aseptic technique within a community setting and to what extent the changed procedure still adhered to the principles of asepsis. METHODS: This study used a mixture of non-participant observation and individual semi-structured interviews to examine adherence to the principles of the aseptic technique among the district nurses. Data were collected from one Trust in England with a total of 10 district nurses taking part and 30 aseptic procedures been observed. RESULTS: The results show that almost all of the staff understood the principles of asepsis and had adapted the standard procedure for use in a patient's home. Common challenges included wound cleaning using a single nurse procedure, the contents of the pack and the home environment. The research also identified misconceptions about clean versus aseptic procedures and a lack of training for staff. CONCLUSIONS: This study highlights the challenges of maintaining the principles of asepsis in a home environment and the fact that district nurses are often relied upon to find creative solutions to such challenges. The study also highlights issues around the implementation of evidence-based practice and the need for clearer guidance about how evidence should be used alongside existing procedures.

A literature review on community-acquired methicillin-resistant Staphylococcus aureus in the United States: clinical information for primary care nurse practitioners.

PURPOSE: To analyze the state of the science of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in the United States to support the integration of current knowledge for primary care nurse practitioners' (PCNP) practice. DATA SOURCES: Published research limited to U.S. studies in MEDLINE, CINAHL, and Cochrane Review from 1950 to the week of September 4, 2008. Investigations were identified through electronic search engines and databases. Manual searches were done of hard copy references in journal articles. Citations and reference lists for English language research studies of CA-MRSA in the United States were reviewed to identify additional research that fit evaluation criteria for this analysis. CONCLUSIONS: Until the late 1990s, healthcare-associated MRSA (HA-MRSA) was the predominant cause of serious infections. Recently, CA-MRSA has caused infections in previously healthy nonhospitalized people. Major demographic and epidemiological differences exist between the two types of resistant bacteria; the emergence of CA-MRSA suggests new implications for primary care. IMPLICATIONS FOR PRACTICE: PCNPs will undoubtedly treat MRSA infections and need a comprehensive understanding of the pathogenicity, diagnosis, and management of CA-MRSA to ensure expedient and appropriate treatment. This will help to prevent invasive disease as a result of improperly treated infections.

Community-acquired methicillin-resistant Staphylococcus aureus: an ongoing challenge for WOC nursing.

Infection is a common complication of chronic wounds that delays healing. Community-acquired methicillin-resistant Staphylococcus aureus has emerged as a common pathogen and major impediment to healing affected chronic wounds. Community-acquired methicillin-resistant S aureus is virulent, highly communicable, and difficult to eradicate. Treatment options include incision and drainage, debridement, and systemic antimicrobials. Early aggressive wound management and appropriate antibiotic therapy are considered essential to successful treatment. Facility-specific protocols should be developed to minimize the spread of this organism to the general population, with particular attention focused on protecting patients burdened with chronic wounds. This article reviews current knowledge of community-acquired methicillin-resistant S aureus, focusing on its impact on persons with chronic wounds.

[Efficacy of hospital at home (HaH) in the treatment of community-acquired pneumonia (CAP) with different degrees of severity]. / Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad.

BACKGROUND AND OBJECTIVE: Different scientific societies propose the use of scales of severity and additional criteria (AC) in order to determine the setting for the treatment of Community-Acquired Pneumonia (CAP).The objective of this study is to correlate the risk regarding three clinical prediction rules (PSI, CURB-65 and PSCRUXO-80) and AC with the effectiveness of hospital at home (HaH). PATIENTS AND METHOD: Evaluation of cases of CAP referred from the Emergency Unit to HaH between January 2000 and May 2008. They were classified regarding three risk scales and presence of AC and its association with the effectiveness of HaH during the treatment was analysed. RESULTS: 146 women and 181 men were admitted, (mean age, 60.3 years). The average stay in HaH was 8.6 days. Two patients died, 25 (7.7%) were admitted to hospital, 219 progressed favourably throughout and 81 after overcoming complications. Hospital at Home was effective in 92.3% of total patients. The rate was 85% for those in PSI=IV or V with or without additional criteria; 80% for CURB-65=2 and 77.5% for a PSCURXO-80 score of 10-19. The effectiveness of HaH is inversely related to severity. CONCLUSIONS: Hospital a Home (HaD) is an effective and safe care option for many cases of CAP in which hospital admission is normally recommended on the basis of prediction rule scores or additional admission criteria.