Avoiding admission and facilitating early discharge through OPAT.

Fifteen years ago, only a small minority of hospital inpatients were considered suitable for outpatient parenteral antimicrobial therapy (OPAT) services (Wiselka and Nicholson, 1997). Now, almost 70% of those treated with intravenous (IV) antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). Around 38-53% of those requiring OPAT are able to self-administer (Hills et al, 2012). The demand for IV antimicrobial therapy is increasing and the way it is being delivered is changing. The delivery of IV anti-microbial therapy in the community has the potential to make a huge difference to the way health care is delivered. It can enable people who would once have been admitted to hospital to be treated in the community. It can facilitate early hospital discharge (Nazarko, 2013a). Potentially, there are huge benefits in developing OPAT but there are also risks. People may be subjected to an invasive treatment when it is not necessary; therapy may be continued when it is no longer necessary (Nazarko, 2013b; Conant et al, 2014); and patients may be selected for OPAT who would be best treated in hospital. The key to providing safe and effective care is to work together to maximise benefits and minimise risk (Duncan et al, 2013). This article examines how acute and community services can work together to ensure appropriate selection, treatment and follow-up of patients.

[Managing EHEC in hospital routine]. / Krankenhaushygiene: Umgang mit einem EHEC-Ausbruch.

BACKGROUND: During May and June 2011 an outbreak of enterohemorrhagic Escherichia coli (EHEC) occurred in Germany. More than 4000 patients were infected of which 800 developed hemolytic uremic syndrome (HUS) as a severe complication. Reports in the press led to great concern in the general population. Many people with diarrhea reported to hospitals in order to exclude EHEC infections. METHODS: We describe the management of patients with suspected infectious diarrhea at the university hospital of Essen. A hospital with a significant number of immunocompromised patients. RESULTS: One important measure to handle the surge of contagious patients was to establish a multidisciplinary coordination team under leadership and guidance of the Department of Nephrology and the Department of Hospital Hygiene. Suspected infectious patients were separated in a modified emergency room. A new ward for infectious diseases was established to isolate in-patients. CONCLUSION: In our hospital the management of EHEC outbreak enabled us to treat these additional infectious patients without hampering the treatment of the other patients. As a result we plan the implementation of a coordination team for future epidemics.

Use of a vacuum-assisted device in a neonate with a giant omphalocele.

Wound healing is a complex process that can be even more challenging in neonatal and pediatric patients. Infants and children have special characteristics such as skin immaturity, a high body surface to weight ratio, sensitivity to pain, increased potential for percutaneous absorption of medication, and an immature immune system that adds to the complexity of treating their wounds. The use of controlled topical negative pressure across a wound surface has been used in adults and children since 1995. Recently, the use of this device has been reported in neonates. This article discusses the normal process of wound healing and describes the use of this device in an infant with a giant omphalocele.

A case study of holistic wound management in intensive care.

Complex wounds that have become contaminated after abdominal surgery can cause a great deal of distress to patients, and the management of such wounds requires an holistic and humanistic approach (Torrance, 1985). This case study aims to address the issues of wound management, involving some of the underlying and surrounding problems - exudate, malodour, nutrition and wound pain - that may be associated with chronic wounds after surgery. Further discussed will be the treatment and use of vacuum-assisted closure (VAC) therapy which was administered to the patient in this study. The clinical environment is an intensive care unit (ICU) within a district general hospital. The critical care nurse is primarily involved in caring for resuscitation of the critically ill patient and wound care is often a long way down the list of priorities; however, wound management is important and must be addressed at part of holistic nursing care.