The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

{"title":"Contamination of nebulisers and surrounding air at the bedside of mechanically ventilated patients","authors":"L. V. Heerden, H. V. Aswegen, S. V. Vuuren, R. Roos, A. Dusé","doi":"10.7196/295","DOIUrl":"https://doi.org/10.7196/295","url":null,"abstract":"Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81692737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transportation of blood in a helicopter emergency medical service: The importance of specialised equipment","authors":"Christopher Stein, Eduardo Caetano","doi":"10.7196/SAJCC.2016.V32I2.268","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.268","url":null,"abstract":"Background . Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. Aim . To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. Method . A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. Results . Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were <1°C. The maximum temperature recorded overall was 13°C and the minimum was −3°C. Conclusion . Low-cost, non-specialised materials used in a HEMS operation were not adequate for the safe transport of blood.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"37 1","pages":"62-63"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81292339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The needs of family members of intensive care unit patients : a grounded theory study","authors":"J. Beer, P. Brysiewicz","doi":"10.7196/SAJCC.2016.V32I2.298","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.298","url":null,"abstract":"Background . The unexpected admission of a loved one to an intensive care unit (ICU) may have a negative effect on the everyday lives of family members, as they have had little time to adjust. Hence, it is imperative for healthcare professionals to promote optimal outcomes for both the patient and family members during admission for critical illness. Objective . To explore and describe the needs of families during critical illness and to develop methods to provide family care during a critical illness of a loved one. Methods . The Strauss and Corbin grounded theory approach was used. In-depth interviews with 16 intensive care nurses, 6 doctors and 9 family members in private and public settings were completed. Results . Five codes emerged using the characteristic coding in grounded theory. These were identified as information sharing; reassurance; striving for consolation; garnering of resources; and cultural and religious co-operation. Conclusion . This study elicited the needs of family members of ICU patients. Methods tailored around these needs were presented to support family members during a critical illness.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"2 1","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72855133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care or burn in the ICU","authors":"L. Michell","doi":"10.7196/SAJCC.2016.v32i2.304","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.v32i2.304","url":null,"abstract":"Burnout syndrome (BOS) is a common problem, affecting 25 60% of healthcare professionals (HCPs) working in the intensive care unit (ICU).[1] Recently an American Critical Care Societies’ collaborative statement called for action to improve the ICU working environment.[2] The core symptoms of BOS are emotional exhaustion, depersonalisations and perceived lack of personal accomplishment.[2] In a previous issue of this journal we published an editorial, ‘Crash and burn’, highlighting the problem of BOS and the closely associated condition of post-traumatic stress disorder in ICU personnel.[3] Several studies have identified stressful interactions with relatives as a factor that adds to the burden of this demanding workplace. The response of burnt-out doctors and nurses is to avoid or minimise contact with the relatives, particularly if they are perceived to be demanding or ‘difficult’. Understanding the needs of families can help us support families and, in doing so, help ourselves. Even when we are managing the most hopeless ICU patient, job satisfaction can be achieved by knowing that we have done the best we could to help a family cope with a stressful situation. In this issue we publish a study which used a grounded theory approach to establish the needs of the families of ICU patients.[4] Common themes that emerged were the need for information sharing, reassurance, consolidation, resources, and cultural and religious awareness. Helping families that have been thrust into an unfamiliar and frightening situation to survive emotionally requires an understanding of the coping mechanisms relatives adopt. Establishing trust between HCPs and relatives is the first essential step. This is not achieved if discordant information is being supplied. De Beer and Brysiewicz’s study[4] highlights the problem of contradictory information being supplied by different members of the ICU team. An earlier study[5] conducted in French ICUs also showed that consistent information was the most important factor associated with family satisfaction. Communication is a two-way street and involves not only informing the relatives of the patient’s condition in an appropriate and compassionate way but also listening to family members and allowing them time to voice their fears and concerns. Family conferences where relatives talk more than the doctor are rated as more satisfactory by the family.[6] The need for reassurance was another key theme that emergend from the study. This is not such a simple need to meet in the critically ill. It is our human instinct to reassure, and families are keen to grasp at any straw offered. Unfortunately, we have all seen apparently improving patients suddenly deteriorate, and the ensuing blame games that may follow. The opposite extreme, of being overly pessimistic, is also not appropriate as we should not deny the ‘right to hope’ as long as there is some justification for this. Perhaps the best approach is one of cautious optimism, while ","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"11 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82972085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape","authors":"P. Jordan, C. Bowers, D. Morton","doi":"10.7196/SAJCC.2016.V32I2.253","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.253","url":null,"abstract":"Background . Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective . To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). Methods . A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. Results . Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion . Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"27 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88378933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study","authors":"M. Venter, W. Stassen","doi":"10.7196/SAJCC.2016.V32I2.275","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.275","url":null,"abstract":"Background . Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim . The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods . A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample ( n =7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results . After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion . Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"96 1","pages":"58-61"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80454048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing paediatric ventilator-associated pneumonia – a South African challenge!","authors":"H. Kunzmann, K. Dimitriades, B. Morrow, A. Argent","doi":"10.7196/SAJCC.2016.V32I1.243","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.243","url":null,"abstract":"There has been a decline in ventilator-associated pneumonia (VAP) in the paediatric intensive care units of developed countries. Previous studies at the Red Cross War Memorial Children’s Hospital give an incidence of VAP of >40/1 000 ventilator days, identifying VAP as a priority area for practice improvement. We outline the process and outcome of a practice improvement initiative that implemented an evidence-based bundle of care to reduce VAP. In 2011, this initiative was taken to improve healthcare-associated infections, with the support of the ‘Best Care Always’ project. A task team identified an evidence-based bundle of care aimed at reducing VAP. The bundle consisted of five elements that were adjusted practically to suit the unit. Standardised metrics to measure compliance with the bundle and outcomes of the intervention were instituted and collected prospectively throughout the study period. Following implementation in October 2011, VAP rates decreased from 55/1 000 to 19.1/1 000 ventilator days over the first 5-month period. During this period, compliance remained poor and metrics were poorly collected. With the introduction of a full-time VAP coordinator, compliance improved from 57% to a peak of 83%, with a decrease in VAP to an average of 4/1 000 ventilator days (January 2013 - July 2013). This practice improvement initiative resulted in a significant reduction in VAP. The success of this initiative is attributed equally to the introduction of the bundle of care and driving power of the VAP coordinator.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"5 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78679052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapy practice in South African intensive care units","authors":"H. van Aswegen, M. Lottering","doi":"10.7196/SAJCC.2016.V32I1.248","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.248","url":null,"abstract":"Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists’ practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed ‘very often’ included ICU chart assessment ( n =90, 83.3%), chest auscultation ( n =94, 81.8%) and cough effort ( n =81, 75%). Treatment techniques performed ‘very often’ included manual chest clearance ( n =101, 93.5%), in-bed mobilisation and positioning ( n =91, 84.3%; n =91, 84.3%, respectively), airway suctioning ( n =89, 82.4%), out-of-bed mobilisation ( n =84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises ( n =72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p =0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p =0.01), were involved with weaning patients from MV (42 v. 19%, p =0.00) and used incentive spirometry (76 v. 46%, p =0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p =0.00), extubation (60 v. 25%, p =0.00) and adjustment of MV settings (30 v. 12%, p =0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"30 1","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87485770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-tracheostomy tracheo-oesophageal fistula - an unusual presentation","authors":"C. Deepa, S. Kamat, V. Ravindran","doi":"10.7196/SAJCC.2016.V32I1.232","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.232","url":null,"abstract":"Tracheostomy, one of the oldest known surgical procedures in the history of medicine, is regularly performed in modern intensive care units. Acquired ulcerative tracheo-oesophageal fistula (TOF) is an uncommon but potentially fatal complication of tracheostomy. We report a case of ulcerative TOF with an unusual yet characteristic presentation, in a ventilator-dependent tracheostomised patient with Guillain-Barre syndrome. It presented as sudden progressive severe abdominal distension that was rhythmic with each ventilator breath. The predisposing factors, clinical features and preventive measures of post-tracheostomy TOF are discussed in this case report. Regular monitoring of tracheal tube cuff pressures and volumes, along with avoidance and treatment of various predisposing factors, are advisable for the prevention of this serious consequence.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"72 1","pages":"32-33"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90005406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiotherapy contributions to weaning and extubation of patients from mechanical ventilation","authors":"D. Morar, H. V. Aswegen","doi":"10.7196/SAJCC.2016.V32I1.254","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I1.254","url":null,"abstract":"Background. Liberation of patients from mechanical ventilation (MV) is an important goal of patient care, to avoid the complications and risks associated with prolonged MV. Objective. To determine the extent of South African physiotherapists’ involvement in weaning and extubation of patients from MV and whether current practice is evidence based. Method. A survey questionnaire was developed, and content validated and made available electronically and in hard copy. Physiotherapists working in adult intensive care units in public and private sector hospitals in South Africa (SA) were identified and invited to participate. Results. Response rate was 43% (n=184). The majority of respondents (n=135, 73%) ‘never’ or ‘seldom’ got involved in decision-making to wean patients from MV; a minority (n=8, 4%) were ‘routinely’ involved in decision-making. Some respondents (n=54, 29%) performed extubation ‘often’ or ‘routinely’. The majority used exercises (n=149, 81%), early mobilisation out of bed (n=142, 77%) and deep breathing exercises (DBEs) (n=142, 77%) ‘routinely’ to aid in respiratory muscle training. The majority of respondents ‘never’ adjusted ventilator settings other than fraction of inspired oxygen. No association was found between type of physiotherapy degree respondents held and their involvement in weaning (p=0.24). Conclusion. SA physiotherapists’ contributions towards weaning of patients from MV through prescription of exercise therapy, early outof- bed mobilisation and DBEs is evidence based. Involvement in adjustment of MV settings, decision-making regarding patient weaning, development of weaning protocols for their units and extubation is limited.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"16 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90845374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}