Potential pitfalls in adherence to hand washing in the community

Infection control is vitally important in community settings. Community nurses care for people with complex care needs who are extremely vulnerable to infection. The most important thing a nurse can do to prevent the spread of infection is to maintain good hand hygiene. Nurses can face barriers in their efforts to practice good hand hygiene, including lack of education, lack of time, poor facilities and inappropriate clothing and hand adornments. This article outlines evidence-based practice on how to overcome barriers to good hand hygiene and stresses the important role of the community nurse in working with her team to ensure best practice, cut infection rates and save lives.

Rationalise prescribing and use simple remedies

Prescribing for older adults requires greater skill levels and caution than prescribing for younger people. The prescriber must take into account age- related changes, possible concordance problems, greater risk of side effects and the effects of polypharmacy.

Falls prevention in primary care

Each year 1.57 million older people fall more than three times and 70 000 fracture their hips. Falls can lead to disability and even death. The NSF for Older People identified falls prevention as a major health priority. This paper explains how primary care practitioners can contribute to falls prevention, reduce falls risk and improve quality of life for the older person.

Providing outpatient antibiotic therapy for cellulitis in primary care

Outpatient parenteral antimicrobial therapy (OPAT) is becoming more widespread. OPAT therapy can be used to treat certain patients who have cellulitis. The decision as to which patients to treat at home must be based on local PCT guidelines--not all patients are suitable for OPAT. OPAT improves patient quality of life by delivering care in the patient's home. This is highly skilled work and the community nurse must have appropriate training and support in order to gain the skills required.

Reducing the risk of catheter-related urinary tract infection

Primum non nocere (first do no harm) is the ancient Latin phrase that reminds nurses that first principle of healthcare is not to harm those entrusted to our care. Yet, common healthcare interventions, such as urinary catheterization, have the potential to do patients great harm. The patient may even pay with his or her life if a urinary catheter is inserted without clinical indications or if the nurse fails to do his or her utmost to protect the patient from infection. Urinary tract infection (UTI) is the most common of healthcare-related infection. UTI in hospital inpatients normally occurs in people who have a urinary catheter inserted. Urinary catheterization is common and although the risks of catheter-associated UTI are small, the consequences or catheter-associated UTI can be life threatening. Urinary catheterization increases morbidity by a factor of three. Restricting catheterization to those who clinically require this invasive procedure can reduce the number of people who developed infection and life threatening bacteraemia. The use of silver-coated catheters can reduce the risks of infection. Evidence based practice can further reduce risks of catheterization. It is important that informed consent is obtained prior to catheterization. If a person lacks capacity the clinician must act in the person's best interests.

The clinical management of dysphagia in primary care

Dysphagia: difficulty eating because of swallowing problems is a symptom that affects 15% of hospital inpatients, older people, people with neurological disease, cancers of the head and neck and people with severe reflux. This symptom affects a person's ability to remain well nourished and hydrated and increases the risks of ill health. Effective dysphagia management requires an interdisciplinary approach and can make a huge difference to the quality of life experienced by the person with dysphagia.

Caring for a patient with a urostomy in a community setting

Around 7500 people in the UK have a urostomy. A urostomy is normally performed if a person has bladder cancer, congenital bladder abnormalities. Many people who have a urostomy have long term conditions and may require the help and support of community nurses. This article examines common complications of urostomy including stomal complications, urinary tract infections and dermal complications. Although stoma complications are common and can affect quality of life, many people with a stoma tend not to seek help. Community nurses can provide care and support to optimize stoma management and enable the person with a urostomy to enjoy the best possible quality of life.

Effective evidence based catheter management

People who have long-term urinary catheters commonly experience problems with bypassing and leakage. Changing the catheter is not necessarily the most appropriate solution. Catheter related problems provide nurses with the opportunity to evaluate the clinical indications for continued catheterization and to remove catheters that are not clinically indicated. When catheters are clinically indicated nurses who use an evidence based approach to diagnose and treat problems provide effective care and reduce the risk of patient discomfort and recurrent problems.

Understanding and treating a common dermal problem: pruritus

Although dermatological problems are common in older people, health professionals do not always have the skills and knowledge to identify and treat such problems. Pruritus is the most common skin condition older people experience. It is often linked to systemic disease. This article explains how to identify and treat the causes of pruritus and improve quality of life for the older person.

A guide to continence assessment for community nurses

Problems with continence are common in older people, therefore quality continence assessment advice and follow up are essential in providing a high standard of care. Many older people can be helped to regain some measure of control over their continence. Continence assessment can often focus on containment rather than cure. This is a sad state of affairs which adversely affects patients' well being. This article explains how continence assessment enables the nurse to assess and treat continence issues and improve quality of life.