Nursing home nurses' opinions on the potential evolution of their role in antibiotic stewardship: A French national cross-sectional survey.

AIMS: To assess French nursing home nurses' opinions on the potential evolution of their antibiotic stewardship role, facilitators and barriers, and nurses' characteristics associated with their opinion toward new roles regarding antibiotic prescribing. DESIGN: We conducted a cross-sectional study in French nursing homes with ≥20 beds and for which an email address was available in a national database managed by the French government between May and June 2022. METHODS: A self-administered internet-based questionnaire of 43 closed-ended Likert items was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Data analysis included descriptive statistics and χ2 tests. RESULTS: 7215 nursing homes were sent the online questionnaire; 1090 participants completed it partially or totally and 923 fully filled in the questionnaire. A majority of nurses supported strengthening and expanding their antibiotic stewardship role. Regarding new roles, over 70% agreed that nurses could collect urine samples to perform a urine culture on their own initiative, prescribe microbiological laboratory tests, and change the drug formulation or the administration route of the antibiotic prescribed by the general practitioner. One-third declared that they could initiate antibiotics for some infections and/or change the empirical antibiotic treatment prescribed by the general practitioner. Nurses from public nursing homes with connection to a hospital (27.5% vs. >35% for other status) and with recent experience in nursing homes (31% for <5 years of practice vs. 41% for 10 years or more) were less likely to agree to prescribe antibiotics. CONCLUSIONS: This quantitative questionnaire survey identified potential new nurses' roles in antibiotic stewardship that seem to be acceptable and feasible for participants. These new nurses' roles need to be explored in future experimentations before considering implementation. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines and followed the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: A self-administered internet-based questionnaire was sent to directors of eligible nursing homes by email asking them to forward the link to the questionnaire to the nurses and head nurses of their institution. Nurses and head nurses who were interested and willing could complete the questionnaire online partially or fully. TRIAL AND PROTOCOL REGISTRATION: This study is not a clinical trial and is not eligible for trial registration. We used another suitable study registration site, the Center for Open Science.

Nurses' perceptions of the potential evolution of their role in antibiotic stewardship in nursing homes: a French qualitative study.

Background: In nursing homes, infections and antibiotic prescriptions are frequent. Nursing home nurses (NHNs) and advanced practice registered nurses (APRNs) could promote antibiotic stewardship (ABS). Few studies have explored nurses' knowledge, perceptions and practices towards ABS in nursing homes and none has investigated the potential evolution of their roles. Objectives: To explore French nurses' perceptions on ABS, current and future potential roles in ABS in nursing homes, as well as facilitators and barriers. Methods: We conducted a qualitative study in north-eastern France between October 2020 and March 2021 using semi-structured individual interviews with NHNs and a focus group with APRNs. Transcripts of the interviews were analysed using a thematic analysis. Results: Twenty NHNs and seven APRNs participated. They were aware of antibiotic misuse and potential adverse events but lacked knowledge on some ABS aspects. NHNs' current ABS roles ranged from the detection of clinical infectious signs to clinical monitoring of residents, with some heterogeneity between nurses. They had positive opinions towards playing a more prominent role in ABS. In the future, with additional training, changes in the legislative framework and greater multidisciplinary teamwork, NHNs thought they could prescribe laboratory microbiological analyses and some targeted antibiotic treatments. APRNs thought they could prescribe first-line antibiotics for urinary tract infections. Conclusions: French NHNs' current ABS roles could be expanded and new roles might be considered while taking into account several facilitators and barriers. According to APRNs, they could help to compensate for the limited presence of doctors in nursing homes and develop infectious diseases skills.

Ultrasound-guided versus landmark approach for peripheral intravenous access by critical care nurses: a randomised controlled study.

OBJECTIVE: Establishing a peripheral intravenous catheter (PIVC) after a long intensive care unit (ICU) stay can be a challenge for nurses, as these patients may present vascular access issues. The aim of this study was to compare an ultrasound-guided method (UGM) versus the landmark method (LM) for the placement of a PIVC in ICU patients who no longer require a central intravenous catheter (CIVC). DESIGN: Randomised, controlled, prospective, open-label, single-centre study. SETTING: Tertiary teaching hospital. PARTICIPANTS: 114 awake patients hospitalised in ICU fulfilling the following criteria: (1) with a central venous catheter that was no longer required, (2) needing a PIVC to replace the central venous catheter and (3) with no apparent or palpable veins on upper limbs after tourniquet placement. INTERVENTION: Placement of a PIVC using an UGM. PRIMARY OUTCOME: Number of attempts for the establishment of a PIVC in the upper limbs. RESULTS: 57 patients were respectively included in both the UGM group and LM group. Stasis oedema in the upper limbs was the main cause of poor venous access identified in 80% of patients. Both the number of attempts (2 (1-4), p=0.911) and catheter lifespan ((3 (1-3) days and 3 (2-3) days, p=0.719) were similar between the two groups. Catheters in the UGM group tended to be larger (p=0.059) and be associated with increased extravasation (p=0.094). CONCLUSION: In ICU patients who no longer require a CIVC, use of an UGM for the establishment of a PIVC is not associated with a reduction in the number of attempts compared with LM. TRIAL REGISTRATION NUMBER: NCT02285712; Results.

Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance.

BACKGROUND: Data are sparse regarding the effects of prolonged prone positioning (PP) during VV-ECMO. Previous studies, using short sessions (<12 h), failed to find any effects on respiratory system compliance. In the present analysis, the effects of prolonged PP sessions (24 h) were retrospectively studied with regard to safety data, oxygenation and respiratory system compliance. METHODS: Retrospective review of 17 consecutive patients who required both VV-ECMO and prone positioning. PP under VV-ECMO was considered when the patient presented at least one unsuccessful ECMO weaning attempt after day 7 or refractory hypoxemia combined or not with persistent high plateau pressure. PP sessions had a duration of 24 h with fixed ECMO and respiratory settings. PP was not performed in patients under vasopressor treatment and in cases of recent open chest cardiac surgery. RESULTS: Despite optimized protective mechanical ventilation and other adjuvant treatment (i.e. PP, inhaled nitric oxide, recruitment maneuvers), 44 patients received VV-ECMO during the study period for refractory acute respiratory distress syndrome. Global survival rate was 66 %. Among the latter, 17 patients underwent PP during VV-ECMO for a total of 27 sessions. After 24 h in prone position, PaO2/FiO2 ratio significantly increased from 111 (84-128) to 173 (120-203) mmHg (p < 0.0001) while respiratory system compliance increased from 18 (12-36) to 32 (15-36) ml/cmH2O (p < 0.0001). Twenty-four hours after the return to supine position, tidal volume was increased from 3.0 (2.2-4.0) to 3.7 (2.8-5.0) ml/kg (p < 0.005). PaO2/FiO2 ratio increased by over 20 % in 14/14 sessions for late sessions (≥7 days) and in 7/13 sessions for early sessions (<7 days) (p = 0.01). Quantitative CT scan revealed a high percentage of non-aerated or poorly-aerated lung parenchyma [52 % (41-62)] in all patients. No correlation was found between CT scan data and respiratory parameter changes. Hemodynamics did not vary and side effects were rare (one membrane thrombosis and one drop in ECMO blood flow). CONCLUSION: When used in combination with VV-ECMO, 24 h of prone positioning improves both oxygenation and respiratory system compliance. Moreover, our study confirms the absence of serious adverse events.

[The pathophysiology of septic shock]. / La physiopathologie du choc septique.

Understanding of the pathophysiology of septic shock has benefitted from recent advances. These advances enable the validation of current treatment but also the development of new therapeutic approaches.

[Nursing management of ventilation and sedation in patients suffering from septic shock]. / La prise en charge infirmière de la ventilation et de la sédation chez le patient en choc septique.

A significant number of intubated, ventilated and sedated patients suffering from septic shock develop acute respiratory distress syndrome (ARDS). The supervision by a multidisciplinary team optimises both the management of ventilation and the sedation analgesia of the patient. The nursing supervision and care related to this pathology are specific.

[The cardiology patient's journey]. / Le circuit du patient en chirurgie cardiaque.

In heart surgery departments, patients follow a specific route, from the initial appointment through to the post-operative outpatient appointment. A study was carried out in 2009 in order to compare the caregivers' experience with the needs expressed by patients during this journey. It forms part of a global quality of care improvement approach.