Archive for the ‘Infection control’ Category


Labor Day Déjà Vu – Nurses’ Views of Work, Then and Now

September 2, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

Photo from otisarchives4, via Flickr.

Photo from otisarchives4, via Flickr.

If you like nursing history, there’s a new blog called Echoes and Evidence by the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania. (The first post draws on a 2005 AJN article on how nurses over 100 years ago responded to a series of typhoid epidemics in Philadelphia.)

Because AJN is over 100 years old (115 next year), it has a rich archive that I’ve been digging into recently (see my post from last week about an article Virginia Henderson wrote for AJN 50 years ago, and from late June, about nurses and D-Day).

So it seems especially fitting, just after Labor Day, to point to a January 1953 article by Sister Mary Barbara Ann, a former president of the Iowa Nurses Association (INA), which detailed findings from a survey of 223 general duty nurses in Iowa to learn their opinions of the hospitals in which they worked. I won’t present her exact findings here—we’ve made the article free until the end of September: just click through to the PDF. (Subscribers can always access the archives.) But here’s how she summarized what she learned:

“They [general duty nurses] are asking only for reasonable working conditions in which they can feel happy and secure. They are pleading for recognition and appreciation for what they are as persons and as nurses. They are asking for personnel policies which they have a voice in formulating, which are written and available to all, and which will be strictly adhered to by both nurses and administrators.”

Sound familiar?

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Much Ado About a Fist Bump Study

August 4, 2014

hands touching illustrates post about fist bump study and germsBy Karen Roush, clinical managing editor

In this world of evidence-based care, is there anything to be said for common sense? Last week a study was published in the American Journal of Infection Control that found that a fist bump transmitted fewer organisms than a handshake.

Really? We know that hands carry untold numbers of organisms. We know that skin-to-skin contact transmits organisms. We know that duration of contact plays a role in how many organisms are transmitted. Did we need a study to tell us that hand-to-hand contact with less surface area for a shorter duration of time would transmit fewer organisms?

With the attention being paid to this study, you might think it was a major discovery. Why? Because it’s fun to talk about fist bumps versus handshakes? (David Letterman seems to think so; he recently opened his monologue with a joke about the study results.) Because we kind of like the visual of everyone, from the staid to the cool, walking around giving fist bumps?

Or perhaps, on a serious note, because we’re still struggling unsuccessfully to get people to simply wash their hands and are ready to jump on anything that mitigates the risk of transmission when they don’t? (Adherence to hand hygiene guidelines among health care workers remains low. Read our March 2013 CE–Original Research feature, in which authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal clinic.) Read the rest of this entry ?


Tragic Plane Crash, Truvada Concerns, Changing Infection Rates: AIDS/HIV Issues in the News

July 21, 2014

Truvada / via Wikimedia Commons

By Jacob Molyneux, AJN senior editor

There have been a number of recent high-profile news stories as well as some notable new research related to HIV/AIDS and its treatment and prevention.

First, AJN would like to add its voice to those expressing heartfelt regret at the deaths of a number of prominent and widely respected HIV advocates and researchers in the Malaysia Airlines jet that appears to have been shot down over Ukraine last week.

The Truvada controversy. Those who who died on the plane had been heading to an international conference in Melbourne, Australia, where one of the hot topics under discussion would be the pros and cons of the continuing expansion of the use of the antiretroviral drug Truvada beyond the treatment of existing HIV infection to long-term prophylactic use by the uninfected.

The topic is particularly timely here in New York where Governor Cuomo last week announced that New York State would make Truvada a centerpiece of its HIV-prevention strategy. The drug, taken every day, is more than 90% effective in preventing infection, but, as an NPR story recently described, a number of experts have raised concerns about widespread long-term use of Truvada for HIV prevention, noting

  • serious potential side effects of Truvada.
  • the $1,300/a month cost of the drug.
  • the reduction in the use of condoms by some of those taking Truvada, which could lead to higher rates of other sexually transmitted diseases.

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AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

June 27, 2014

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one of her adolescent patients, and the patient’s mother (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article). Read the rest of this entry ?


Time to Get Serious About ‘Handshake-Free’ Health Care?

June 2, 2014

By Shawn Kennedy, AJN editor-in-chief

Tombstone handshake, from Mel B, via Flickr.

Tombstone handshake, from Mel B, via Flickr.

Last month in JAMA, Mark Sklansky and colleagues wrote a Viewpoint column, “Banning the Handshake From the Health Care Setting.” The article explored the idea and its feasibility, while acknowledging the importance of such rituals as handshakes in human interaction. In the end, the authors argued that it’s an idea we might need to start taking more seriously.

Is this an antisocial idea? That’s debatable, but it would certainly be a good step towards reducing transmission of infections—and one that’s probably long overdue.

It’s well known that pathogens are easily transmissible from health care workers’ hands, even if they practice hand hygiene in between seeing patients. But as the authors remind us, heath care workers are notoriously bad at doing so—they cite research showing that “compliance of health care personnel with hand hygiene programs averages 40%.”

And it’s no better in ambulatory care settings—an original research article we published in March 2013 that measured hand hygiene compliance by health care workers in an ambulatory care clinic found that, even after a campaign to improve adherence, compliance (as measured by direct observation) had only improved to between 32% and 51% at one-month follow-up. The introduction of alcohol-based hand sanitizers helped, but they aren’t effective against all pathogens, including C. difficile and some noroviruses

Bacteria have been shown to live on many surfaces—computer keyboards, telephones, uniforms, and even paper (see our December 2011 research article, “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands”). If a conscientious nurse charted on a paper chart or entered a patient’s vital signs into the electronic record after providing care but before washing hands, bacteria could be transmitted to whoever next picked up the chart or used the keyboard. Then that person might shake hands with a family member or colleague, and so on, and so on . . .

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MERS: A Lucid Overview of What Nurses Need to Know

May 22, 2014

By Jacob Molyneux, AJN senior editor

Coronaviruses derive their name from the fact that under electron microscopic examination, each virion is surrounded by a "corona," or halo. This is due to the presence of viral spike peplomers emanating from each proteinaceous envelope. CDC image by: Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin

Coronaviruses derive their name from the fact that under electron microscopic examination, each virion is surrounded by a ‘corona,’ or halo. CDC image by Cynthia Goldsmith/Maureen Metcalfe/Azaibi Tamin

In recent weeks, there have been a number of news stories following the first U.S. cases of Middle East respiratory syndrome (MERS-CoV) and the first transmission of the virus that occurred on U.S. soil. This novel coronavirus (the common cold is a coronavirus; so is SARS) can cause respiratory failure and death. So far, the number of identified cases are relatively few, though the numbers are growing. Disease surveillance has been aggressive since the first case was identified in Saudi Arabia.

Back in January, before the U.S. had seen its first cases, infection prevention specialist Betsy Todd provided a clear, engaging overview of MERS in our Emerging Infections column. “Middle East Respiratory Syndrome (MERS CoV)” lucidly and succinctly describes early MERS cases, the clinical findings as we currently understand them, the speedy development of worldwide surveillance efforts and the rapid development of an assay, the possible sources and transmission of the virus, and what we know about prevention. The article will be free until June 30. Read the rest of this entry ?


Remembering Nurses Who Go Above and Beyond as Volunteers

May 14, 2014

By Shawn Kennedy, AJN editor-in-chief

A severely dehydrated patient receives iv fluids from Kari Jones, MD, as she is carried by a family member from triage to a tent at the Bercy CTC. Photo courtesy of Samaritan’s Purse.

A severely dehydrated patient receives IV fluids from Kari Jones, MD, as she is carried by a family member from triage to a tent at the Bercy CTC. Photo courtesy of Samaritan’s Purse.

So another Nurses Week winds down and many nurses have been acknowledged for the fine work they do. But I think more recognition should be given to nurses who go above and beyond their usual nursing work and volunteer to help those in dire circumstances. This month in AJN, one of the two CE articles is called “Responding to the Cholera Epidemic in Haiti.” It details the work of one organization and its nurses. Here’s the overview:

While Haiti was still recovering from the January 12, 2010, magnitude-7 earthquake, an outbreak of cholera spread throughout the nation, soon reaching epidemic proportions. Working through the faith-based nongovernmental organization Samaritan’s Purse, an NP, an epidemiologist, and a physician joined the effort to prevent the spread of disease and treat those affected. Here they describe the prevention and intervention campaigns their organization initiated, how they prepared for each, and the essential elements of their operations.

The article provides essential information about such topics as setting up cholera treatment centers, assessment, rehydration priorities, prevention, enlisting family members in monitoring fluid intake and outtake, and the use of oral antibiotics. Near the conclusion, the authors have this to say about their heightened awareness of the difference fundamental nursing care can make in such settings:

The three of us were profoundly affected by the rapid progression and overwhelming effects of cholera in people who had been well just hours earlier. Fortunately, when cholera infection is managed correctly, its resolution is as dramatic as its onset. Few diseases that are as devastating and can kill as abruptly as cholera can be so quickly and successfully managed.


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