Critical care nursing quarterly
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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.
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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. ⋯ 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.
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This article reports the results of a study on the effect of alcohol disinfection duration on bacterial load on catheter hubs. Three different levels of disinfection (3, 10, and 15 seconds) were analyzed as well as a positive and negative control. All hubs with the exception of the negative controls were contaminated with a 10 bacterial solution and allowed to dry for 24 hours. ⋯ The duration of disinfection did not significantly change the bacterial load on the hub. However, any disinfection duration significantly decreased the bacterial load as compared to the positive control. A larger study would likely detect a significant result among the disinfections.