Intensive & critical care nursing最新文献

{"title":"Risk factors for colonisation by Multidrug-Resistant bacteria in critical care units.","authors":"Yolanda Garcia-Parejo, Jesus Gonzalez-Rubio, Jesus Garcia Guerrero, Ana Gomez-Juarez Sango, Jose Miguel Cantero Escribano, Alberto Najera","doi":"10.1016/j.iccn.2024.103760","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103760","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial resistance is a major public health challenge recognised by the WHO as an urgent global healthcare concern. Patients in Intensive Care Units (ICUs) are particularly prone to colonisation and/or infection by multidrug-resistant organisms (MDROs).</p><p><strong>Objectives: </strong>Delineate the epidemiological characteristics and risk factors for MDROs colonisation in mixed ICUs and Resuscitation Units by focusing on initial and nosocomial colonisation.</p><p><strong>Material and methods: </strong>A descriptive observational study with analytical elements. It uses the Zero-Resistance register from the Preventive Medicine Service of the Albacete General University Hospital (Spain) from April 2016 to December 2021. It identifies the risk factors for MDROs colonisation.</p><p><strong>Results: </strong>Of 7,541 cases, 61.0 % with initial colonisation had risk factors for MDROs versus 34.0 % not colonised upon hospitalisation (p < 0.001). Significant risk factors for initial colonisation included hospitalisation for ≥ 5 days within the last 3 months, prior MDROs colonisation/infection and institutionalization. No significant risk factor differences were found for nosocomial colonisation. An association between longer ICU stays and nosocomial colonisation (p < 0.001) was noted.</p><p><strong>Conclusions: </strong>Significant risk factors for initial MDROs colonisation were hospitalisation for ≥ 5 days in the last 3 months, prior MDROs colonisation/infection and institutionalisation. Longer ICU stays increased the nosocomial colonisation risk.</p><p><strong>Implications for clinical practice: </strong>This study underscores the importance to early identify and manage patients at risk for MDROs colonisation in ICUs. By recognising factors (i.e. previous hospitalisations, existing colonisation or infection, impact of prolonged ICU stay), healthcare providers can implement targeted strategies to mitigate the spread of MDROs; e.g. enhanced surveillance, stringent infection control measures and judicious antibiotics use. Our findings highlight the need for a comprehensive approach to manage antimicrobial resistance in critical care settings to ultimately improve patient outcomes and reduce MDROs burden in hospitals.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581867","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":"Global predictors of tracheostomy-related pressure injury in the COVID-19 era: A study of secondary data.","authors":"Chandler H Moser, Chakra Budhathoki, Sarah J Allgood, Elliott R Haut, Michael J Brenner, Vinciya Pandian","doi":"10.1016/j.iccn.2024.103720","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103720","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence.</p><p><strong>Design: </strong>Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records.</p><p><strong>Setting: </strong>27 hospitals, primarily in the United States, United Kingdom, and Australasia.</p><p><strong>Patients: </strong>6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021.</p><p><strong>Measurement: </strong>TRPI as a binary outcome, reported as odds ratios.</p><p><strong>Results: </strong>TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR: 0.64), severe obesity (OR: 2.62), ICU admission (OR: 2.05), cuffed tracheostomy (OR: 1.49), fenestrated tracheostomy (OR: 15.37), percutaneous insertion (OR: 2.03) and COVID-19 infection (OR: 1.66). For children, associated risks were diabetes mellitus (OR: 4.31) and ICU admission (OR: 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR: 1.014) and children (OR: 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC: 0.227; children ICC: 0.138) indicated unmeasured hospital-level factors played a significant role.</p><p><strong>Conclusions: </strong>Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors.</p><p><strong>Implications for clinical practice: </strong>These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159311","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":"Intensive care nurses' experiences of caring. Part 1: Consideration of the concept of caring.","authors":"J. Beeby","doi":"10.1054/ICCN.2000.1489","DOIUrl":"https://doi.org/10.1054/ICCN.2000.1489","url":null,"abstract":"Curiosity as to what other intensive care nurses experienced as caring practice in a high-tech environment such as intensive care was prompted by a dilemma that arose in the author's own clinical practice. One consequence was this study which took place in a 12-bedded intensive and coronary care unit (ICU). Although there is a vast body of literature discussing caring in nursing, little is related to the intensive care environment. The first part of this paper contains discussion of the concept of caring related to this aspect of nursing, thus addressing the initial stages of the research process. This was guided by the research question 'What is caring?' Part two of this paper will present the phenomenological research study designed to answer this question.","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79411530","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}