Archive for the ‘Infection control’ Category


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.

Read the rest of this entry ?


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 . . .

Read the rest of this entry ?


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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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic


The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?


AJN’s March Issue: New Series on Systematic Reviews, HIV Update, C. Diff on the Rise, Sexual Assault, More

February 28, 2014

AJN0314.Cover.OnlineAJN’s March issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Advances in HIV testing and treatment. The photo on our cover, showing members of  Sexy With A Goal (SWAG), a program provided for lesbian, gay, bisexual, and transgender individuals affected by HIV and AIDS by the AIDS Service Center of New York City’s Lower East Side Peer Outreach Center, reflects the changing face of the AIDs epidemic. Thirty years ago, a diagnosis of HIV was tantamount to a death sentence. But the young men on our cover prove that this is no longer the case. With advances in treatment and patient advocacy, education, and support, HIV is now a chronic, manageable disease. A CE feature, “Nursing in the Fourth Decade of the HIV Epidemic,” discusses HIV epidemiology and policy in the United States, the HIV care cascade, advances in HIV testing and treatment, and how nurses can continue to have a positive impact on the HIV epidemic.

If you’re reading AJN on your iPad, you can watch a video describing one author’s early experience with an HIV-infected patient by tapping on the podcast icon on the first page. The video is also available on our Web site. A

New option for victims of sexual assault. Until recently, survivors of sexual assault were not entitled to a free medical forensic examination unless they reported the assault to law enforcement. The authors of “Giving Sexual Assault Survivors Time to Decide: An Exploration of the Use and Effects of the Nonreport Option,” March’s original research CE, studied the implementation of the new nonreport option, exploring its impact on survivors, the criminal justice system, and sexual assault nurse examiners. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New series on systematic reviews. Since the advent of evidence-based practice in health care, nurses and other clinicians have been expected to rely on research evidence to inform their decisions. But how does one uncover all the evidence relevant to a question? “Systematic Reviews, Step by Step: The Systematic Review: An Overview,” the first article in a new series from the Joanna Briggs Institute, provides a synopsis of the systematic review as a scientific exercise, and introduces nurses to the steps involved in conducting one. Read the rest of this entry ?


AJN’s January Issue: Perceptions of Employment-Based Discrimination Among FENs, Self-Management of Incontinence, Book of the Year Awards, More

December 26, 2013

AJNJANAJN’s January issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Experts say that nursing shortages could reappear as soon as 2015. Historically, foreign-educated nurses (FENs) have been essential in filling those spaces. This month’s original research article, “Perceptions of Employment-Based Discrimination Among Newly Arrived Foreign-Educated Nurses,” surveyed FENs to determine whether they perceived they were being treated equitably in the U.S. workplace.

Earn 2.5 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by clicking on the podcast icon on the first page. The podcast is also available on our Web site.

Incontinence can have many distressing physical and social outcomes, and many sufferers try to deal with the condition on their own. “Self-Management of Urinary and Fecal Incontinence” provides nurses with strategies that can be incorporated within the framework of self-management to control urinary, fecal, or dual incontinence. Earn 2.3 CE credits by reading this article and taking the test that follows.

Violence is a recognized public health problem in the Unites States, and the media’s focus on recent tragic stories has likely reinforced the common perception that mental illness causes violence. “Mental Health and Violence,” an article in our Mental Health Matters column, reviews the relevant research and describes how all nurses can identify the signs and symptoms of potential violence in their patients. Listen to a podcast interview with the author on your iPad by clicking on the podcast icon on the first page of the article or download the podcast from our Web site.

Last year, a new and severe acute respiratory infection was discovered in Saudi Arabia. “Middle East Respiratory Syndrome (MERS-CoV),” an article in our Emerging Infections column, describes the rapid identification of the causative organism and the story of how this often deadly infection was tracked.

Looking for a good read? The votes are in, and the winners of AJN’s annual Book of the Year Awards are listed in this issue. A supplemental online-only companion to the article provides the judges’ reviews for each book.

There’s plenty more in this issue, including an update to an article on resources for leadership development that we originally published in 2006 and AJN‘s special “Annual Year in Review 2013” in In The News. And don’t forget to check out our January cover. AJN’s take on Norman Rockwell’s Before the Shot, painted by Jerry Miller, shows a primary care provider we’re increasingly likely to see in today’s changing health care landscape: an NP. For more on the growing role of the NP, see this month’s editorial, “The New Paradigm: The Nurse as Family Doctor.”

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Predicting Who’ll Show Up: Research on Nurses’ Intentions to Work during a Public Health Crisis

December 16, 2013

By Sylvia Foley, AJN senior editor

Figure 1. Percentage of respondents indicating willingness to work during a flu pandemic according to self-reported perception of flu threat

During disasters and emergency situations, the public expects health care workers to show up and do their jobs. But this isn’t a given—there are always some who are either unable or unwilling to do so. So far, most of the research in this area has used convenience samples, hypothetical situations, or untested survey instruments, and very little has focused solely on nurses.

To learn more, Sharon Dezzani Martin and colleagues decided to explore further. This month’s original research CE, “Predictors of Nurses’ Intentions to Work During the 2009 Influenza A (H1N1) Pandemic,” reports on their findings. Here’s the abstract, which offers a brief overview.

Objective: This study examined potential predictors of nurses’ intentions to work during the 2009 influenza A (H1N1) pandemic.
Methods: A questionnaire was mailed to a random sample of 1,200 nurses chosen from all RNs and LPNs registered with the Maine State Board of Nursing during the second wave of the flu pandemic.
Results: Of the 735 respondents, 90% initially indicated that they intended to work during a flu pandemic. Respondents were significantly more likely to work if provided with adequate personal protective equipment (PPE) but significantly less likely without adequate PPE or if they feared family members could become ill with pandemic flu. They were also significantly less likely to work if assigned to direct care of a flu patient; if a colleague were quarantined for or died of pandemic flu; if they feared Read the rest of this entry ?


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