Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

OBJECTIVE: To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. BACKGROUND: Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. DESIGN: Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. METHODS: The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. RESULTS: Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. CONCLUSION: NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. RELEVANCE FOR CLINICAL PRACTICE: Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. PATIENT OR PUBLIC CONTRIBUTION: Experts participated in the Delphi rounds and nurses in the pilot test.

Fractura de Pelvis. Una fractura compleja / Fracture of the Pelvis. A complex fracture

Se presenta el caso de un paciente joven con fractura de pelvis por accidente de tráfico. La fractura se presentó con una clínica abdominal y ECO FAST positivo con respuesta transitoria a la fluidoterapia. La biomecánica del accidente permitió sospechar la existencia de lesiones no observables con la proyección radiológica básica. El estudio de imagen diferido en 3D reveló la existencia de lesiones no visibles en la radiografía inicial, pero sospechadas por los antecedentes traumáticos. El presente caso nos permite repasar la sistemática de actuación ante un paciente politraumatizado (A-B-C-D-E), así como destacar la importancia que las fracturas de pelvis pueden tener en estos pacientes, ya que son causa de shock por pérdida de sangre masiva a nivel interno. Los pacientes con sospecha de fractura pélvica deben ser movilizados en bloque, manteniendo la alineación del eje cabeza-cuello-tronco, y una vez comprobada la estabilidad se debe proceder a la inmovilización de la pelvis, bien mediante un fajado pélvico o bien mediante dispositivos específicos para ello (AU)

We present a case of a young patient with a fractured pelvis due to a traffic accident. The patient had a positive FAST scan and transient response to fluid therapy. Due the biomechanics of the accident we suspected the existence of lesions that could not be observed with basic X-ray procedures. A 3-D image study revealed the lesions that were not visible by X-ray but suspected due to the nature of the trauma. This case enables us to review the A-B-C-D-E approach to the assessment of a polytraumatised patient and to emphasis the importance that a fractured pelvis could have for these patients as it is a cause of shock due to massive internal haemorrhage. Patients with a suspected fracture of the pelvis should be moved in block, maintaining the head-neck-trunk in line and once stabilised the pelvis should then be immobilised using a pelvic binder or other specific devices (AU)