Community-associated MRSA among Indigenous children in remote settings: Best practices for NPs.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major public health concern for Indigenous pediatric populations worldwide. It is the leading cause of skin and soft tissue infections in this demographic. This article reviews the literature and presents an evidence-based algorithm for the assessment and management of CA-MRSA among Indigenous children in remote settings.

The value of the infection prevention and control nurse led MRSA ward round.

Meticillin-resistant S. aureus (MRSA) is prevalent in most parts of the world. The study took place at Queen Elizabeth Hospital Birmingham (QEHB) a UK tertiary referral hospital. At QEHB innovative nurse led daily ward rounds for patients that acquire hospital acquired MRSA during their hospital stay are undertaken. The aim is to optimise care delivered for these patients whilst at QEHB, thereby reducing the risk of infection in patients with healthcare-acquired MRSA. A segmented Poisson regression model suggests that the MRSA bacteraemia rate was affected where an 88.94% reduction (p = 0.0561) in bacteraemias was seen by the introduction of these ward rounds. We describe a nurse led MRSA ward round which was associated with a lower rate of MRSA bacteraemias.

Abordaje y manejo de úlcera por presión afectada de celulitis por Proteus mirabilis y Staphylococcus aureus / Approach to and handling of a Pressure Ulcer affected by Cellulitis of Proteus mirabilis and Staphylococcus aureus

Introducción: La mayor dificultad en el tratamiento de las úlceras por presión es el manejo del exudado y de la infección. Es vital la elección de apósitos que simplifiquen las curas, tratando ambos problemas al mismo tiempo de forma eficiente. Objetivo: Realizar el mejor abordaje posible de la lesión desde una visión holística de la paciente. Metodología: Realizamos un estudio clínico descriptivo, prospectivo y longitudinal de 3 meses de duración, basado en el proceso de atención enfermera y en las curas en ambiente húmedo. Resultados: El uso de la tecnología alveolar gelificante ha sido satisfactoriamente costo-efectivo, al mejorar la calidad de vida de la paciente y reducir el tiempo de enfermería. Conclusión: Este caso clínico pone de manifiesto que un plan de cuidados individualizados basados en la evidencia científica y el uso de la cura en ambiente húmedo son clave para obtener resultados óptimos en la curación de heridas

Introduction: The most difficult part of the treatment of pressure ulcers is handling exudate and infection. It is crucial to choose the dressing that simplifies cures, treating efficiently both problems at the same time. Aim: To carry out the best possible approach to the wound from a holistic point of view of the patient. Methodology: We carried out a descriptive, prospective and longitudinal case study in three months based on the nursing care process and moist wound healing. Results: The usage of gelifying alveolar technology has had a very successful result in terms of cost-effectiveness, improving the patient quality of life and reducing the nursing timing. Conclusions: This case study shows that a customized treatment based on scientific evidence and the usage of moist wound healing are crucial to reach optimal results in wound healing

High rates of methicillin-resistant Staphylococcus aureus colonisation in a Brazilian Intensive Care Unit.

OBJECTIVE: To evaluate the colonisation rate of Staphylococcus aureus in the oropharynx and the insertion site of central venous catheters in intensive care unit patients. DESIGN: Cross-sectional study. SETTING: Brazilian intensive care unit. MEASUREMENTS: Samples were collected from October to December 2015 from the oropharyngeal cavity and central venous catheter insertion site of 110 patients. Samples that presented growth of Staphylococcus aureus were isolated and their sensitivity profiles were tested for several antimicrobials. FINDINGS: The study participants (110) were mostly females older than 60 years (53.6%). The mean length of hospitalisation was 15.5 days (±31.3). A total of 188 biological samples were collected: 110 collected from the oropharynx and 78 from the central venous catheter insertion site. A 35% (n = 38/110) S. aureus colonisation rate of the patients was observed in at least one collection site. In the oropharynx alone, a 31% rate (n = 34/110) was found, and a 12.8% rate (n = 10/78) at central venous catheter insertion sites only. MRSA colonisation in the oropharynx or at the central venous catheter occurred in 29 (26.4%) patients and vancomycin resistant Staphylococcus aureus was present in 24 (22.4%) of the patients studied. Patients hospitalised for seven days or more were 4.8 times more likely to be colonised compared to patients hospitalised less than seven days (95% CI = 1.2-28.5). CONCLUSION: The oropharynx and the central venous catheter are important reservoirs of this bacterium that in critical conditions may become pathogenic. The data showed a high degree of resistance of the bacterial populations isolated to different drugs, which may hinder the control of these organisms.

[Screening for Staphylococcus aureus before heart surgery]. / Dépister le Staphylococcus aureus avant une chirurgie cardiaque.

One patient out of four having to undergo an operation is a carrier of Staphylococcus aureus. This, notably in cases of heart surgery, increases the risk of developing a nosocomial infection with this very germ in the post-operative period. Nurses must implement appropriate care procedures to favour decolonisation and the education of these patients.

Staphylococcus Infections in Pregnancy: Maternal and Neonatal Risks.

Staphylococcus aureus is carried by up to one third of the general population; about 2% are carriers for methicillin-resistant S. aureus (MRSA). Infections caused by the antibiotic-resistant form include skin and soft tissue infections, as well as pneumonia, sepsis, and wound infections. Although the risks of hospital-associated systemic infections have decreased with attention to infection control procedures, serious obstetric illness remains a concern. This article describes the range of MRSA infection in the setting of pregnancy and discusses risks to both mother and newborn associated with active MRSA infection during pregnancy and childbirth. Methicillin-resistant S. aureus remains a risk to mothers and newborns, requiring prompt identification and appropriate management.

Experiences of nursing staff caring for patients with methicillin-resistant Staphylococcus aureus.

BACKGROUND: Methicillin-resistant Staphylococcus aureus is a resistant variant of S. aureus and can cause pneumonia, septicaemia and, in some cases, death. Caring for patients with antibiotic resistant bacteria is a challenge for healthcare personnel. There is a risk of spreading the bacteria among patients and of healthcare personnel being infected themselves. AIM: To describe nursing staffs' experiences of caring for patients with methicillin-resistant S. aureus in Sweden. METHOD: A descriptive qualitative approach was used and 15 nurses from different hospitals and care units, including emergency and geriatric wards and nursing homes in Stockholm, were interviewed. All nurses had been involved in the care of patients with methicillin-resistant S. aureus, but not on a regular basis. The interviews were analysed using qualitative content analysis. FINDINGS: Three themes emerged from the data: feeling ignorant, afraid and insecure, feeling competent and secure and feeling stressed and overworked. The more knowledge the nurses acquired about methicillin-resistant S. aureus, the more positive was their attitude to caring for these patients. DISCUSSION AND CONCLUSION: Caring for patients with methicillin-resistant S. aureus without adequate knowledge of how to protect oneself and other patients against transmission may provoke anxiety among personnel. Guidelines, memos and adequate information at the right time are of central importance. Healthcare personnel must feel safe in their role as caregivers. All patients have the right to have the same quality of care regardless of the diagnosis and a lack of knowledge influences the level of care given. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study demonstrates the importance of education when caring for patients with infectious diseases. Hopefully, knowledge gained from our study can provide guidance for future health care when new diseases and infections occur.

Winning the war on surgical site infection: evidence-based preoperative interventions for total joint arthroplasty.

Postoperative surgical site infections (SSIs) are the most common cause of expensive and debilitating revision surgeries. The Institute for Healthcare Improvement has introduced a three-intervention package, titled Project JOINTS, which attempts to control preoperative and perioperative factors contributing to postoperative SSI in patients undergoing total joint arthroplasty (TJA). The three interventions are preoperative screening for Staphylococcus aureus, decolonizing the skin and nares, and intraoperative administration of combined antimicrobial and alcohol agents to the skin. Canton-Potsdam Hospital was an early adopter of the Project JOINTS protocol, and this quality improvement project has demonstrated a reduced SSI rate throughout the two years of implementation. Before implementation, 596 TJAs were performed with an S aureus SSI rate of 1.8%. During Project JOINTS, 305 TJAs were conducted with a significantly (P = .050) lower S aureus SSI rate of 0.66%. Thus, Project JOINTS is effective at reducing the postoperative incidence of S aureus SSIs in patients undergoing TJA.

Pilot study of an oral care protocol on poststroke survivors.

PURPOSE: The pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients. DESIGN: This study is a randomized controlled clinical trial. METHOD: Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care. FINDINGS: Subjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%). CONCLUSIONS/CLINICAL RELEVANCE: These findings demonstrate the importance of oral care in the poststroke patient with dysphagia.

The relationship of bedside nurses' emotional intelligence with quality of care.

Emotional intelligence, a predictor of productivity and success, may impact behaviors responsible for quality of care. This study examined if emotional intelligence of units' bedside nurses is related to the quality of care delivered to the patients. In this study, emotional intelligence was found to be correlated to the number of Clostridium difficile infections, MRSA infections, patient falls with injury, and pressure ulcer screenings (P < .001) in the inpatient acute care setting.