High impact actions: fighting infection.

In this article, Aseptic Non-Touch Technique clinical director Stephen Rowley and Simon Clare, who are both cancer nurses, explain the importance of aseptic technique, Alison Ruffell, a sister in critical care, describes a local initiative to reduce ventilator-associated pneumonia and, in conclusion, Jeanette Beer of the National Patient Safety Agency focuses on a national programme to reduce infections associated with central venous catheters.

Ventilator-associated pneumonia: prevention is better than cure.

BACKGROUND: The prevention of ventilator Assisted Pneumonia (VAP), a hospital acquired infection, among intensive care patients is a major clinical challenge. It is a condition that is associated with high rates of morbidity, mortality, length of stay and hospital costs. AIM: The aim of this paper is to critically review the available literature and identify current evidence based nursing and medical interventions to support practitioners in preventing VAP in their patients. METHODS: A literature search using keywords, including 'ventilator-associated pneumonia' were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, however only a small sample came from nursing journals. Only those papers, which discussed specific strategies for managing VAP were selected for analysis and inclusion in this review. DISCUSSION: We identified a number of practical and evidence based strategies that nurses can incorporate into their practice to prevent VAP and to reduce its incidence. In addition, the introduction of newer techniques, advances in equipment and use of multidisciplinary care bundles can further support and improve the quality and delivery of safe patient care. CONCLUSION: Targeted strategies aimed at preventing VAP, should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Front-line critical care nurses need to understand the factors which place their patients at risk of developing VAP and, institute evidence-based interventions that will compromise the patients' survival and recovery.

The LoTrach system: its role in the prevention of ventilator-associated pneumonia.

OBJECTIVES: To discuss the development of the LoTrach system in light of current evidence around the prevention of ventilator-associated pneumonia (VAP) and its practical application in the intensive care setting. BACKGROUND: VAP causes substantial morbidity and mortality in ventilated patients in the Intensive Care Unit (ICU), increases length of stay in ICU and is extremely costly. Strategies are needed to reduce the risk of VAP. METHOD: We examine the need for an endotracheal tube (ETT) specifically designed for the critically-ill patient, the development of the LoTrach system from conception to production, and the role of the various components of the system in preventing VAP. Early issues in implementing this revolutionary equipment into ICU are explored and three case studies highlight advantages of this system. CONCLUSION: The LoTrach system has been designed to facilitate the provision of a number of evidence-based interventions that have been shown to reduce VAP. Pulmonary aspiration is ubiquitous with conventional cuffs but prevented by the cuff of the LoTrach system when held at a constant and safe pressure against the tracheal wall with a cuff pressure controller. Other aspects incorporated in the ETT are aimed at clearing the secretions from the subglottic space, preventing tube occlusion and accidental extubation, and avoiding damage to the airway. In this way the LoTrach system employs a multifactorial approach to the prevention of VAP and the cost savings from LoTrach rather than a standard ETT will be considerable because of an average 3 day reduction in ICU length of stay related to this. It thus has the potential to be a very useful tool in the ICU setting in the prevention of VAP.

The utilisation of continuous veno-venous haemofiltration for the removal of septic mediators in patients with systemic inflammatory response syndrome.

Septic shock is the leading cause of morbidity and mortality in critically ill patients. If the mediators responsible for the continuum of the sepsis cascade could be blocked or removed, patient outcome might improve. Researchers have been attempting to eliminate such mediators by continuous veno-venous haemofiltration (CVVH) but, despite over a decade of studies, many obstacles still remain. In this article, a comparison has been made of four similar research studies to ascertain any significant findings. Future research proposals have been considered in conjunction with the role the nurse within critical care might play in what could arguably be considered to be within the medical domain.

Sepsis strategies: an ICU package?

--Mortality of patients with severe sepsis remains at unacceptable levels and recent new strategies are not being widely embraced. --Five strategies are discussed within this article [low tidal volumes in acute lung injury/acute respiratory distress syndrome, early goal-directed therapy, drotrecogin alfa (activated), moderate dose corticosteroids and tight control of blood glucose]. --The critical care nurse plays a leading role in the detection, monitoring and treatment of patients with severe sepsis. --The role of the critical care nurse within the multidisciplinary team is explored. --Education, combination of strategies and the use of protocols are discussed.