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How Nurse Burnout Affects Hospital-Acquired Infections

How Nurse Burnout Affects Hospital-Acquired Infections

Previous research has linked invasive devices and clinical practice to hospital-acquired infections (HAIs). There is now evidence suggesting that elements of nursing care are also linked to the prevalence of HAIs. Few studies have rigorously examined the possible underlying mechanisms of the relationship between nurse staffing and HAIs. In the American Journal of Infection Control, my colleagues and I had a study published that assessed job-related burnout among registered nurses to determine its accountability for the relationship between nurse staffing and infections acquired during hospital stays. Burnout Affects Infection Rate Our findings show that job-related burnout among nurses appears to be a plausible explanation for some HAIs. Nurses had an average total of 17 years experience, caring for an average of about six patients. Almost 37% reported high levels of burnout. At the hospitals involved in the study, 16 of 1,000 patients acquired some type of infection, particularly urinary tract infections (UTIs), surgical site infections (SSIs), and gastrointestinal infections, as well as pneumonia. For modeling and further analysis, we limited the types of infection to UTIs and SSIs. As patient loads escalated, the number of UTIs and SSIs increased significantly. In additional modeling, nurse burnout was highly associated with these infections, a finding that hasn’t been reported in previous research. A 10% increase in a hospital’s composition of high-burnout nurses was linked to an increase of nearly one UTI and two SSIs per 1,000 patients. Perhaps the most important finding from our model was that reducing nurse burnout by 30% could prevent more than 4,000 UTIs and more than 2,200 SSIs each year and save up to $69 million...
Progress Elusive for New Antibiotics

Progress Elusive for New Antibiotics

There has been a desperate need for new antibiotics to treat infections caused by multidrug-resistant gram-negative bacilli (GNB) bacteria. In 2010, the Infectious Diseases Society of America (IDSA) launched its 10 x ’20 Initiative, which established a goal to develop 10 new systemic drugs to treat infections caused by resistant GNB bacteria by 2020. Unfortunately, there are still many barriers to the approval of these needed additional antibiotics, and it’s highly unlikely that these new drugs will be developed by 2020. Accelerated Efforts on Antibiotic Development Needed According to recent data, only seven new drugs are currently in development for the treatment of infections caused by GNB bacteria. Since the IDSA’s 10 x ’20 Initiative, only one new systemic antibiotic has been approved. There is also no guarantee that the drugs currently in development will actually gain FDA approval or will work against the most resistant bugs. While some progress has been made, ground is still being lost because new drugs aren’t being developed quickly enough to keep pace with antibiotic resistance.   At this time of greatest need, the number of pharmaceutical companies investing in antibiotic research and development (R&D) has decreased substantially. Only four multinational pharmaceutical companies have engaged in antibacterial discovery. R&D resources are typically strongest for developing drugs for chronic disease like high cholesterol, diabetes, and cancer. These drugs can provide significant financial rewards, partly because they’re intended for use for long periods of time. Antibiotics are a different story because they’re intended to be taken for shorter courses. This has made it less appealing for the pharmaceutical industry to use R&D resources for such...
Bronchitis in the ED: Analyzing Antibiotic Use

Bronchitis in the ED: Analyzing Antibiotic Use

Although antibiotics are often used in patients with common bacterial causes of acute bronchitis, current guidelines recommend against this practice, especially for cases of uncomplicated acute bronchitis, as most are viral in etiology. Fever, purulent sputum, shortness of breath, the presence of comorbid conditions, and a provider age of 30 or younger are factors that increase the likelihood of prescribing antibiotics for acute bronchitis. Better characterization of prescribing practices in the ED is needed in order to guide efforts to reduce the inappropriate use of antibiotics. A Closer Look at Antibiotic Use My colleagues and I had a study published in the Journal of Emergency Medicine that reviewed antibiotic and bronchodilator prescribing practices of emergency physicians at two EDs in patients with acute bronchitis. The investigation aimed to characterize key factors that were associated with antibiotic prescribing practices. Specifically, we looked at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and related factors, including age, gender, chief complaint, duration of cough, and comorbid conditions. In our analysis, antibiotics were grossly overprescribed in acute bronchitis, with 74% of adults receiving these therapies. Of those who were prescribed these medications, most (about 77%) received broad-spectrum antibiotics. Prescribing practices for acute bronchitis did not decrease significantly from what has been shown in prior studies. Patients aged 50 and older and those who smoked were more likely to be prescribed antibiotics, but no other factors appeared to increase antibiotic prescribing practices. Among patients without asthma, nearly half were discharged without a bronchodilator, and more than 90% were discharged without a spacer device. Impact on Patient Care for Acute Bronchitis Although there...
Critical Considerations for Blood Culture

Critical Considerations for Blood Culture

Sepsis and septic shock are leading causes of morbidity and mortality in the United States and represent an increasing problem for patients, providers, and healthcare systems. Studies indicate that these conditions contribute to more than 20,000 deaths per day worldwide. Despite the emergence of newer microbiology technologies, blood cultures continue to be indispensable tests for the microbiology laboratory. Positive blood cultures are often a critical step in diagnosing sepsis and are required for downstream identification and susceptibility testing. Significant advances have been made in automated blood culture systems, including the addition of enriched growth media, enhancements in automated agitation systems, and improved growth algorithms. Despite the progress, obtaining blood cultures before initiating anti-infective therapy and ensuring appropriate fill volumes of 20 mL to 40 mL of blood per venipuncture remain key factors in the successful detection of adult bacteremia. In some healthcare settings, anaerobic bacteremia has reemerged as a significant clinical problem, most likely due to more patients presenting to these institutions with complex underlying diseases. Reaching Clinical Goals Initiation of prompt, appropriate antimicrobial therapy in patients at risk for sepsis is a critical clinical goal, but doing so before culture collection may delay or prevent pathogen recovery. To address this issue, blood culture manufacturers have incorporated blood-broth ratios and/or proprietary antimicrobial removal systems into media to minimize the impact of antimicrobials and facilitate pathogen detection. For example, the BACTEC Plus (Becton Dickinson) and BacT/Alert (bioMérieux) are two frequently used aerobic blood culture media that incorporate the use of proprietary antimicrobial removal systems. The BACTEC medium uses proprietary resin beads, whereas the BacT/Alert medium uses Ecosorb (a blend of...

Society of Critical Care Medicine’s 2012 Annual Congress

New research was presented at the 2012 Society of Critical Care Medicine’s Critical Care Congress from February 4-8 in Houston. The features below highlight just some of the studies that emerged from the conference. >> Analyzing Short-Course Antibiotic Use for VAP >> Caloric Restrictions & Acute Lung Injury >> Assessing VTE Prophylaxis After Intracranial Hemorrhage Analyzing Short-Course Antibiotic Use for VAP The Particulars: Antibiotic treatment for ventilator-associated pneumonia (VAP) caused by organisms other than non–lactose-fermenting Gram-negative bacilli (NLFGNB) is typically stopped after 8 days. Data suggest that infections persist at Day 8 when VAP is caused by NLF-GNB. It is unknown if an 8-day course of antibiotics for NLF-GNB infection would be adequate or result in persistent primary infection. Data Breakdown: A retrospective review of 77 patients with VAP showed that persistent primary infection was present in 60% of patients with NLF-GNB infection after 8 days of antimicrobial therapy. Among those with NLF-GNB, only 56% of pathogens obtained on repeat bronchoalveolar lavage remained sensitive to the antimicrobial therapy. Take Home Pearls: An 8-day course of antimicrobial therapy for VAP caused by NLF-GNB infection appears to be insufficient. Study results suggest this course of treatment may result in persistent primary infection.  Caloric Restrictions & Acute Lung Injury The Particulars: Mechanically ventilated patients are generally provided some form of artificial nutrition, but the optimal nutritional strategy in critically ill patients is undetermined. Some studies suggest better outcomes with initial full enteral feeding, while others indicate that hypocaloric feeding improves short-term outcomes. Data Breakdown: A study of mechanically ventilated patients randomized participants to receive trophic feeding (400 kcal/ day) or full enteral...
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