Archive for the ‘Infection control’ Category


Top Health Story Picks of AJN Contributing Editors for 2015

November 19, 2015

By Diane Szulecki, AJN associate editor

Kelley Johnson by Disney | ABC Television Group via Flickr

Nurse and Miss America contestant Kelley Johnson by Disney | ABC Television Group via Flickr

With the end of the year steadily approaching, AJN asked its contributing editors, editorial board members, and staff to share what they consider to be the most significant health care and nursing-related headlines of 2015 so far. Now it’s readers’ turn. See the top picks below and feel free to leave a comment to share your thoughts and additions to the list.

Clinical/Care Issues

  • The growing patient experience movement and the limitations of patient satisfaction measurements
  • The rise in chronic diseases due to lack of prevention efforts and unhealthy lifestyles
  • Substance abuse, including alcohol, prescription drugs, heroin
  • Vaccinations and issues regarding public trust of vaccines

Professional Issues

  • Nurses’ responses to critical comments made on The View and related ongoing discussion about the nursing profession’s image
  • Challenges and trends in nursing education: the shift toward advanced practice as a career path for many nurses and rapid growth in the number of DNP programs and applicants
  • Workplace stresses: staffing issues, moral distress, strain caused by an aging population with multiple comorbidities, plus an increase in the number of insured due to the Affordable Care Act

U.S Health Care and Health System Issues

  • Gun violence as a critical public health issue
  • Lack of adequate mental health care
  • Health care used as a political wedge by feuding political parties
  • Issues surrounding access to health care, including health equity and culturally sensitive care

Global Health Issues Read the rest of this entry ?


Ebola, One Year Later: What We Learned for the Next Big Epidemic

November 6, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

Read the rest of this entry ?


AJN in September: Pain Management in Opioid Use Disorder, STIs in the U.S., Teaching Vs. Unit Needs

September 2, 2015

AJN0915.Cover.OnlineOn this month’s cover, perianesthesia nurse Carolyn Benigno helps prepare a young patient for surgery at Children’s National Medical Center in Washington, DC. The photo, the first-place winner of AJN’s 2015 Faces of Caring: Nurses at Work photo contest, shows Benigno practicing “Caring through Play.” The art of working at a pediatric hospital, she says, is “learning how to play with children so that part of your nursing care is play.” Such play can both distract a child in the moment and help the child cope with the disorienting experience of hospitalization.

For another piece on how nurses try to make hospitalization less stressful for children, see this month’s Cultivating Quality article, “Improving Pediatric Temperature Measurement in the ED.”

Some other articles of note in the September issue:

CE Feature:Acute Pain Management for Inpatients with Opioid Use Disorder.” Inpatients diagnosed with opioid use disorder (OUD) commonly experience acute pain during hospitalization and may require opioids for pain management. But misconceptions about opioids and negative attitudes toward patients with OUD may lead to undermedication, unrelieved pain, and unnecessary suffering. This article reviews the current relevant literature and dispels common myths about opioids and OUD. Read the rest of this entry ?


As with Ebola Outbreak, Social Determinants of Health Crucial in Recent Rural U.S. HIV Outbreak

August 25, 2015

Rachel Parrill, PhD, RN, APHN-BC, is an associate professor of nursing at Cedarville University in Ohio

by banditob/flickr creative commons

by banditob/flickr creative commons

This past fall, with the world watching, a crisis unfolded in West Africa that challenged our understanding of sociocultural environments, epidemiology, and health. The spread of Ebola and the intercontinental transmission of the disease exposed weaknesses in our epidemiological defense system. It also drew attention to the powerful role that cultural beliefs and practices can have on disease transmission during outbreaks.

In that same time frame, and with similar cultural etiologies, another infectious crisis played out much closer to home. The setting: the rural Midwest, in and around the small town of Austin, Indiana. The disease: HIV. The crisis: an unprecedented outbreak—one with incidence rates (up to 22 new cases a day at the height of the outbreak) estimated to be higher than those in many sub-Saharan African nations and transmission rates through injection drug use higher than in New York City. Contributing to this “perfect storm” were socioeconomic factors characteristic of many rural settings, including poverty, low education levels, limited access to health care, and few recreational or employment opportunities.

In my work as a faculty member in a rural Midwest setting, I introduce undergraduate and graduate nursing students to concepts of public health nursing and try to provide opportunities for them to engage in local health initiatives. However, I often encounter an unconcerned or unengaged attitude towards the health risks associated with rural life—both on the part of my students and the community members that we serve.

Our local rural community seems mostly untouched by notable urban problems such as injection drug use, prostitution, sexually transmitted infections, and rampant violence, and issues seen in surrounding larger metropolitan communities like homelessness and human trafficking typically capture the interest of my nursing students far more than the run-of-the-mill comorbidities they often see in rural community members, such as heart disease, diabetes, cancer, and unintentional injury.

So I was captivated by the story that unfolded this past year in nearby Austin, Indiana, just a three-hour drive from our university. The devastation experienced by this community so similar to the one I call home provided a poignant learning opportunity for my nursing students, and for the broader nursing community.

In my role as a faculty member, I challenge nursing students to consider a broad range of social determinants of health when examining the health of a community. For example, I invite students to examine the income and educational levels of a community in light of important health indicators. We discuss the fact that health is too often connected with wealth, educational opportunities, neighborhood characteristics, race and gender inequalities, and social policy.

Similar to the West African Ebola outbreak, the HIV outbreak in Austin reveals the effects of sociocultural environments on health. The outbreak occurred among a network of injection drug users, mostly within multiple generations of a small group of families. In terms of context, Austin suffered from not only a high rate of prescription drug use, but also a lack of medical and drug rehabilitation services, inadequate public health infrastructure, a knowledge deficit regarding HIV risk, and a strong community-fed stigma surrounding HIV infection very similar to the one that played a role during efforts to combat the Ebola crisis. Read the rest of this entry ?


Legionnaires’ Outbreak in New York City: Some Basics for Nurses

August 12, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

11148_loresIn the largest U.S. outbreak of Legionella infection since 1976, when there were 221 cases and 34 related deaths in an outbreak at a Philadelphia American Legion convention, more than 113 cases of the disease have been diagnosed in New York City since mid-July. Twelve people have died.

Legionnaires’ disease is neither rare nor exotic; it is a type of community-acquired pneumonia (it can also be hospital acquired). Symptoms include fever, cough, and progressive respiratory distress. Legionella can also cause a milder, flulike illness known as Pontiac fever that generally resolves without treatment. Because many cases of Legionnaires’ disease are never actually diagnosed, mortality rates are difficult to determine, but the rate currently is estimated at 5% to 30%.

The CDC estimates that 8,000 to 18,000 people are hospitalized with Legionnaires’ disease each year in the U.S., yet only about 3,000 cases are diagnosed and reported. Most cases of Legionnaires’ disease are sporadic, unlinked to any outbreak. The infections often are not recognized as Legionnaires’ disease, for several reasons.

  • Legionella infection is easily treated empirically (that is, without confirmatory lab testing) with common antibiotics, with the patient usually recovering. This is a practical and cost-effective approach to community-acquired pneumonia, but many cases of Legionnaires’ disease are never diagnosed as anything more specific than “pneumonia.”
  • When Legionnaires’ disease is suspected, the most common test ordered—Legionella urinary antigen—tests for only one of more than 46 Legionella species: pneumophila serotype 1. While a significant percentage of cases may be attributable to pneumophila serotype 1, a negative Legionella urinary antigen test does not rule out Legionnaires’ disease.
  • Only a Legionella culture has the potential to identify any Legionella strain, and special culture media is needed. In most labs, a respiratory specimen sent for culture is not routinely tested for Legionella.

Legionella does not spread from person to person. It is transmitted by aerosolized water from sources such as whirlpools, hot tubs, hydrotherapy tubs, showers, indoor waterfalls or decorative fountains, grocery produce misters, or cooling towers on large buildings. Legionella prefers large, complex plumbing systems over natural bodies of water, because plumbing systems provide the temperature range, commensal organisms, and stasis that best support Legionella growth.

Who’s at risk. As with community-acquired pneumonia caused by other organisms, the people most likely to become infected are those with preexisting health problems such as COPD, diabetes, or immunosuppression; smokers; and people over 50. Children are usually not infected with Legionella unless they are immunosuppressed. Read the rest of this entry ?


AJN in August: Oral Histories of African Nurses, Opioid Abuse, Misplaced Enteral Tubes, More

August 3, 2015

AJN0815.Cover.OnlineOn this month’s cover, a community nurse practices health education with residents of a small fishing village in rural Uganda. Former AJN clinical managing editor Karen Roush took the photo in a small community center made of dried mud bricks, wood, and straw.

According to Roush, nurses wrote the lessons out on poster-sized sheets of white paper and tacked them to the mud wall as they addressed topics like personal hygiene, sanitation, food safety, communication, and prevention of infectious diseases. The reality of nursing in Africa is explored this month in “‘I Am a Nurse’: Oral Histories of African Nurses,” original research that shares African nurse leaders’ stories so we may better understand nursing from their perspective.

Some other articles of note in the August issue:

CE feature: A major source of diverted opioid prescription medications is from friends and family members with legitimate prescriptions.  “Nurses’ Role in Preventing Prescription Opioid Diversion” describes three potential interventions in which nurses play a critical role to help prevent opioid diversion.

From our Safety Monitor column: More than 1.2 million enteral feeding tubes are placed annually in the United States. While the practice is usually safe, serious complications can occur. “Misplacements of Enteral Feeding Tubes Increase After Hospitals Switch Brands,” a report from the Pennsylvania Patient Safety Authority, reviews cases of misplaced tubes and offers guidance for how nurses can prevent such errors in their own practice.

Clinical feature: It is no surprise that physical activity comes with numerous physical and mental benefits, nor that a majority of Americans do not get enough exercise. “The Evolution of Physical Activity Promotion” updates nurses on physical activity guidelines and provides tips for encouraging patients to improve their physical activity. This feature also highlights the importance of decreasing one’s amount of sedentary and sitting time, even in physically active people. Read the rest of this entry ?


Hepatitis A, B, and C: The Latest on Screening, Epidemiology, Prevention, Treatments

July 16, 2015
One of several posters created by the Centers for Disease Control and Prevention to raise awareness that millions of Americans of all ages, races, and ethnicities have hepatitis C—and many don’t know it. Posters are available to order or download for printing at Poster © Centers for Disease Control and Prevention.

One of several CDC posters intended to raise awareness that millions of Americans of all ages, races, and ethnicities have hepatitis C—and many don’t know it. Posters are available to order or download for printing at Poster © Centers for Disease Control and Prevention.

It’s crucial that nurses in all health care settings stay informed about the changing landscape of viral hepatitis in the United States. Hepatitis affects the lives of millions, too many of whom are unaware that they have been infected.

Right now, there’s good news and bad news about hepatitis in the U.S. While the incidences of hepatitis A and B in the United States have declined significantly in the past 15 years, the incidence of hepatitis C virus infection, formerly stable or in decline, has increased by 75% since 2010. Suboptimal past therapies, insufficient provider awareness, and low screening rates have hindered efforts to improve diagnosis, management, and treatment of viral hepatitis.

The authors of a CE feature in the July issue of AJN, Viral Hepatitis: New U.S. Screening Recommendations, Assessment Tools, and Treatments,” are thoroughly versed in the subject. Corinna Dan is viral hepatitis policy advisor, Michelle Moses-Eisenstein is a public health analyst, and Ronald O. Valdiserri is director, all in the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services (HHS).

Their article succinctly and clearly covers

  • the epidemiology, natural history, and diagnosis of viral hepatitis.
  • new screening recommendations, assessment tools, and treatments.
  • the HHS action plan, focusing on the role of nurses in prevention and treatment.

Read the rest of this entry ?


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