Water Quality Trade-offs for Risk Management Interventions in a Green Building.

Premise plumbing water quality degradation has led to negative health impacts from pathogen outbreaks (e.g., Legionella pneumophila and non-tuberculous mycobacteria), as well as chronic effects from exposure to heavy metals or disinfection by-products (DBP). Common water quality management interventions include flushing, heat shock (thermal disinfection), supplemental disinfection (shock or super chlorination), and water heater temperature setpoint change. In this study, a Legionella pneumophila- colonized Leadership in Energy and Environmental Design (LEED) certified building was monitored to study health-relevant water quality changes before and after three controlled management interventions: (1) flushing at several points throughout the building; (2) changing the water heater set point; and (3) a combination of interventions (1) and (2) by flushing during a period of elevated water heater set point (incompletely performed due to operational issues). Microbial (culturable L. pneumophila, the L. pneumophila mip gene, and cATP) and physico-chemical (pH, temperature, conductivity, disinfectant residual, disinfection by-products (DBPs; total trihalomethanes, TTHM), and heavy metals) water quality were monitored alongside building occupancy as approximated using Wi-Fi logins. Flushing alone resulted in a significant decrease in cATP and L. pneumophila concentrations (p = 0.018 and 0.019, respectively) and a significant increase in chlorine concentrations (p = 0.002) as well as iron and DBP levels (p = 0.002). Copper concentrations increased during the water heater temperature setpoint increase alone to 140°F during December 2022 (p = 0.01). During the flushing and elevated temperature in parts of the building in February 2023, there was a significant increase in chlorine concentrations (p = 0.002) and iron (p = 0.002) but no significant decrease in L. pneumophila concentrations in the drinking water samples (p = 0.27). This study demonstrated the potential impacts of short term or incompletely implemented interventions which in this case were not sufficient to holistically improve water quality. As implementing interventions is logistically- and time-intensive, more effective and holistic approaches are needed for informing preventative and corrective actions that are beneficial for multiple water quality and sustainability goals.

Iron-Deficiency Anemia in CKD: A Narrative Review for the Kidney Care Team.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with increased mortality and reduced health-related quality of life. Anemia is characterized by a decrease in hemoglobin, the iron-rich protein that the body uses for oxygen transport. Iron is required to produce hemoglobin, and disruptions in the iron homeostasis can lead to iron-deficiency anemia. Management of anemia in individuals with CKD is typically performed by a team of physicians, nurse practitioners, physician assistants, or registered nurses. Throughout the care continuum, the management can be enhanced by multidisciplinary care, and individuals with CKD can benefit from the involvement of other specialties, with dietitians/nutritionists playing an important role. However, a key area of unmet clinical need is how to assess and address iron-deficiency anemia. This review aims to provide an overview of iron-deficiency anemia in CKD and how this may be diagnosed and managed by the entire kidney care team, such as describing the mechanisms underlying iron homeostasis, the complications of iron-deficiency anemia, and the current challenges associated with its diagnosis and treatment in CKD. Opportunities for each multidisciplinary team member to add value to the care of individuals with CKD and iron-deficiency anemia are also described.

Nephrology Nursing Scope and Standards of Practice: Take Pride in Practice.

The Nephrology Nursing Scope and Standards of Practice, 9th Edition, published by the American Nephrology Nurses Association, defines the scope of nephrology nursing and provides standards of practice, standards of professional performance, and competencies for registered nurses and graduate-level prepared registered nurses (e.g., advanced practice registered nurses, clinical nurse specialists) in an approach consistent with the American Nurses Association's Nursing Scope and Standards of Practice, published in 2021. Discussions addressing respect, equity, inclusion, and social justice have been included in the 9th edition. A new section related to altered/crisis standards has been added to assist nephrology nurses in developing strategies for implementing those standards. The section on how to use the standards has been updated with forms that organizations can download and individualize. This article provides an overview of the scope, standards, competencies, and strategies for implementing them in clinical practice.

The Authority for Certain Clinical Tasks Performed by Unlicensed Patient Care Technicians and LPNs/LVNs in the Hemodialysis Setting: An Update and Invitation to Take Action.

As the demand on time and resources of licensed health care professionals increases and cost-containment measures challenge organizations, the use of unlicensed assistive personnel for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when registered nurses (RNs) delegate certain tasks and aspects of patient care. The principles of delegation from the American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the RN for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting varies significantly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. Knowing individual state Nurse Practice Acts remains the responsibility of the individual. This article discusses the results of a review of the available information on state positions on delegation of clinical tasks in hemodialysis.

Online mentoring: ANNAConnections.

As the number of patients with chronic kidney disease (CKD) rises exponentially, there is an increased demand for nephrology nurses with expertise in all areas of practice. At this time of a serious nursing shortage, professional associations are needful of members able to assume leadership positions and prepare the organizations for the future. Novices to nursing, to nephrology or to leadership present a challenge to all areas of practice, from CKD clinics to dialysis units to transplant units, and to the maintenance and growth of professional associations. The purpose of this article is to introduce an innovative mentoring program that allows facilitation of the growth and development of nephrology nurses from novice to expert in multiple areas of career or leadership development.