Sepsis best practices: Definitions, guidelines, and updates.

ABSTRACT: Sepsis remains a complex and costly disease with high morbidity and mortality. This article discusses Sepsis-2 and Sepsis-3 definitions, highlighting the 2021 Surviving Sepsis International guidelines as well as the regulatory requirements and reimbursement for the Severe Sepsis and Septic Shock Management Bundle (SEP-1) measure.

Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses.

BACKGROUND: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival. METHOD: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines. RESULTS: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis. CONCLUSION: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes. [J Contin Educ Nurs. 2024;55(5):224-230.].

Protocolos gerenciados por enfermeiros para identificação precoce da sepse: revisão de escopo / Nurse-managed protocols for early identification of sepsis: a scoping review / Protocolos administrados por enfermeros para la identificación temprana de la sepsis: revisión del alcance

Objetivo: mapear os protocolos assistenciais utilizados por enfermeiros para identificação precoce da sepse no ambiente hospitalar. Método: trata-se de uma revisão de escopo ancorada nas recomendações do Joanna Briggs Institute, desenvolvida em sete bases de dados. A busca e seleção ocorreu em 17 de julho de 2021, utilizando os descritores: sepse, protocolos de enfermagem, avaliação de enfermagem e cuidados de enfermagem. Resultados: a amostra foi composta de seis estudos, destacaram-se os protocolos implementados por projetos de melhoria de qualidade e utilização sistemas eletrônicos de alerta para deterioração clínica. Conclusão: protocolos assistenciais impulsionam a aderência dos profissionais às recomendações oficiais para o manejo da sepse no ambiente hospitalar e o desenvolvimento de cuidados de enfermagem baseados em evidências, contribuindo para melhorar os indicadores de qualidade e reduzir a mortalidade entre pacientes com sepse(AU)

Objective: to map the care protocols used by nurses for the early identification of sepsis in the hospital environment. Method: this is a scope review anchored in the recommendations of the Joanna Briggs Institute, developed in seven databases. The search and selection took place on July 17, 2021, using the descriptors: sepsis, nursing protocols, nursing assessment and nursing care. Results: the sample consisted of six studies, highlighting the protocols implemented by quality improvement projects and the use of electronic warning systems for clinical deterioration. Conclusion: care protocols boost professionals' adherence to official recommendations for the management of sepsis in the hospital environment and the development of evidence-based nursing care, contributing to improve quality indicators and reduce mortality among patients with sepsis(AU)

Objetivo: mapear los protocolos de atención utilizados por las enfermeras para identificar de forma temprana la sepsis en el ambiente hospitalario. Método: se trata de una revisión de alcance anclada en las recomendaciones del Instituto Joanna Briggs, desarrollada en siete bases de datos. La búsqueda y selección se realizó el 17 de julio de 2021, utilizando los descriptores: sepsis, protocolos de enfermería, evaluación de enfermería y cuidados de enfermería. Resultados: la muestra estuvo compuesta por seis estudios, se destacaron los protocolos implementados por los proyectos de mejora de la calidad y utilización de sistemas electrónicos de alerta con respecto al deterioro clínico. Conclusión: los protocolos asistenciales impulsan la adherencia de los profesionales a las recomendaciones oficiales para el manejo de la sepsis en el ámbito hospitalario y el desarrollo de cuidados de enfermería basados en evidencias, contribuyendo a mejorar los indicadores de calidad y reducir la mortalidad entre los pacientes con sepsis(AU)

Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial.

OBJECTIVES: To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization. DESIG: n: Multisite pragmatic randomized clinical trial. SETTING: Three hospitals in North Carolina from January 2019 to March 2020. PATIENTS: Eligible patients hospitalized for suspected sepsis and deemed high-risk for mortality or readmission by validated internal risk models. INTERVENTIONS: Patients were randomized to receive usual care alone (i.e., routine transition support, outpatient care; n = 342) or additional Sepsis Transition And Recovery support (n = 349). The 30-day intervention involved a multicomponent transition service led by a nurse navigator through telephone and electronic health record communication to facilitate best practice postsepsis care strategies during and after hospitalization including: postdischarge medication review, evaluation for new impairments or symptoms, monitoring comorbidities, and palliative care approach when appropriate. Clinical oversight was provided by a Hospital Medicine Transition Services team. MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite of mortality or hospital readmission at 30 days. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prognostic covariates: age, comorbidity, and organ dysfunction at enrollment). Among 691 randomized patients (mean age = 63.7 ± 15.1 yr; 52% female), a lower percentage of patients in the Sepsis Transition And Recovery group experienced the primary outcome compared with the usual care group (28.7% vs 33.3%; risk difference, 4.7%; odds ratio, 0.80; 95% CI, 0.58-1.11; adjusted odds ratio, 0.80; 95% CI, 0.64-0.98). There were 74 deaths (Sepsis Transition And Recovery: 33 [9.5%] vs usual care: 41 [12.0%]) and 155 rehospitalizations (Sepsis Transition And Recovery: 71 [20.3%] vs usual care: 84 [24.6%]). CONCLUSIONS: In a multisite randomized clinical trial of patients hospitalized with sepsis, patients provided with a 30-day program using a nurse navigator to provide best practices for postsepsis care experienced a lower proportion of either mortality or rehospitalization within 30 days after discharge. Further research is needed to understand the contextual factors associated with successful implementation.

Assistência de enfermagem ao paciente com sepse: análise à luz do modelo conceitual de Myra Levine / Cuidados de enfermería a pacientes con sepsis: análisis a la luz del modelo conceptual de Myra Levine / Nursing care to patients with sepsis: analysis in the light of Myra Levine's conceptual model

RESUMO Objetivo estimular a reflexão acerca da assistência de enfermagem ao paciente com sepse a partir dos quatro princípios de conservação propostos pelo modelo conceitual de Myra Levine. Método estudo teórico-reflexivo sobre a relação existente entre os princípios de conservação de Levine e o paciente com sepse. Resultados vigilância aos princípios da conservação da energia observando oferta do oxigênio, idade dos pacientes e os parâmetros energéticos (sinais vitais); da integridade estrutural ao reconhecer precocemente às disfunções orgânicas no pacote hora-1; da integridade pessoal ao preservar a identidade do cliente com dificuldade de verbalizar ou outra condição e da integridade social ao relacionar-se com o paciente e família incluindo-os no processo de cuidado. Conclusão e implicações para a prática os princípios de conservação do modelo proposto apresentam relação com a assistência realizada pela equipe de enfermagem na manutenção do equilíbrio físico, pessoal e social do paciente com sepse. Espera-se que os enfermeiros articulem o conhecimento científico geral da assistência ao paciente com sepse ao seu conhecimento específico, por meio de um referencial teórico, para a promoção da adaptação, conservação e integridade do indivíduo.

RESUMEN Objetivo estimular la reflexión acerca de la atención de enfermería al paciente con sepsis a partir de los cuatro principios de conservación propuestos por el modelo conceptual de Myra Levine. Método estudio teórico-reflexivo sobre la relación entre los principios de conservación de Levine y el paciente con sepsis. Resultados vigilancia de los principios de conservación de la energía, observando el aporte de oxígeno, la edad de los pacientes y los parámetros energéticos (signos vitales); de la integridad estructural mediante el reconocimiento temprano de las disfunciones orgánicas en el paquete hora-1; de la integridad personal al preservar la identidad del cliente con dificultad para verbalizar u otra condición e de la integridad social al relacionarse con el paciente y su familia, incluyéndolos en el proceso de cuidado. Conclusión e implicaciones para la práctica los principios de conservación del modelo propuesto se relacionan con la atención brindada por el equipo de enfermería en el mantenimiento del equilibrio físico, personal y social del paciente con sepsis. Se espera que los enfermeros articulen el conocimiento científico general del cuidado del paciente con sepsis con sus conocimientos específicos, a través de un referencial teórico, para promover la adaptación, conservación e integridad del individuo.

ABSTRACT Objective encourage reflection on nursing care for patients with sepsis based on the four conservation principles proposed by Myra Levine's conceptual model. Method theoretical-reflective study on the relationship between Levine's conservation principles and the patient with sepsis. Results attentiveness to the principles of energy conservation, observing oxygen supply, patients' age and energy parameters (vital signs); of structural integrity by early recognition of organic dysfunctions in the hour-1 bundle; of personal integrity when preserving the identity of the client with difficulty to verbalize or another condition and social integrity when relating to the patient and family, including them in the care process. Conclusion and implications for practice the conservation principles of the proposed model are presented in relation to assistance provided by the nursing team in maintaining the physical, personal and social balance of the patients with sepsis. Nurses are expected to articulate the general scientific knowledge of sepsis patient care with their specific knowledge, through a theoretical framework, to promote the individual's adaptation, conservation and integrity.

Detecção precoce de sepse nos serviços de urgência e emergência: revisão integrativa / Detección temprana de la sepsis en servicios de urgencia y emergencia: revisión integradora / Early detection of sepsis in urgent and emergency services: integrative review

RESUMO Objetivo identificar elementos que subsidiam a construção de protocolo clínico para detecção precoce de sepse em serviços de urgência e emergência. Método revisão integrativa da literatura, do período de 2017 a junho de 2021, nas bases Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Eletronic Library Online, Scopus e Web of Science. Resultados foram encontrados 193 artigos e selecionados nove que compuseram a amostra final. Os elementos identificados foram: recomendações da campanha de sobrevivência à sepse; triagem e abertura de protocolo por enfermeiro; treinamentos; sistemas de alerta, uso dos critérios da síndrome da resposta inflamatória sistêmica; times de resposta ou gerente de protocolo; escore de alerta precoce; check-list de verificação; comunicação multiprofissional e lista de antibióticos. Conclusão os resultados contribuem para assistência ao paciente séptico em serviços de urgência e emergência, favorecendo desfechos positivos, a partir do reconhecimento precoce e aplicação oportuna do tratamento inicial.

RESUMEN Objetivo identificar elementos que apoyen la construcción de un protocolo clínico para la detección temprana de sepsis en servicios de urgencia y emergencia. Método revisión integradora de la literatura, de 2017 a junio de 2021, en las bases de datos Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Electronic Library Online, Scopus y Web of Science. Resultados se encontraron 193 artículos de los cuales nueve compusieron la muestra final. Los elementos identificados fueron: recomendaciones de la campaña supervivencia a la sepsis; cribado y apertura de protocolo por enfermero; capacitaciones; sistemas de alerta, uso de los criterios del síndrome de respuesta inflamatoria sistémica; equipos de respuesta o gerente de protocolo; puntuación de alerta temprana; lista de verificación de verificación; comunicación multiprofesional y listado de antibióticos. Conclusión los resultados contribuyen a la atención de los pacientes sépticos en los servicios de urgencia y emergencia, favoreciendo resultados positivos, basados ​​en el reconocimiento temprano y la aplicación oportuna del tratamiento inicial.

ABSTRACT Objective to identify elements that support the construction of a clinical protocol for early detection of sepsis in urgent and emergency services. Method integrative literature review, from 2017 to June 2021, in the Medical Literature Analysis and Retrieval System Online, National Library of Medicine, Scientific Electronic Library Online, Scopus and Web of Science. Results 193 articles were found and nine composed the final sample. The elements identified were: recommendations from the surviving sepsis campaign; screening and opening of protocol by nurse; trainings; warning systems, use of systemic inflammatory response syndrome criteria; response teams or protocol manager; early warning score; checklist of verification; multiprofessional communication and antibiotic list. Conclusion the results contribute to care for septic patients in urgent and emergency services, favoring positive outcomes, based on early recognition and timely application of the initial treatment.

Association of hospital nursing and postsurgical sepsis.

Despite concerted research and clinical efforts, sepsis remains a common, costly, and often fatal occurrence. Little evidence exists for the relationship between institutional nursing resources and the incidence and outcomes of sepsis after surgery. The objective of this study was to examine whether hospital nursing resource quality is associated with postsurgical sepsis incidence and survival. This cross-sectional, secondary data analysis used registered nurses' reports on hospital nursing resources-staffing, education, and work environment-and multivariate logistic regressions to model their association with risk-adjusted postsurgical sepsis and mortality in 568 hospitals across four states. Better work environment quality was associated with lower odds of sepsis. While the likelihood of death among septic patients was nearly seven times that of non-septic patients, better nursing resources were associated with reduced mortality for all patients. Whereas the preponderance of sepsis research has focused on clinical interventions to prevent and treat sepsis, this study describes organizational characteristics hospital administrators may modify through organizational change targeting nurse staffing, education, and work environments to improve patient outcomes.

Sentiment Analysis Based on the Nursing Notes on In-Hospital 28-Day Mortality of Sepsis Patients Utilizing the MIMIC-III Database.

In medical visualization, nursing notes contain rich information about a patient's pathological condition. However, they are not widely used in the prediction of clinical outcomes. With advances in the processing of natural language, information begins to be extracted from large-scale unstructured data like nursing notes. This study extracted sentiment information in nursing notes and explored its association with in-hospital 28-day mortality in sepsis patients. The data of patients and nursing notes were extracted from the MIMIC-III database. A COX proportional hazard model was used to analyze the relationship between sentiment scores in nursing notes and in-hospital 28-day mortality. Based on the COX model, the individual prognostic index (PI) was calculated, and then, survival was analyzed. Among eligible 1851 sepsis patients, 580 cases suffered from in-hospital 28-day mortality (dead group), while 1271 survived (survived group). Significant differences were shown between two groups in sentiment polarity, Simplified Acute Physiology Score II (SAPS-II) score, age, and intensive care unit (ICU) type (all P < 0.001). Multivariate COX analysis exhibited that sentiment polarity (HR: 0.499, 95% CI: 0.409-0.610, P < 0.001) and sentiment subjectivity (HR: 0.710, 95% CI: 0.559-0.902, P = 0.005) were inversely associated with in-hospital 28-day mortality, while the SAPS-II score (HR: 1.034, 95% CI: 1.029-1.040, P < 0.001) was positively correlated with in-hospital 28-day mortality. The median death time of patients with PI ≥ 0.561 was significantly earlier than that of patients with PI < 0.561 (13.5 vs. 49.8 days, P < 0.001). In conclusion, sentiments in nursing notes are associated with the in-hospital 28-day mortality and survival of sepsis patients.

Sepsis knowledge, skills and attitudes among ward-based nurses.

BACKGROUND: Nurses are in a prime position to identify sepsis early by screening patients for sepsis, a skill that should be embedded into their daily practice. However, compliance with the sepsis bundle remains low. AIMS: To explore the effects of sepsis training on knowledge, skills and attitude among ward-based nurses. METHODS: Registered nurses from 16 acute surgical and medical wards were invited to anonymously complete a questionnaire. FINDINGS: Response rate was 39% (98/250). Nurses with sepsis training had better knowledge of the National Early Warning Score 2 for sepsis screening, and the systemic inflammatory response syndrome (SIRS) criteria, demonstrated a more positive attitude towards sepsis screening and management, were more confident in screening patients for sepsis and more likely to have screened a patient for sepsis. CONCLUSIONS: Sepsis training improves nurses' attitudes, knowledge and confidence with regards to sepsis screening and management, resulting in adherence to evidence-based care, and should become mandatory for all clinical staff.

Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care.

BACKGROUND: It is necessary to analyze the characteristics and risk factors of catheter-related bloodstream infection (CRBSI) in newborns with peripherally inserted central catheter (PICC). METHODS: Newborns undergoing PICC catheterization in the neonatal department of our hospital from January 1, 2020 to January 31, 2021 were included. The characteristics of newborns with and without CRBSI newborns were compared and analyzed. Logistic regression analyses were performed to evaluate the risk factors of CRBSI in newborns with PICC. RESULTS: Three hundred eighty-six newborns with PICC were included, of whom 41 newborns had the CRBSI, the incidence of CRBSI in newborns with PICC was 10.62%. There were significant differences regarding the birth weight, durations of PICC stay, 5-min Apgar score, site of PICC insertion of PICC between CRBSI and no CRBSI group (all P < 0.05), and there were no significant differences regarding the gender, gestational age, cesarean section, mechanical ventilation and length of hospital stay between CRBSI and no CRBSI group (all P > 0.05). Escherichia coli (26.08%) and Staphylococcus aureus (23.92%) were the most common CRBSI pathogens in newborns with PICC. Logistic regression analysis indicated that birth weight ≤ 1500 g (OR 1.923, 95% CI 1.135-2.629), durations of PICC stay ≥ 21 days (OR 2.077, 95% CI 1.024-3.431), 5-min Apgar score ≤ 7 (OR 2.198, 95% CI 1.135-3.414) and femoral vein insertion of PICC (OR 3.044, 95% CI 1.989-4.306) were the independent risk factors of CRBSI in neonates with PICC (all P < 0.05). CONCLUSION: For newborns with low birth weight, longer durations of PICC stay and femoral vein PICC insertion, they may have higher risks of CRBSI, and medical staff should take targeted measures to reduce the development of CRBSI.

Study on clinical nursing pathway to promote the effective implementation of sepsis bundle in septic shock.

BACKGROUND: There is still a certain gap between the effective implementation and requirements of sepsis bundle. Our aim is to establish the clinical nursing pathway of the cluster treatment of septic shock in the Intensive Care Unit and promote effective implementation of the cluster treatment of septic shock. METHODS: By means of evidence-based method, quality control index requirements and on-site investigation, the implementation process of clinical nursing pathway of the cluster treatment within 6 h of diagnosis of septic shock was established. RESULTS: After the implementation of clinical nursing pathway, the completion rate of septic shock cluster treatment was 81.4% (66.4%) in 1 h, 89.4% (77.0%) in 3 h, 95.5% (82.3%) in 6 h (P < 0.05), which was significantly improved in the experimental group compared with the control group. CONCLUSIONS: The clinical nursing pathway of septic shock cluster treatment is guided by evidence-based nursing, which emphasizes standardization and standardization of septic shock cluster treatment nursing under the guidance of the guideline, and can promote the effective implementation of septic shock cluster treatment, significantly improve efficiency of septic shock treatment and the quality of medical care.

Teaching Evidence-Based Sepsis Care: A Sepsis Escape Room.

BACKGROUND: Using evidence-based sepsis guidelines, nurse educators identified the nursing skills required to recognize and treat sepsis. METHOD: Nurse educators created an innovative, interactive sepsis escape room to provide sepsis education. The escape room included a manikin, puzzles, distractors, riddles, and props. Participants were given 20 minutes to solve four puzzles/riddles to treat the sepsis patient and escape the room. RESULTS: All but two (N = 16) groups solved the clues and riddles to prioritize treatment in the allotted time. Evaluations were excellent. Mean score (1 = poor to 5 = outstanding) for overall escape room experience was 4.92. Adherence data improved on the Surviving Sepsis Campaign sepsis performance measure intervention bundles (SEP 1-3 care bundles) 2 months following the escape room. Bundles are a group of interventions that improve care. CONCLUSION: The escape room engaged nurses in educational gaming, stimulating critical thinking and problem solving contributing to improved clinical outcomes. [J Contin Educ Nurs. 2021;52(5):217-225.].

Can You Escape Sepsis? Using a Healthcare Escape Room as an Innovative Approach to Nursing Education.

PURPOSE/OBJECTIVES: The purpose of this article is to provide the clinical nurse specialist with an interactive, creative, and fun approach using an escape room to increase the retention and application of knowledge about caring for patients with sepsis and improve patient care outcomes. DESCRIPTION OF THE PROJECT: This project involved the design of a healthcare-based escape room, where clinical nurses and interprofessional learners engaged in a series of puzzles and problem-solving experiences to apply clinical judgment and critical thinking about patient care. THEORY AND FRAMEWORKS: Knowles' theory of adult learning guided the development of this gamified learning. OUTCOME: The clinical nurse specialist was critical to the success of the escape room. The escape room created an innovative learning environment, expanding opportunities to engage staff and promote high-quality care for best patient outcomes. CONCLUSION: The benefits of incorporating adult learning principles with gamification-based education as a teaching strategy are evident in the feedback and overwhelmingly positive responses received from participants. The successes of the sepsis escape room have presented opportunities to continue supporting progressive, fun, and evidence-based learning environments and positively impact both nursing education and patient care outcomes.

Effectiveness of the sepsis six bundle in the management of acute adult sepsis in the UK.

There are up to 11 million sepsis-related deaths worldwide each year. Management of sepsis requires early recognition, appropriate antibiotic treatment and careful management of haemodynamic status. In 2006, the UK Sepsis Trust introduced the sepsis six care bundle to simplify the guidelines for managing sepsis and identify actions for management that were more accessible to junior clinicians. This article reports findings from a literature review that explored the effectiveness of the sepsis six bundle in the management of adult sepsis patients in the UK and assessed the level of clinician compliance in UK clinical settings. The effectiveness of sepsis six was based on patient mortality during hospital stay, rate of intensive care unit admissions and length of hospital stay, all of which were found to have improved since the introduction of the tool.

Identifying and treating sepsis in older people: a quality improvement project in hospitals and nursing homes in Texas.

Sepsis, if not identified and treated early, can be fatal, particularly in older people. A lack of knowledge and understanding of sepsis among nursing staff can result in a missed or delayed diagnosis, leading to delayed treatment and potentially to patient death. A quality improvement project was conducted in nine hospitals and 200 nursing homes in the Lower and Upper Rio Grande Valley regions of Texas, in the US, to improve the identification and treatment of sepsis by nursing staff. Interventions included educational webinars for hospital staff and train-the-trainer sessions for nurse leaders in nursing homes. All participating hospitals had implemented a sepsis screening tool and sepsis care bundles by the end of the project, and an overall decline in sepsis mortality rates was seen in these hospitals. Among participating nurse leaders in nursing homes, a dramatic improvement in sepsis knowledge was seen. The outcomes of the project support the use of comprehensive nursing staff education on sepsis identification and treatment. Sepsis education needs to be ongoing to maintain optimal levels of knowledge among nursing staff.

The influence of nurse allocated triage category on the care of patients with sepsis in the emergency department: A retrospective review.

BACKGROUND: 'Gold standard' sepsis care encompasses the recognition and treatment of sepsis within one hour of emergency department (ED) presentation. Early treatment of patients with sepsis reduces mortality. The aim of this study was to examine the effect that the nurse allocated Australasian Triage Scale (ATS) Category allocation had on ED patient treatment for severe sepsis and septic shock. METHODS: A two-year retrospective observational cohort study from a single major metropolitan ED, including all patients with severe sepsis or septic shock. RESULTS: Sixty patients were included in this study. Sepsis was recognised at triage for the majority of patients (n=38, 63%), and most were allocated an ATS Category Two (n=39). Almost half of the patients received all elements of the sepsis bundle within one hour of arrival (n=27,45%). Patients allocated an ATS Category One or Two had a shorter time to lactate collection (p=0.003), blood culture procurement (p=0.009) and intravenous antibiotic administration (p=0.021) compared with patients who were allocated ATS Category Three or Four. CONCLUSIONS: Most patients presenting with sepsis were recognised by the triage nurse and allocated a high acuity ATS category accordingly. As sepsis is a time-critical condition and a high acuity triage allocation reduces time to treatment, we recommend all Australian EDs should implement a standard approach to sepsis triage by allocating an ATS Category of One or Two to all patients suspected of having sepsis, thus reflecting the urgency of their disease.

Impact of COVID-19 on nursing time in intensive care units in Belgium.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection.

OBJECTIVES: To investigate the role of nurse-led, goal-directed lung physiotherapy on the prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection. METHODS: Patients with sepsis caused by A. baumannii pulmonary infection were recruited and divided into a control group (phase 1) and a treatment group (phase 2). Both groups received standard therapy for sepsis, and patients in phase 2 also received nurse-led, goal-directed lung physiotherapy. The primary outcome measure was 28-day mortality. RESULTS: Among 742 patients with sepsis, 201 were diagnosed with A. baumannii pulmonary infection. Compared with patients in phase 1, patients in phase 2 had a significantly shorter duration of mechanical ventilation {median 4 (interquartile range (IQR) 3-5] vs 5 (IQR 3-12) days; P = 0.004}, lower intensive care unit (ICU) mortality [13.6% (18/132) vs 27.5% (19/69); P = 0.016] and lower 28-day mortality [21.2% (28/132) vs 37.7% (26/69); P = 0.012]. As a protective factor, nurse-led, goal-directed lung physiotherapy (odds ratio 0.341, 95% confidence interval 0.155-0.751; P = 0.008) was an independent risk factor for 28-day mortality. CONCLUSIONS: Nurse-led, goal-directed lung physiotherapy shortened the duration of mechanical ventilation and ICU stay, and decreased ICU mortality and 28-day mortality in patients with sepsis caused by A. baumannii pulmonary infection.

Fatores associados ao desenvolvimento de sepse em pacientes internados em terapia intensiva cirúrgica: estudo retrospectivo / Factores asociados al desarrollode sepsis en pacientes internados en cuidado intensivoquirúrgico: estudio retrospectivo / Factors associated with the development of sepsis in patients hospitalized in intensive surgical therapy: a retrospective study

RESUMO Objetivo: verificar a associação entre os fatores de risco e o desenvolvimento de sepse em pacientes cirúrgicos ou hemodinâmicos internados em uma unidade de terapia intensiva (UTI) cirúrgica. Métodos: estudo de corte transversal, de abordagem retrospectiva, realizado na UTI cirúrgica de um hospital de grande porte, no período de janeiro a abril de 2018, com uma amostra final de 113 internamentos. Os dados foram coletados em prontuários, transcritos para formulários de coleta e, em seguida, tabulados e analisados por meio do programa Statistical Package for the Social Sciences (SPSS), versão 22.0. Calcularam-se razão de prevalência (RP), Qui-quadrado de Pearson e teste exato de Fisher, considerando estatisticamente significantes os resultados com o valor de p<0,05. Resultados: a sepse teve uma prevalência de 8% na unidade de estudo e uma associação estatisticamente significativa com o tempo de internamento prolongado na UTI (RP=21,1; IC=2,759-162,316; p=0,000) e a ocorrência de óbito (RP=6,6; IC=2,375-18,357; p=0,005). Conclusão: os dados encontrados poderão estimular a realização de novas pesquisas, cooperando com a produção científica e a discussão sobre a temática, refletindo positivamente na prática assistencial, especialmente em terapia intensiva.

RESUMEN Objetivo: averiguar la asociación entre los factores de riesgo y el desarrollo de sepsis en pacientes quirúrgicos o hemodinámicos internados en una unidad de cuidados intensivos (UCI) quirúrgica. Métodos: estudio de corte transversal, de abordaje retrospectivo, realizado en la UCI quirúrgica de un hospital de gran tamaño, en el período de enero a abril de 2018, con una muestra final de 113 hospitalizaciones. Los datos fueron recogidos en registros médicos, transcriptos para formularios de recolección y luego tabulados y analizados por medio del programa Statistical Package for the Social Sciences (SPSS), versión 22.0. Se calcularon razón de prevalencia (RP), Chi-cuadrado de Pearson y prueba exacta de Fisher, considerando estadísticamente significativos los resultados con el valor de P<0,05. Resultados: la sepsis tuvo una prevalencia del 8% en la unidad de estudio y una asociación estadísticamente significativa con el tiempo de hospitalización prolongado en la UCI (RP=21,1; IC=2,759-162,316; p=0,000) y la ocurrencia de óbito (RP=6,6; IC=2,375-18,357; p=0,005). Conclusión: los datos encontrados podrán fomentar la realización de nuevas investigaciones, colaborando con la producción científica y la discusión sobre la temática, repercutiendo positivamente en la práctica asistencial, especialmente en cuidados intensivos.

ABSTRACT Objective: to check the association between risk factors and the development of sepsis in surgical or hemodynamic patients hospitalized in a surgical intensive care unit (SICU). Methods: cross-sectional study, with a retrospective approach, performed in the surgical ICU of a large hospital, from January to April 2018, with a final sample of 113 hospitalizations. Data were collected from medical records, transcribed into collection forms, then tabulated and analyzed through the Statistical Package for the Social Sciences (SPSS), version 22.0; Prevalence ratio (PR), Pearson's Chi-square and Fisher's exact test were calculated, considering statistically significant the results with a value of p<0.05. Results: sepsis had a prevalence of 8% in the study unit and a statistically significant association with prolonged SICU stay (PR=21.1; CI=2.759-162.316; p=0.000) and the occurrence of death (PR=6.6; CI=2.375-18.357; p=0.005). Conclusion: the data found may encourage further research, cooperating with scientific production and discussion on the topic, reflecting positively on care practice, especially in intensive care.