What is the evidence linking disposable ECG cables and lead wire systems to decreased hospital acquired infections (HAIs)? What would the cost savings be?

Posted on September 15, 2014 by Amy

Studies focus on identifying presence of bacteria on devices, as opposed to devices being associated as the cause of HAI cases. Likewise, no published literature was identified that specifically demonstrated that use of disposable leads reduces the rate of HAIs.

Evidence Summary sources:

Joanna Briggs
Xue, Yifan. Noninvasive Portable Clinical Items: Healthcare Associated Infections. [Evidence Summaries]. JBI11266, 2014.
Cites studies demonstrating the prevalence of low-risk, potentially pathogenic, and multidrug resistant bacteria on non-invasive devices, including ECG lead wires.

Literature databases:

PubMed: cross infection AND (electrocardiography OR noninvasive devices) AND (disposable OR reusable OR reuse OR “single use”)

Microbial colonization of electrocardiographic telemetry systems before and after cleaning.
Reshamwala A, McBroom K, Choi YI, LaTour L, Ramos-Embler A, Steele R, Lomugdang V, Newman M, Reid C, Zhao Y, Granger BB.
Am J Crit Care. 2013 Sep;22(5):382-9. doi: 10.4037/ajcc2013365.
PMID: 23996417
contamination after cleaning reusable leads

Disposable vs reusable electrocardiography leads in development of and cross-contamination by resistant bacteria.
Brown DQ.
Crit Care Nurse. 2011 Jun;31(3):62-8. doi: 10.4037/ccn2011874.
PMID: 21632593
Review article

Cleaned, ready-to-use, reusable electrocardiographic lead wires as a source of pathogenic microorganisms.
Albert NM, Hancock K, Murray T, Karafa M, Runner JC, Fowler SB, Nadeau CA, Rice KL, Krajewski S.
Am J Crit Care. 2010 Nov;19(6):e73-80. doi: 10.4037/ajcc2010304.
PMID: 21041188
presence of pathogens on reusable leads

Potential micro-organism transmission from the re-use of 3M Red Dot adhesive electrocardiograph electrodes.
Daley AJ, Hennessy D, Cullinan J, Thorpe S, Alexander R.
J Hosp Infect. 2005 Nov;61(3):264-5. Epub 2005 Jul 5. No abstract available.
PMID: 16002182

CINAHL

A similar search of CINAHL did not identify any unique, relevant articles.

Cost savings

The cost savings of decreasing HAIs can be calculated by multiplying the estimated cost of an HAI by the number of HAIs in a given period of time. Then, subtract the cost of disposable equipment for all procedures occurring during that time period (i.e., the number of disposable cables that would be used with patients).

The CDC provides data on estimated cost of HAIs. Start at http://www.cdc.gov/hai/surveillance/. The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009, includes estimates for specific types of infections beginning on p. 5.

Learning style and nursing preceptorship

Posted on September 3, 2014 by John

Do different pairings of teaching styles and learning styles make a difference? Preceptor and resident perceptions.
Teaching and learning in medicine [1040-1334] yr:2008 vol:20 iss:3 pg:239

“Impact of preceptor and orientee learning styles on satisfaction: a pilot study.” Journal for nurses in staff development 23.1 (2007):36.

Preceptorship planning is essential to perioperative nursing retention: matching teaching and learning styles.
Canadian Operating Room Nursing Journal [0712-6778] yr:2010 vol:28 iss:1 pg:8

Learning style theories: matching preceptors, learners, and teaching strategies in the perioperative setting.
Seminars in perioperative nursing [1056-8670] yr:2001 vol:10 iss:4 pg:184

“Orientation with style: matching teaching/learning style.” Journal for nurses in staff development 14.4 (1998):192.

Jasmine, Lee Xin Yu. Registered nurses’ perception of their preceptor role towards pre-registration nursing students during clinical placement: A systematic review.. [Systematic Review Protocols] AN: JBI4677

Joyce . Faculty strategies that influence the student transition from registered nurse to nurse practitioner: a systematic review protocol 2014 vol:12 iss:5 pg:34 -41

Searched CINAHL and Joanna Briggs using keywords: preceptorship, learning style.

What evidence dated within the last ten years is there on use of sweet oral substances to alleviate discomfort in infants?

Posted on September 2, 2014 by Lisa

Twelve systematic reviews and meta-analyses dated within the last 10 years are found with a search in PubMed. Here’s how to conduct this search.

You may start with the Woodruff Health Sciences Center Library homepage at http://health.library.emory.edu/ and then click “PubMed” or you may use this direct link to Emory’s instance of PubMed at http://www.ncbi.nlm.nih.gov/sites/entrez?otool=emorylib
Copy and paste this search into the search box and click “Search.”infant AND (oral administration OR chewing gum) AND (pain management OR (pain AND (male circumcision OR intravenous injection OR blood specimen collections OR punctures))) AND (sucrose OR sweetening agents)
To impose the filter/limit of 10 years, click “10 years” to the left of the search results page (listing of articles found with the search).
To impose the filter/limit of meta-analysis or systematic review, click “More” under the bold heading for “Article types” on the left side of the search results page. Then click the boxes beside “Meta-Analysis” and “Systemic Reviews” and click “Show.” This step made the filters/limits visible for use in the search. Then click “Meta-Analysis” and “Systematic Review” to impose these filters/limits on the current search.

What are examples of policies, protocols, and safety measures for waterbirths in hospitals?

Posted on August 28, 2014 by John

Dahlen, Hannah G Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery (MIDWIFERY), 2013; 29 (7): 759-64.

UKCC statement on waterbirth. The current position. Midwives (13558404) (Midwives (13558404)), 1995 Jan; 108 (1284): 12.

US WATERBIRTH STUDY. Midwives (MIDWIVES), 2014; 17 (3): 11.

Chapman B Waterbirth protocols: five North Island hospitals in New Zealand. New Zealand College of Midwives Journal (NZ COLL MIDWIVES J), 2004 Apr; 30: 20-4.

Nutter, Elizabeth; Waterbirth: An Integrative Analysis of Peer-Reviewed Literature. Journal of Midwifery & Women’s Health (J MIDWIFERY WOMENS HEALTH), 2014 May; 59 (3): 286-319.

Benko A Waterbirth: is it a real choice? Midwifery Matters (MIDWIFERY MATTERS), 2009 Autumn (122): 9-12. (32 ref)

Maznin, Nur Liyanna Bt. Creedy, Debra Kay. A comprehensive systematic review of factors influencing women’s birthing preferences. The JBI Library of Systematic Reviews. 10(4):232-306, 2012.

Click here to run a PubMed search on your topic

What is the evidence for quality and safety benefits of a bedside shift report?

Posted on August 6, 2014 by Lisa

1. Go to http://health.library.emory.edu and then click on the PubMed link on right side of page.
2. When PubMed opens, copy/paste this search strategy in the search box and click “Search:”
bedside AND ((shift AND (report OR reports OR reporting)) OR (handoff OR handoffs)) AND (quality OR safety) NOT 22157495[uid] NOT 24264936 [uid] NOT 18989136[uid] NOT 17102266[uid] NOT 19540761[uid] NOT 21041119[uid]

The search will find at least 31 articles.

What is the evidence for oral care of a patient on a ventilator?

Posted on August 5, 2014 by Amy

The systematic reviews identified below include slightly different findings, so a review of the objective of each review, as well as the patient populations in the included studies, will be important for extrapolating results to a specific setting. Guidelines were identified in DynaMed and in PubMed.

Evidence summary resources

From Mechanical Ventilation entry. In: DynaMed Plus.
Under Adjunctive Therapies > Other Supportive Care

A systematic review (JAMA 2014) found that oral care with chlorhexidine may reduce lower respiratory tract infections in adults following cardiac surgery, but is not associated with reduction in VAP in non-cardiac surgery patients. The review was limited by the heterogeneity of the settings/populations.

JAMA Intern Med. 2014 May;174(5):751-61. Klompas M, et al. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis.

A systematic review (with heterogeneity) of 6 RCTs concluded that toothbrushing may not reduce risk of ventilator-associated pneumonia in critically ill patients
Society for Healthcare Epidemiology of America (SHEA) guideline on strategies to prevent ventilator-associated pneumonia in acute care hospitals Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S31

From Joanna Briggs

Oral Hygiene Care: Acute Care Setting. Chu WH. [Evidence Summaries], AN: JBI5215, 2013.
References a systematic review (Cochrane 2013) concluded that use of chlorhexidine was associated with reduction in rate of VAP in adult, but not pediatric, patients.

Cochrane Database Syst Rev. 2013 Aug 13;8:CD008367. Shi Z, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.

Oral Care. [Recommended Practices, AN: JBI5264, 2013.
References a systematic review (Am J Crit Care 2007) concluding that toothbrushes can be a source of contamination and should be kept clean.

PubMed

View the results of a search for relevant systematic reviews and meta-analyses:
(“Pneumonia, Ventilator-Associated/prevention and control”[Mesh] OR “Respiration, Artificial/adverse effects”[Mesh]) AND (“Anti-Infective Agents, Local”[nm] OR “oral hygiene”[MeSH Terms]) AND (Meta-Analysis[ptyp] OR systematic[sb])

Additional guideline

Berry AM, et al. Consensus based clinical guideline for oral hygiene in the critically ill. Intensive Crit Care Nurs. 2011 Aug;27(4):180-5.

What is the evidence on family members being present during cardiopulmonary resuscitation?

Posted on July 21, 2014 by Amy

A search of DynaMed and Joanna Briggs did not identify RCTs or other documents that referenced RCTs evaluating family presence during resuscitation.

A PubMed search of resuscitation AND family – Filtered by Randomized Controlled Trial only identified one RCT. Removing the filter and adding “randomized OR random” as search terms did not identify additional studies.
Family presence during cardiopulmonary resuscitation.
Jabre P, et al. N Engl J Med. 2013 Mar 14;368(11):1008-18. doi: 10.1056/NEJMoa1203366.
PMID: 23484827

Family presence during resuscitation: a randomised controlled trial of the impact of family presence. Holzhauser K; Finucane J; De Vries SM; Australasian Emergency Nursing Journal, 2006; 8 (4): 139-47.

There are also quasi-experimental studies included in these search results.

Evidence Matters

Evidence-based information for Emory