EFFECT of daily antiseptic body wash with octenidine on nosocomial primary bacteraemia and nosocomial multidrug-resistant organisms in intensive care units: design of a multicentre, cluster-randomised, double-blind, cross-over study.

INTRODUCTION: Nosocomial infections are serious complications that increase morbidity, mortality and costs and could potentially be avoidable. Antiseptic body wash is an approach to reduce dermal micro-organisms as potential pathogens on the skin. Large-scale trials with chlorhexidine as the antiseptic agent suggest a reduction of nosocomial infection rates. Octenidine is a promising alternative agent which could be more effective against Gram-negative organisms. We hypothesise that daily antiseptic body wash with octenidine reduces the risk of intensive care unit (ICU)-acquired primary bacteraemia and ICU-acquired multidrug-resistant organisms (MDRO) in a standard care setting. METHODS AND ANALYSIS: EFFECT is a controlled, cluster-randomised, double-blind study. The experimental intervention consists in using octenidine-impregnated wash mitts for the daily routine washing procedure of the patients. This will be compared with using placebo wash mitts. Replacing existing washing methods is the only interference into clinical routine.Participating ICUs are randomised in an AB/BA cross-over design. There are two 15-month periods, each consisting of a 3-month wash-out period followed by a 12-month intervention and observation period. Randomisation determines only the sequence in which octenidine-impregnated or placebo wash mitts are used. ICUs are left unaware of what mitts packages they are using.The two coprimary endpoints are ICU-acquired primary bacteraemia and ICU-acquired MDRO. Endpoints are defined based on individual ward-movement history and microbiological test results taken from the hospital information systems without need for extra documentation. Data on clinical symptoms of infection are not collected. EFFECT aims at recruiting about 45 ICUs with about 225 000 patient-days per year. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the University of Leipzig (number 340/16-ek) in November 2016. Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS-ID: DRKS00011282.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

BACKGROUND: Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. METHODS: A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. RESULTS: The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. CONCLUSIONS: In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Hyperoxic ventilation improves survival in pigs during endotoxaemia at the critical hemoglobin concentration.

AIM OF THE STUDY: Recently it has been demonstrated that short term hyperoxic ventilation (HV) can improve glucose metabolism, reduce pulmonary and hepatic apoptosis, and improve gastrointestinal perfusion during acute sepsis. However, it is unknown whether additional O(2) improves survival. Therefore we investigated the effects of increased plasma O(2) on survival during extreme anaemia and concomitant endotoxaemia in order to quantify the efficacy of HV. METHODS: Endotoxaemia (Salmonella abortus equi-LPS) was induced in 14 anesthetized pigs ventilated with room air (FiO(2)=0.21). Simultaneously, animals were haemodiluted by exchange of whole blood for 6% hydroxyethyl starch (200,000:0.5) until the individual critical hemoglobin concentration (Hb(crit)) was achieved (outermost limit of tissue oxygenation). Subsequently, animals were either ventilated with an FiO(2) of 0.21 (NOX, n=7) or an FiO(2) of 1.0 (HOX, n=7), and observed thereafter for 6 h without further intervention. RESULTS: HV significantly prolonged survival time at Hb(crit) (NOX, 30 [27/35] min; HOX, 172 [111/235] min, p<0.05). In contrast to the NOX group, HV maintained MAP, and improved DO(2) and tissue oxygenation in the HOX group. CONCLUSION: The improvement of survival, oxygen transport and tissue oxygenation seems to underline the efficacy of HV during endotoxaemia and concomitant acute anaemia. Further studies are needed to transfer these results into daily clinical practice.

Epidemiology of and factors associated with end-of-life decisions in a surgical intensive care unit.

OBJECTIVE: To investigate the epidemiology of and possible factors associated with end-of-life decisions in a surgical intensive care unit. DESIGN: Analysis of prospectively collected data. SETTING: University hospital surgical intensive care unit. PATIENTS: All patients admitted to the surgical intensive care unit between September 2002 and July 2006. MEASUREMENTS AND MAIN RESULTS: During the study period, 14,720 patients were admitted to the surgical intensive care unit (61.8 male; mean age, 62 yrs). The prevalence of end-of-life decisions was 2.7% (n = 398); 230 patients (1.6%) had a do-not-resuscitate order, 90 (0.6%) had a decision to withhold therapy, and 78 (0.5%) had a decision to withdraw life-supportive therapy. Patients with end-of-life decisions had higher severity scores on the day of intensive care unit admission, were mostly unplanned admissions, were older, and were more commonly referred from the emergency room or other hospitals compared to those who did not have an end-of-life decision. The prevalence of end-of-life decisions increased significantly with the severity of sepsis. An end-of-life decision was made for 29% of the patients who died in the intensive care unit. Intensive care unit and hospital mortality rates were 6.1% and 10.3%, respectively, overall, and 65.1% and 82.2%, respectively, in patients with an end-of-life decision. In multivariate analysis, older age, admission from another hospital, cirrhosis, sepsis syndromes, simplified acute physiology score II, and sequential organ failure assessment scores were independently associated with end-of-life decisions. CONCLUSIONS: Twenty-nine percent of patients who die in the surgical intensive care unit have an end-of-life decision. Severe sepsis/septic shock was associated with a 16-fold increased likelihood of having an end-of-life decision.

[Meta-analysis and its synonyms]. / Meta-Studien und ihre Synonyme.

The purpose of meta-interpretive literature reviews is to combine the individual findings of different studies into a single, coherent analysis (here: meta-studies). The positions on how to handle that differ enormously. This is reflected in the variety of terms and definitions for synonym circumstances, e.g. "meta-analysis", "systematic review", "narrative review", "meta-syntheses". Also ambiguous is why in some cases the systematic is highlighted due to prefix the term "systematic", in others not. This article is part of a master thesis at the Institute of Nursing Science (University Witten/Herdecke, Germany). The aim of this article is to constitute the different opinions and put the terms in order. Illustrative examples of the synonymously used terms will therefore be identified and embedded in the underlying philosophies. It is assumed that the different positions result from the underlying philosophies. Further on there is evidence that "narrative" often wrongly is interpreted as the opposite to "systematic". The article concludes with options of how to put the terms in order.

Nurses' perception of shift handovers in Europe: results from the European Nurses' Early Exit Study.

AIM: This paper reports a study exploring nurses' perceptions of the shift handover and the possible reasons for reported dissatisfaction in 10 European countries. BACKGROUND: The nursing handover fulfils a number of purposes and has important consequences for the continuity of patient care and nurses' satisfaction with the quality of care they are able to provide. However, the performance and function of shift handovers in health care is a widely neglected topic in practice and research. METHOD: The Nurses' Early Exit Study (http://www.next-study.net) investigates the working conditions of nurses and variables influencing nursing retention. The data for this analysis were collected between 2002 and 2003 by self-report questionnaires in 10 European countries. FINDINGS: The percentage of nurses dissatisfied with shift handovers ranged from 22% in England to 61% in France. In most countries the main reason for dissatisfaction with shift handovers was 'too many disturbances', followed by 'lack of time'. Most countries showed similar associations of dissatisfaction with qualification level and occupational seniority, but not with position and type of shift. 'Poor quality of leadership' and 'poor support from colleagues', were strongly associated with dissatisfaction. CONCLUSIONS: In several (but not all) European countries, shift handovers may be a frequent cause for nurses' irritation. The underlying causes appear to be of an organizational nature. The findings have implications for solutions. Further debate and research should clarify the different purposes of shift handovers and relate them to handover style and to the quality of patient care.

[Abdominal massage as intervention for patients with paraplegia caused by spinal cord injury--a pilot study]. / Bauchmassage als Intervention bei Menschen mit Querschnittlähmung--eine Pilotstudie.

UNLABELLED: Patients with paraplegia caused by spinal cord injuries have to deal with the loss of the central nervous regulation of the bowel functions. The management of defaecation can take a lot of their daily time. To support the colon motility, different methods of abdominal massage are used in nursing practice. But a review of current international literature reveals, that there is still a lack of evidence for the effect of abdominal massage on defaecation. In order to prove this effect, a pilot study was conducted using a quasi-experimental design with time series and including seven patients with paraplegia caused by spinal cord injury. Data were collected over three weeks: one week before intervention, during the intervention week and one week after intervention. In the intervention week, the patients received a specific abdominal massage each morning before breakfast. Following outcome-criteria have been considered: frequency and duration of defaecation, amount and consistency of faeces as well as subjective perception of the massage and its effects. RESULTS: Some distinctive changes in the frequency and duration of defaecation could be registered over time. Most patients regarded the massage as a comfortable intervention that may have positive effects of the defaecation. Due to the pilot character of the study further research is necessary in order to validate these effects.

[The problems of the form of address Du vs. Sie between nurses and patients in Germany]. / Die Problematik der Anrede Du vs. Sie zwischen Pflegepersonal und Patientinnen/Patienten in Deutschland.

This article is an overview of selected nursing and linguistic literature examining the use of the pronoun Du vs. Sie in Germany. The aim of this literature review is to show the difficulties faced when one is choosing a form of address and relate these difficulties to the daily nursing routine. This overview will show clearly that the choice of pronoun can "form social reality". Linguistic literature distinguishes two dimensions: One is the vertical dimension (power semantic) which shows the unequal relationship of the speaker and the listener. The other is the horizontal dimension (solidarity semantic) which shows the equality of the talking partners. The analysis of nursing literature brought to light that the choice of form of address should be considered with regard to the aspects power, familiarity vs. distance, distain vs. respect.