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Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers., (© 2020 The Authors. Hepatology published by Wiley Periodicals, Inc. on behalf of American Association for the Study of Liver Diseases.)

Purpose: To explore pediatric nurses' perceptions of their role in antimicrobial stewardship., Design and Methods: Twelve focus group sessions were conducted at a freestanding children's hospital including 90 nurses across a range of settings, units, and years of experience. Transcripts of the focus group sessions were jointly coded, from which themes were developed., Results: Specific nursing roles in antibiotic stewardship identified include: (1) advocating for the patient, (2) communicating with the team, (3) administering medications safely, (4) educating caregivers, and (5) educating themselves. Identified barriers hindering effective execution of these roles include inconsistent inclusion on rounds and lack of institutional protocols for antibiotic use., Conclusion: Nurses easily identified numerous daily nursing tasks that fit within the framework of antimicrobial stewardship and desired additional education and engagement in antibiotic stewardship., Implications: Engaging nurses could improve the structure of antibiotic stewardship programs and break down the barriers that keep nurses from fulfilling their role., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Neonatal bacterial infections leading to sepsis occur frequently in the first few days or weeks of life. NPs must be able to recognize the early signs of sepsis and understand the need for rapid evaluation and treatment. This article discusses antibiotic treatments for various types and locations of bacterial infections and sepsis in the neonate.

Background: As more is understood regarding the human microbiome, it is increasingly important for nurse scientists and healthcare practitioners to analyze these microbial communities and their role in health and disease. 16S rRNA sequencing is a key methodology in identifying these bacterial populations that has recently transitioned from use primarily in research to having increased utility in clinical settings., Objectives: The objectives of this review are to (a) describe 16S rRNA sequencing and its role in answering research questions important to nursing science; (b) provide an overview of the oral, lung, and gut microbiomes and relevant research; and (c) identify future implications for microbiome research and 16S sequencing in translational nursing science., Discussion: Sequencing using the 16S rRNA gene has revolutionized research and allowed scientists to easily and reliably characterize complex bacterial communities. This type of research has recently entered the clinical setting, one of the best examples involving the use of 16S sequencing to identify resistant pathogens, thereby improving the accuracy of bacterial identification in infection control. Clinical microbiota research and related requisite methods are of particular relevance to nurse scientists-individuals uniquely positioned to utilize these techniques in future studies in clinical settings.

Due to the high risk of infection, the geriatric population is regularly subjected to antibiotics. Faced with bacterial resistance, particularly among elderly dependent patients, it is essential to promote proper use and correct prescription of antibiotics. A study evaluated antibiotic prescription in a geriatric hospital with 598 beds and highlighted the importance of collaboration between geriatricians and infectious disease specialists., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Greece is among the countries with the highest rates of antimicrobial resistance (AMR) and simultaneous antibiotic consumption., Aim: The aim of this study was to assess the perceptions and knowledge of AMR and irrational antibiotic prescribing of nurses working in paediatric hospitals in Greece., Method: A self-administered questionnaire was distributed to nurses in paediatric hospitals and paediatric clinics in Greece. Descriptive and multivariate statistical analyses were performed. Levels of significance were two-tailed and statistical significance was p=0.05., Results: A total of 87% of participants reported irrational prescribing to be an important cause of AMR. Diagnostic uncertainty was stated by 55.5% as the main cause of irrational antibiotic prescribing and 94% suggested the use of protocols and guidelines as the main measure to control overprescribing. Parental demand for antibiotics in hospitals has increased according to 51.8% of respondents. Strong correlation was observed between social-demographic characteristics and antibiotic resistance, as well as irrational prescribing., Conclusions: Assessing nurses' knowledge and perceptions of antimicrobial resistance and irrational prescribing is vital as nurses actively participate in the antibiotics administration process and antimicrobial management in Greece. Their involvement could contribute to educate patients and parents on the public-health implications of overprescribing and antimicrobial resistance.

Community nursing teams, alongside other primary care services and nurses in working in community hospitals, are caring for people who are older, sicker and require more complex care. The nurse's ability to use evidence to make informed judgements is vitally important to patient care. Nurses often give paracetamol that is prescribed on an 'as required' basis to patients with bacterial infections who are pyrexial. This practice is supported by guidelines from the National Institute of Health and Care Excellence and the British National Formulary. This article reviews the evidence and suggests that the administration of paracetamol in people with pyrexia should be reconsidered and given on an individualised basis rather than as a routine.

Infections in children and adolescents with cancer are a significant cause of morbidity and mortality, especially in those receiving chemotherapy who are neutropenic and/or immunocompromised. The aim of this article is to review existing evidence in order to provide a practice recommendation to prevent or minimize infections in neutropenic and/or immunocompromised patients receiving chemotherapy and/or stem cell transplant. Systematic reviews were undertaken and research was graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A variety of interventions are implemented to reduce infections in the neutropenic and/or immunocompromised population; however, few are supported by research evidence. Existing literature should continue to be reviewed to further identify interventions that can influence positive patient outcomes and provide opportunities for individuals in the medical field to work together to improve clinical care., (© 2014 by Association of Pediatric Hematology/Oncology Nurses.)

Purpose: To evaluate the effectiveness of a nurse-driven indwelling urinary catheter removal protocol in an acute care setting., Background: The most common hospital-acquired infection is catheter-associated urinary tract infection (CAUTI). These infections account for 40% of all hospital-acquired infections. Although indwelling urinary catheters may be a needed intervention, studies have demonstrated over half of the patients who receive a urinary catheter do not have a valid indication for its use., Methodology: A retrospective chart review allowed measurement of prevalence of catheter usage, dwell time, and CAUTIs before and after implementation of the protocol. Indwelling catheter usage was tabulated monthly from nursing clinical documentation. The sum of catheter days was divided by the total patient days and multiplied by 100 to get a percentage of catheter usage for each month. Dwell time was calculated by tabulating the length of time in days each patient had an indwelling catheter and dividing it by the total number of catheterized patients to determine the mean duration in days. The number of CAUTIs was divided by the total number of patients with urinary catheters and multiplied by 100 to get the percentage of CAUTI., Results: Prior to implementing the nurse-driven removal protocol, indwelling urinary catheter usage was 37.6%, mean dwell time was 3.35 days, and the CAUTI rate was 0.77%. After implementation of the protocol, catheter usage was 27.7%, mean dwell time was 3.46 days, and the CAUTI rate 0.35%., Implications for Nursing: Findings support the use of a nurse-driven protocol to reduce the incidence and duration of urinary catheterization, to decrease incidence of CAUTI, and to improve the quality of care for hospitalized patients.

Although the National Patient Safety Agency published a Rapid Response Report on reducing harm resulting from omitted or delayed medication in 2010, omitted doses continue to occur frequently. The Francis report raised awareness of the problem and its potential impact on care. This article discusses the findings from a multicentre point-incident collaborative audit, focused on antimicrobials. We reviewed records from 6,062 patients prescribed 21,825 doses of antimicrobials; 13% were affected by omitted doses. Some doses are omitted in patients' best interests, but organisations need to identify those that occur for no acceptable reason and target them as a priority. We need national initiatives, strong local nursing leadership and multidisciplinary engagement to support a range of targeted interventions to achieve effective, sustained improvements. The tools developed from this study may help others to begin tackling this issue.

Antimicrobial treatment is a mainstay therapy in the neo-natal intensive care unit (NICU). Given the lack of specificity for clinical symptoms of infection in the newborn and the overwhelming impact of infection with rapid multisystem dissemination, NICU providers tend to treat early while awaiting laboratory results. With the high vulnerability of our special population to a variety of potential infecting microbes, a combination of antibiotics is preferred for initial treatment. The selection of these antibiotics is based on the known or presumed environment of exposure. If the newborn is within a week of birth, we can reasonably expect the likely environment of exposure is the community or the mother. If the newborn is older or has undergone numerous procedures, we can presume the exposure is more likely to be hospital-based.

Purpose: To explore selected factors related to the prevention of catheter-associated urinary tract infections (UTIs) in older adults., Data Sources: This review of the literature examined multiple studies regarding UTIs, and UTIs in relation to silver-tipped catheters, cranberry juice/extract, and the bacterial lysate Escherichia coli OM-89., Conclusions: Silver-tipped catheters retarded the development of the biofilm. The use of cranberry juice/extract showed few if any adverse reactions and avoided the problems of induced antibiotic resistance or introduction to supra-infections, such as Clostridium difficile infection. The immune stimulant OM-89 shows promise and may lead to simple and inexpensive preventive measures. Further research is needed to include elders, both men and women, and elders with long-term indwelling catheters., Implications for Practice: Nurse practitioners (NPs) can assure that basic nursing principles regarding long-term indwelling catheter care are upheld, measures such as proper assessment and insertion, as well as the appropriate use of silver-tipped catheters. NPs can prescribe cranberry juice/extract and incur no apparent harm while possibly reducing infection rate. NPs must be aware of the dangers of administering prophylactic antibiotics that increase resistant microorganisms and can also increase susceptibility to C. difficile infection., (©2011 The Authors Journal compilation ©2011 American Academy of Nurse Practitioners.)

Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique.

This article uses a case study approach to demonstrate good clinical outcomes using a bacterial binding dressing range on a variety of difficult wounds. A case study approach can demonstrate a clinician's perspective on the practicalities of dressing choice in practice. All wounds, whether acute or chronic, offer pathogenic micro-organisms the opportunity to flourish - this can result in slow healing. Antimicrobial dressings use active ingredients but the Cutimed Sorbact range is a bacterial binding wound dressing that offers an alternative approach to the management of bio-burden. All dressings have a cost implication and holistic wound assessment is the key to accurate diagnosis and treatment, as well as directing the practitioner to an appropriate management strategy.

Background: The urinary system is the most common site for all hospital-acquired infections, accounting for approximately 40% of all nosocomial infections. The US Centers for Medicare & Medicaid Services has enacted 2 policies that have focused considerable attention on the optimal use of indwelling catheters in the acute and long-term care settings and the prevention of complications including catheter-associated urinary tract infection (CAUTI)., Objectives: This is the first of a 2-part Evidence-Based Report Card reviewing current evidence pertaining to nursing actions for prevention of CAUTIs in patients with short- and long-term indwelling catheters. Part 1 reviews evidence for materials for catheter construction, including incorporation of antimicrobial substances into the catheter, and selection of catheter size., Search Strategy: Nursing actions for prevention of CAUTIs were identified based on search of electronic databases and Web-based search engines for national or international clinical practice guidelines focusing on this topic. Evidence related to 2 common nursing interventions, selection of the material of construction and selection of catheter size, was identified by searching electronic databases MEDLINE, CINAHL, the Cochrane Library, and the ancestry of articles identified in these searches., Results: We found robust evidence supporting insertion of a silver alloy-coated catheter to reduce the risk of CAUTIs for up to 2 weeks in adult patients managed by short-term indwelling catheterization. We also found evidence supporting the insertion of an antibiotic-impregnated catheter for reduction of CAUTI risk for up to 7 days. There was insufficient evidence to determine whether regular use of an antimicrobial catheter reduces the risk of CAUTIs in adults managed with long-term indwelling catheterization. There was insufficient evidence to determine whether selection of a latex catheter, hydrogel-coated latex catheter, silicone-coated latex catheter, or all- silicone catheter influences CAUTI risk. Expert opinion suggests that selection of a smaller French-sized catheter reduces CAUTI risk, but evidence is lacking., Implications for Practice: Insertion of an antimicrobial catheter, either silver alloy or antimicrobial coated, is recommended for patients with short-term indwelling catheterization. There is insufficient evidence to recommend their use in patients managed by long-term indwelling catheterization. Selection of smaller French sizes for short- or long-term catheterization is thought to improve comfort and reduce CAUTI risk, but further research is needed to substantiate these best practice recommendations.

A hydrogen breath test is a safe, easy-to-perform, 2-to 3-hour outpatient procedure used to identify the presence of small intestine bacterial overgrowth, evaluate carbohydrate maldigestion or malabsorption, and measure intestinal transit time. Breath sample analysis can reveal bacterial overgrowth in the small intestine by the characteristic early rise in breath hydrogen concentration (i.e., an earlier-than-expected rise at approximately 90 minutes when the substrate reaches the colon). Patients with irritable bowel syndrome are often referred for a hydrogen breath test because of symptoms of abdominal bloating, cramping, and diarrhea that are also characteristic of bacterial overgrowth. The elderly are at greater risk for nutritional compromise from untreated small intestine bacterial overgrowth than are younger patients. Treatment often consists of one or more courses of antibiotics. Most patients experience a reduction in symptoms with treatment.