Internal Intensive Care Unit Research Articles

The effect of physical restraint on neurovascular complications in intensive care units

BackgroundTo reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate. ObjectivesThe objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate. MethodsA prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary. ResultsRedness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications. ConclusionsThe duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey.

Comparison of Beers criteria and EU(7) potentially inappropriate medications list for the potentially inappropriate medications in Indian elderly inpatients

Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (≥65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p&lt;0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.

Effect of Designing Nursing Teaching Protocol on Patients Undergoing Chemotherapy to Minimize Complications of Neutropenia

Background Patients undergoing chemotherapy are at risk of developing neutropenia that may cause life-threatening infections and death. Aim: Evaluate effect of designing nursing teaching protocol on patients undergoing chemotherapy to minimize complications of neutropenia. Design: A Pre and Post test research design was utilized. Sample: sixty adult patients undergoing chemotherapy both males and females. Setting: The study was carried out in the internal medical oncology departments and intensive care unit at South Egypt Cancer Institute. Tools: An interview questionnaire sheet for the patient, A designed nursing teaching protocol for patients undergoing chemotherapy to minimize complications of neutropenia and patient`s assessment sheet for complications of neutropenia. Results: There were highly statistically significant differences between pre and post application of the designed nursing teaching protocol in both all knowledge items and complications of neutropenia P<0.001. Conclusion: there were highly statistically significant differences between studied patients pre and post application of the designed nursing teaching protocol regarding total knowledge and complications of neutropenia. Recommendation: Tangible tools and education of patients, families and healthcare workers are keys to speedy recognition of potentially life-threatening symptoms associated with neutropenia.

Acute Management of Diabetic Ketoacidosis in Adults at 3 Teaching Hospitals in Canada: A Multicentre, Retrospective Cohort Study.

Diabetic ketoacidosis (DKA) is a common acute complication of diabetes mellitus and is associated with significant morbidity and mortality. There is currently a paucity of data concerning the Canadian experience with DKA. We aimed to characterize the acute management and course of DKA at several Canadian hospitals. We performed a retrospective cohort study of patients admitted to 3 teaching hospitals in Edmonton, Canada. We extracted clinical and laboratory data from the medical charts of patients admitted to general internal medicine wards or intensive care units with moderate or severe DKA. We included 103 admissions (84 patients) in our study. The majority (68.9%) had type 1 diabetes and presented with severe DKA (60.2%). In the first 24h, the median (interquartile range) intravenous fluid received was 7.0 (5.5 to 8.8) litres; 23.3% received a priming insulin bolus, 24.3% received bicarbonate and 91.3% received potassium. Hypoglycemia was relatively rare (5.8%), but hypokalemia was common (41.7%). The median time to anion gap ≤12mmol/L was 8.8 (6.0 to 12.3) h. In 27.1% of cases, intravenous insulin was stopped prior to subcutaneous insulin administration, with a median of 95 (30 to 310) min elapsing before subcutaneous insulin was given. DKA-related mortality was 2.9%. The acute management of DKA was generally aligned with clinical guidelines. Areas for improvement include preventing hypokalemia by proactively increasing potassium repletion, reducing initial insulin boluses, administering subcutaneous insulin before stopping intravenous insulin and administering sodium bicarbonate judiciously. Protocols and preprinted order sets may be helpful, especially in smaller centres.

Prevalence of Clostridium Difficile-Associated Diarrhoea in Hospitalised Patients (Results of a Russian Prospective Multicentre Study).

IntroductionThe objective of the study was to evaluate the prevalence of Clostridium difficile-associated diarrhoea (CDAD) among hospitalised patients with antibiotic-associated diarrhoea (AAD) in general and by specific types of medical care and hospital units.MethodsA prospective, cross-sectional, non-interventional, multicentre study. The main inclusion criteria were: patient age ≥ 18 years, hospital stay of at least 48 h, current antibiotic therapy or antibiotic therapy within the previous 30 days, loose stools (Bristol stool types 5–7 and stool frequency ≥ 3 within ≤ 24 consecutive hours or exceeding normal for the patient) and signed informed consent form. The stool sample was taken to the local (study site) microbiology laboratory for detection of glutamate dehydrogenase (GDH) and toxins A/B using enzyme immunoassay (EIA) stool test.ResultsFrom April 2016 to April 2017, a total of 1245 patients from 12 large hospitals were enrolled in the study. Data on 81 patients were excluded from the analysis for different reasons. Data on 1164 patients (45.2% males and 54.8% females) with a mean age of 54.9 years (range 18–95 years) were analysed. Length of hospitalisation was 2–188 days (median, 8 days). The EIA stool test showed CDAD-positive results in 21.7% (253/1164) patients. The patients were from surgery units (546/1164), internal medicine units (510/1164) and intensive care units (108/1164). The prevalence of CDAD among patients from surgery, internal medicine and intensive care units was 26.2, 17.8 and 17.6%, respectively. Oncology, gastroenterology, septic surgery, oncohaematology and general medical hospital units accounted for more than 75% of all patients included; the prevalence of CDAD by those hospital units was 11.3, 15.0, 39.2, 17.6, and 27.2%, respectively. The proportion of GDH-positive and toxin A/B-negative patients by the rapid stool test result was 16.8% (196/1164). The prevalence of CDAD varied widely between the hospitals (from 0 to 44.3%).ConclusionsThe prevalence of CDAD among hospitalised patients with AAD in this study was 21.7% (95% confidence interval: 14.8 and 28.7%). The percentage of CDAD varied widely between hospitals and by specific types of medical care and hospital units.

Falls prevention strategies for adult inpatients in a university hospital of São Paulo, Brazil: a best practice implementation project.

The main objective of this project was to reduce the incidence and harm from falls that occur among patients admitted in the acute Internal Medicine Unit and Intensive Care Unit in a public teaching hospital in São Paulo, Brazil. Falls are a challenge for health professionals and healthcare services as they may result in high-impact outcomes for patients, such as functional decline, increase in length of hospital stay, increase in the cost of healthcare services, and death. In an attempt to promote safe care the World Health Organization (WHO) launched the World Alliance for Patient Safety in 2004 that encourages the adoption of best practice to reduce adverse events in healthcare services. The project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in health practice. A baseline audit was conducted measuring eight best practice criterias, followed by the implementation of target strategies and a follow-up audit. The results of the baseline audit identified large gaps between current practice and overall compliance with best practice. The GRiP module helped identify strategies related to education programs for patients, families and nursing teams, and a falls risk assessment with an accurate tool to address the gaps in compliance. The follow-up audit cycle was satisfactory as all best practice audit criteria showed an improvement as an aggregated result. The project used the audit and feedback strategy to translate evidence into practice. Some of the measured criteria improved to moderate-high compliance with best practice. The results showed that implementation of evidence-based practice leads to an improvement in falls prevention. Future audits are required to sustain improvements.

Opinions of nurses on the ethical problems encountered while working as a team in intensive care units

BackgroundThe intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices.ObjectiveTo determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital.MethodThe descriptive research was conducted on nurses working in intensive care units (n = 96). A 56-item data collection form consisting of two parts developed by the researchers was used. Frequency (percent) and median were evaluated, and statistical calculations were used for group comparisons.ResultsOut of the 82 (85.4%) nurses who participated in the study, 65 (82.3%) were university graduates. About 52 (66.7%) of the participants were female with a mean age of 28.12 ± 5.84; 26 (31.6%) had intensive care certification, and 54 (65.1%) had ethical training. The internal intensive care unit nurses were less satisfied with their jobs, able to use tools, said that they had the right to refuse the patient compared to the surgical intensive care unit nurses. Discussion and conclusions: It is a positive situation for the participants to score low with ethical problems based on suggestion as the probability of meeting with their teammates. However, it is important that the problems that affect the motivation of the nurses are different according to the intensive care unit and the employees.

Evaluation of aspiration, nebulization and oxygenization practices of patients with a tracheostomy

Aim: The aim of the study is to determine the frequency of aspiration, nebulization and oxygenization practices and factors that affect these practices after tracheostomy operation in seven days period.Method: This cross-sectional study was carried out in internal intensive care unit in a university hospital in Turkey. The sample of the study consisted of 60 patients with tracheostomy. Data was collected by using two forms. First one was patient descriptive characteristics form and second one was patient observation form about aspiration, nebulization and oxygenization practices.Results. Mean of aspiration number was 9.9±1.3, and aspiration was carried out more frequently than oxygeniation (8.4±1.7) and nebulization (6.5±1.5) practices. Patients’ age, their habit of cigarette smoking and having chronic disease situations affect aspiration, nebulization and oxygenization practices patients with tracheostomy (p&lt;0.001).Conclusions. The frequency of aspiration, nebulization and oxygenization practices was changed according to post-operation days and affected by some of patients’ descriptive characteristics.

Weak Professional Interactions as main Cause of Medication Errors in Intensive Care Units in Iran

Background: The goal of healthcare professionals is to provide safe care, prevent injury, and promote the health of patients. Different factors and conditions, in particular, medication errors, may threaten patient safety. Objectives: This study was conducted to explore and to describe the role of interactions among healthcare professionals regarding medication errors in intensive care units. Methods: The study was conducted using a descriptive qualitative method in 2016. The participants were purposively chosen. Data were collected by semi-structured interviews and used qualitative content analysis for the analysis. The setting of the study included 16 internal, surgical, poisoning, and cardiac intensive care units of 7 educational hospitals affiliated to Isfahan University of Medical Sciences located in central Iran with a total of 190 beds. Participants included 19 members of the healthcare team (physician, nurse and clinical pharmacist) with at least 1 year of work experience in intensive care units. Results: The main category and 3 sub- categories were extracted from interviews. The 3 sub- categories were: “weak interprofessional interaction (physician and nurse)”, “weak intraprofessional interaction (among physicians)”, and “weak interaction of physician as well as nurse with the patient and family”. Conclusions: The findings suggest that medication errors may occur due to lack of interprofessional collaboration and weak communication of the healthcare team with the patient and his family. The collaboration between healthcare providers and communication with patients directly had an impact on patient outcomes. To improve the quality and safety of care delivery, healthcare center managers need to promote interprofessional collaboration, the participation of patient and family in care plan, interprofessional development, and implementation of programs to prevent as well as reduce medication errors in intensive care units.

Hand hygiene in intensive care units: a matter of time?

Healthcare-associated infections are a frequent threat to patient safety and cause significant disease burden. The most important single preventive measure is hand hygiene (HH). Barriers to adherence with HH recommendations include structural aspects, knowledge gaps, and organizational issues, especially a lack of time in daily routine. To determine the number of hand hygiene opportunities (HHOs), compliance rates, and time spent on hand hygiene in intensive care units (ICUs). We conducted an observational study in two ICUs to determine the average number of HHOs per patient. Documentation was based on the World Health Organization concept of 'five moments for hand hygiene'. HHOs were collected in 12 patient rooms for 12h each. On average, 134 (internal ICU) and 182 (surgical ICU) HHOs per patient were observed during the 12h observation period. Overall HH compliance was 42.6%. Considering additional HHOs during the night shift, we estimated 218 (internal ICU) and 271 (surgical ICU) HHOs per patient-day. The average duration of hand disinfection was 7.6s. The time spent on HH was 8.3 (internal ICU) and 11.1 (surgical ICU) min during the day shift for each patient for all healthcare workers (nurses: 6.9min in the internal ICU and 8.3min in the surgical ICU). If nurses fully complied with guidelines, 58.2 (internal ICU) and 69.8 (surgical ICU) min would be spent on HH for each patient during the day shift. Complying with guidelines is time-consuming. Sufficient time for HH should be considered in staff planning.

Knowledge attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, Uttarakhand

Background: Pharmacovigilance deals with identification, assessment and prevention and reporting of adverse drug reaction (ADR), play a pivotal role in ensuring safe use of drugs. However, in spite of having well established ADR reporting system in India and worldwide, the ADR underreporting is a big challenge till date. It is therefore very important to assess the level of awareness of Pharmacovigilance among healthcare professionals to identify the factors affecting ADRs reporting. The objective of the study was to evaluate knowledge, attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, India.Methods: It was a cross sectional observational study conducted at HIMS over a period of 1 year. Nursing professionals who work in internal medicine, Surgery, PAC and intensive care unit (ICU) were included in this study. A self-administered questionnaire comprising of 15 items related to ADRs and Pharmacovigilance programme of India (PvPI) activity was provided to them and sufficient time to fill the questionnaire was given. The completely filled questionnaire was collected and data was analyzed using SPSS ver.20.0.Results: A total of 415 participants were included in the study. The mean age of the participant was 28.52 years. The number of female was more than male participants. Majority of participant (56%) couldn’t answer the meaning of pharmacovigilance. Only 25% participants were aware about ADR reporting process to ADR monitoring centre (AMC). Although majority of the participants understand the necessity of ADR reporting and aware about AMC centre and PvPI, but most of them showed unfamiliarity about ADR reporting form and previous experience of any kind of ADR. The most common reason for not reporting the ADR was difficulty in deciding the nature of adverse effects (AE) (44%) followed by lack of time (30%). Majority of participant (67%) denied any previous pharmacovigilance training and almost all (98%) have shown their interest in PvPI training.Conclusions: Nursing professionals in our hospital may lack adequate knowledge about ADR reporting and may need more education and training on the National Pharmacovigilance System and ADR reporting process.

Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study.

The prognostic significance of serum albumin levels in patients with sepsis has previously been reported; however, these studies have not excluded the potential confounding effect of exogenous albumin administration. In this study, we investigate the predictive value of serum albumin for the prognosis of severe sepsis without the interference of exogenous albumin administration. A prospective cohort study was conducted from April to November 2014 in the internal and surgical intensive care units of a tertiary care hospital. During the study period, due to a supply shortage, patients were not treated with human albumin. Serum albumin levels were measured, and laboratory and clinical data were collected at the onset of severe sepsis. Prognostic factors were analyzed using receiver operating characteristic curve and multivariate Cox proportional hazard regression analysis. Survival was assessed by Kaplan-Meier method. One hundred sixteen patients were included in the study. The overall 28-day mortality was 26.7%. The most common infection sources were lower respiratory tract, abdomen/pelvis, and bloodstream. Compared to patients who survived, those who died had lower serum albumin levels and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Receiver operating characteristic curves demonstrate that albumin level is a strong predictor of 28-day mortality, and the optimal cutoff value maximizing sensitivity and specificity is 29.2 g/L. Through multivariate Cox regression analysis, low serum albumin levels (<29.2 g/L) and APACHE II scores are identified as independent risk factors for mortality. Patients with lower serum albumin levels more often had abdominal/pelvic sources of infection, acute kidney or liver injury, septic shock, and higher APACHE II and SOFA scores. The 28-day survival rate was lower for patients with serum albumin below 29.2 g/L than for patients with serum albumin at or above this level. Having excluded potential confounding effect of exogenous albumin administration, low serum albumin levels are associated with an increased risk of death in patients with severe sepsis.

Analysis of the third- and fourth-generation cephalosporin use for the treatment of infections caused by Gram-negative bacteria in hospital settings.

The aims of our study were to assess the prevalence and distribution of Gram-negative (G-) bacteria in hospital isolates, their sensitivity to the third- and fourth-generation cephalosporins (c3 and c4), therapeutic use of c3 and c4 in the treatment of G- infections and drug utilisation data. This cross-sectional study collected medical records data from the General Hospital "Gornji Milanovac" (GM) and the University Medical Center "Bezanijska kosa" (BK). The time frame of the study was 12months. Microbiological and clinical parameters, and c3/c4 drug utilisation were analysed. Escherichia coli were the most predominant pathogen in GM and BK, accounting for 43% and 28% of all G- isolates, respectively (GM), 884G- isolates obtained from 606 patients; BK, 1766 isolates obtained from 1045 patients). Nearly half of the isolates (55% and 43%) were obtained from urine samples collected from the surgical ward (GM), and the internal medicine wards and intensive care unit (BK). On average, the resistance rate of G- strains against c3 and c4 reached 40% and 70%, respectively (lowest in E.coli, 8%-25%; highest in Acinetobacer baumannii, 67%-100%). Resistance rate of Pseudomonas spp. to cefepime and ceftazidime was low/moderate (0%-30% and 19%-47%). In BK, the adult patients were older than in GM (75 vs 66years), with longer hospital stay (19 vs 10days) and bacteria were isolated later during hospitalisation (10 vs 2days). C3 and c4 were more often used in empirical therapy (83% vs 64%) in BK. Ceftazidime and cefepime were used more often in BK than in GM (2.036 vs 69 DDD/y and 586 vs. 126 DDD/y, respectively). The use of c3 and c4 in the treatment of G- infections in both hospitals should be re-evaluated in accordance with current guidelines and local resistance.

The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

Background: Investigating the conditions and the appropriateness of admission of patients in hospitals is an important issue which can improve the efficiency of health care delivery. Intensive care unit (ICU) is important due to applying expensive financial sources; therefore, its efficient application is of great priority. In this regard, the current study aimed to determine the financial burden of inappropriate admissions in internal intensive care units (IICUs). Methods: It was a cross-sectional study conducted in 2014. A total of 294 patients admitted to IICUs of Shahid Faghihi and Nemazee hospitals of Shiraz, Iran, in 2012 were enrolled into this retrospective study. The study was conducted in two phases, using the guidelines of American critical care association (ACCA) and experts’ opinion to investigate the financial burden of inappropriate admissions in IICUs of the above-mentioned hospitals. Results: The results showed no statistically significant relationships among insurance status, insurance type, age, gender and inappropriate admission by applying Chi-square. Among 294 admitted patients under the study, the inappropriate admissions were 11.2% based on the guidelines and 13.6% based on the experts’ opinion. The level of agreement of the guidelines and experts’ opinion for the inappropriate admissions was 0.076 based on Kappa coefficient. The total financial burden imposed on the insurance agencies and the patients by inappropriate admissions was US$ 47867.78 based on the guidelines and US$ 83241.68 based on the experts’ opinion. Conclusions: Inappropriate admissions to ICUs may impose additional costs to the health system and the patients on one hand, and deprives other patients from receiving health services. Therefore, it is crucial to effectively plan for the application of ICU beds.

Antifungal susceptibilities of Candida species isolated from urine culture.

Candida spp. are the most common opportunistic mycosis worldwide. Although Candida albicans is the most common cause of urinary tract infections, the frequency of non-albicans Candida species is increasing with common use of antifungal in the prophylaxis and treatment. This may lead to difficulties in treatment. Antifungal tests should be applied with identification of species for effective treatment. In this study, identification of Candida species isolated from urine culture and investigation of susceptibility of these strains to amphotericin B, flucytosine, fluconazole, voriconazole was aimed. In this study, 58 Candida strains isolated from urine cultures at Osmaniye State Hospital between January 2012 and April 2013 were included. Urine culture and antifungal susceptibility tests were applied. Incidence rate of Candida spp. was determined as C. albicans (56.9%), Candida glabrata (20.6%), Candida tropicalis (10.3%), Candida parapsilosis (7%), Candida krusei (3.4%), Candida kefyr (1.8%). Most of the isolates were susceptible to amphotericin B, flucytosine, fluconazole, voriconazole. Twenty three (39.7%) Candida strains were isolated from internal medical branches and Intensive Care Unit and 12 (20.6%) from the Surgical Medical Branches. C.albicans and C.glabrata species were isolated most frequently as a candiduria factor in this hospital between January 2012 and April 2013. The analysis of antifungal susceptibility profile shows no significant resistance to antifungals.

Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit.

The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. In this observational prospective study, 60adult immunocompetent patients who stayed at least 7days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued. The mean age of patients was 63.3years (±23.4years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p= 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p= 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p= 0.035). There is aneed for extended studies with alarger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.

Tracheostomy in Patients Who Need Mechanical Ventilation: Early or Late? Surgical or Percutaneous? A Prospective Study in Iran

Tracheostomy can be performed surgically or by percutaneous (percutaneous dilatory tracheostomy, PDT) methods, and it may be used early or late. In a 3-month follow-up, all patients who underwent tracheostomy in Semnan in 2013 were evaluated for complications of tracheostomy considering the method used and the timing of operation. A total of 55 patients underwent tracheostomy (26 cases surgery, 29 cases PDT, 30 cases early, and 25 cases late based on 14days reference). The mean durations of operation were 19.19 ± 5.78min in the surgery method and 4.7 ± 2.42min in the PDT method (P < 0.001). The mean durations of the need for ventilator after the tracheostomy were 10.7 ± 9.25 and 18.6 ± 14.39days in early and late tracheostomy, respectively (P = 0.024). The mean intensive care unit (ICU) stay were 12.70 ± 10.24 and 23.44 ± 18.49days (P = 0.014) and the mean hospital stay were 16.04 ± 10.88 and 23.48 ± 18.47days, respectively (P = 0.100). Short-term complications were observed in six cases (10.09%) in the surgery group, including emphysema (two), bleeding (two), wound infection (one), and clot formation inside the tube (one). Only one complication (bleeding) occurred in one case in the PDT group. After 3months, 21 patients survived. Compared with surgery, the most important advantage of the PDT method was its shorter duration of surgery. Nearly half of the patients underwent tracheostomy late, while the majority of the patients in the late group were referred from internal ICU. No major and minor complications were noted during the procedure, as well as no tracheostomy-related deaths were observed. Early tracheostomy was shown to be superior to late, reducing the time of mechanical ventilation and ICU or hospital stay.

A Survey of the quantity and type of biological aerosols in selected wards of a teaching hospital in Ghazvin.

IntroductionBioaerosols are agents that can cause infection, allergy or induce other toxic effects in the human body. If the person exposed to such particles is not capable of their destruction or elimination from the body, the established chemical and physiological disorders can result in disease or death. The aim of this study was to assess the concentrations of bioaerosols in several wards of a teaching hospital.MethodsGiven that gas air-conditioners (split and window types) were used for ventilation in the eye operating room, internal intensive care unit, and the respiratory isolation room, these wards were selected for passive sampling. Sterile plates containing culture medium were exposed for two hours to the wards’ indoor ambient air. After this time, they were transferred to a lab to undergo incubation, colony count, and identification of the microorganisms. The data were analyzed using SPSS software, version 18, and the significance level of less than 0.05 was used.ResultsBased on our findings, the highest colony-forming bacterial unit was observed 22 cfu/plate/h in the eye operating room and, the highest colony-forming fungal unit was observed 4 cfu/plate/h in the internal intensive care unit. Based on the results of the differential tests, the most prevalent bacteria identified were Staphylococcus epidermidis (75%) in the air of eye operating room and Staphylococcus saprophyticus (52%) in the internal intensive care unit and isolation room. The most prevalent identified fungi in the air of selected wards were related to Alternaria alternata (43%), Aspergillus flavus (24%), Penicillium (36%) and Curvularia (21%) types. Based on Spearman’s correlation test, no significant relationship was observed between the factor of temperature and the number of fungal and bacterial colonies (r = 0.201, p = 0.42; r = −0.197, p = 0.41). Moreover, a meaningful relationship was observed only between the number of individuals and the bacterial colonies present in the air (r = 0.749, p = 0.0001).ConclusionComparing the number of diagnosed colonies by 25 cfu/plate/h value showed that the numbers of colonies in all samples were lower than the mentioned values. So, the air-conditioning systems’ performance in reducing the number of bioaerosols in the studied wards was satisfactory. However, since the remaining bacterial and fungal contamination can cause serious infections in patients, it is highly necessary that the cleaning intervals and replacement time points of such filters be programmed based on the number of individuals present in the wards and their active surgical hours.

Hospital-Acquired Infections in Internal-Surgical Intensive Care Unit Patients: A Retrospective Study

Introduction: Hospital-acquired infections cause the length of stay in hospital, morbidity, mortality, and increase the cost of treatment. The aim of this study was to determine the incidence of hospital-acquired infections in adult internal-surgical intensive care unit patients, distribution of infections according to the intensive care units, the types, diagnosis and causative microorganisms of infections. Method: In this retrospective study, the archive documents of the patients diagnosed with a hospital-acquired infection and staying in the internal-surgical intensive care units of a university hospital in Turkey between 2013 and 2014 were evalauted. From 9547 patient’s documents that stayed in the adult and pediatrics intensive care units, 448 of them were diagnosed with hospital-acquired infections. From 448 patient’s documents 102 pediatrics intensive care units documents were excluded. In total, 346 adult internal-surgical intensive care unit patients' files were evaluated. Results: The mean age of the patients was 67,91±14,76, 58.9% of them were male, the mean length of stay in intensive care unit was 27,02±25,68 days, 60.7% of the patients stayed in internal intensive care units, and 39.3% of the patients stayed in the surgical intensive care units. The incidence of the hospital-acquired infection in the internal-surgical intensive care units was 4.16%. It was determined that 46% of the patients had a bacteremia infection, 31.8% VIP, 5.8% fungemia, and 4.9% organ-space surgical site infection. 16.8% of the causative microorganisms of the hospital-acquired infections were Acinetobacter SPP, 11.3% had no causative microorganism, 7.2% were E-Coli, 5.8% Acinnobacter Baumanii, 5,5% Stenotrophomanas Maltophilia, 5,2% Psedomanas Spp.IBL+, 4,3% Candida Albicans, 3,8% Klebsialla Pneumoniae, 3,5% Psedomanas Aeriginosa. Conclusion: The incidence of the hospital-acquired infections was low, and most of the infections were associated with blood and respiration. As the rate of the hospital-acquired infections is the most important indicator in the quality of patient care, it becomes important for the intensive care nurses to use their roles as a caregiver and as an educator in the prevention of the hospital-acquired infections. Also, the determination of the agents of the hospital-acquired infections in intensive care units becomes important in the determination of the treatment process.

Physical assessment techniques performed by Italian registered nurses: a quantitative survey.

The aims of the study were to describe which of the core techniques of the physical assessment are regularly performed by a sample of Italian nurses, and to investigate the potential predictors of a more complete examination. Physical examination is among the essential tasks of nursing professionals, who are requested to perform a correct and complete physical assessment. Cross-sectional survey. The study was performed between August 2013 and January 2014 in 17 Italian regions. A total of 1182 questionnaires were collected. Most participants were females (age range 41-50 years), and worked in Internal Medicine, Intensive Care and Surgical hospital units. Of the 30 core techniques that are currently taught and performed according to the Italian Baccalaureate degree requirements, 20 were routinely performed, 6 were seldom used and 4 were learnt but almost never performed (auscultation of lung, heart and bowel sounds and spine inspection). Graduate and postgraduate nurses, working in Intensive Care Units and Nursing Homes, were more prone than the others to carry out a more complete physical assessment. The skills to perform a physical assessment are suboptimal among this sample of Italian nurses. Health and educational providers should pose more attention and efforts to provide nurses with an acceptable training in physical examination practice. This study describes the specific physical techniques performed by nurses in real practice and provides information on which skills require more attention in nursing educational programmes.