Critical care nursing quarterly
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Review
Methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Impacting patient care.
With the emergence and rising prevalence of methicillin-resistant Staphylococcus aureus among individuals in the community, it is imperative to standardize patient care and develop best practices among health care providers. Evidence-based standard patient care guidelines for community-acquired methicillin-resistant S aureus skin and soft tissue infections have the potential to positively impact patient outcomes, decrease health risk, reduce hospitalization from insufficient treatment, and decrease or even prevent further transmission to unaffected individuals. ⋯ It is essential that community-acquired methicillin-resistant S aureus skin and soft tissue infections are consistently treated by evidence-based treatment standards, especially with the growing number of pathogens displaying resistance to antibiotics, rising mortality, rapid spread of antimicrobial resistant microbes, and the escalating health care costs. The purpose of this literature review is to provide health care providers with current evidence-based health care guidelines for the treatment and management of community-acquired methicillin-resistant S aureus skin and soft tissue infections.
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Multidrug-resistant (MDR) gram-negative infections have become challenging to treat when there is only a limited armamentarium of anti-infectives that are commercially available. In particular, increasing resistance of gram-negative organisms such as Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species have become concerning. ⋯ Because of the potential for nephrotoxicity or neurotoxicity with the polymyxins, clinicians should be vigilant in preventing its adverse effects. Clinicians are encouraged to support the Infectious Diseases Society of America's 10 × '20 Initiative in gaining global commitment to develop additional antimicrobials for the future.
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This case study explores the management of an unusually complicated case of acute respiratory distress syndrome (ARDS) extending over 52 days of hospitalization. Despite the utilization of conventional medical treatments and optimum respiratory support modalities, the patient's condition worsened and death was imminent without salvage therapy. ⋯ The patient recovered and was able to return to regular employment. The collaborative roles of the acute care nurse and intensivist will be discussed in association with clinical evaluation and management.
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Hospital checklists are gaining momentum, particularly since the World Health Organization's Safe Surgery Saves Lives Program published results of its study in 2009, indicating that a safety checklist significantly improved surgical outcomes in hospitals across the world. The South Carolina Hospital Association, in partnership with Dr Atul Gawande, has launched a program to implement the World Health Organization Surgical Safety Checklist in every operating room in the state over the next few years. ⋯ Drawing on research, recent initiatives, and the company's experience in high-acuity units, this article explores the implications and challenges of implementing checklists in today's hospitals. If a checklist is to succeed as a mechanism for transforming evidence-based care and safety protocols into best and actual practice, it needs to be used consistently and durably; to achieve this, hospitals need to foster a supportive environment as well as acquire a system to monitor, measure, and manage a culture that effectively embraces checklists.