Skin problems associated with using of personal protective equipment in COVID-19 intensive care units.

BACKGROUND: Health care workers, who worked intensively during the COVID-19 pandemic, faced some problems, including skin problems, due to the personal protective equipment (PPE) they used to control the spread of infection. AIMS: This study aimed to identify the skin problems because of using PPE by nurses during the delivery of health care in three COVID-19 intensive care units (ICUs) within one hospital service. STUDY DESIGN: The study was designed as a cross-sectional survey. The study was conducted with nurses working in three intensive care units in the metropolitan districts of Ankara, Turkey. The data were collected online with a questionnaire developed by the researchers between December 2021 and June 2022. RESULTS: In this study, 82/120 (68.33%) nurses responded to the questionnaire at least once during the distribution period. The mean of the duration of PPE utilization per each time including goggles, N95 mask, bonnet, face-shield, gloves, boots/shoe covers and coverall was 3.76 ± 1.36 h. The proportion of nurses who experienced any skin problem related to any PPE at least two or more was 74/82 (90.24%). The proportion of pressure sores, acne, skin reaction including allergic dermatitis or contact urticaria, and regional pain varied between 4.9% and 79.3%. The proportion of nurses who applied any protective application to prevent skin problems was 53.66%. Among the protective applications, pressure-reducing surfaces were used the most. The use of protective applications for goggles (p = .010), bonnet (p = .000) and face shield (p = .000) effectively reduced PPE-related skin problems. CONCLUSION: During the pandemic, nurses faced a wide variety of skin problems because of PPEs. It may be beneficial to design a study programme that reduces the duration of PPEs use in clinics. In addition, there is a need for effective protective applications to prevent skin problems and new development of PPE that do not cause skin problems. RELEVANCE TO CLINICAL PRACTICE: In the pandemic, skin problems have developed because of the use of PPE in nurses who provide health care, intensively. These problems, which were not seen as a priority in the pandemic, may adversely affect the health of nurses, their performance in the treatment and care process and their work quality.

Determination of microbial contamination on the outer surface of needleless connectors before and after disinfection.

OBJECTIVES: The aim of this study was to determine bacterial contamination of needleless connectors before and after disinfection to assess the risk for the point of catheter-related bloodstream infections. RESEARCH METHODOLOGY/DESIGN: Experimental study design. SETTING: The research was carried out on patients with a central venous catheter hospitalized in the intensive care unit. MAIN OUTCOMES MEASURES: Bacterial contamination of needleless connectors integrated into central venous catheters was assessed before and after disinfection. Antimicrobial susceptibilities of colonized isolates were investigated. In addition, the compatibility of the isolates with the bacteriological cultures of the patients was determined over a one-month period. RESULTS: Bacterial contamination varied between 5×103 and 1×105 colony forming unit was detected before disinfection in 91.7% of needleless connectors. Most common bacteria were coagulase-negative staphylococci; others were Staphylococcus aureus, Enterococcus faecalis, and Corynebacterium species. While most isolates were resistant to penicillin, trimethoprim-sulfamethoxazole, cefoxitin, and linezolid, each was susceptible to vancomycin or teicoplanin. Bacterial survival was not detected on needleless connectors after disinfection. There was no compatibility between the one-month bacteriological culture results of the patients and the bacteria isolated from the needleless connectors. CONCLUSION: Bacterial contamination was detected on the needleless connectors before disinfection, although they were not rich in bacterial diversity. There was no bacterial growth after disinfection with an alcohol-impregnated swab. IMPLICATIONS FOR CLINICAL PRACTICE: The majority of needleless connectors had bacterial contamination before disinfection. Needleless connectors should be disinfected for 30 seconds before use, particularly in immunocompromised patients. However, the use of needleless connectors with antiseptic barrier caps may be a more practical and effective solution instead.

The antibacterial activity of photodynamic agents against multidrug resistant bacteria causing wound infection.

Antimicrobial photodynamic inactivation (aPDI) of multidrug-resistant (MDR) wound pathogens was evaluated with cationic porphyrin derivatives (CPDs). MDR bacterial strains including Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae were used. The CPDs named PM, PE, PN, and PL were synthesized as a photosensitizer (PS). A diode laser with a wavelength of 655 nm was used as a light source. aPDI of the combinations formed with different energy densities (50, 100, and 150 J/cm²) and PS concentrations (ranging from 3.125 to 600 µM) were evaluated on each bacterial strain. Dark toxicity, cytotoxicity, and phototoxicity were determined on fibroblast cells. In the aPDI groups, survival reductions of up to 5.80 log10 for E. coli, 5.90 log10 for P. aeruginosa, 6.11 log10 for K. pneumoniae, and 6.78 log10 for A. baumannii were obtained. The cytotoxic effect of PL and PM on fibroblast cells was very limited. PN was the type of CPD with the highest dark toxicity on fibroblast cells. In terms of providing broad-spectrum aPDI without or with very limited cytotoxic effect, the best result was observed in aPDI application with PL. The other CPDs need some modifications to show bacterial selectivity for use at 50 µM and above.

Student Nurses' Assessment of Medical Errors.

PURPOSE: The aim of this study was to evaluate the quality of nursing students' assessment of cases of medical error. METHOD: This descriptive cross-sectional study was conducted with 145 nursing students in Izmir, Turkey. The epidemiology of the medical errors that the students witnessed during clinical practice was examined. Then, the success of the students in using the Text-Based Medical Error cases tool developed by the researchers was examined. RESULTS: Of the students, 24.1% had witnessed medical errors during clinical practice. The percentage of students successfully analyzing cases of medical errors related to patient identification, falling, medication administration, blood transfusions, health-care-associated infections, and pressure ulcers were 51.72%, 7.59%, 17.24%, 8.28%, 45.52%, and 56.55%, respectively. CONCLUSION: The students' ability to evaluate cases of medical error needs improvement.

The effect of oropharyngeal aspiration before position change on reducing the incidence of ventilator- associated pneumonia.

The aim of this study was to investigate the effect of oropharyngeal aspiration on ventilator-associated pneumonia (VAP) incidence just prior to changing patient position. This randomized controlled experimental study was conducted between July 2015 and April 2019 in anesthesiology and reanimation of intensive care unit (ICU). The patients of experimental group underwent oropharyngeal aspiration under surgical aseptic conditions before each position change. Patients of the control group received oropharyngeal aspiration only as needed. The mean age of the patients was 62.87 ± 17.33 years. The mean and median duration of stay in the ICU were 27.28 ± 30.69 and 18.00 days respectively. The mean and median of duration of the mechanical ventilation support were 26.72 ± 30.65 and 18.00 (min 4; max 168) days respectively. Thirty percent of the patients were VAP. The mean duration of VAP development was 7.50 ± 5.07 days. The rate of VAP development was 11.23/1000 mechanical ventilator days. Only 8.3% of the experimental group patients developed VAP; 91.7% of the control group patients developed VAP. The VAP rate in the control group was 16.82/1000 mechanical ventilator days and the VAP rate in the experimental group was 2.41/1000 mechanical ventilator days. Most VAP agents were multidrug resistant. Distribution of isolated microorganisms was as Acinetobacter baumannii, Pseudomonas aeruginosa, Corynebacterium striatum, Staphylococcus aureus, Providencia stuartii, Serratia marcescens, Stenotrophomonas maltophilia, and Aspergillus flavus. In our study, it was concluded that oropharyngeal aspiration performed prior to patient position change prevented the development of VAP.

The effectiveness of scenario-based learning to develop patient safety behavior in first year nursing students.

The aim of this study was to examine the effect of scenario-based learning (SBL) compared to traditional demonstration method on the development of patient safety behavior in first year nursing students. During the 2016-2017 academic year, the Fundamentals of Nursing course curriculum contained the teaching of demonstration method (n=168). In the academic year 2017-2018 was performed with SBL method in the same context (n=183). Objective Structured Clinical Examination (OSCE) that assesses the same three skills was implemented in both academic terms to provide standardization so that students could evaluated in terms of patient safety competency. It was found that students' performance of some of the steps assessed were not consistently between the demonstration and SBL methods across the three skills. There was a statistically significant difference between demonstration method and SBL method for students' performing the skill steps related to patient safety in intramuscular injection (p<0.05) Our results suggest that the integration of SBL into the nursing skills training may be used as a method of teaching in order to the development of patient safety skills.

The Effect of Nurses' Leadership Behavior on the Quality of Nursing Care and Patient Outcomes.

OBJECTIVE: The effect of nursing management styles on patient outcomes and the quality of nursing care (QNC) has recently become a topic of discussion. This review was conducted to examine the effects of leadership styles or behaviors on QNC and on patient outcomes. METHODS: 13 research studies published between 1 January 2010 and 31 May 2016 which conformed to the inclusion criteria were reviewed. RESULTS: The effects of nursing leaders' leadership styles or behaviors were examined in studies on patient mortality, QNC from the perspective of nurses, patient satisfaction, unwanted/adverse events, health-care-associated infections, pressure ulcers, falls, unwanted weight loss, hospital readmissions, mismanagement of feeding tubes, and inadequacies in daily nursing care. CONCLUSIONS: Relationship-focused leadership behaviors directly or indirectly improved patient outcomes and raised the QNC compared with task-focused leadership behaviors.

Antibacterial activity of porphyrin derivatives against multidrug-resistant bacteria.

In this study, it was aimed to investigate the antibacterial activities of the cationic porphyrin derivatives against some multi drug resistant clinical bacterial isolates and standard strains for the development of potential antibacterial agents. In addition to the standard strains, methicillin-resistant Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa clinical isolates were studied. We synthesized eight (P1-P8) cationic porphyrin derivatives. The minimum inhibitory concentrations (MIC) of these substances were determined by micro dilution method. Ciprofloxacin was used for quality control. The study was repeated three times. All porphyrin derivatives exhibited antibacterial activity at different levels according to the studied bacteria. The strongest antibacterial activity was obtained with compounds P6, P7 and P8. These compounds were found to have MIC values of <5-156µg/ml. Because of the low MIC values, it has been concluded that these synthesized porphyrin derivatives may be high-potency agents against bacteria with high resistance profile.

Photodynamic antimicrobial activity of new porphyrin derivatives against methicillin resistant Staphylococcus aureus.

Methicillin resistant Staphylococcus aureus (MRSA) with multiple drug resistance patterns is frequently isolated from skin and soft tissue infections that are involved in chronic wounds. Today, difficulties in the treatment of MRSA associated infections have led to the development of alternative approaches such as antimicrobial photodynamic therapy. This study aimed to investigate photoinactivation with cationic porphyrin derivative compounds against MRSA in in-vitro conditions. In the study, MRSA clinical isolates with different antibiotic resistance profiles were used. The newly synthesized cationic porphyrin derivatives (PM, PE, PPN, and PPL) were used as photosensitizer, and 655 nm diode laser was used as light source. Photoinactivation experiments were performed by optimizing energy doses and photosensitizer concentrations. In photoinactivation experiments with different energy densities and photosensitizer concentrations, more than 99% reduction was achieved in bacterial cell viability. No decrease in bacterial survival was observed in control groups. It was determined that there was an increase in photoinactivation efficiency by increasing the energy dose. At the energy dose of 150 J/cm2 a survival reduction of over 6.33 log10 was observed in each photosensitizer type. While 200 µM PM concentration was required for this photoinactivation, 12.50 µM was sufficient for PE, PPN, and PPL. In our study, antimicrobial photodynamic therapy performed with cationic porphyrin derivatives was found to have potent antimicrobial efficacy against multidrug resistant S. aureus which is frequently isolated from wound infections.

Intensive care unit nurses' knowledge of medication administration via enteral tubes.

BACKGROUND: Medication administration via enteral tubes is a complex and key application for which nurses in intensive care units are responsible. AIM: The aim of this study was to evaluate drug administrations via enteral tubes by nurses in intensive care units. METHODS: This research was conducted using a descriptive and cross-sectional research design. The study was conducted with 289 nurses at intensive care units in hospitals in Izmir, Turkey. The data of the study were collected with the 'Sociodemographic Information Form' and the 'Enteral Medication Administrations Questionnaire', which was designed in accordance with the literature and consists of questions on interventions before, during and following medication administrations via enteral tubes. RESULTS: It was found that more than half the nurses (62.3%) use nasogastric tubes for medication administrations and that all of them use the enteral way for the administration of medications in the form of tablets, while 58.8% use this method to administer the medications in the form of enteric-coated tablets. It was determined that approximately half the nurses (52.6%) apply more than one medication separately, and a majority (84.1%) use tap water to wash the enteral tube. CONCLUSIONS: Enteral medication administration practices are inconsistent. Some nurses use unsafe practices and may therefore compromise patient care. RELEVANCE TO CLINICAL PRACTICE: Conduction of education programmes on medication administration via enteral tubes for intensive care unit nurses is important in improving nurses' knowledge.