The Effect of an Educational Program on Nursing Knowledge and Empowerment in Antimicrobial Stewardship in a Surgical Intensive Care Unit.

BACKGROUND: Hospital antimicrobial stewardship (AS) interventions have been shown to reduce the overuse and misuse of antimicrobials and rates of resistant organisms. To date, nurses have had limited involvement in AS. Improving nursing AS knowledge and sense of empowerment may improve their engagement in AS. OBJECTIVE: The purpose of this study was to evaluate the impact of an educational intervention on AS knowledge and sense of empowerment among bedside registered nurses (RNs) in a surgical intensive care unit in an academic medical center. METHODS: This was a quasi-experimental pre-post study. RESULTS: Forty-four RNs (85%) participated. There was a statistically significant (P < .01) increase in both AS knowledge and empowerment level of staff RNs. Registered nurses identified participation in patient care rounds and use of antibiotic timeouts as strategies for increasing their AS engagement. Perceived barriers included lack of physician/other team member support and knowledge deficits. CONCLUSIONS: The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.

Developing and implementing an infection prevention and control program for a COVID-19 alternative care site in Philadelphia, PA.

BACKGROUND: On March 27, 2020, the city of Philadelphia was given permission by Temple University to convert the Liacouras Center gymnasium to an alternate care site (ACS) to treat low-acuity COVID-19 patients. ACSs, especially those created to specifically care for infectious patients, require a robust infection prevention and control (IPC) program. METHODS: The IPC program was led by a physician and nurse partnership, both of whom had substantial experience developing IPC programs in US and low-resource settings. The IPC program was framed on a previously described conceptual model commonly referred to as the "4S's": Space, Staff, Stuff, and Systems. RESULTS: The gymnasium was transformed into red, yellow, and green infection hazard zones. The IPC team trained 425 staff in critical IPC practices and personal protective equipment standards. Systems to detect staff illness were created and over 3,550 staff health screening surveys completed. DISCUSSION: Use of existing guidance and comprehensive facility and patient management assessments guided the development of the IPC program. Program priorities were to keep staff and patients safe and implement procedures to judiciously use limited resources that affect infection transmission. CONCLUSION: Planning, executing, and evaluating IPC standards and requirements of an ACS during a pandemic requires creative and nimble strategies to adapt, substitute, conserve, reuse, and reallocate IPC space, staff, stuff, and systems.

Left ventricular assist device driveline infection and the frequency of dressing change in hospitalized patients.

OBJECTIVES: To determine if driveline infection is related to dressing change frequency in hospitalized adult patients with newly implanted left ventricular assist devices (LVAD). BACKGROUND: Guidelines do not exist for the frequency of driveline exit-site dressing change in hospitalized patients resulting in wide variation in practice. METHODS: A retrospective chart review was conducted on 68 patients implanted with a HeartMate II LVAD between August 2008 and September 2013 at an urban medical center. RESULTS: No driveline infections were found. Frequency of the driveline dressing change varied from daily, three times a week, and weekly. The daily dressing change group was younger in age compared to the weekly group (p = 0.005) and three times a week group (p = 0.001). No other differences were found. CONCLUSION: Driveline infections do not appear to be related to the frequency of dressing change in this population. Our data and other studies on this topic thus far are too limited to draw definitive conclusions about optimal frequency of dressing change for infection prevention.