Archive for the ‘infection control’ Category


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 ?


Scrubs on the Street: Big Concern?

November 20, 2013
This colorized 2005 scanning electron micrograph (SEM) depicted numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, commonly referred to by the acronym, MRSA; Magnified 2390x. CDC/via Wikimedia Commons

This colorized 2005 scanning electron micrograph (SEM) depicted numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, commonly referred to by the acronym, MRSA; Magnified 2390x. CDC/via Wikimedia Commons

By Shawn Kennedy, AJN editor-in-chief

Last week I came across this article on the Reporting on Health blog from the Annenberg School of Communications and Journalism at the University of Southern California. It discusses one woman’s campaign to get hospital health care providers to stop wearing scrubs outside of the hospital. She wants people to photograph the ‘offenders’ and send the photos to hospital administrators. She’s concerned that the clothing will pick up infection-causing bacteria in the community and spread infection to weak, immunocompromised patients.

Wearing uniforms outside of the clinical setting has been debated on and off for years. Here’s an excerpt from an editorial comment that appeared in the March 1906 issue of AJN (you can read the full article for free as a subscriber):


So again, the concern was about bringing bacteria into the environment of sick people. Recently, though, the concerns have evolved to include as well the reverse scenario: bringing resistant hospital bacteria home. (See a nurse’s follow-up post at Reporting on Health for a good summary of some current issues.)

As one person quoted in the initial post about this idea of “outing” people in scrubs outside the hospital points out, evidence remains inconclusive on whether bacteria on clothing is at play in causing infections. (One of its links includes a 2007 evidence review that notes the following: “The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence.”) Aside from our pretty universal agreement as to the need for the strict compliance observed in the OR, how concerned should we be about hospital personnel wearing uniforms from home to hospital and home again, perhaps doing errands along the way?

I asked AJN’s infection control consultant, Betsy Todd, MPH, RN, CIC, about any recommended standards around this. She replied, “There’s just the AORN standards for OR wear. We long ago stopped worrying about leaving our work shoes in our lockers; and I think, despite the periodic microbiologic surveys of ties, coat sleeves, etc., the general idea still is that no links have been shown between organisms on clothing and the spread of infection.”

However, she further notes the following: “I always tell nurses that the first thing they should do when they get home is get out of their uniforms before hugging kids or the dog. I suspect the risk is bigger in this direction—more superbugs likely to be riding home with us than riding into the hospital with us.”

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‘Spread the Word, Not the Germs’ – Infection Control During Religious Gatherings

November 6, 2013

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Last week there was a disconcerting report from the Associated Press about a Catholic clergyman in North Dakota who may have inadvertently exposed many members of his church to hepatitis A. According to the report, the ill bishop had probably contracted the illness from contaminated food while attending a conference in Italy and, because he didn’t immediately feel ill (incubation period usually ranges from two to four weeks, though can be as long as eight weeks), continued to dispense communion at several area churches.

According to the Centers for Disease Control and Prevention (CDC) Web page for hepatitis A, infection “is primarily transmitted by the fecal–oral route, by either person-to-person contact or consumption of contaminated food or water.” A person is infectious from two weeks before to one week after the onset of symptoms. The FAQ page on the site does say, in regards to infected food handlers (which would seem to fit this case, in that the bishop handled communion hosts), that “transmission to patrons is unlikely”—and also offers some guidance for postexposure prophylaxis (PEP). In this case, too much time had elapsed: PEP needs to be given within two weeks of exposure.

SpreadTheWordNottheGermsOpeningSpreadScreenshotThis situation made me wonder, though, as we’re about to enter peak flu season, if there are any infection control guidelines appropriate for religious services. Some faiths include taking communion or drinking from a communal cup, and many include shaking or clasping the hands of other congregants. Certainly these practices are ripe for transmission of bacteria and viruses. And if your church is anything like mine, there are many frail elderly people and families with infants and young children who would be at high risk.

I asked a colleague, Kathy Schoonover-Shoffner, PhD, RN, the editor of the Journal of Christian Nursing, if she was aware of any guidelines. Well, it happens that her journal addressed this topic two years ago in an article in preparation for the H1N1 influenza pandemic: “Spread the Word, Not the Germs” (abstract only). The article discusses, among other related topics, the process of creating a free toolkit, Infection Control and Emergency Preparedness Toolkit for the Faith Community. (You can download the 200-page PDF document for free.) Read the rest of this entry ?


AJN’s November Issue: Voices of New RNs, Intraosseous Vascular Access, Measuring Dyspnea, Coccidiodomycosis, More

October 25, 2013

AJN1113 Cover OnlineAJN’s November issue is now available on our Web site. Here’s a selection of what not to miss.

New RNs. Hospitals invest in orientation or residency programs for newly licensed nurses, but turnover rates for first-year nurses remain relatively high. This month’s original research article, “Hearing the Voices of Newly Licensed RNs: The Transition to Practice,” looks at the orientation experience of new nurses in order to explore how institutions can best transition new nurses from an academic to a clinical setting. 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 of the article. The podcast is also available on our Web site.

Starting an IV. Nurses are often faced with the challenge of starting an IV line in a patient who is dehydrated, has suffered trauma, or is in shock. This month’s Emergency CE feature, “Intraosseous Vascular Access for Alert Patients,” describes how nurses can use this fast, safe, and effective route for delivering fluids and medications when IV access fails. Earn 2.1 CE credits by reading this article and taking the test that follows. Don’t miss the video demonstration of the placement of an intraosseous  (IO) needle in the proximal tibia using an IO access power driver (click on the video icon on the first page of the article if you’re using your iPad, or click here).

Measuring dyspnea. Though many studies show that dyspnea is an important indicator of adverse outcomes, including death, little is known about its general prevalence in hospitalized patients. “Routine Dyspnea Assessment on Unit Admission” describes a nurse-led pilot study that sought to test the feasibility of measuring dyspnea as part of the initial patient assessment performed by nurses in a large urban hospital. You can earn 2.4 CE credits by reading this article and taking the test that follows. Read the rest of this entry ?


Why Don’t We Pay Attention to Oral Care in the ICU?

October 16, 2013

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

“Although meticulous oral care has been shown to reduce the risk of ventilator-associated pneumonia (VAP), oral care practices among critical care nurses remain inconsistent, with mouth care often perceived as a comfort measure rather than as a critical component of infection control.”

scanning electron micrograph of Pseudomonas aeruginosa bacteria, one several types that can cause VAP/CDC

Scanning electron micrograph of Pseudomonas aeruginosa, one of several bacteria types that can cause VAP/ CDC image

So begins one of our CE feature articles in the current issue of AJN. In “Mouth Care to Reduce Ventilator-Associated Pneumonia” (which you can read for free), the authors discuss why mouth care is so important among the interventions to reduce VAP—and why it is often not given a high priority among patient care procedures.

I have to confess that in my clinical days, mouth care was done almost as an afterthought. In our critical care unit, we were always diligent in monitoring vitals signs and IV fluids, suctioning, turning and positioning the patient, but oral care usually was a perfunctory task, completed with a few quick swipes with lemon-glycerine swabs.

Booker and colleagues explain why oral care deserves the careful attention we give to other measures. They also review the research on barriers to our providing this care. Many nurses are simply unaware of the connection between oral flora and subsequent development of VAP or the importance of addressing oral hygiene in the first few days after admission. This article is an eye-opener.

In addition, the authors include an evidence-based, step-by-step guide to providing oral care for intubated patients. Read the rest of this entry ?


Gel and a Poster: A Hand Hygiene Campaign Gets Tested in Two Outpatient Clinics

March 11, 2013

By Sylvia Foley, AJN senior editor


Hand by, via Flickr

The trouble with hands is that they get into everything, and rapidly move between mouths, noses, eyes, and other people’s hands.

So says David Owen in his recent New Yorker article “Hands Across America,” which describes the development of the first gel sanitizer—and of course it’s nothing nurses and other clinicians don’t already know, just as they know that the practice of hand hygiene is crucial to reducing health care–associated infection rates. Yet adherence to hand hygiene guidelines among health care workers remains low. Interventions to improve hand hygiene have been tested in hospitals with demonstrated success, but have seldom been evaluated in other settings. In this month’s CE–Original Research feature, authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal (GI) clinic.

The intervention. At each clinic, the researchers observed health care workers for the frequency of hand hygiene (attempts versus opportunities). After compiling baseline data, they initiated an intervention, which consisted of introducing an alcohol-based gel sanitizer and an informational poster to each clinic. (The gel sanitizer was provided as an alternative to foam sanitizer and soap and water.) One week later, interventional data were collected for five nonconsecutive days. Afterwards the posters and gel sanitizers were removed, and one month later, follow-up data were collected. Lastly, three months after follow-up observations ended, workers at each clinic were surveyed to evaluate their perceptions of the campaign.

Some findings. In both clinics, hand hygiene frequency was poor at baseline, just 11% at the oncology clinic and 21% at the GI clinic. But after the intervention it improved significantly, to 36% at the oncology clinic and 54% at the GI clinic—and the improvements were maintained during the follow-up period. Reported barriers to hand hygiene included skin irritation, forgetfulness, and insufficient time. Although a majority of surveyed workers at both clinics said they preferred soap and water, direct observations showed that once gel sanitizer was available, its use predominated. Indeed, when it was removed following the campaign’s end, many workers began carrying their own.

The researchers concluded that “introducing a gel sanitizer and providing informational posters can yield modest short-term improvements in overall hand hygiene performance in outpatient clinics.” They recommend that administrators and influential health care workers

  • collaborate in fostering an environment conducive to adherence.
  • provide a variety of hand hygiene products, including gel sanitizer.
  • encourage workers to participate in creating motivational posters.

For full details, please read the article—it’s free online. We’ve also got an exclusive podcast with the lead author. And as always, please consider sharing your thoughts and experiences with us in the comments.

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How Bad Is the Flu Right Now, and Should Nurses Get Vaccinated?

January 14, 2013

Shawn Kennedy, MA, RN, AJN editor-in-chief

The news has been full of reports about the influenza outbreak, deaths from complications, and shortages of vaccine and antivirals. Is the flu season as bad as purported, or are we experiencing media hype? Nurses are frequently asked for information by family, friends, and neighbors (and strangers—I was in a restaurant once and a diner at a nearby table, having overheard my conversation with a colleague, leaned over and asked if he could ask me a health question!), so here’s the latest information.


Week ending 1/5/2013; brown indicates states w/ widespread flu activity. CDC

According to the latest Centers for Disease Control and Prevention (CDC) report for the week ending January 5, epidemiologists from all states except three reported (see map) widespread “influenza-like illness” (ILI, meaning fever and cough or sore throat). California and Mississippi reported regional activity and Hawaii reported sporadic activity. The District of Columbia reported local spread. And while officials in some cities and states declared public health emergencies, the CDC notes that “influenza activity remained elevated in the U.S., but may be decreasing in some areas.”

One of the indicators is the proportion of people seeking treatment for ILI. Thus far, that number has risen as high as 6.0%, but has since fallen to 4.3%, as of January 5. In prior years deemed as moderately severe flu seasons, that indicator rose as high as 7.6%.

So in terms of history, we’re having a moderately severe flu season, but not the worst one we’ve had—at least not yet, as we’re still just in the middle of our season. Flu season typically begins in October, peaks in January or February, and usually ends in April, though timing can vary.

Some hospitals are getting tough on employees who refuse to receive the flu vaccine or take other actions to protect patients. ABC News reports that an Indiana hospital fired eight employees—including three nurses—who failed to get vaccinated against the flu; and USA Today ran the story of a Missouri nurse who was fired after she refused the flu vaccine and also refused to wear a surgical mask.

Many feel that those who work in clinical areas should be required to get vaccinated so they won’t transmit influenza to patients, but each year the issue of mandated flu vaccines for health care workers is again debated. In 2010, following the 2009 H1N1 pandemic, AJN explored this issue, presenting a “pointcounterpoint” as well as a commentary from an ethicist. (These three AJN articles will be free until February 15.)

Me? I think health care workers—and not just nurses, but all who come in contact with patients and people who have compromised immune systems—are ethically bound to act in the best interests of their patients. That means either getting the flu vaccine, or wearing a mask to reduce the chance of transmission. And we should consider masks for hospital visitors, too.

So how do you stand?

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