Infections in Acute Care: Still More to Do

A sharply increased focus on hospital-acquired infections (HAIs).

This month marks the 14th anniversary of the National Healthcare Safety Network (NHSN), the CDC’s data repository for health care–associated infections. Since 2005, when a limited number of hospitals began reporting infections data, the health care community has sharply increased its focus on the prevention, early recognition, and treatment of infections in the hospital. Research on risk factors, closer attention to limiting device use (urinary catheters, central lines), and support for meticulous hand hygiene and environmental cleaning protocols have decreased rates of CAUTIs, CLABSIs, and surgical site infections.

The risk is always there.

Still, as nurses well know, hospitalized patients remain at increased risk for developing infections, especially if they are immunosuppressed or have diabetes, need invasive devices, have many comorbidities, or stay in a critical care unit.

The current evidence reviewed.

In “Infection in Acute Care: Evidence for Practice” in this month’s AJN, Douglas Houghton reviews the latest evidence on common infections in acute care settings, including community- and hospital-acquired pneumonia, surgical site infections, and C. difficile. […]

2019-10-09T10:09:54-04:00October 9th, 2019|infection control, Nursing|1 Comment
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A Nursing Conference Focused on Quality and Safety, and a Big ‘What If?’

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 […]

2016-11-21T13:03:03-05:00February 9th, 2015|Nursing, nursing perspective, nursing research, safe staffing|2 Comments
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Time to Get Serious About ‘Handshake-Free’ Health Care?

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 […]

2016-11-21T13:04:36-05:00June 2nd, 2014|nursing perspective|2 Comments
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AJN’s October Issue: Reducing VAP, Decreasing Patient Agitation, Bedbugs, Helping Transgender Kids, More

AJN1013.Cover.OnlineAJN‘s October issue is now available on our Web site. Here’s a selection of what not to miss.

Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections and a leading cause of death in ICUs. The authors of “Mouth Care to Reduce Ventilator-Associated Pneumonia” discuss the importance of oral care in infection control and offer an evidence-based, step-by-step guide to providing optimal mouth care for intubated patients. You can earn 2.3 CE credits with this article. 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.

The stress of hospitalization can lead to anxiety or agitation, especially in patients with psychiatric or cognitive disorders, putting them at increased risk for falls and self-harm. “Decreasing Patient Agitation Using Individualized Therapeutic Activities” describes a nurse-led quality improvement project that reduced agitation in patients suffering from cognitive impairment, delirium, and other behavior-altering conditions who were receiving continuous observation on a nonpsychiatric unit. Earn 2.4 CE credits by reading this article and taking the test that follows. Don’t miss the podcast interview with the author (click on the podcast icon on the first page of the article if you’re using your iPad, or visit our podcasts page).

Increasing […]

2016-11-21T13:06:27-05:00September 30th, 2013|Nursing|0 Comments
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Hand Washing: What’s It Going to Take to Get the Job Done?

Handwashing Handwashing (Photo credit: kokopinto)

By Shawn Kennedy, AJN editor-in-chief

I took a few days off last week and caught up on some reading. Perhaps the article that struck me most was one from the New York Times on the various methods that many hospitals are using to improve rates of hand washing among nurses, physicians, and other direct care providers. Hospitals are trying everything from buttons that offer gentle reminders to camera monitors to mandating that direct caregivers wear electronic sensors that indicate whether or not they washed their hands.

Perhaps the most disturbing part of the article was the remarks made by Elaine Larson, a nursing professor at Columbia University School of Nursing who had done extensive research on hand washing. She spoke of how some health professionals go out of their way to avoid washing their hands, even ducking under scanners.

A 2009 report from the Centers for Disease Control and Prevention estimated that HAIs (hospital-acquired infections), cost U.S. hospitals between $28.4 to $33.8 billion annually in direct medical costs. Just think about what could be done with that money.

I don’t get it. We all know the importance of hand washing. From Ignaz Semmelweis, who introduced hand washing in obstetrical clinics in 1847 and as a result reduced puerpal fever, to Florence Nightingale, whose insistence on good hygiene and basic cleanliness helped to reduce death rates during the Crimean War, to the extensive body of research conducted by […]

2016-11-21T13:07:04-05:00July 10th, 2013|nursing research|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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