Author Archives: Amy

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Clinical Informationist at EUH Branch Library

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

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The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

  • Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults.  Clin Infect Dis 2005 Mar 1;40(5):643.
    • Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter.  Also recommends screening pregnant women.
    • IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
    • IDSA does not make any recommendation about screening renal or other solid organ transplant recipients
  • United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults.  National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
    • Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations:  chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients.  Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

What is the efficacy of sheepskin and phenytoin for treating or preventing pressure ulcers in acute care patients?

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Joanna Briggs Institute EBP Database includes many systematic reviews and evidence summaries on interventions to prevent or treat pressure ulcers.

Sheepskin

Pressure ulcers a prevention of pressure related tissue damage.   2011.  [Technical Reports – Joanna Briggs]]
Reviews studies on use of sheepskin

McInnes E, et al.  Support surfaces for pressure ulcer prevention.  Cochrane Database Syst Rev. 2011 Apr 13;(4):CD001735. doi: 10.1002/14651858.CD001735.pub4.

Studies in PubMed published since these systematic reviews

Phenytoin

A search of PubMed retrieved some systematic reviews and original studies evaluating use of phenytoin in pressure ulcer management.

pressure ulcers AND phenytoin

Systematic reviews in the search results include:

Reddy M. Pressure ulcers. Clin Evid (Online). 2011 Apr 28;2011. doi:pii: 1901.
Review. PubMed PMID: 21524319; PubMed Central PMCID: PMC3217823.

Mao CL, Rivet AJ, Sidora T, Pasko MT. Update on pressure ulcer management and
deep tissue injury. Ann Pharmacother. 2010 Feb;44(2):325-32. doi:
10.1345/aph.1M315. Epub 2010 Jan 5. Review. PubMed PMID: 20118142.

Cullum N, Petherick E. Pressure ulcers. Clin Evid (Online). 2008 Mar 19;2008.
doi:pii: 1901. PubMed PMID: 19450317; PubMed Central PMCID: PMC2907959.

Reviewed 4/20/14 AA

Do interventions to orient new nurses to a unit/hospital affect staff retention?

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The results below include several case studies and evaluations of programs to orient/train/acclimate new hospital nursing staff, including effects on turnover/retention, including:

  • NURSING U: a new concept for nursing orientation.Detail Only Available Cullevy, Thomas; Babbie, Andrea; Clancey, Jeanne; Clouse, Kathy; Hines, Rosemerry; Kraynek, Monica; Tutro, Josephine; Wittman, Susanne; Nursing, 2011 Nov; 41 (11): 59-61
  • Structured orientation for new graduates: a retention strategy.  Marcum EH; West RD; Journal for Nurses in Staff Development, 2004 May-Jun; 20 (3): 118-26.
  • Designing an outcome-focused model for orienting new graduate nurses.Detail Only Available Journal for Nurses in Staff Development, 2011 Nov-Dec; 27 (6): E6-7.
  • Strategies for easing the role transformation of graduate nurses.Detail Only Available (includes abstract) Young ME; Stuenkel DL; Bawel-Brinkley K; Journal for Nurses in Staff Development, 2008 May-Jun; 24 (3): 105-12.
  • Tool kit for the staff mentor: strategies for improving retention. Butler MR; Felts J; Journal of Continuing Education in Nursing, 2006 Sep-Oct; 37 (5): 210-3.

Results of the CINAHL search
((MH “Personnel Turnover”) OR (MH “Personnel Turnover”)) AND ( (orientation OR mentorship OR (MH “Work Environment” AND attitude*) OR MH “Support, Psychosocial”) AND nurses AND (new N3 (hire* OR employee* OR staff OR graduate*)) AND hospital* )

A search of CINAHL using these concepts:
Personnel turnover, personnel retention
Orientation, mentorship, (subject heading for work environment combined with the term attitude), subject heading for psychosocial support
Nurses
New staff, new employees, new hires, new graduates
Hospitals

Are there guidelines for use of high frequency oscillatory ventilation in patients with acute lung injury?

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DynaMed, a good source for locating the most current guidelines.

Mechanical ventilation: The guidelines seem to be about when to wean, or how to prevent ventilator-associated pneumonia
ARDS:  the only one I saw specifically addressing oxygen therapy was from American Association of Respiratory Care (2001).

Professional organization websites:

Society for Critical Care Medicine
http://www.learnicu.org/pages/guidelines.aspx
Did not locate any guidelines on respiratory failure that mention HFOV

American Association for Respiratory Care
A paper (2007) on the site – http://www.rcjournal.com/contents/09.07/09.07.1224.pdf – indicates that at that time the technique was not included in any AARC guidelines.
Did not locate any other guidelines on the site that address use of HFOV.

AACN Procedure Manual for Critical Care (in EUH Branch Library), 2011.  Indicates that there has not been enough evidence to show superiority of HFOV over conventional modes of ventilation in patients with ARDS (p. 278).

Also see:  What is the latest evidence and nursing implications on the use of high frequency ocsillatory ventilation?

What is the risk for transmitting infection by healthcare providers using a stethoscope as he or she moves from patient to patient?

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Bottom line:  Stethoscopes, mostly the earpieces, are a reservoir for bacteria, but there is no evidence directly addressing any association between use of stethoscopes on multiple patients and transmission of the bacteria found on the stethoscope

Halcomb E, et al. Role of MRSA reservoirs in the acute care setting. JBI Library of Systematic Reviews. 2008; 6(16): 633-685.
Identified one observational study of the eartips of stethoscopes dedicated to patients on contact precaution for MRSA.  13 of 78 (17%) eartips examined had potentially pathogenic bacteria on them, but none of the bacteria were the same as the infectious agents in the patients.

Other similar studies were identifed in a PubMed search.   Only the Brook (1997) paper below describes an actual infection (in a nurse) traced to an earpiece of a stethoscope.  The other studies show that most common organisms identified on stethoscopes (mostly earpieces) is S. aureas.

Gopinath KG, et al. Pagers and stethoscopes as vehicles of potential nosocomial pathogens in a tertiary care hospital in a developing country.  Trop Doct. 2011 Jan;41(1):43-5.  PMID: 21109607

Youngster I, et al. The stethoscope as a vector of infectious diseases in the paediatric division.  Acta Paediatr. 2008 Sep;97(9):1253-5.   PMID:18554272

Bernard L, et al.  Bacterial contamination of hospital physicians’ stethoscopes.  Infect Control Hosp Epidemiol. 1999 Sep;20(9):626-8.  PMID:10501265

Brook I.  Bacterial flora of stethoscopes’ earpieces and otitis externa.  Ann Otol Rhinol Laryngol. 1997 Sep;106(9):751-2.  PMID:9302906

Smith MA, et al.  Contaminated stethoscopes revisited.  Arch Intern Med. 1996 Jan 8;156(1):82-4.  PMID:8526701

Wright IM, et al.  Stethoscope contamination in the neonatal intensive care unit.  J Hosp Infect. 1995 Jan;29(1):65-8.  PMID:7738341

Search strategy:
Consulted and evidence summary source:  Searched Joanna Briggs Institute for “stethoscope and infection” – Identified a systematic review, which cited a paper on stethoscopes dedicated to MRSA-infected patients as as reservoirs.
Looked up that reference in PubMed and identified terms for a focused PubMed search:
(“Stethoscopes/microbiology”[MAJR] OR “Equipment contamination”[MAJR]) AND (nosocomial OR “hospital-acquired infection”)

Used QUOSA to identify articles from this set that discuss stethoscopes.

What is the evidence on the effect of nurses’ sleep habits on patient safety?

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A search of Joanna Briggs, PubMed, and CINAHL identified the following relevant references.

Joanna Briggs Institute
No documents focusing on sleep and patient safety

CINAHL
The search (MH “Nursing Staff, Hospital” OR MH “Nurses+”) AND (safety OR error*) AND sleep LIMITERS: Research articles identified observational studies on effects of sleep on safety, including Johsnon 2014, Lockley 2007, Admi 2008, Biddle 2011, and Muecke 2005.  There was at least one study evaluating an intervention (Scott 2010). No articles by Geiger-Brown, who has written on nurses and sleep, appeared in search results above or in this search: sleep AND safety AND geiger-brown.

A search of Geiger Brown and sleep in CINAHL identified these papers.

PubMed

A search for articles by Geiger-Brown and sleep in PubMed identified an additional article that specifically mentions safety:
Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiol Int. 2012 Mar;29(2):211-219.

An additional search in PubMed for “Nurses”[Mesh] AND “Sleep”[Mesh] AND (“Safety”[Mesh] OR “Medical Errors”[Mesh]) found the following two articles.

Dorrian, Jillian, et al. “Sleep and errors in a group of Australian hospital nurses at work and during the commute.” Applied Ergonomics 39.5 (2008):605-613.

Dorrian, Jillian, et al. “A pilot study of the safety implications of Australian nurses’ sleep and work hours.” Chronobiology international 23.6 (2006):1149-1163.

Reviewed and updated 4/8/2014 ldt