VIOLENCE IN THE ED
Nurses still report high rates of abuse
Among more than 7,000 surveyed ED nurses, nearly half reported experiencing verbal abuse and almost 13% reported physical abuse during a 7-day period in 2010. These rates are consistent with those reported in a similar survey conducted in 2009.
The most common forms of verbal abuse were yelling or swearing. Physical abuse typically involved grabbing or pulling. Among the findings:
* 66% of nurses who were physically assaulted didn't file a formal report, but they notified someone, such as an immediate supervisor or security personnel. Over 70% received no response from the hospital about the assault.
* 86% of nurses who were verbally abused didn't report it.
* In cases of physical assault, 98% of perpetrators were patients; four out of five incidents occurred in the patient's room.
* Rates of physical violence and verbal abuse were lower in hospitals with a higher commitment to safety and zero-tolerance policies. Of nurses who reported experiencing no incidents of violence or abuse in the past 7 days, 92% worked in facilities with reporting policies.
The survey, conducted by the Emergency Nurses Association, is available at http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf.
PEDIATRICS
Bundle up to prevent bloodstream infections
Nurses and physicians who followed a few basic guidelines when caring for young patients with central venous catheters (CVCs) prevented nearly a thousand central line- associated bloodstream infections (CLABSIs) and saved more than a hundred lives over 3 years, according to results of a multiinstitutional study involving 29 pediatric ICUs. Consistent adherence to two central line bundles (insertion and maintenance bundles) dramatically reduced the CLABSI rate by 56%.
Researchers also studied two additional interventions: chlorhexidine scrub prior to CVC entry and use of chlorhexidine-impregnated sponges. They found that these interventions "did not produce any statistically significant additional reduction" in CLABSI rates.
Source: Miller MR, Niedner MF, Huskins WC, et al. Reducing PICU central line-associated bloodstream infections: 3-year results. Pediatrics. 2011;128(5):e1077-e1083.
INFECTION CONTROL
Clean gloves, dirty hands
In a recent study of hand hygiene and glove usage involving 7,578 moments when hand hygiene was indicated, researchers found that healthcare workers are less likely to perform hand hygiene appropriately when they wear gloves. Wearing gloves is no substitute for hand hygiene under current well-established standards. Without glove use, compliance with hand hygiene standards was only 50%, but it was even lower with glove use: 41%. In other words, glove use was strongly associated with lower levels of hand hygiene.
The study also revealed the gloves are too often worn when not needed or vice versa: Gloves were worn in 17% of low-risk contacts and not used in 21% of high-risk contacts, both inappropriate choices. Researchers conclude that "hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene."
Source: Fuller C, Savage J, Besser S, et al. "The dirty hand in the latex glove:" a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol. 2011;32(12):1194-1199.
PREVENTING ANTIBIOTIC OVERUSE
Get with the program
Antibiotic stewardship programs, implemented by hospitals to reduce antibiotic overuse, are paying off. Research presented at the 49th Annual Meeting of the Infectious Diseases Society of America (IDSA) in Boston found both lower rates of antibiotic resistance and reduced costs associated with these programs.
In 2007, guidelines for antimicrobial stewardship programs in acute care hospitals were issued by the IDSA and the Society for Healthcare Epidemiology of America. However, a survey of 270 U.S. hospitals with stewardship programs revealed that fewer than one in three were fully compliant with the guidelines.
Although stewardship programs appear to work, they can be expensive to implement. But research has shown that they're cost-effective, significantly reducing expenses by preventing inappropriate antibiotic use and substituting generic drugs whenever possible. For more information, visit IDSA's Web content about the annual meeting at http://www.idmeeting.org.
HYPERTENSION CONTROL
Taking BP drugs at bedtime has benefits for CKD patients
Does the time of day a patient takes antihypertensive medication matter? To find out, researchers randomly assigned 661 patients with chronic kidney disease (CKD) to take all prescribed antihypertensive drugs either before bedtime or upon awakening in the morning. After 5.4 years of follow-up, they found that patients who took at least one of their drugs at night were about one-third less likely than morning drug takers to experience cardiovascular events such as myocardial infarction, angina pectoris, and heart failure. Compared with patients on morning treatment, those who took drugs before sleep had significantly lower average sleep-time BP and better ambulatory BP control. Each 5-mm Hg decrease in average sleep-time systolic pressure was associated with a 14% reduction in the risk of cardiovascular events during the follow-up period. Researchers concluded that in patients with CKD, taking at least one antihypertensive medi cation at bedtime improves BP control and reduces cardiovascular risks.
Source: Hermida RC, Ayala DE, Mojon A, Fern[spacing acute]ndez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011 Oct 24. [Epub ahead of print]
CABG SURGERY
Blood type may affect patient outcomes
How well a patient fares after coronary artery bypass graft (CABG) surgery may depend in part on blood type, according to a new study presented recently at the American Society of Anesthesiologists' meeting in Chicago. The study showed that patients with AB blood type were 20% less likely to die after CABG surgery than patients with A, B, or O blood types.
Two proteins responsible for clotting, the von Willebrand factor and Factor VIII, could explain the reduced risk. The gene associated with group O confers lower levels of these clotting proteins. People with the AB blood type have no O gene and thus have the higher levels of clotting proteins, which may help protect them from bleeding complications.
Evidence suggests that people with type AB blood may be more likely to develop blood clots and less likely to bleed after surgery, said lead study author Ian J. Welsby, MD. These blood clots don't seem to cause complications, but the lower tendency to bleed could contribute to improved survival in these patients because they're less likely to require blood transfusions. Bleeding and transfusions increase the risk of post-op complications.
For more information, visit the website of the American Society of Anesthesiologists at http://www.asahq.org.
SURVEY RESPONSES
Does peer recognition matter?
Nurses who recently visited our website answered this question: What's more meaningful to you: recognition from your peers or recognition from your employer?
Answer monthly survey questions and see results from past surveys by visiting http://www.nursingcenter.com/poll, or check out the Quick poll at http://www.nursing2012.com.
RETIREMENT PLANNING
Is your nest egg shrinking?
In a recent nationwide survey by Fidelity Investments, 71% of nurses said they don't think they're saving enough money for retirement. That's a significant increase over the 57% of nurses who reported that opinion in a 2007 survey. However, 80% said they feel secure about their jobs and financial future, and more than half said they "love their jobs and can't imagine giving them up, even in retirement."
Nearly half (49%) of nurses said their retirement plans have changed because of the economic downturn. Now, 26% of nurses plan to retire later than they'd expected, and 42% say they may never fully retire.
Among the study's conclusions: "Nurses are highly reliant on their employers for retirement benefits.... Most find retirement planning overwhelming and wish they could get more guidance and education."
For additional results from the 2011 Fidelity Investments Nurses Study, visit http://www.fidelity.com/inside-fidelity/individual-investing/TEM-nurses-survey.
SHIFT WORK
Hairy news about long-term consequences
In young adults, performing shift work is associated with long-term elevations of cortisol and increased body mass index (BMI), a feature of metabolic syndrome. Findings from a new study are consistent with previous research showing that long-term elevated cortisol levels can lead to increased abdominal obesity, hypertension, diabetes, and cardiovascular risk.
In the study, researchers collected hair samples from 33 shift workers and 89 day workers, and tested the samples for cortisol. They found that shift workers had higher hair cortisol levels than day workers, and that cortisol levels and BMI were positively correlated. Dividing subjects into age groups, they found that elevated cortisol levels were present only in younger shift workers (under age 40). They concluded that "shift work at a young age is associated with elevated long-term cortisol levels and increased BMI...[which] may contribute to the increased cardiovascular risk found in shift workers."
Source: Manenschijn L, van Kruysbergen RG, de Jong FH, Koper JW, van Rossum EF. Shift work at young age is associated with elevated long-term cortisol levels and body mass index. J Clin Endocrinol Metab. 2011:96(11): E1862-E1865.
In January, celebrate
* Cervical Health Awareness Month http://www.nccc-online.org/awareness.html
* Thyroid Awareness Month http://www.aace.com
* National Birth Defects Prevention Month http://www.nbdpn.org
* National Glaucoma Awareness Month http://preventblindness.org.