Effect of a care bundle on prevention of nasal pressure injury in patients with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia / 中国实用护理杂志

Objective:To investigate the effect of care bundles on prevention of nasal medical device-related pressure injury in patients with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia.Methods:This was a retrospective study. Using the convenient sampling method, patients with a surgical time more than 4 hours and a surgical grade of 3 or 4, with nasotracheal intubation undergoing oral and maxillofacial surgery under general anesthesia from Hospital of Stomatology, Sun Yat-sen University were selected. A total of 96 patients from July to December 2019 were in the control group, and 99 patients from July to December 2020 were selected as the observation group. The control group was treated with routine nursing measures, the observation group was subjected to a nursing care bundle. The incidence of nasal pressure injury was observed after the operation, 24, 48, 72 hours after the nasotracheal intubation was removed, and patients′ satisfaction score was compared.Results:The incidence of nasal pressure injury in the control group was 6.25% (6/96). None of the patients in the observation group had any pressure injury, which was significantly lower than the control group (Fisher exact probability method, P=0.013). The satisfaction scores in the observation group was significantly higher than that in the control group (26.88 ± 1.94 vs 24.71 ± 3.33), the difference was statistically significant ( t=-5.54, P<0.01). Conclusions:The care bundle can effectively prevent the occurrence of nasal pressure injury in patients undergoing oral and maxillofacial surgery with nasotracheal intubation and improve patient satisfaction.

Effect of a surgical care bundle on the incidence of surgical site infection in colorectal surgery: a quasi-experimental intervention

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Focusing on renal recovery——How to prevent and treat acute kidney injury / 医学研究生学报

Acute kidney injury (AKI) is a common clinical syndrome of critical illness in the world, with high incidence in critically ill patients and having strong association with short-term and long-term poor prognosis in patients. It carries an increased risk of mortality, chronic kidney disease (CKD), end stage renal disease (ESRD) and cardiovascular adverse events, causing a huge burden of disease around the world. Yet AKI can be preventable and treatable. With the continuous exploration into the clinical research of AKI, renal recovery becomes a new target for AKI prevention and treatment. Here, we focused on influence factors of kidney recovery after AKI, integrating the new advances in AKI early risk prediction, early identification of AKI based on biomarkers, AKI electronic alert system, AKI care Bundle and standardized acute renal replacement therapy, to clarify how to prevent and treat AKI to accelerate renal recovery.

Effect of PAD bundle in mechanically ventilated patients for preventing delirium / 中国实用护理杂志

Objective To evaluate the effect of PAD bundle in mechanically ventilated patients for preventing delirium. Methods Two hundred and forty three patients with mechanical ventilation who were admitted in ICU from January 2015 to February 2018 were divided into two groups according to the method of random number table. The patients in the control group(120 cases) received routine nursing care. The patients in the experimental group(123 cases) received the PAD bundle on the basis of routine nursing care. The scores of Richards Campbell Sleep Questionnaire(RCSQ), the doses of sedatives and analgesics, incidence of delirium, duration of delirium, ventilator time, ICU length of stay and the 28-day ICU mortality were compared between the two groups. Results The incidence of delirium, duration of delirium, ventilator time, ICU length of stay was 23.58％(29/123), (2.83±1.20) d, (153.07±55.61) d, (7.88± 2.89) d in the experimental group, 40.00％(48/120), (4.02 ± 1.99) d, (170.90 ± 63.51) d, (10.13 ± 3.41) d in the control group, and there was significant difference between the two groups (χ2=8.298, Z=2.840, 2.276, 5.325, P <0.01 or 0.05). The total score of RCSQ was (55.23 ± 17.89) points in the experimental group, (51.86±16.45) points in the control group, and there was significant difference between the two groups(Z=5.654, P<0.05). There was no significant difference in 28-day ICU mortality between the two groups (P>0.05). Conclusions The PAD bundle can decrease the incidence of delirium, the duration of delirium and improve prognosis of the patients with mechanical ventilation.

Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants

Objective: To improve the usage of expressed breast milk invery low birth weight infants admitted in the neonatal intensivecare unit of a tertiary centre in India.Methods: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas likeantenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth,standardization of Kangaroo mother care, and non-nutritivesucking protocol. Data was analyzed using statistical processcontrol charts.Results: 156 very low birth weight infants were deliveredduring the study period, of which 31 were excluded due tovarious reasons. Within 6 months of implementation, theproportion of very low birth weight infants who receivedexpressed breast milk within 48 hours improved to 100% from38.7% and this was sustained at 100% for next 8 months. Themean time of availability and volume of expressed breast milkwithin 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7mL to 15.8 mL, respectively. The mean proportion of expressedbreast milk once infant reached a feed volume of 100 mL/kg/dayalso improved from 61.3% to 82.3%.Conclusion: Quality improvement interventions showedpromising results of increased expressed breast milk usage invery low birth weight infants.

Bundles of care prevents postoperative delirium in elderly patients with hip fractures / 中华创伤杂志

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures.Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017.The patients were divided into experimental group (n =43) and control group (n =37) according to the random number table method.The experimental group received bundles of care,while the control group received routine nursing.The patients in both groups were all surgically treated,and the confusion assessment method (CAM) was applied to diagnose delirium after surgery.Gender,age,fracture type,duration from injury to operation,internal fixation type,operation time,total amount of bleeding,visual analogue scale (VAS),incidence of delirium,complications,and adverse events were compared between the two groups.Results Among the 80 patients,there were 11 males and 69 females,aged averagely 79.3 years (range,65-95 years).No significant differences were found between experiment group and control group in terms of gender (male:6 cases vs.5 cases,females:37 cases vs.32 cases),age [(79.8 ± 7.8) years vs.(78.7 ± 8.9) years],cause of injury (traffic injuries:7 cases vs.4 cases;falling injuries:36 cases vs.33 cases),duration from injury to operation [(66.1 ±14.3)hours vs.(63.4 ±14.9) hours],fracture type (femoral neck:13 cases vs.10 cases;intertrochanteric:26 cases vs.24 cases;subtrochanteric:4 cases vs.3 cases),internal fixation type (artificial total hip:5 cases vs.5 cases;artificial femoral head:8 cases vs.5 cases;PFNA:29 cases vs.27 cases),operation time [(55.5 ± 16.8) minutes vs.(51.6 ± 17.0) minutes],total blood loss [(114.4 ± 73.9) ml vs.(108.1 ±72.0) ml] (P ＞ 0.05).After bundles of care intervention,the postoperative VAS [(2.2 ± 0.8) points vs.(4.3 ± 1.2) points],postoperative delirium incidence (9％ vs.32％),incidence of complications and adverse events (2％ vs.19％) in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium,complications,and adverse events in elderly patients with hip fracture.

Post-resuscitation care

Following return of spontaneous circulation (ROSC) after cardiac arrest, the challenge is to institute measures that ensure a higher likelihood of neurologically intact survival. Regardless of the cause of collapse, multiple organ systems may be affected secondary to post-cardiac arrest syndrome. Interventions required for post-ROSC care are bundled into a care regimen: prompt identification and treatment of the cause of cardiac arrest; and treatment of electrolyte abnormalities. It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimise haemodynamic management via judicious intravenous fluids and vasoactive drugs. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes. Glycaemic control of blood glucose levels at 6-10 mmol/L, adequate seizure management and measures to optimise neurological functions should be integrated into the care bundle. The interventions outlined can potentially lead to more patients being discharged from hospital alive with good neurological function.

Effect of care bundle on preventing neonatal ventilator-associated pneumonia / 中国感染控制杂志

Objective To evaluate effect of care bundle on preventing neonatal ventilator-associated pneumonia (VAP). Methods Eighty neonates who met the inclusion criteria were selected and randomly divided into trial group and control group,two groups of neonates were both given routine nursing care,trial group were implemen-ted care bundle to prevent VAP on the basis of routine nursing care. Incidence of VAP,average length of neonatal intensive care unit (NICU)stay,and average hospitalization expense were compared between two groups of neo-nates.Results A total of 80 neonates were monitored,trial group and control group were both 40 cases. Incidence of VAP in trial group and control group were 21.21‰ and 35.04‰ respectively(P<0.05);average length of NICU stay in trial group and control group were (17.84±4.03)d and (23.50±4.81)d respectively(P<0.05);average hospitalization expense in trial group and control group were(26200.71 ±389.45)yuan and (38506.36±582.13) yuan respectively(P<0.05).Conclusion Care bundle can effectively prevent the occurrence of VAP,reduce the length of NICU stay,decrease hospitalization expense,and improve nursing quality and satisfaction.

A Quality Improvement Program to Reduce Central Line Associated Blood Stream Infections in Neonates.

Introduction: Late onset sepsis is a common problem among neonatal intensive care unit (NICU) population with central venous catheter (CVC) being the primary source of infection in the majority of the cases. Central line associated bloodstream infections (CLABSIs) have been significantly reduced by care bundles implanted in NICUs. This study is conducted to detect the overall CLABSI rate, by comparing the rate per 1000 line days in the pre-intervention to that in the post-intervention periods, to prove that change could be attributed to the quality improvement bundles. Methods: This was a retrospective observational study. It included all patients with central line inserted at NICU of MGH from January 2012 to February 2014 and compared these patients with historical cohort from 22 months of 2010 and 2011. Specific interventions were designed for the central line related practices. Specific interventions according to CDC recommendations emphasize best practices in all areas of central line care: reduction of line entries, aseptic entries into the line, and aseptic procedures when changing line components. Results: Overall, CLABSI rates, in our NICU, declined significantly by 57.3% from 15 CLABSI per 1000 central line days in the pre-intervention period to 6.4 CLABSI in 1000 central line days in the post-intervention period (P<0.05). Significant reductions in CLABSI rates were noted for neonates with birth weight less than <1000g and neonates between 1001 g and 1500 g during the postintervention period, compared with the CLABSI rates for neonates from pre-intervention period. Conclusion: We found that our efforts didn’t result in a decrease in the use of CVC among neonates. Hence, central line utilization rate was not associated, in our study, with CLABSI risk. Our quality improvement effort was successful in significantly reduced CLABSI rates. The majority of our success can be linked to educational efforts based on pertinent and timely data and literature.

The clinical significance of cluster care of the prevention and treatment of ventilator-associated pneumonoia / 中华急诊医学杂志

Objective To investigate the value of cluster cate forpatients with ventilator-associated pneumo-nia (VAP) in the intensive care unit. Method Three hundred fifty-four consecutive patients with mechanical ven-tilation support in the Emergency Intensive Care Unit of Nanjing First Hospital from January 2006 to September 2007 were included in this study. The cluster care included elevating patient's head and chest to at least 30 de-grecs to the horizontal level, intensiving frequency of oral-pharyngeal nursing with thorough suction, washing hands, changing ventialtor tube at shorter regular interval, closely observing temperature, sputmn, WBC count, pu-turn, white blood cell count, chest X-ray examination and respiratory tract bacterial culture etc. Another 398 me-chanical ventilated patients with conventional care in the Hospital from January 2004 to November 2005 were taken as control. The t -test and X2 -test were used for analysis. Results The morbidity of VAP was significantly de-creased after cluster care(16.6 % vs. 24.6% P<0.01), the length of intensive care unit stay (LOS) was shorter in patients with cluster care than those in patients of control [(10.75±5.86) d vs. (14.26±9.40) d, P <0.05]. Conclusions Pneumonia associated with mechanical ventilation can be effectively reduced by the cluster care.