Archive for the ‘Infection control’ Category

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AJN in April: Deep Breathing for Dialysis Patients, Isolation Care, Sleep Loss in Nurses, More

March 27, 2015

AJN0415.Cover.OnlineOn our cover this month is Pablo Picasso’s Le Rêve (The Dream). We chose this portrait of a woman in a restful pose to highlight the importance of proper sleep to a person’s overall health and well-being. Unfortunately, not many Americans are able to get the proper amount of rest. The Institute of Medicine (IOM) estimates that 50 to 70 million U.S. adults have chronic sleep and wakefulness disorders—and nurses are not immune.

Between long shifts and the stressful nature of their jobs, nurses are especially vulnerable to not getting an adequate amount of quality sleep. Fatigue from lack of sleep may diminish the quality of nursing care. Sleep loss has been linked to impaired learning, memory, and judgment and is also associated with a slew of chronic diseases. This month’s CE feature, “The Potential Effects of Sleep Loss on a Nurse’s Health,” describes the acute and chronic effects of sleep loss on nurses, strategies nurses can use to improve the quality of their sleep, and institutional policies that can promote good rest and recuperation.

This feature offers 2 CE credits to those who take the test that follows the article. You can further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Deep breathing for dialysis patients. Chronic kidney disease (CKD) generally has a poor prognosis and often causes poor sleep quality, reduced quality of life, and is associated with high rates of hospitalization. It’s no surprise that an estimated 25%–50% of patients with CKD suffer from depression. This month’s original research CE, “The Efficacy of a Nurse-Led Breathing Training Program in Reducing Depressive Symptoms in Patients on Hemodialysis: A Randomized Controlled Trial,” examines the efficacy of a nurse-led breathing training program in reducing depression and improving quality of sleep in patients on maintenance hemodialysis. This feature article offers 2.5 CE credits to those who take the test that follows the article. Read the rest of this entry ?

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Measles 101: The Basics for Nurses

February 11, 2015

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

Measles rash/CDC

Measles rash/CDC

While debates about measles vaccination swirl around the current U.S. measles outbreak, most U.S. nurses have never actually seen the disease itself, and right now we are a lot more likely to encounter a case of measles than of Ebola virus disease. Here, then, is a measles primer.

Symptoms. Measles is an upper-respiratory infection with initial symptoms of fever, cough, runny nose, red and teary eyes, and (just before the rash appears) “Koplik spots” (tiny blue/white spots) on a reddened buccal mucosa. The maculopapular rash emerges a few days after these first symptoms appear (about 14 days after exposure), beginning at the hairline and slowly working its way down the rest of the body.

Infected people who are severely immunosuppressed may not have any rash at all. “Modified” measles, with a longer incubation period and sparse rash, can occur in infants who are partially protected by maternal antibodies and in people who receive immune globulin after exposure to measles.

Transmission. The virus spreads via respiratory droplets and aerosols, from the time symptoms begin until three to four days after the rash appears. (People who are immunosuppressed can shed virus and remain contagious for several weeks.) Measles is highly contagious, and more than 90% of exposed, nonimmune people will contract the disease. There is no known asymptomatic carrier state, and no nonhuman animal is known to carry or spread the virus. The virus survives for less than two hours in the air or on surfaces, and is rapidly inactivated by heat, light, acids, and disinfectants.

Isolation. When measles is suspected, airborne isolation is necessary. If negative pressure is not available, the patient should be placed in a room with the door closed. Only immune staff wearing N-95 masks should enter the room.

Diagnosis. The usual test for measles is serologic testing for immunoglobulin M (IgM) antibody; a positive test confirms the diagnosis. IgM is often evident as soon as the rash appears, and can be detected for about a month. A negative IgM test on a specimen taken within 72 hours of rash onset may be a false negative; the test should be repeated. Read the rest of this entry ?

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A Nursing Conference Focused on Quality and Safety, and a Big ‘What If?’

February 9, 2015

2015ANAQualityConferenceBanner600x100
By Maureen ‘Shawn’ Kennedy, AJN editor-in-chief

“What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization?”

Last week I attended the 2015 American Nurses Association Quality Conference in Orlando. The conference, which had its origins in the annual National Database of Nursing Quality Indicators (NDNQI) conference, drew close to 1,000 attendees. Here’s a quick overview of hot topics and the keynote speech by the new Secretary of the Department of Veterans Affairs, plus a note on an issue crucial to health care quality that I wish I’d heard more about during the conference.

Most sessions presented quality improvement (QI) projects and many were well done. There were some topics I hadn’t seen covered all that much, such as reducing the discomfort of needlesticks, enhancing postop bowel recovery, and promoting sleep. But projects aimed at preventing central line infections, catheter-associated urinary tract infections (CAUTIs), and pressure ulcers ruled the sessions. These of course are among the hospital-associated conditions that might cause a hospital to be financially penalized by the Centers for Medicare and Medicaid Services (CMS). The ANA also had a couple of sessions on preventing CAUTIs by means of a tool it developed in the Partnership for Patients initiative of the CMS to reduce health care–associated infections.

The keynote by Robert McDonald, the fairly new Secretary of the Department of Veterans Affairs, touted the services and resources available for the 9 million veterans who access care through the VA system. He surprised me and—if the murmuring I heard around me was any indication—a lot of others when he reported that patients in the VA system rated their care higher than did patients at general hospitals. The comment from an attendee: “Well, I guess it’s good once you get an appointment.”

He said the VA was “using the crisis of last year to move forward” and acknowledged that improving access was a priority, noting that the VA has hired 1,578 nurses since last year.

What if? It seemed appropriate that a meeting focused on quality took place at a venue known for its high quality customer focus. What would quality in hospitals look like if health care institutions were as single-minded about serving clients as the Disney organization? I’m not talking about the superficial attempts some hospitals implement, like valet parking or blazer-wearing patient service representatives. Read the rest of this entry ?

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A Little Levity to Ease the Family Caregiver’s Burden

February 2, 2015
Illustration by Hana Cisarova for AJN/All right reserved.

Illustration by Hana Cisarova for AJN/All right reserved.

According to the CDC, almost 21% of households in the U.S. are affected by family caregiving responsibilities. The pressures and costs of this unpaid labor of love have been well documented.

This month’s Reflections essay, “Swabbing Tubby,” is written from the family caregiver perspective rather than that of a nurse. It’s about the wife and two adult daughters of an ailing older man as they are coached in one of the skills they will need to care for him at home.

It’s a tough situation, but one in this case leavened by the ability of these three women to laugh a little at the more absurd aspects of their predicament. Here’s the beginning:

In retrospect, I can’t help feeling sorry for the earnest young woman who tried so hard to show my mother, my sister, and myself how to hook up our brand-new, at-home, IV feeding device. She was all of 25, with the freshly scrubbed look of a young schoolgirl. Her youthful perkiness was no match for the trio of exhausted, crabby women who faced her across the empty hospital bed. Dad was down in X-ray having yet another CT scan, and the three of us were awaiting instructions on do-it-yourself intravenous feeding.

It’s not that they don’t take what they’re doing seriously or appreciate the training they are being given, or care for their suffering husband or father. But nurses know as well as anyone that resilience in the face of round-the-clock responsibility for another’s health and comfort demands more than just strong will—humor can be a crucial tool of those with real staying power. Read the rest of this entry ?

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Ebola Still Deserves Our Attention

January 26, 2015

By Shawn Kennedy, AJN editor-in-chief

Photographed by Centers for Disease Control and Prevention’s (CDC) team member, and EIS Officer, Dr. Heidi Soeters during Guinea’s 2014 Ebola outbreak, this image depicts what resembled a garden of red- and green-colored gloves propped up on sticks in order to dry after having been washed in a hyperchlorinated solution, thereby, killing any live Ebola viral particles. The pink-colored gloves were merely inside-out red gloves with their interiors exposed. The image was captured on the grounds of Donka Hospital, located in the country's capital city of Conakry/CDC

Taken by Dr. Heidi Soeters during Guinea’s 2014 Ebola outbreak, photo depicts red- and green-colored gloves propped on sticks to dry after being washed in a hyperchlorinated solution./CDC

It’s sad but not surprising that Ebola has all but disappeared from the headlines. After all, it’s not an imminent threat here anymore. There’s no more news hype—no “you heard it here first” messaging each day to grab headlines.

While the numbers of new cases and deaths appear to have abated in most affected countries, the World Health Organization (WHO) emergency committee on the 2014 Ebola outbreak recently cautioned that “the event continues to constitute a Public Health Emergency of International Concern” and concluded:

“the primary emphasis must continue to be on ‘getting to zero’ Ebola cases, by stopping the transmission of Ebola within the three most affected countries [Sierra Leone, Guinea, and Liberia]. This action is the most important step for preventing international spread. Complacency is the biggest risk to not getting to zero cases.”

As of the latest figures (Jan 21), there have been a total of 21,724 documented cases and 8,641 deaths worldwide—almost a 40% mortality rate. Among health care workers, there were 828 cases and 499 reported deaths.

Yet as communities are struggling to get back to normal routines (Sierra Leone, one of the hardest hit countries, with over 10,300 cases and 3,100 deaths, announced it will reopen schools in March for the first time in eight months), the rest of the world seems to have moved on, comfortable that the global threat has been mitigated.

The response of many governments and private organizations that poured resources into the hard-hits areas was laudable, and we saw how knowledgeable health care workers with the right equipment quickly made a difference.

But now what? What of the conditions—lack of health infrastructure, inadequate equipment, too few health care workers educated about Ebola and community health practices—that allowed the Ebola infection to spread unchecked for so long? The first WHO report on the Ebola outbreak was on August 29, 2014, but at first, the rest of the world remained unperturbed, seemingly viewing Ebola as an a problem specific to Africa. Read the rest of this entry ?

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Nurses at Center Stage: AJN’s Top 10 Blog Posts of 2014

December 12, 2014

By Jacob Molyneux, AJN senior editor/blog editor

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

Filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

It’s unsurprising that some of our top blog posts this past year were about Ebola virus disease. But it’s worth noting that our clinical editor Betsy Todd, who is also an epidemiologist, cut through the misinformation and noise about Ebola very early on—at a time when many thoughtful people still seemed ill informed about the illness and its likely spread in the U.S.

Ebola is scary in itself, but fear was also spread by media coverage, some politicians, and, for a while, a tone-deaf CDC too reliant on absolutes in its attempts to reassure the public.

While the most dire predictions have not come true here in the U.S., it’s also true that a lot of work has gone into keeping Ebola from getting a foothold. A lot of people in health care have put themselves at risk to make this happen, doing so at first in an atmosphere of radical uncertainty about possible modes of transmission (uncertainty stoked in part by successive explanations offered as to how the nurses treating Thomas Eric Duncan at a Dallas hospital might have become infected).

And while, relative to the situation in Africa, a lot of knowledge and resources were readily available to support nurses and physicians who treated Ebola patients, the crisis has focused much-needed attention on the quality of the personal protective equipment (PPE) hospitals have been providing to health care workers.

Meanwhile, the suffering continues in Sierra Leone and other countries. Time magazine this week made the Ebola fighters here and overseas its collective Person of the Year for 2014. (See our recent post by Debbie Wilson, a Massachusetts nurse who worked in an Ebola treatment center in Liberia this fall. She will be visiting our offices next week for lunch with the staff.) Read the rest of this entry ?

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Counting Your Blessings

November 26, 2014

By Maureen Shawn Kennedy, AJN editor-in-chief

A perhaps idealized past: 'Home for Thanksgiving,' Currier and Ives lithograph/Wikimedia Commons

A perhaps idealized past: ‘Home for Thanksgiving,’ Currier and Ives lithograph/Wikimedia Commons

At the Thanksgiving holiday in the U.S., it’s customary to take some time to reflect on our good fortune—to give thanks for what we have. For many of us, it means being thankful for family and good health. But what about all the other people who may make a difference in how we live our lives, who make the world in which we live better or in some indirect way have had an impact on what we do, how we do it, how we feel about life or our work?

Here are some folks I’d like to thank:

  • The incredibly talented team here at AJN who are committed to fulfilling AJN’s mission to provide accurate, evidence-based content with high journalistic standards, and the publishing team that provides the resources it takes to deliver on our mission.
  • AJN’s editorial boards, contributing editors, and peer reviewers, who contribute their expertise and wisdom to keep AJN on track.
  • Organizations like the Robert Wood Johnson Foundation, AARP, Johnson & Johnson, the Jonas Foundation, the John Hartford Foundation, the Macy Foundation, and others who believe in the value of nursing and provide support to further the profession.
  • Carolyn Jones, the photographer and filmmaker, for her wonderful book and film project, The American Nurse, which portrays the incredible work of nurses across settings and makes it visible to the public.
  • Brave people like nurses Kaci Hickox and Debbi Wilson and physician Craig Spencer and their colleagues at Doctors without Borders/MSF and at other relief agencies who volunteer (often with considerable risk to themselves) to provide care and compassion to those who need it (read about Wilson’s experience in a Liberian Ebola-treatment center in her recent blog post).
  • Nurses who make the hard decisions and are examples to us all, like the U.S. Navy nurse who has refused to force-feed detainees at Guantanamo Bay because it violates professional ethics.
  • Nursing faculty, who pursue teaching careers because they are committed to educating the next generation of nurses.
  • Nurses who stand up for colleagues, new and old, and work to promote teamwork and unity in the workplace.
  • And the nurses who, every day, show up and do whatever it takes to meet the needs of the patients in their care.

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