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

Multi-Drug-Resistant Organisms and Contact Precautions

When MRSA was new on the scene, strict isolation precautions were the norm.

Photo by Rick Sforza, Redlands Daily Facts / SCNG.

Years ago, when we first started to see patients with methicillin-resistant Staphylococcus aureus (MRSA) infections at the hospital where I worked, we kept them in what was then called “strict isolation.” These patients were kept on one unit and cohorted in two rooms at the end of the hall. Staff wore gowns, gloves, masks, and hair covering. How we hated having to put on all that gear!

The current challenge of MDROs.

Today, we understand more about transmission, and isolation precautions are better tailored to the epidemiology of each drug-resistant organism. Unfortunately, though, since that time antibiotic resistance has rapidly increased, and we now find ourselves not only with a lot more MRSA to contend with, but with patients whose infections are susceptible to only one or two antibiotics (and occasionally, to none).

Some of these multi-drug-resistant organisms (MDROs) seem to be persistent colonizers—that is, the organism “takes up residence” on or in the body without causing infection, and can still be transmitted to others. In some cases these patients will need to be on isolation precautions every time they are admitted […]

Nurses Aren’t Just Healers, They’re Teachers Too: A Patient’s View

Illustration by Jennifer Rodgers. All rights reserved. Illustration by Jennifer Rodgers. All rights reserved.

A teeny red bump had mysteriously appeared on my left index finger. It hurt when I pressed on it. I figured it was nothing. . . .

That’s the start of the June Reflections essay in AJN, “Ms. Lisa and Ms. MRSA,” a patient experience narrative by freelance writer Shannon Harris. As luck would have it, the bump on her finger, it turns out, is not nothing. It’s MRSA.

The diagnosis takes a while. Finally the situation worsens, and surgery is needed. The author takes it all in stride, at least in retrospect:

The third physician stood out to me most. He asked to take a picture of my green and black, staph-infected finger with his iPhone. “Sure. Look at it! I thought this only happened to pirates,” I told him as he snapped away. He glanced at the young, button-nosed nurse standing beside him. “Don’t you want a picture? For your records?” he asked.

She shook her head, squinting and gritting her teeth. “I know. Yuck,” I said. I later shared photos of my infection journey online, to the great wonder and disgust of my friends and family. Before that, though, came surgery.

The author’s tone is light, but the situation […]

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