Archive for the ‘Infection control’ Category

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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 ?

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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 www.cdc.gov/knowmorehepatitis/media/posters.htm. 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 http://www.cdc.gov/knowmorehepatitis/media/posters.htm. 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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An Unending Series of Challenges: APIC Highlights the ‘New Normal’ in Infection Control

July 6, 2015

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

Panelists to the Opening Plenary, Mary Lou Manning, Michael Bell, CDC, Russell Olmsted, Trinity Health, Phillip W. Smith, Nebraska Biocontainment Unit discuss various topics pertaining to infection control.

APIC panelists (APIC president Mary Lou Manning; Michael Bell, CDC; Russell Olmsted, Trinity Health; Phillip W. Smith, Nebraska Biocontainment Unit) discuss various topics pertaining to infection control.

At the 42nd annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC), held in late June in Nashville, experts from around the world shared information and insights aimed at infection preventionists but of interest to nurses in many practice settings.

APIC president Mary Lou Manning, PhD, CRNP, CIC, FAAN, opened the first plenary with the observation that to be presented with an unending series of challenges is the “new normal” in infection control and prevention. Collaboration is more important than ever in health care, she said, and “there is strength in our combined efforts.”

Cathryn Murphy, PhD, RN, CIC, in accepting APIC’s highest infection prevention award, added that trust, friendship, and passion are essential if these efforts are to succeed.

‘I’m not at Ground Zero. I’m in Dallas.’ The highlight of the opening session was a fascinating conversation with key U.S. players in the Ebola crisis. Seema Yasmin, MD, a former CDC Epidemic Intelligence Service officer and now a staff writer at the Dallas Morning News, described how hard it had been to convey accurate information in the midst of rising public hysteria in the U.S.

As an epidemiologist, Yasmin became an interview subject as well as reporter. She recalled that, after months of worrying about colleagues at risk in West Africa, a reporter asked her, “How does it feel to be at Ebola Ground Zero?” Her reply: “I’m not at Ground Zero. I’m in Dallas.”

Later in the conference, Dr. Yasmin reminded the audience that every disaster drill should include a “public information” component and warned that “misinformation spreads much quicker than a virus” in today’s media environment, adding that we “can’t repeat the same [accurate, informative] message often enough.”

Practice drills vs. the real thing. Philip W. Smith, MD, medical director of the Biocontainment Unit at the University of Nebraska Medical Center, described the unit staff’s experiences in treating Ebola. UNMC’s special unit was built more than 10 years ago after the devastating SARS outbreak in Canada that left 33 dead, including several health care workers. Until Ebola cases arrived in the U.S., the unit had been used for training and occasional patient overflow. Dr. Smith emphasized that, even while the unit was not being used, their mantra was “drill, drill, drill” to ensure that staff would function expertly when this specialty care was needed.

Then, in August of 2014, “Suddenly, nine years of drills had to be translated into reality, and there was not much room for error.” He spoke of how inserting a central line while wearing three pairs of gloves, a face shield, and maximal personal protective equipment (PPE) topped by a sterile gown was a very different challenge from repeated practice runs of the same procedure.

Dr. Smith also noted that the transport of patients with Ebola—airlifting from West Africa, ambulance transport, and movement through the hospital to the unit—was “enormously complex and time-consuming.” A special incident command structure was set up just for transport, in addition to the main hospital incident command center.

A horizontal culture was also vital to their work. “There was no hierarchy,” he said. Cultivating a “classless society,” staff developed a strong sense of team under stressful conditions where they were responsible for each other’s safety.

Nonhierarchical work habits stayed with staff after the unit was closed and they returned to their regular assignments. However, when they continued to make “best practice” suggestions to coworkers, they were met with anger and pushback instead of the thanks and cooperation that had been the norm in the Biocontainment Unit. Read the rest of this entry ?

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AJN July Issue: Hepatitis Update, Ehlers-Danlos Syndrome, Nursing’s Blind Spots, More

July 1, 2015

World_Hepatitis_Day_AJN_July_CoverOn the cover of AJN‘s July issue is the 2015 logo for World Hepatitis Day, which takes place on July 28. About 400 million people around the globe live with viral hepatitis, a disease that kills 1.4 million people every year—approximately 4,000 a day. While incidences of hepatitis A and B have declined in the United States in recent years, hepatitis C infection, formerly stable or in decline, has risen at an alarming rate. To learn more about hepatitis in the U.S.—and the role nurses can play in prevention and treatment—read our July CE, “Viral Hepatitis: New U.S. Screening Recommendations, Assessment Tools, and Treatments.”

The article reviews the epidemiology and diagnosis of viral hepatitis, new screening recommendations and innovations in assessment and treatment, and an updated action plan from the Department of Health and Human Services, in which nurses can play an important role in the coordination of care.

Some other articles of note in the June issue:

• CE feature: “Nursing Management of Patients with Ehlers–Danlos Syndrome.” An often debilitating condition, Ehlers–Danlos Syndrome (EDS) refers to a group of hereditary connective tissue disorders that has historically been misunderstood and underdiagnosed due to a lack of familiarity with its signs and symptoms. As awareness and recognition of the syndrome improve, nurses are increasingly likely to care for patients with EDS. This article gives an overview of the syndrome and provides guidance on ways to manage symptoms, recognize and prevent serious complications, and improve patients’ quality of life. Read the rest of this entry ?

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Breastfeeding’s Benefits vs. Fear of Infection Risks from a Mother’s New Tattoo

June 24, 2015

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

scalesPeople, it seems, still have strong feelings about tattoos—and about breastfeeding, too. This month, a judge in Sydney, Australia, ordered the newly tattooed mother of an 11-month-old baby to stop breastfeeding. The judge maintained that the mother’s tattooing the previous month presented “an unacceptable risk of harm” to the baby because the mother could have contracted HIV or hepatitis B (HBV) during the procedure.

The woman had tested negative for both HIV and hepatitis B since she received the tattoos. But poor aseptic technique during tattooing can result in the transmission of bloodborne infections, and people infected with HIV or HBV may not immediately test positive for either virus.

However, while HIV can be transmitted in breast milk, studies indicate that breastfeeding by hepatitis B surface antigen-positive women does not pose a significant risk of infection to their infants.

The theoretical risks put forth by the judge in this case were no match for the well-documented benefits of breastfeeding, and the injunction has already been overturned on appeal.

Still, the case raises interesting questions about how risks to a breastfeeding baby are determined. What if the father had been the person with new tattoos, and he still had a sexual relationship with the baby’s mother? It’s unscientific (and discriminatory) to focus on the breastfeeding mom as the sole potential source of bloodborne pathogen risk. Read the rest of this entry ?

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MERS: Where Are We Now and What Do Nurses Need to Know?

June 15, 2015
WHO map of MERS cases by country

WHO map of MERS cases by country. Click to enlarge.

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

Middle East respiratory syndrome (MERS) first emerged in Saudi Arabia in September 2012. Until last month, most MERS cases have occurred in that country. But on May 20, South Korea reported its first laboratory-confirmed case of MERS, in a 68-year-old man who had recently returned from a business trip to the Middle East.

The diagnosis was made only after the man had visited four health care facilities since his return home. This resulted in nosocomial transmission to other patients, health care workers, and visitors. To date, the Republic of Korea’s Ministry of Health has identified 108 cases of MERS in South Korea. Nine patients (all with serious preexisting health conditions) have died.

The WHO notes that all of these cases are epidemiologically linked to the index case. That is, there is no evidence that a new “reservoir” of MERS virus has suddenly surfaced in South Korea—all cases thus far stem from the Korean traveler who acquired his infection while visiting the Arabian Peninsula.

This is the largest outbreak of MERS so far outside of the Middle East, and therefore a reason for some concern. However, person-to-person transmission of MERS is not new, and there has as yet been no sustained community transmission in South Korea or elsewhere. Readers may recall that two U.S. hospitals safely diagnosed and managed patients with MERS during the spring of 2014. These two unrelated cases in the U.S. were imported via health care providers who lived and worked in Saudi Arabia. The patients were isolated and successfully treated at Community Hospital in Munster, Indiana, and Dr. P. Phillips Hospital in Orlando, Florida, and there was no further transmission of the virus.

In response to the South Korean outbreak, the CDC has updated its case definition for “patients under investigation” to include a history of having been in a health care facility (as patient, worker, or visitor) in South Korea within 14 days of symptom onset. Read the rest of this entry ?

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A Nurse Epidemiologist’s Notes on Issues Raised by a Recent Death from Lassa Fever

June 5, 2015

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

Lassa fever is most often diagnosed by using enzyme-linked immunosorbent serologic assays (ELISA), which detect IgM and IgG antibodies as well as Lassa antigen. Reverse transcription-polymerase chain reaction (RT-PCR) can be used in the early stage of disease. The virus itself may be cultured in 7 to 10 days, but this procedure should only be done in a high containment laboratory with good laboratory practices. Immunohistochemistry, performed on formalin-fixed tissue specimens, can be used to make a post-mortem diagnosis.

Some aspects of last month’s case of Lassa fever in New Jersey seemed to parallel the story of Thomas Duncan, who died last October in Dallas after contracting Ebola virus disease in Liberia.

A man arrived in the U.S. from Western Africa. He was screened for Ebola at the airport and instructed to monitor his temperature for 21 days. The next day, he developed a fever. Instead of calling the county health department, he headed to a hospital. He reportedly didn’t mention his travel history to staff, and was sent home on antibiotics. His condition worsened, and three days later he returned to the ED. When clinicians learned that he had recently arrived from Liberia, he was isolated, admitted, and tested for Ebola and Lassa. Positive for Lassa fever, he died soon afterwards.

Like Ebola, Lassa is a zoonotic hemorrhagic fever endemic to Western Africa. As with Ebola, the early symptoms of Lassa fever are nonspecific: fever, headache, malaise, nausea, vomiting . . .

But here the similarities end. Unlike Ebola, 80% of Lassa fever cases are mild or asymptomatic, and the overall case fatality rate is just 1%. (The risk of dying rises to 15%–20% if the disease progresses and requires hospitalization.) The most common complication of Lassa fever is deafness—one-third of those infected experience some degree of hearing loss—which occurs in both mild as well as severe cases.

Missed opportunities? This recent and upsetting story once again highlights the limitations of communicable disease follow-up based on self-monitoring and accurate individual reporting. Airport temperature screening of passengers arriving from certain geographical areas (which appears to be of questionable value) is supposed to result in the isolation and testing of anyone with a fever. But the vast majority of disembarking passengers are afebrile. They are instructed to monitor their temperature for a prescribed period of time (depending upon the disease of concern), and to call their local health department if they develop symptoms.

There are, of course, many holes in this surveillance “safety net.” Passengers may not reveal their connection to an epidemic area because of fear of reprisal, denial of their own at-risk status, or language-related misunderstandings at the point of screening. They may or may not subsequently monitor their health. When fever develops and becomes undeniable, they may not know how to contact their local health department, or if they do call, may quickly become impatient if met with a busy signal or no answer. Panic about what symptoms might mean will cause some people to run to the nearest ED for medical care; health department notification is not a high priority when you think you’re fighting for your life. Read the rest of this entry ?

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