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A multimodal nursing pedagogy utilizing simulation was incorporated into annual nurse competencies at a 465-bed academic medical center to translate into practice the required surveillance of a potentially septic patient and the necessary clinical decision-making. Pretest/posttest was used to determine knowledge retention from simulation. Nurses' sepsis knowledge following simulation was improved. Simulation can provide long-term knowledge retention of sepsis for application into clinical practice and be a viable option for competency assessment for professional nurses. [ABSTRACT FROM AUTHOR]

This section offers news briefs pertaining to nursing as of February 1, 2020. Topics discussed include health technology hazards, the benefits of introducing a digital sepsis alert system into a multisite hospital network, and the results of a survey which show that one in five registered nurses holds a second job.

Sepsis is a leading cause of critical illness and hospital mortality. Early recognition and intervention are essential for the survival of patients with this syndrome. In 2002, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) launched the Surviving Sepsis Campaign (SSC) to reduce overall patient morbidity and mortality from sepsis and septic shock by driving practice initiatives based on current best evidence. The SSC guidelines have been updated every four years, with the most recent update completed in 2016. The new guidelines have increased the focus on early identification of infection, risks for sepsis and septic shock, rapid antibiotic administration, and aggressive fluid resuscitation to restore tissue perfusion. In 2014, the SCCM and the ESICM convened a task force of specialists to reexamine the definitions of terms used to identify patients along the sepsis continuum. In 2016, this task force published the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The new definitions and recommendations included tools, based on an updated understanding of the pathobiology of sepsis, that can be used to predict adverse outcomes in patients with infection. This article discusses the new SSC treatment guidelines, changes in the sepsis bundle interventions, and the Sepsis-3 definitions and tools, all of which enable nurses to improve patient outcomes through timely collaborative action. [ABSTRACT FROM AUTHOR]

Objectives: To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients.Design: Retrospective cohort study, with external validation in a deidentified ICU database.Setting: Eleven ICUs in three university hospitals within an academic healthcare system in 2014.Patients: Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation.Intervention: NoneMEASUREMENTS AND MAIN RESULTS:: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance.Conclusions: Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis. [ABSTRACT FROM AUTHOR]

Objectives: Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode.Design: Retrospective cohort study.Setting: University of Michigan Health System.Patients: All hospitalizations (May 15, 2013 to May 14, 2015) with a principal International Classification of Diseases, Ninth revision, Clinical Modification diagnosis of septicemia (038.x), severe sepsis (995.92), or septic shock (785.52), as well as all subsequent hospitalizations and sepsis readmissions within 90 days. We determined organism and site of sepsis through manual chart abstraction.Interventions: None.Measurements and Main Results: We identified 472 readmissions within 90 days of sepsis, of which 137 (29.1%) were for sepsis. In sepsis readmissions, the site and organisms were most commonly urinary (29.2%), gastrointestinal (20.4%), Gram negative (29.9%), Gram positive (16.8%), and culture negative (30.7%). Ninety-four readmissions (68.6%) were for infection at the same site as initial sepsis hospitalization. Nineteen percent of readmissions were confirmed to be same site and same organism. However, accounting for the uncertainty from culture-negative sepsis, as many as 53.2% of readmissions could plausibly due to infections with both the same organism and same site.Conclusions: Of the patients readmitted with sepsis within 90 days, two thirds had infection at the same site as their initial admission. Just 19% had infection confirmed to be from the same site and organism as the initial sepsis hospitalization. Half of readmissions were definitively for new infections, whereas an additional 34% were unclear since cultures were negative in one of the hospitalizations. [ABSTRACT FROM AUTHOR]

The Sepsis "Sniffer" Algorithm (SSA) has merit as a digital sepsis alert but should be considered an adjunct to versus an alternative for the Nurse Screening Tool (NST), given lower specificity and positive predictive value. The SSA reduced the risk of incorrectly categorizing patients at low risk for sepsis, detected sepsis high risk in half the time, and reduced redundant NST screens by 70% and manual screening hours by 64% to 72%. Preserving nurse hours expended on manual sepsis alerts may translate into time directed toward other patient priorities. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis causes 1.4 million (36%) neonatal deaths annually. Staphylococcus aureus (SA), a common skin pathogen, remains the second leading cause of late-onset sepsis in the neonatal intensive care unit (NICU). Methicillin-resistant Staphylococcus aureus (MRSA), a resistant strain of SA, has created a significant global communicable health risk, especially in the NICU.Purpose: To examine evidence related to NICU infection control practices surrounding MRSA surveillance, identification, and isolation in response to the clinical question, "What strategies should be universally implemented in the NICU to identify and prevent the spread of MRSA?"Methods/search Strategy: Databases were examined for articles on the topical area of MRSA in the neonate. Key terms were used to streamline the search, resulting in 20 primary works and 3 guideline/consensus statements considered imperative in response to the clinical questions.Findings/results: Hand hygiene remains the cornerstone to sound infection control practice. Colonization often leads to systemic infection, with smaller neonates at greatest risk. Hospital infection control compliance has improved outcomes. MRSA surveillance has reduced horizontal spread. No universal, specific recommendations exist to guide surveillance and management of MRSA in the NICU.Implications For Practice: Standardized guidelines with procedures for hand hygiene, patient surveillance and isolation, and patient cohorting with recommended staffing patterns should guide practice in the NICU. Both MRSA culture and polymerase chain reaction effectively identify positive patients. Decolonization practices are not yet clear.Implications For Research: Evaluation of standard isolation practices versus outbreak response and approaches to neonatal decolonization should be evaluated for efficacy, safety, and resistance. [ABSTRACT FROM AUTHOR]

Each day an estimated 2000 to 3000 new cases of sepsis are identified and treated in US hospitals. Despite the enormity of the problem, less than one-half of all US adults have heard of sepsis. This article reviews the financial costs of sepsis in the United States, examining the evidence for its economic impact across both hospitals and nursing homes. A brief description of payment models and government programs to promote more coordinated care between hospitals and nursing homes is provided to highlight areas where advances in sepsis care may be incentivized and sustained in new systems emerging in response to the Affordable Care Act. Finally, the costs of sepsis care to the Medicare program in a specific health care market (Pittsburgh) are estimated to highlight the challenges and opportunities for interorganizational collaborative strategies in value-based models of care delivery. [ABSTRACT FROM AUTHOR]

Health care-associated infections result in a staggering number of preventable patient deaths per year. Numerous point-of-practice initiatives and action plans have been implemented, requiring ongoing and continuing education for practicing clinicians. Equally important is the implementation of prevention practices and protocols throughout programs responsible for preparing health care providers. The use of simulation as an experiential form of learning is effective in nursing education as fundamental concepts and best practices in sepsis prevention are repeated and reinforced. [ABSTRACT FROM AUTHOR]

The article describes the sepsis prevention program at Medical Center Health System in Odessa, Texas. The program uses a multimodal approach to ensure that sepsis education reaches all nursing staff. The sepsis surveillance nurse's role was added to assist in tracking efforts for patients age 18 or older with severe sepsis and septic shock.

Over the last decade, hospitalizations for sepsis have more than doubled and the incidence of postsurgical sepsis tripled between 1997 and 2006. This upward trend is expected to continue for several reasons, including population-specific characteristics (eg, age, chronic disease status) and health care-specific characteristics (eg, lack of understanding of sepsis, medical treatments that leave patients susceptible). Highly effective, focused, quality improvement teams need to be established in order to successfully manage this condition. Quality improvement, and specifically quality improvement in health care, has evolved substantially over the past few decades. This evolution has been pushed by government initiatives and private accrediting bodies that have exposed concerns regarding quality of care. Hospitals have responded with not only corrective actions but also actions that improve quality despite a lack of noted deficiencies (ie, taking quality from "good" to "better"). Key components of a successful quality improvement program have been identified, as have components of successful quality improvement teams. By applying these components to a physician-led sepsis quality improvement team, hospitals can successfully decrease sepsis mortality and increase compliance with the application of sepsis best practice in the emergency department, intensive care unit, or non-intensive care unit nursing units. [ABSTRACT FROM AUTHOR]

Neutropenic sepsis results as a post-cancer treatment complications and is considered an on-cologic emergency. Neutropenic sepsis can result in mortality, especially if it is not identified at an early stage. Septic syndrome is the leading cause of nonrelapse mortality in patients with hematologic malignancies and solid tumors. Therefore, intensive care unit (ICU) nurses must possess a thorough understanding of cancer treatments, hematopoiesis, neutropenia, sepsis, risk factors, and the ability to perform a comprehensive assessment of the oncology patient. Each of these components plays a vital role in the patient's overall management following treatments with chemotherapy, radiation, and stem cell transplantation. The ICU nurse who encompasses this understanding will be able to identify neutropenic sepsis in a timely manner. The early identification of neutropenic sepsis will enable the ICU nurse to expeditiously implement preventive treatment and management to prevent mortality. [ABSTRACT FROM AUTHOR]

The article describe the results of a Brazilian nationwide quality improvement initiative in sepsis management. It is mentioned that the initiative improved compliance with sepsis bundle elements in both public and private hospitals. Researchers have found thatpublic hospitals in Brazil had poor compliance with minimal improvement during their observation period, whereas the private hospitals had greater improvements in both compliance and in in-hospital mortality.

Severe sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion leading to tissue injury and organ failure. The primary goal of sepsis treatment is to prevent morbidity and mortality. Crystalloids are now recommended over colloids for volume resuscitation, one of the key interventions for patients with sepsis. INSET: TABLE l. Potential empiric IV antimicrobial regimens for.... [ABSTRACT FROM AUTHOR]

The author reflects on the risk of sepsis after hematopoietic stem cell transplantation (HSCT). He considers sepsis and sepsis-related complications such as multiple organ dysfunction syndrome (MODS) and acute lung injury or acute respiratory distress syndrome as the leading causes of morbidity and mortality in critically ill patients worldwide. He also discusses a study on the development sepsis after HSCT.

The article discusses the results of researcher which confirm that readmission with sepsisis frequent (30%) and is now demonstrated that the majority of readmission for sepsis within 90 days seem due to new infections taking root in the site causing the initial admission. The diagnosis offered and the progress is discussed.

The article presents a case report of a 70-year-old man who presented in emergency with low back pain, painful urination, and fever, had diabetes mellitus and liver transplant 5 years previously, and had a lithotripsy a week before. He was diagnosed with urosepsis who needed interventions to avoid further hemodynamic compromise. The signs, symptoms, and risk factors for urosepsis are given. The patient recovered after receiving antimicrobials, fluid resuscitation, and intensive care treatment.

The author reflects on the disadvantages of penalizing hospital readmission among sepsis survivors focusing on the common incidences of postsepsis readmission that are expensive and preventable. He discusses methods used by Centers for Medicare and Medicaid Services (CMS) to generate a risk-standardized readmission rate (RSRR) for every hospital in U.S. The need to develop readmission metrics and effective interventions to reduce sepsis readmissions is also mentioned.

The authors reflect on the practice guidelines of the 2016 edition of the Surviving Sepsis Campaign focusing on the accurate implementation of the guidelines. They discuss the role of the journal, its reviewers and editors in the providing actionable information to the health care setting, the development and refinement of the guideline, and expectation of editors for readers and users to challenge the guidelines and its goal to improve patient care.

The article informs that Hour-1 bundle, which combined elements of the 3-hour and 6-hour sepsis bundles, was recommended by the Surviving Sepsis Campaign (SSC) in 2018. Topics discussed include criticism of American College of Emergency Physicians (ACEP) for the Hour-1 bundle for suitability of implementation in the U.S.; association of turbulence with adoption of the Hour-1 bundle; and protocol of Hour-1 bundle.

The author reflects on the highlights of the article "Derivation of a Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis" by H. E. Wang and others published in the July 2016 issue of the journal "Critical Care Medicine." Topics covered include the use of the Reason for Geographic and Racial Differences in Stroke (REGARDS) cohort to study sepsis risk in adults, the sepsis risk prediction scores derived from REGARDS, and the different uses of the derived scores.

The article discusses the use of automated detection and alert system with clinical decision support in improving the care and patient outcomes suffering from sepsis. Topics mentioned include the failure of the alert and detection system without the clinical decision support system, the direct investigation on alert delivery and provider group to improve the compliance of the system, and the algorithm that detects the criteria of modified systemic inflammatory response syndrome (SIRS).