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Raurell-Torredà M, Arrogante O, Aliberch-Raurell AM, Sánchez-Chillón FJ, Torralba-Melero M, Rojo-Rojo A, Gomez-Ibañez R, Lamoglia-Puig M, Farrés-Tarafa M, Zaragoza-García I. Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios. J Clin Nurs 2024; 33:3188-3198. [PMID: 38348543 DOI: 10.1111/jocn.17010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 07/09/2024]
Abstract
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.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Clinical Care, Universitat de Barcelona, Barcelona, Spain
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
| | - Oscar Arrogante
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | - Anna María Aliberch-Raurell
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francisco Javier Sánchez-Chillón
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Simulation Centre, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Martín Torralba-Melero
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Hospital General Universitario de Albacete, Albacete, Spain
| | - Andrés Rojo-Rojo
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Universidad Católica de Murcia, Campus de los Jerónimos, Murcia, Spain
| | - Rebeca Gomez-Ibañez
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Department of Nursing, Universitat Autónoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Montserrat Lamoglia-Puig
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Sant Joan de Déu Teaching Campus, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Farrés-Tarafa
- Member of the GRISimula Research Group (2017 SGR 531), Barcelona, Spain
- Sant Joan de Déu Teaching Campus, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Zaragoza-García
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
- InveCuid Group, Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
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Chen Y, Cao X, Liu C, Sheng W, Wang J, Zhao L. Examining the knowledge level of nurses regarding aseptic non touch technique in nurses: a cross-sectional study. BMC Nurs 2024; 23:525. [PMID: 39085915 DOI: 10.1186/s12912-024-02154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice. METHODS The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses. RESULTS A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master's degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest. CONCLUSIONS ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use.
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Affiliation(s)
- Yilin Chen
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiuzhu Cao
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Chang Liu
- Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wanting Sheng
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jie Wang
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Linfang Zhao
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Dobrescu A, Constantin AM, Pinte L, Chapman A, Ratajczak P, Klerings I, Emprechtinger R, Allegranzi B, Zingg W, Grayson ML, Toledo J, Gartlehner G, Nussbaumer-Streit B. Effectiveness and Safety of Measures to Prevent Infections and Other Complications Associated With Peripheral Intravenous Catheters: A Systematic Review and Meta-analysis. Clin Infect Dis 2024; 78:1640-1655. [PMID: 38593192 DOI: 10.1093/cid/ciae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. METHODS We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980-16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. RESULTS 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33-.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49-1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non-chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. CONCLUSIONS Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. CLINICAL TRIALS REGISTRATION The protocol was registered in the Open Science Framework (https://osf.io/exdb4).
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Affiliation(s)
- Andreea Dobrescu
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Alexandru Marian Constantin
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Larisa Pinte
- Department of Internal Medicine Clinical Hospital Colentina, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Andrea Chapman
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
| | - Robert Emprechtinger
- Berlin Institute of Health at Charité (BIH), BIH QUEST Center for Responsible Research, Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - M Lindsay Grayson
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Infectious Diseases Department, Austin Health, Melbourne, Australia
| | - Joao Toledo
- Infection Prevention and Control Unit, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- High Impact Epidemics, WHO Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
- Center for Public Health Methods, RTI International, Research Triangle Park, North Carolina, USA
| | - Barbara Nussbaumer-Streit
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, University for Continuing Education Krems, Krems, Austria
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Buchanan C, Burt A, Moureau N, Murray D, Nizum N. Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2023:11297298231169468. [PMID: 37125815 DOI: 10.1177/11297298231169468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.
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Affiliation(s)
| | - Amy Burt
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Nancy Moureau
- PICC Excellence, Hartwell, GA, USA; Griffith University, Brisbane, QLD
| | | | - Nafsin Nizum
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
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Ackerman R, Riley M, Anwar MAF, Mitchell D, Vorenkamp K, Udani A, Yi P. Multidisciplinary simulation of local anaesthetic systemic toxicity improves diagnostic and treatment skills and self-confidence for pain clinic procedural staff. BMJ Open Qual 2023; 12:bmjoq-2022-002213. [PMID: 37041019 PMCID: PMC10106041 DOI: 10.1136/bmjoq-2022-002213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 04/13/2023] Open
Abstract
Local anaesthetic systemic toxicity (LAST) is a rare complication after outpatient interventional pain procedures, which can present as an emergent and life-threatening condition. Proficiency and confidence in managing this rare situation necessitates strategies to ensure team members can perform necessary tasks. The primary objective was to familiarse the pain clinic procedural staff-physicians, nurses, medical assistants, and radiation technologists-with concise and current instruction and an opportunity to practice in a controlled environment. A two-part series was designed and led by the pain physicians, with the assistance of the simulation centre and clinic staff. A 20 min didactic session was held to familiarise the providers with relevant details and information regarding LAST. Then, 2 weeks later, all team members participated in a simulation exercise intended to portray a LAST encounter, tasking participants to recognise and manage the condition in a team-based model. Before and after the didactic and simulation sessions, the staff was administered a questionnaire to assess knowledge of LAST signs, symptoms, management strategies, and priorities. Respondents were better able to identify signs and symptoms of toxicity and prioritise management steps, and felt more confident in recognising symptoms, starting treatment and coordinating care. Furthermore, participants emphasised the positive of debriefing, practicing a rare situation and learning strategies for effective communication, team dynamics and role clarity. FORMAT Small group didactic session, simulation exercise in a clinical simulation lab. TARGET AUDIENCE Attending, fellow, and resident physicians, medical students, registered nurses, certified medical assistants, and radiation technologists working in a pain clinic procedure suite. OBJECTIVES To acquaint the pain clinic procedural staff with current training related to LAST and an opportunity to practice in a controlled environment.
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Affiliation(s)
| | | | | | | | | | | | - Peter Yi
- Duke University, Durham, North Carolina, USA
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6
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Peters N, Thomas J, Woods C, Rickard C, Marsh N. Remotely supervised ultrasound-guided peripheral intravenous cannulation training: A prospective cohort study examining success rates and patient experience. Australas J Ultrasound Med 2022; 25:176-185. [PMID: 36405792 PMCID: PMC9644440 DOI: 10.1002/ajum.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Ultrasound-guided peripheral intravenous cannulation (USGPIVC) benefits patients with difficult intravenous access (DIVA) through visualising otherwise non-visible and non-palpable veins. Supervised live-case training is an important component of learning this skill, but supervisor availability can present a barrier limiting or delaying staff completing their training. Aims The aim of this study was to determine the first-attempt success rate of newly trained USGPIVC inserters using remote supervision and timely written feedback based on app-based screen recordings taken during insertion. Secondary aims were overall procedural success, and inserter and patient experiences. Methods This study is an observational cohort study carried out between October and December 2021. Fourteen newly trained junior medical officers (JMOs) were eligible to utilise USGPIVC on a minimum of five consenting patients while simultaneously recording the ultrasound screen during insertion to capture their technique. Feedback was generated following expert review of these recordings against a standardised feedback tool. Results Average first-attempt success was 71% (n = 72) in the 102 patients recruited. The average time for JMOs to receive feedback was 30 h, and 13 JMOs (93%) felt well supported and completed the remote training pathway. The majority of patients were female (n = 59; 58%), were aged 41-80 years (n = 75; 74%) and had ≥2 risk factors for DIVA (n = 57; 56%). Conclusions First-attempt success rates were similar when comparing remote supervision used in this study to direct supervision used by other studies.This finding supports incorporating remote supervision into training guidelines for USGPIVC as an alternative method of supervision, particularly when supervisor availability is limited.
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Affiliation(s)
- Nathan Peters
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Joel Thomas
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Christine Woods
- Department of Anaesthesia and Perioperative MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- University of QueenslandBrisbaneQueenslandAustralia
| | - Claire Rickard
- University of QueenslandBrisbaneQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
| | - Nicole Marsh
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Alliance for Vascular Access Teaching and Research GroupGriffith UniversityBrisbaneQueenslandAustralia
- Metro North Hospitals and Health ServiceBrisbaneQueenslandAustralia
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The Influence of Nursing Simulation on Patient Outcomes and Patient Safety: A Scoping Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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