Search

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 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.

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.

Quantifying the critical impact nurses have on the prevention and early recognition of potential complications and adverse events, such as those identified by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI), is becoming increasingly important. In this paper, we describe how the AHRQ PSI may be used to identify nursing-specific opportunities to improve care based on data from the national AHRQ PSI validation pilot project. [ABSTRACT FROM AUTHOR]

The article discusses a study which tested whether resveratrol administration would reverse downregulation of peroxisome proliferator to activated receptor-, coactivator 1α, preserve mitochondrial integrity and prevent sepsis-induced myocardial failure in mice. It concluded that the effects of resveratrol on cecal ligation and puncture-induced myocardial dysfunction are associated with increased peroxisome proliterater-activated receptor-~, coactivator 1α abundance and function.

This article is a case study of a patient cared for in the hours before her death. After the patient's death, we learned the patient died of a black widow spider bite. This article sheds light on the potential seriousness of this venom and allows for more rapid detection and treatment of those who are unfortunate enough to be bitten. The authors have documented the sequence of events for the patient, outlined the care the patient received, examined the pathophysiology of the body to a spider bite, and then made a passionate appeal for other nurses who work in critical care to do the same with patients in similar situations. [ABSTRACT FROM AUTHOR]

The article presents a study regarding operative treatment for chest wall injuries. It mentions that fractures of consecutive ribs serve as independent markers of injury severity that heighten morbidity and mortality. It states that patients who underwent open reduction and internal fixation (ORIF) of flail chest injuries require less ventilator support to reduce growth infection and septicemia. Moreover, it says that oblique radiograph boosts sensitivity in detecting rib fractures.

Objectives: The purpose of this study was to examine whether anandamide, an endogenous cannabinoid receptor ligand, is involved in the pathogenesis of septic encephalopathy.Design: Prospective, controlled study.Subjects: Male Wistar rats (7 wks old) were randomly divided into four groups as follows: group 1, control (0.5 mL of saline injected subcutaneously); group 2, sham (surgical abdominal incision and suturing were performed, but ligation and puncture of the cecum were omitted); group 3, cecal ligation and puncture (CLP); group 4, CLP + AM 281 ([N-morpholin-4-yl]-5-[2,4-yl]-5-[2,4-dichlorophenyl]-4-methyl-1H-pyrazole-3-carboxamide) as the cannabinoid receptor antagonist (1 mg/kg intraperitoneally).Interventions: Sepsis was induced by CLP under pentobarbital anesthesia (10 mg/kg intraperitoneally) with 1% isoflurane. A 2-Fr high-fidelity micromanometer catheter was inserted into the left ventricle via the right carotid artery to assess hemodynamics. Each of the rats was neurologically assessed at 30 mins and 12, 24, and 48 hrs after the treatment. The cytoplasmic levels of caspase-3 in the hippocampi were assayed before surgery and at 30 mins and 24 and 48 hrs after surgery using Western blotting techniques. To examine the effects of AM 281 on neurologic function and mortality rate, we set another control group treated solely with AM 281. Selective inducible nitric oxide synthase inhibitor, L-N6-(1-iminoethyl)-lysine (4 mg/kg), was injected intraperitoneally immediately after CLP to produce the CLP + L-N6-(1-iminoethyl)-lysine group to exclude the influence of depressed hemodynamics on neurologic impairment.Measurements and Main Results: It was found that administration of AM 281 could prevent the hemodynamic changes induced by sepsis. Reflex responses, including the pinna, corneal, paw or tail flexion, and righting reflexes, and the escape response significantly decreased in the CLP and CLP + L-N6-(1-iminoethyl)-lysine groups at 48 hrs after the surgery. In contrast, no changes in these reflex responses were found between the CLP + AM 281 and control and sham groups. In addition, no effects of the administration of AM 281 on neurologic function and mortality rate in the control group were found. Tissue caspase-3 levels were elevated at 48 hrs after CLP in the CLP alone group (means +/- sd: control, 3.9 +/- 0.4; sham, 4.2 +/- 0.4; CLP, 7.1 +/- 1.0 [p < .01]; CLP + AM 281, 4.0 +/- 0.5 densitometric units). In addition, administration of AM 281 also decreased the mortality rate (p < .05).Conclusions: Administration of AM 281 prevented the hemodynamic changes and development of neurologic dysfunction occurring in association with septic shock, and could decrease the mortality rate in experimentally induced septic shock in rats. Although further studies are necessary to determine whether endogenous cannabinoids cause septic encephalopathy in rats directly or via their effects on systemic hemodynamics, the beneficial effects of AM 281 on these rats might have significant therapeutic implications in cases of septic encephalopathy. [ABSTRACT FROM AUTHOR]

Objective: Peripheral blood mononuclear cell (PBMC) dysfunction occurs following major abdominal surgery and correlates with an increased rate of septic complications. Studies have shown that dehydroepiandrosterone (DHEA) restores cell-mediated immune responses after trauma-hemorrhage in mice. Nonetheless, it remains unknown whether DHEA has any salutary effects on depressed PBMC function in surgical patients.Design: Laboratory experiment.Setting: University laboratory.Patients: Fifteen patients undergoing major abdominal surgery.Interventions: Blood samples were obtained preoperatively and 2 hrs postoperatively.Measurements and Main Results: PBMCs were cultured with 33% plasma in the presence or absence of DHEA (10(-10) M, 10(-8) M physiologic concentration, 10(-6) M, 10(-5) M). In an additional set of samples, the estrogen receptor antagonist tamoxifen (10(-6) M) was added. The release of proinflammatory cytokines (interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha) was measured in the supernatants by enzyme-linked immunosorbent assay. Abdominal surgery resulted in depressed interleukin-1beta and tumor necrosis factor-alpha release by PBMC. Addition of DHEA to the culture medium, however, significantly improved the release of interleukin-1beta and tumor necrosis factor-alpha and stimulated the interleukin-6 release capacity of PBMC. This effect was most pronounced for a concentration of 10(-5)M DHEA. The immunomodulatory effect of DHEA on PBMC cytokine release was completely blocked by tamoxifen. In contrast, the modulatory effect of DHEA was enhanced by the addition of postoperative plasma.Conclusions: DHEA stimulates proinflammatory cytokine release capacities of human PBMCs following major abdominal surgery. The estrogen receptor appears to be involved in mediating the immunomodulatory effect of DHEA. Thus, DHEA might be a useful adjunct for preventing immunosuppression in surgical patients. [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 case of a major infectious post-loop electrosurgical excision procedure (post-LEEP) complication in an HIV-infected female. A cellulose hemostatic agent was used in the LEEP, which was uneventful. The infection, though severe, was successfully treated with minor surgery and antibiotics. The authors recommend perioperative antibiotics or cervical cleansing to prevent sepsis in immunocompromised hosts.

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).

The author reflects on the sepsis survival campaign that requires robust evaluation and high-quality research. He discusses the campaign's objectives which led to a partnership with the Institute of Healthcare Improvement. He argues that the effectiveness of the individual works of the sepsis bundles issue should first addressed which he presents different studies conducted related on the issue. He also presents various logistic regression models to find the change in observed mortality.

The article presents information that nurses can use to protect themselves and their patients from lawsuits related to home infusion therapy which uses infiltrated peripheral intravenous catheters. A discussion of methods that nurses can use to reduce the risk of the development of nerve compression injuries or sepsis related to catheter use is presented.

Reports on news and developments related to critical care medicine in the United States as of November 11, 1990. Results of a study which examined whether regular changing of intravenous catheter helps prevent sepsis in intensive care unit patients; Results of a survey among critical care unit (CCU) nurses on job-related issues; On-call system for the CCU of Richland Memorial Hospital in Columbia, South Carolina.

Answers questions related to nursing. Cause of diarrhea in tube-fed patients; Avoiding catheter-related sepsis.

The article focuses on a statewide program in Michigan aimed to prevent catheter-related bloodstream infections (CBSI) in intensive care patients. The program provides an evidence-based checklist for clinicians who insert central venous catheters. Items on the checklist include hand washing, cleaning the patient's skin with chlorhexidine and removing unnecessary catheters.