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Higiene: cuidado básico que promueve la comodidad en pacientes críticos
Abstract
Patients who are hospitalized in critical care settings require nursing care to meet their basic needs. These interventions are integrated as indicators of patient outcomes and quality of care in critical care units. Objective: To analyze the social relevance and disciplinary nature of hygiene, as basic nursing care required for critically ill patients. Method: A literature review and article selection from the ISI-Web of Knowledge, Scopus, Science Direct, Proquest, Ebsco, Medline, Ovid, and SciELO databases and other sources, such as unpublished documents and web pages. This review included 3 qualitative studies, 27 quantitative studies, 1 mixed study, 40 documentary works, and 4 editorials that were published by nursing professionals and health professionals in other areas. Results: The results were divided into the following 4 categories: basic nursing care in critical care settings, hygiene as basic care for critically ill patients, hygiene and comfort, and research recommendations. Clinical Relevance: It is essential that nursing professionals satisfy patients' hygiene needs and thus provide for their safety, comfort, and welfare. There is an opportunity during the delivery of nursing care for nursing professionals to communicate with patients, assess physical and psychological states, identify potential anxieties and fears, plan patient care, and provide individual attention.
... Para ello, es necesario contar con un enfoque holístico que permita contemplar al sujeto de cuidado en su plenitud como ser humano (13). Un buen cuidado básico de enfermería es un pilar fundamental de la práctica, y gestionarlo sin valorar correcta y completamente a las personas puede afectar la atención individualizada y ocasionarles alteraciones en la integridad, seguridad y satisfacción (14). ...
... Para enfermería, esta propuesta logró sensibilizar frente a un enfoque holístico, como se ha recomendado (13), trasciende la mirada de las personas como seres vulnerables (12) y retoma planteamientos de cuidado para fomentar su autonomía en medio de la situación (10, 11), sin olvidar la importancia de contar con la mejor evidencia disponible (26), y de fortalecer el vínculo tanto con los pacientes y sus cuidadores familiares, atendiendo sus criterios de satisfacción con la atención (14). El presente desarrollo buscó, como lo sugieren experiencias anteriores, que los pacientes y sus familiares perciban que todas sus necesidades son verdaderamente escuchadas y atendidas (15,16,17). ...
Introducción. Conocer y atender debidamente las necesidades de un ser humano en medio de su vulnerabilidad continúa siendo un reto vigente. Objetivo. Describir la transformación de la “Atención a las necesidades básicas” en un momento de cuidado de enfermería para favorecer la adaptación del paciente y su cuidador familiar durante la hospitalización, en la Clínica Universidad de La Sabana, para el periodo 2018-2019. Método. Esta es una investigación metodológica en enfermería, realizada bajo lineamientos del Modelo de Enfermería Universidad de La Sabana, que incluyó cuatro fases. Resultados. Es preciso que la atención a las necesidades básicas sea respaldada en la mejor evidencia disponible, y con un trato humanizado. Hacer visible este proceso permitió medirlo y mejorarlo. Conclusiones. Para brindar un cuidado humano y seguro, no basta la buena intención, es necesario garantizar dos condiciones; por un lado, el compromiso requerido para soportarlo con la mejor evidencia disponible, aumentando la calidad del cuidado y la calidez o tono humano; y, por otro, el respeto y reconocimiento de la dignidad de las personas, favoreciendo el vínculo con ellas y su autonomía, lo que a su vez repercute positivamente en el desarrollo de la enfermería.
... De acuerdo con lo señalado, se muestra una atención óptima con elementos de libertad, que integran un conjunto de servicios e intervenciones que se encaminan hacia la satisfacción de necesidades de las parejas, inherentes al rol de la paternidad, que posibilita llevarlo a cabo con seguridad, comodidad y cumpliendo las expectativas (9) ; es decir, cuando la enfermera realiza su labor con esmero, forma un fuerte vínculo emocional con la gestante, se da una aproximación que corresponde a sus expectativas. La buena recepción puede ser entendida como una acción del proceso de reorganización del trabajo, y una postura/práctica necesaria en los profesionales de salud, garantizando acceso, resolutividad y lazos de vinculación (10) ; según las representaciones sociales se construye una relación de empatía donde el paciente pueda hablar de cosas íntimas y supuestamente revela el trauma causal de su situación. ...
Objetivo: interpretar el significado de acompañamiento del padre durante la atención perinatal. Metodología: investigación cualitativa, descriptiva, sustentada por la teoría de representaciones sociales; participaron 34 parejas, seleccionadas por haber sido atendidas durante toda la etapa perinatal; colecta de datos mediante entrevista, se efectúa el análisis de datos bajo un marco interpretativo, mediante técnica cromática, los resultados se discuten con base en representaciones sociales de Moscovici, conceptualizando la categoría; se confronta el dato empírico con la teoría, así plasmar el razonamiento lógico. Resultados: percepción de participación del padre y significado del acompañamiento de este en la atención, tipo de experiencia obtenida, concientización del esposo en la atención del neonato, destacar el rol del padre en la atención perinatal integral, patentizar su intervención como parte del trinomio. Conclusión: el significado que la madre manifiesta de la participación del padre durante el periodo del parto es la relevancia de su presencia.
... 3 Ayudar a los pacientes dependientes en el mantenimiento de su higiene personal es un aspecto fundamental de los cuidados de enfermería, contribuye a su bienestar, seguridad y dignidad así como a evitar infecciones y debe ser llevado a cabo con competencia y sensibilidad, teniendo en cuenta las preferencias individuales, culturales y religiosas de cada paciente. 4,5 La intimidad es un aspecto crucial en la asistencia sanitaria, lo que no implica que siempre sea tenida en cuenta, ya que a veces se relativiza a favor de otras necesidades consideradas más básicas en el sistema sanitario, más relacionadas con la enfermedad que con el paciente. 2 Ciertas situaciones vividas por el paciente en el hospital suponen una importante agresión a la intimidad e integridad de sus valores y, cuando es tenido en cuenta por el personal de enfermería resulta uno de los elementos que provocan más satisfacción y confianza. ...
Correspondencia: avillalobos@santpau.cat (Alba Villalobos Abelló) Resumen Objetivo principal: Conocer cómo se lleva a cabo el baño en cama de nuestros pacientes por parte del personal de enfermería. Metodología: Estudio cualitativo mediante metodología de grupo focal con participación de enfermeras y auxiliares además de entrevista semiestructurada a 8 pacientes a los que se les practicó higiene general en cama en el turno de mañana, entre Agosto 2016 y Febrero de 2017. Resultados principales: Las cargas de trabajo y la falta de tiempo se aceptan, por parte de los profesionales, como condicionantes a que el cuidado básico se vea entorpecido por diferentes motivos. En general, los pacientes entrevistados, hacen una buena valoración de la higiene en cama que se les ha realizado, con pequeños matices. Conclusión principal: Los profesionales son conscientes de que el procedimiento de la higiene en cama puede mejorar de forma importante. Palabras clave: Higiene. Atención de Enfermería. Privacidad. Seguridad del paciente. Toallitas Humedecidas. Autocuidado. Hygiene in bed: A basic nursing care in danger of extinction Abstract Objective: To know how is carried out hygiene in bed of our patients by the nursing staff. Methods: Qualitative study using the focal group methodology with participation of nursing staff. Also, included a semi-structured interview to 8 patients who were practiced general hygiene in bed on the morning shift between August 2016 and February 2017. Results: Workloads and lack of time are accepted by professionals, as conditions for basic care to be hindered for different reasons. In general, the patients interviewed, make a good evaluation of the hygiene in bed, with small nuances. Conclusions: Professionals are aware that the procedure of bed hygiene can improve significantly. Introducción El proceso de enfermedad expone al paciente a una impor-tante situación de vulnerabilidad física y psicológica en la que enfermería ha de optimizar los cuidados para preservar la seguridad y dignidad de la persona. 1 La práctica asistencial supone desarrollar nuestra tarea pro-fesional en un campo muy complicado de sentimientos, emo-ciones, afectos, una necesidad de empatía, respeto a los dere-chos, la privacidad y la dignidad de los pacientes. 2 La piel es el órgano mayor del organismo y su función es protegerle de factores externos como microorganismos pató-genos, temperatura y sustancias químicas. 3 Ayudar a los pacientes dependientes en el mantenimiento de su higiene personal es un aspecto fundamental de los cuida-dos de enfermería, contribuye a su bienestar, seguridad y dig-nidad así como a evitar infecciones y debe ser llevado a cabo con competencia y sensibilidad, teniendo en cuenta las prefe-rencias individuales, culturales y religiosas de cada paciente. 4,5 La intimidad es un aspecto crucial en la asistencia sanita-ria, lo que no implica que siempre sea tenida en cuenta, ya que a veces se relativiza a favor de otras necesidades consideradas más básicas en el sistema sanitario, más relacionadas con la enfermedad que con el paciente. 2 Ciertas situaciones vividas por el paciente en el hospital suponen una importante agresión a la intimidad e integridad de sus valores y, cuando es tenido en cuenta por el personal de enfermería resulta uno de los elementos que provocan más satisfacción y confianza. 6 La intimidad de los pacientes es un concepto complejo de definir por ser personal, y depende de las situaciones y contex-to en que se entienda. Es un derecho inalienable de la persona que en todo momento ha de estar asegurado. 2 La real academia de la lengua española define intimidad como "zona espiritual íntima y reservada de una persona o de un grupo, especialmente de una familia, cualidad de íntimo: "lo más interior o interno". 2 La intimidad es un derecho con-templado en el artículo 18 de la Constitución Española. 6 Por tanto, el derecho a la intimidad debe ser preservado, no sólo en
... Los cuidados de higiene que realiza el personal de enfermería son altamente valorados por los pacientes y por la familia exponiendo una percepción de calidad de la atención, la relación con seguridad y calidad de la atención se observa desde que ella inició, sin embargo, Carvajal indica que las intervenciones que realiza el profesional de enfermería de higiene son rutinarias y mecanizadas no tomando en cuenta las necesidades de los pacientes, además que dependiendo de la técnica, experiencia y conocimiento de la enfermera provocará en los pacientes placer, rejuvenecimiento, o angustia y temor 29 . Por tanto, ubicar a la persona en las mejores condiciones posibles a través de dichas premisas para que la naturaleza actúe sobre ésta, no sólo representa bienestar en el proceso salud-enfermedad, también refleja indicios de calidad de cuidado y seguridad del paciente, así como diferentes niveles de gestión. ...
div>La obra de Florence Nightingale está
estrechamente relacionada con su orientación
filosófica sobre la interacción del paciente con su
entorno. Al revisar desde un contexto actual las
acepciones que aporta Florence Nightingale en
su principal obra Notas de Enfermería: Qué es y
qué no es, sugieren un acercamiento a los actuales
modelos de calidad y seguridad del paciente. En
su obra incluye conceptos de calidad en el cuidado
al considerar aspectos como la higiene, entorno,
alimentación y cuidado del paciente; convirtiéndose
así en la enfermera pionera de la gestión.</div
Sobrecrecimiento Bacteriano del Intestino Delgado, se define como el aumento excesivo de las bacterias intestinales, concretamente del intestino delgado. Asociado a determinados síntomas, como son dolor abdominal, hinchazón, gases, diarrea y/o estreñimiento. De tratamiento variado y aun no muy específico.
Objective.
To describe the transformation of decisive moments that arise within the nurse-patient and family caregiver interaction to turn them into moments of care capable of favoring adaptation.
Methods.
In a high complexity hospital in the city of Bogotá (Colombia), a "nursing methodological research"-type study was conducted. It was developed in five stages: 1) identification of the institutional route of patients and their caregivers and, within it, the moments of encounter with nursing; 2) typical day of the nurse; 3) analysis of the nurse-patient and family caregiver encounters; 4) literature review on how to strengthen the nurse-patient and family caregiver relationship; and 5) proposal to transform decisive moments into moments of care.
Results.
Patients and their family caregivers usually experience six moments of encounter with nursing that include admission, assessment, satisfaction of basic needs, administration of medication, shift change, and discharge; all of them cross-cut by education and communication. Recognition of experiences during moments of encounter allowed transforming them into moments of nursing care.
Conclusion.
The transformation of decisive moments into moments of nursing care to favor adaptation of patients and their family caregivers is consequence of the nursing commitment and human nature expressed in every encounter of the care process.
23. The article shows the exclusive attention of nurses in a maternity, whose objective was to analyze the social representations of the users about the attention given by the obstetric nurses in the institution. It is a research with a qualitative, descriptive approach; Directed by the theory of social representations of Moscovici. 34 women attended in the maternity were interviewed. The data analysis was carried out through an interpretative framework, selecting the ideas highlighted by means of chromatic technique; next, the empirical data confronted with the theory is discussed. The users point out that the care received was part of a framework of humanization, responsibility, and trust, which makes it possible to attend a delivery according to their customs, which, based on theory, reflects professional autonomy. It is concluded that the care model shows that nursing care is based on knowledge, experience, and values that potentiate the practice, from which human care is appreciated, warm and personalized.
Objetivo
Identificar las necesidades y las medidas de comodidad del paciente internado en cuidados intensivos.
Material y Método
Las preguntas de la investigación son: ¿cuáles son las necesidades de comodidad del paciente internado en cuidados intensivos? Y¿cuáles las medidas que promueven comodidad al paciente internado en cuidados intensivos? Se procedió al análisis de las palabras clave del DeCS y MeSH en el ámbito de la comodidad del paciente mayor en cuidados intensivos. Búsqueda booleana en los motores de búsqueda de bases de datos: EBSCO, PubMed, B-ON, RCAAP, BVS, Cochrane Library, SciELO. Se obtuvo un total de 6488 artículos, constituyendo la muestra 10 artículos. Se procedió al análisis del contenido del corpus (corresponde a los cuidados de enfermería), del que se obtuvieron 2 categorías con un total de 55 unidades de registro.
Resultados
La distribución de los datos ha sido hecha de acuerdo con los presupuestos teóricos de la Teoría de Kolcaba: en la categoría de las Necesidades de Comodidad (28 unidades de registro) - 28% son de contexto fisico, 14% ambiental, 56% psico-espiritual y 14% social; de las Medidas de Comodidad (27 unidades de registro) - 18% son tipo alivio, 56% tranquilidad y 26% transcendencia.
Conclusión
Las necesidades de comodidad derivan esencialmente del contexto fisico y psico-espiritual y las medidas de comodidad más a menudo adoptadas son para el alivio y la tranquilidad. La disciplina de Enfermería es la que más preocupación demostra por los cuidados de comodidad.
This study was conducted to evaluate nursing documentation on patient hygienic care and to analyze the consistency between actual care given by nurses and that of documented in nursing record. Data were collected from 85 nurses employed at critical care units, on whom 255 sets of observations were performed through a structured participant observation form, which could be used to record the observation episodes and to audit nursing records. Results indicated that the most frequent performed hygienic care was oral care, perianal care, hand washing and bed bathing. The consistency between actual patient hygienic care and its documentation was 77.6%. The quality of nursing records was poor and inadequate to reflect individualized nursing care. Results suggest that more emphasis is needed in nursing practice and nursing education on the quality of record keeping in nursing to increase its evidential value.
Objectives:
The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients.
Methods:
The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time.
Results:
A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment.
Conclusions:
Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
Critically ill patients are particularly at risk for developing hospital-acquired infections. An understanding of the predisposing factors, the epidemiology of disease, and guidelines to treat and to prevent hospital-acquired infections is necessary to incorporate infection control into the daily care of the critically ill trauma patient. Although it remains a challenge, infection control programs have moved from providing surveillance data and guidelines recommendations to implementation and engagement programs aimed at a shared responsibility for hospital-acquired infections prevention. We describe a multidisciplinary approach to infection control in the critically ill trauma patient with a special focus on ventilator-associated pneumonia at a level 1 trauma and burn center.
The concept of comfort is an important one for nursing, but because of its complexity, it has not been analyzed, operationalized or structured for nursing science. In this paper, three technical senses of the term are derived from: (a) contemporary and archaic lexical entries; (b) analysis of how the concept is used in contemporary and historical nursing literature; and (c) theoretical support found in the disciplines of nursing and ergonomics. Next, the contexts of patients' needs are explored and four contexts are derived from the nursing literature on holism. When the three senses and the four contexts of needs are juxtaposed, a 3 x 4 grid with 12 elements emerges that encompasses the total domain of patient comfort. Each element describes an aspect of comfort from which empirical indicators, antecedents, consequents and test items can be developed. The grid represents a taxonomic structure of the concept that organizes the meanings of this complex concept. The structure can be used to develop comfort pretests as the nurse assesses possible needs in a given situation and to develop comfort post tests, to assess the effectiveness of comfort measures.
Although the construct of comfort has been analysed, diagrammed in a two-dimensional content map, and operationalized as a holistic outcome, it has not been conceptualized within the context of a broader theory for the discipline of nursing. The theoretical work presented here utilizes an intra-actional perspective to develop a theory of comfort as a positive outcome of nursing case. A model of human press is the framework within which comfort is related to (a) interventions that enhance the state of comfort and (b) desirable subsequent outcomes of nursing care. The paper concludes with a discussion about the theory of comfort as a significant one for the discipline of nursing.
Patient comfort is a goal of therapeutic nursing practice and a primary nursing function. Residents in nursing homes have many comfort needs including physical, psychospiritual, sociocultural, and environmental. These comfort needs are addressed by various caregivers including nurses, nursing assistants, and family members. Hand massage is a simple comfort intervention that can be incorporated readily into routine nursing care activities and conveys caring through touch, individual attention, and presence. As an intervention, hand massage promotes comfort and facilitates communication between care recipients and caregivers. The purpose of this study was to test the effectiveness of hand massage as an intervention that affects nursing home residents' comfort and satisfaction. Results are presented for 35 participants who received hand massage and 25 participants in a comparison group. Findings showed no significant differences in comfort levels or satisfaction with care over time. Significant group differences, however, were found for comfort and satisfaction when measured at specific time periods. The discussion highlights these mixed findings and presents implications for further development of hand massage as part of nursing home residents' care.
Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?’ sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN Critical Care Nursing. Sydney: Elsevier; 2006.]. How well patients are cared for has a direct effect on their sense of wellbeing and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of “holding” wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed.
The hygiene of the patient in critical condition is a common nursing technique in the intensive care unit, which does not mean that doing it is exempt of risk for the patient’s state. We carry out a study to measure the frequency of the appearance of certain adverse events during the hygiene care and their clinical repercussion.
Hygiene of the critical patients was monitored, measuring the appearance of certain events at the time of hygiene and until one hour after to assess if the complications were at the moment or had a greater repercussion on the state of the patient. During the study period, some adverse event appeared in 48% (CI 95%: 43-52) of the hygiene performed while none appeared in 52% (CI 95%: 48-56) of it. The events that appeared most frequently were: desaturation in 18% (CI 95%: 15-21) of the hygiene performed, the deadaptation of the mechanical ventilation in 11% (CI 95%: 9-14), arterial hypertension in 21% (CI 95%: 18-25) and arterial hypotension in 11% (CI 95%: 9-14). The intracranial hypertension appeared in 42% (CI 95%: 26-61) of the hygiene performed to patients who were carriers of intraventricular catheter, 9% (CI 95%: 2-25) continued with elevated values 1 hour after concluding the hygiene. The rest of the events monitored presented a lower frequency, although the appearance of one episode of cardiorespiratory arrest and two of auricular fibrillation with rapid ventricular response, one of which required cardioversion, stand out.
We conclude that it is an essential job of the nursing staff to correctly assess the risks that the performance of hygiene means for the critical patient, so that the technique should be applied rationally and under strict monitoring and control.
Objectives
Critically ill patients have an especially high risk of adverse events (AE). We sought to study the incidence of AE in an intensive care unit (ICU) to identify which factors could increase the risk of AE, determine their severity, and evaluate their influence on length of stay.
Chlorhexidine is increasingly being used not only as an antiseptic to prevent hospital infections and an adjuvant in oral hygiene but also as a preservative in personal care products. As exposure to the agent becomes more widespread, reports of adverse reactions to it are increasing. Complications range from mild irritant contact dermatitis to life-threatening anaphylaxis. Allergic contact dermatitis in some cases precedes anaphylaxis. It is imperative that physicians be aware of the many possible sources of contact with this antiseptic and be alert to recognize the potentially debilitating and catastrophic reactions that may occur because of chlorhexidine sensitization.
This article evaluates the evidence for and efficacy of the use of mechanical hygiene and chlorhexidine in the prevention of ventilator-associated pneumonia (VAP).
Inclusion criteria: primary research articles; randomized controlled trials; systematic reviews. Exclusion criteria: quasi-experimental trials; opinion articles. Search Engines: PubMed; CINAHL; and EBSCO.
VAP is the commonest infection found in critically ill patients who are mechanically ventilated. It is associated with increased mortality, increased length of stay in intensive care and increased costs.
VAP is a health care-associated infection consistent with the presence of an endotracheal tube and mechanical ventilation for greater than 48 h. Efforts aimed at reducing infection rates include oral decontamination and mechanical hygiene to control the bacteria responsible, since there is an association between changes in bacteria found in the oropharynx and its development. Tooth brushing and the use of an oral antiseptic such as chlorhexidine gluconate are increasingly recommended in ventilator care bundles.
While there have been a number of studies conducted evaluating the efficacy of both approaches, there is limited evidence to support their use. The frequency of oral decontamination and mechanical hygiene interventions have not been established and chlorhexidine 2% seems to be more effective compared to weaker concentrations, but data is mainly confined to patients following cardiothoracic surgery.
Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients' outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. Despite awareness of the importance of practicing by using best evidence, achieving and sustaining evidence-based practice within practice environments can be challenging, and research suggests that integration of evidence-based practice into daily clinical practice remains inconsistent. This article addresses 4 practice issues that, first, are within the realm of nursing and if changed might improve care of patients and, second, are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics addressed are (1) noninvasive measurement of blood pressure in children, (2) oxygen administration for patients with chronic obstructive pulmonary disease, (3) intravenous catheter size and blood administration, and (4) infection control practices to prevent infections. The related beliefs, current evidence, and recommendations for practice related to each topic are described.
Despite infection-prevention initiatives, hospital-acquired infections (HAIs) are still a common occurrence. Chlorhexidine gluconate (CHG) is an important antibacterial agent. Research indicates that the intervention of bathing with CHG can reduce the number of HAIs. Chlorhexidine gluconate is known to reduce the bioload of several bacteria, including multiple strains of methicillin-resistant Staphylococcus aureus. Research regarding the intervention of bathing with CHG was assessed and found to reduce central line-related blood stream infections, ventilator-associated pneumonia, and vancomycin-resistant enterococci. The reduction in HAIs was found to be greater as compared to bathing with soap and water. The reduction of these HAIs will allow for a saving of resources, finances and staff time, which may ultimately be passed on to the patient. While further research is indicated, a strong conclusion is drawn that bathing with CHG reduces the number of HAIs.
: Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP).
: Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation.
: This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE.
: Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care.
: No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.
Invasive devices, such as urinary catheters and peripheral and central venous catheters, can form part of essential patient care and may provide life-saving support and treatment. However, the invasive nature of these devices and the vulnerability of patients can increase the risk of acquiring a healthcare-associated infection (HCAI). This article highlights the importance of best practice in relation to insertion and management of invasive devices, incorporating hand hygiene, to reduce the risk of HCAI. Although the information can be applied to invasive devices in general, the focus is on urinary catheters.
Background:
Hand hygiene (HH) compliance can be affected by the accessibility of products (alcohol-based products or chlorhexidine) and by the formulations of these products. There are few published studies comparing different alcohol-based hand disinfection formulations.
Methods:
This study was conducted in a 41-bed medical-surgical intensive care unit at a private tertiary care hospital. Over a 16-week period, we assessed HH compliance by direct observation of practice using iPods and measurement of the amount of product used [alcohol and chlorhexidine] in two 4-room pods in which an alcohol gel product was used compared with two other 4-room pods in which an alcohol-based foam formulation was used.
Results:
A total of 3,895 opportunities for HH were observed, and the overall rate of HH compliance was 36.9%. No statistically significant differences were found in overall HH compliance or alcohol-based HH compliance between the alcohol foam unit and the alcohol gel unit. However, there was a statistically significant difference in chlorhexidine HH compliance between the alcohol foam unit and the alcohol gel unit (7.0% [130 of 1,853] vs 3.8% [77 of 2,042]; P < .01).
Conclusions:
Alcohol handrub use was greater than chlorhexidine use, but HH compliance was low in both units independent of the alcohol formulation available. The similarity of use of both alcohol formulations suggests that health care workers tend to use whatever product is readily available.
Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups.
Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines.
Trauma rates increased from 6.4% to 10.0% (p=0.346), and medical/surgical rates decreased from 3.3% to 1.0% (p=0.042). Results revealed changes in nurses' beliefs regarding pre-admission colonisation (p=0.027) and having adequate training. Nurses' perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4hours or less was 88.6% and toothbrush use at 12hours or less was 71%, with significant changes in frequency of oral care post intervention.
Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses' attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.
This paper reports a study examining the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students with the aim of informing undergraduate curricula.
In comparison with registered nurses, physician status is a risk factor for non-compliance with hand hygiene guidelines. Little research has been conducted to determine if differences between the professions in relation to hand hygiene are apparent at the undergraduate level. Cross-disciplinary studies that may provide an insight into this topic are lacking.
A questionnaire was administered to a convenience sample of 117 nursing and 119 medical students in a large university in Rome, Italy, to determine their hand hygiene knowledge, beliefs and practices. The data were collected in 2007-2008.
Nursing students' hand hygiene knowledge (F = 9·03(1,230); P = 0·003), percentage compliance (Z = 6·197; P < 0·001) and self-reported hand hygiene practices (F = 34·54(1,230); P < 0·001) were significantly higher than that of medical students. There were no statistically significant differences between hand hygiene beliefs. Mean scores on the knowledge questions were low for both groups, reflecting primarily a knowledge deficit in relation to the use of alcohol-based hand rubs to decontaminate hands in the healthcare setting.
Statistically significant disciplinary differences in hand hygiene knowledge and self-reported practices were apparent among undergraduate Italian healthcare students. Further research is needed to determine the causative factors. The overall low scores on the knowledge items indicate that these students require further education on hand hygiene, particularly in relation to the use of alcohol-based hand rubs.
Oropharyngeal colonisation has been identified as a factor contributing to ventilator associated pneumonia (VAP) in the Intensive Care Unit (ICU). We sought to develop a clinical practice guideline for providing oral hygiene in the critically ill.
Following a systematic literature review a prospectively derived consensus development conference was convened and sponsored by a clinical governance unit.
The consensus development conference generated 12 recommendations for tools and solutions; frequency and duration of cleaning; oral assessment tools and oral hygiene protocols. These recommendations underwent a validation process.
In light of sparse high level evidence to inform guidelines, further research is needed inform clinical practice. Oral hygiene is a critical element of nursing care and a standardised approach has the potential to improve clinical outcomes.
Aims:
To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices.
Background:
Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance.
Design:
A before-after evaluation study.
Methods:
The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series).
Results:
Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ).
Conclusions:
Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities.
Relevance to clinical practice:
This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact.
Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene.
The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome).
A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste.
Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 ± 17 years, simplified acute physiology score II: 44 ± 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p=0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%.
While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies.
Oral hygiene in seriously ill patients is a nursing responsibility. Oral hygiene regimens in conjunction with standardized ventilator-associated pneumonia "bundles" reduce the incidence of pneumonia, length of stay, and associated costs in critical care. Following strict adherence to the recommended ventilator-associated pneumonia bundle, the ventilator-associated pneumonia rate at the Northeast Baptist Hospital intensive care units has remained 0% for 36 months. Oral care in this patient population, however, has remained vague based on ritual and nurse preference. This article describes the development of an oral care protocol based on best evidence, providing a rationale for standardization of oral hygiene and the plan for surveillance and updating.
Multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and toxin-producing organisms such as Clostridium difficile have been a concern for over 30 years. An increasing focus is being placed on the role that an unclean environment can play in transmission. This article describes the pathogens of concern and the use of a robust environmental cleaning program to help reduce the chances for hospital-acquired infections.
The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses' (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used.
The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2-5 years ICU experience; and RNs with greater than 5 years ICU experience.
During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00h in 161 episodes (30%), took 15-30min to complete (n=195, 36.2%) and was completed within the last 8h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n=379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n=86, 16.1%) or other agents such as pre-packaged washcloths (n=65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three levels of RN ICU experience highlighted a transition of patient hygiene practice philosophy from shades of grey - falling in line for inexperienced clinicians to experienced clinicians concrete beliefs about patient bed-bath needs.
This study identified variation in process and products used in patient hygiene practices in four ICUs. Further study to improve patient outcomes is required to determine the appropriate timing of patient hygiene activities and cleansing agents used to improve skin integrity.
La falta de cuidado y protección de la piel puede suponer una de las primeras manifestaciones de dependencia, ya que ello puede ser debido a algún tipo de dificultad que le impide llevar a cabo por sí mismo el autocuidado en su higiene corporal. Si la persona además está hospitalizada, precisará de la ayuda de otras personas para poder realizar los cuidados higiénicos. Por otro lado, la higiene de la piel y la conservación de su integridad son necesarias por ser la primera línea de defensa del organismo. Con el objetivo de cubrir esta necesidad, las profesionales de enfermería que trabajamos en la UCI hemos diseñado un plan de cuidados para ayudar al paciente dependiente en la realización de la higiene de la piel, mucosas y cabello.
Maintaining good oral hygiene in patients who have had a stroke is an essential part of care. This literature review highlights the poor provision of such care in acute medical and rehabilitation settings. It reveals a lack of evidence for current practices and suggests that research may be helpful in defining which nursing interventions are most effective.
This quasi-experimental study explored initial and sustained effects of educational and behavioral interventions on hand hygiene adherence and the relationships between hand hygiene adherence and health care-associated infections. Education paired with positive reinforcement behavioral interventions significantly improved hand hygiene adherence after the first month (χ² = 4.27; P = .039); however, the improvement was not sustained over 6 months. There were no significant differences in infection rates between the treatment and control groups.
The literature reports inconsistent evidence of the effects of nurse staffing on mortality despite continuing examination of this association.
To examine differences in provision of basic nursing care and in-hospital and 30-day mortality by nurse staffing of ICUs and general wards among acute stroke patients admitted to ICUs during hospitalization.
A cross-sectional design that included survey and administrative data.
The study included 6957 patients with hemorrhagic and ischemic stroke who were admitted to ICUs of 185 Korean hospitals.
Nurse staffing of ICUs and general wards was graded based on the bed-to-nurse ratios of each hospital. Provision of basic care was measured by whether five activities, such as bathing and feeding assistance, were fully provided by ICU nursing staff without delegation to patient families. Hospitals were categorized into low, middle, and high mortality groups for in-hospital and 30-day mortality based on z-scores that indicated standardized difference between observed and expected mortality after controlling for patient characteristics.
In 83.8% of hospitals, basic care was provided fully by ICU nursing staff. The overall in-hospital and 30-day mortality rates were 21.9 and 25.4%, respectively. Hospitals with higher ICU staffing were more likely to fully provide basic care. Better ICU and general staffing tended to be associated with lower in-hospital and 30-day mortality. Compared with in-hospital mortality, 30-day mortality had a more distinct increase as nurse staffing became worse.
The findings provide evidence that nurse staffing may impact provision of basic care and patient mortality and suggest the need for policies for providing adequate nurse staffing.
Infections are considered nosocomial if they occur 48 hours or more after hospital admission or within 30 days after discharge. One third of these infections are considered preventable. Many studies have shown that with proper education and use of strict guidelines, we can prevent nosocomial infections in the intensive care unit. In this article, we will review the literature on preventing catheter-associated urinary tract infection, central line-associated blood stream infection, and ventilator-associated pneumonia.
To explore patients' views regarding the factors that contribute to the maintenance of their dignity while in hospital, together with their perceptions of whether or not these were realised.
It has long been recognised that a consideration of patients' dignity in the hospital setting is of paramount importance and its maintenance can contribute to the 'emotional comfort' that may assist recovery. There have been several attempts to define dignity as a theoretical concept, but few studies of the factors that contribute to its maintenance from the patients' perspective.
A phenomenological hermeneutic approach was used.
Interviews were conducted with 102 patients in three hospitals in the UK over 18 months. The intention was to interpret what was being said and also the underlying meaning of how patients considered that their dignity was compromised.
The findings revealed that although many patients were satisfied with the maintenance of their dignity while in hospital, a significant number were not. Six key themes that contribute to the preservation of their dignity were identified -- privacy; confidentiality; communication and the need for information; choice, control and involvement in care; respect and decency and forms of address. Patients provided details of their expectations with respect to these factors.
Patients, irrespective of their situation and degree of health have their own expectations in relation to their dignity. These need to be assessed and matched by relevant nursing activities to assist recovery.
Nurses have an important role in meeting patients' expectations of how they would like their dignity to be maintained. The identification of the most important factors that contribute to this from patients' perspective will help develop dignified nursing practice.
This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.
The purpose of this study was to establish the safest way to bathe patients with myocardial infarction (MI) through measuring the hemodynamics during and after bathing. Seventy patients with MI were bathed supine in a Hubbard tank filled with 42 degrees C tap water for 5 min. The subjects were divided into 2 groups depending on their hemodynamic values 10 min after bathing: pulmonary capillary wedge pressure unchanged even after bathing (group A), and decreased pressure after bathing (group B). The left ventricular ejection fraction of group B was significantly higher than that of group A: 53.6% vs. 39.7%, respectively (p<0.01). The physical work capacity of group B was significantly higher at 5.6 METs, than that of group A with 4.5 METs (p<0.05). During the average of their 37-month follow-up period, there were 3 cardiac events in group B and 6 in group A. There were 2 cardiac events during bathing, both of which occurred in group A. When patients with MI take a bath, it is essential to closely monitor them, especially to those patients with lower cardiac function, because they have a higher possibility of a cardiac event.
A research-based policy and procedure to improve the oral hygiene care of intubated and other seriously ill patients was developed, implemented, and evaluated. The project resulted in (a) improved oral hygiene for patients, (b) standardization and simplification of nursing practice, and (c) a reduction in supply costs. The project has implications for nursing practice and evidence-based practice protocol development.
Hot bathing has been associated with sudden death and so the present study investigated its effects on autonomic activity and hemodynamics in the elderly patient and the healthy young by analyzing heart rate variability (HRV). Subjects were 9 elderly men (mean age, 75 years) and 9 young men (mean age, 27 years), who were immersed up to shoulder level while in a sitting position for 10min with the bath temperature at 40 degrees C. Blood pressure (BP) and heart rate (HR) were monitored. BP in the young decreased during bathing (p<0.01), whereas in the elderly BP had a maximum value just at the start of immersion (p<0.05) with a slight decline at 4 min after the start of immersion. Although HR in the young increased (p<0.01), in the elderly there was an abrupt increase in HR just at the start of immersion (p<0.05), followed by a decrease in HR. With regard to HRV, the high-frequency (HF) component in the young men was suppressed during immersion (p<0.01), but was unaffected in the elderly. The LF (low frequency)/HF ratio in the elderly decreased at 4 min (p<0.05). In conclusion, hypotensive syncope may cause sudden death by drowning during hot bathing, and is a consequence of the decrease in sympathetic tone that develops approximately 4min after immersion.
Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients' morbidity. Clustering nocturnal care has been recommended to improve patients' sleep.
To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients' variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.
A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.
Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients' acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.
The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
For bedridden patients unable to perform personal hygiene measures because of acute illness or chronic debilitation, the bed bath, with either the traditional basin or, more recently, disposable baths, has long been a measure for improving hygiene and costs.
To compare the traditional basin bed bath with a prepackaged disposable bed bath in terms of 4 outcomes: time and quality of bath, microbial counts on the skin, nurses' satisfaction, and costs.
Forty patients in surgical, medical, or cardiothoracic intensive care units received both types of bath on different days. Baths were observed, timed, and scored for quality. Cultures of the peri-umbilicus and groin were obtained before and after each bath. At the end of the study, nurses were interviewed about their preferences.
Neither total quality scores nor microbial counts differed significantly between the 2 bath types. Significantly fewer products (P < .001) and less time were used, cost was lower, and nurses' ratings were significantly better with the disposable bath.
The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and long-term care settings, and it may even be preferable to the traditional basin bath.
The aim of the study was to determine the frequency and types of nursing activities on sedated and non-sedated patients in the intensive care unit at night shift.
The complex intensive care unit and nursing activities has been described as an environment in which patients enter in a physiological crisis. This is even more so when the patient is unable to communicate or heavily sedated or unable to move. Nursing activities, fear and apprehension cause low morale and sleep disturbance.
The study was carried out on a descriptive basis in the Surgical Intensive Care Unit. Thirty sedated and 30 non-sedated patients to whom the nursing care was applied during 19.00-07.00 hours for three consecutive nights were chosen with simple random sampling. Data were gathered by means of retrospective examination of the standard nursing chart notes about the 60 patients for three consecutive nights. Data were analysed using percentage calculations and chi-square test.
The results demonstrate that patient records indicated a mean of 51 interactions per patient per night. Nursing activities were more frequent between 02.00 and 05.00 hours. It was detected that nursing activities such as mouth and eye care, decubitus ulcer care, change of dressing, bed bath, catheter change for three night shifts were more frequently between 24.00 and 05.00 hours. Mechanical ventilation control and endotracheal suctioning were more frequently performed on sedated patients than on non-sedated patients (P < 0.05).
These findings of this study indicate that the nursing activities in the intensive care unit were focused on the activities, which will maximize what is seen to be physiological stability.
This study has provided further data that identify the activities of nurses working in the intensive care unit at night shift. We hope to contribute to the development of the sleep protocol in surgical intensive care units.
The ‘been there, done that’ attitude is reducing nursing care to a series of physical tasks on patients. More and more these days one hears care assistants, students and senior nurses referring to clinical nursing practice as something which one goes through, does the work and moves on to better things or higher salaries.