CARDIAC ARREST
In-hospital survival linked to RN staffing
When a patient experiences an in-hospital cardiac arrest (IHCA), nurses are likely to be the first responders. To examine the relationship between nurse staffing, work environments, and patient survival following IHCA, researchers conducted a cross-sectional study of data on 11,160 adults age 18 and older between 2005 and 2007 in 75 hospitals in four states. They found that each additional patient per nurse on a medical/surgical unit was associated with a 5% lower likelihood of IHCA survival to discharge. In addition, poor work environments were associated with a 16% lower likelihood of IHCA survival. Work environment was assessed based on an evaluation of the level of nurse participation in hospital affairs, nursing foundations for quality care, nurse manager ability, leadership, support of nurses, and nurse-physician relations.
Researchers conclude that patient outcomes improve "when nurses have a more reasonable workload and work in good hospital work environments."
Source: McHugh MD, Rochman MF, Sloane DM, et al. Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Med Care. 2016;54(1):74-80.
INFLUENZA
Most hospitals don't require vaccination
A recently published study shows that in 2013, only 43% of facilities surveyed required healthcare personnel to get an influenza vaccination. About 10% of respondents reported that their facility would require employee vaccination for the following flu season.
Survey results were based on responses from infection control preventionists at 77 Veterans Affairs (VA) facilities and 386 non-VA facilities. Just over 1% of VA hospitals required flu vaccination for healthcare workers. Union resistance and lack of a VA mandate were the main reasons cited for the low vaccination rate. Among the most commonly cited reasons for low rates in non-VA facilities were a lack of hospital mandates for vaccination and the use of declination policies.
According to the authors, research has shown that institutional requirements for vaccination significantly increase vaccination coverage among healthcare personnel. Facilities that enforce strong consequences for failure to vaccinate, including termination of employment, experience the greatest gains.
The Healthy People 2020 goal for influenza vaccination for healthcare personnel is 90%. The VA is aiming for near-universal flu vaccination in its hospitals by 2020.
Sources: Greene MT, Fowler KE, Krein SL, et al. Infuenza vaccination requirements for healthcare personnel in U.S. hospitals: results of a national survey. Infect Control Hosp Epidemiol. [e-pub November 27, 2015]. Less than half of U.S. hospitals require flu shots for staff, study suggests-despite risk to patients. University of Michigan, Ann Arbor. News release. December 8, 2015.
EMERGING HEALTH THREATS
Is your state prepared for disease outbreaks?
Most states are inadequately prepared to respond effectively to disease outbreaks, according to a new report. Only five states-Delaware, Kentucky, Maine, New York, and Virginia-scored 8 out of 10 on key indicators related to preventing, detecting, diagnosing, and responding to outbreaks. Twenty-eight states demonstrated preparedness on 5 or fewer indicators, and seven states scored only 3. The indicators were based on data related to such factors as public health funding, central-line associated bloodstream infection rates, childhood and flu vaccination rates, hepatitis C and HIV surveillance, food safety, syringe-exchange programs, climate-change adaptation plans, and lab capabilities.
The report, issued by the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation, calls for greater efforts to protect people from emerging disease threats, such as Middle East respiratory syndrome coronavirus (MERS-CoV); antibiotic-resistant pathogens; and resurging illnesses such as pertussis, tuberculosis, and gonorrhea.
"The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country's ability to prepare for infectious disease threats," said Jeffrey Levi, PhD, executive director of TFAH. "We cannot afford to continue to be complacent."
To see the complete report, including scoring by state and priority recommendations, visit http://www.healthyamericans.org.
Source: Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). Report Finds Major Gaps in Country's Ability to Prevent and Control Infectious Disease Outbreaks. News release. December 17, 2015.
SURVEY RESULTS
RNs have mixed feelings about nursing
In a recent national survey, 8,828 RNs voiced their opinions on retirement, education, emerging nursing roles, and more. Asked if they're satisfied with their choice of nursing as a career, 85% agree or strongly agree. But 50% worry that their job is affecting their health and 30% often feel like quitting.
Other findings suggest that a coming "wave of retirements" will soon worsen the nursing shortage.
* Nearly 40% of all RN respondents and 62% of those age 54 and older plan to retire within 3 years, and 21% of older nurses say they plan to start working part-time. Besides draining the profession of nursing expertise, this outflow of talent will deprive new nurses of experienced mentors.
* Forty-four percent of nurse educators say they're contemplating retirement. A growing shortage of educators will exacerbate the shortage of clinical nurses. A shortage of educators is especially worrisome because nurses expressed a strong interest in furthering their education: About 75% of younger nurses surveyed said they plan to pursue a higher degree within 3 years and more than one-third of nurses younger than 40 want to become nurse practitioners.
* About 75% of respondents were aware of new and emerging nursing roles and 60% would be willing to get training to qualify for them.
The survey was conducted by AMN Healthcare. For complete survey findings, visit AMN's website at http://amnhealthcare.com/2015rnsurvey.
Source: AMN Healthcare. 2015 Survey of Registered Nurses: Viewpoints on Retirement, Education and Emerging Roles. 2015.
CHEMOTHERAPY
Keeping a cool head
The FDA has approved the DigniCap scalp cooling system to reduce the severity of chemotherapy-related alopecia in female breast cancer patients. This is the first and only FDA-approved device for this indication.
A computer-controlled system circulates cool liquid through the cooling cap, constricting blood vessels in the scalp and reducing the amount of drug reaching hair follicles. A second cap is worn over the cooling cap to keep it in place and provide insulation. The cap's temperature is reduced gradually to prevent discomfort.
The device's efficacy was studied in 122 patients with Stage I and II breast cancer using chemotherapy regimens known to cause hair loss. The primary outcome was a self-assessment of hair loss using photographs at 1 month postchemotherapy. Two-thirds of the patients using the device kept more than half their hair. The most common adverse reactions were headaches, neck discomfort, chills, and pain associated with prolonged use of the device.
Because the device is FDA-approved, infusion centers will be able to offer it to patients during treatments. The device may not be appropriate for all chemotherapy regimens, however, so patients should discuss this option with their healthcare provider.
Sources: Food and Drug Administration. FDA allows marketing of cooling cap to reduce hair loss during chemotherapy. News Release. December 8, 2015. Dignicap home. http://www.dignicap.com.
In March, celebrate
* National Colorectal Cancer Awareness Month http://preventcancer.org
* National Endometriosis Awareness Month http://www.endometriosisassn.org
* Problem Gambling Awareness Month http://www.npgaw.org
* Trisomy Awareness Month http://trisomy.org
* World Kidney Day (March 10) http://www.worldkidneyday.org
PREMATURE INFANTS
Get in touch with "kangaroo mother care"
Premature and low-birth-weight (LBW) infants may benefit significantly from prolonged skin-to-skin contact with their mothers, a new review finds. Called kangaroo mother care (KMC), the concept was pioneered in Colombia in the 1970s for LBW infants as an alternative to incubators. Besides early, continuous, and prolonged skin-to-skin contact, KMC includes exclusive breastfeeding, early hospital discharge, and close follow-up at home, according to the World Health Organization.
More than 120 studies were included in the systematic review and meta-analysis to estimate the association between KMC and neonatal outcomes. The study examined outcomes in infants regardless of birth weight or gestational age.
Compared with conventional care, KMC was associated with a 36% reduction in mortality in LBW infants. KMC also decreased the risk of neonatal sepsis, hypoglycemia, and hospital readmission, and increased exclusive breastfeeding. In addition, newborns receiving KMC had better head circumference growth, higher oxygen saturation levels, and lower mean respiratory rate and pain measures. These findings encourage expanded implementation of KMC as an effective and inexpensive alternative to technologies such as incubators, which may be cost-prohibitive in some global settings.
Source: Boundy EO, Dastjerdi R, Spiegelman D, et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137(1):1-16.
BRAIN DEATH
Standards vary widely in practice
Defined as the irreversible cessation of function in the entire brain, brain death is medically and legally accepted as a mechanism of death worldwide. In 2010, the The American Academy of Neurology (AAN) issued updated guidelines for the diagnosis of brain death, but a recent study indicates that these guidelines are inconsistently followed in the United States.
The study involved a data analysis of 492 unique hospital protocols from facilities in all 50 states spanning more than 3 years. Researchers found that 56% of policies failed to require the exclusion of hypotension in the determination of brain death and 79% failed to require exclusion of hypothermia. Both conditions can create the illusion of brain death and may be reversible.
The AAN guidelines require an apnea test to determine that patients can no longer breathe on their own-an essential finding to support a brain death diagnosis-but about 10% of protocols studied had no such requirement. In addition, only 33% of protocols required the clinician diagnosing brain death to have expertise in neurology or neurosurgery.
Although the researchers identified no cases of misdiagnosed brain death, clinicians must follow all steps specified in the guidelines to diagnose brain death with 100% certainty, says lead researcher David Greer, MD. "You should be able to take [the AAN] checklist to the bedside, follow it point by point, and be able to get through it."
Sources: Greer DM, Wang HH, Robinson JD, Varelas PN, Henderson GV, Wijdicks EF. Variability of brain death policies in the United States. JAMA Neurol. [e-pub December 28, 2015]. Hospitals brain death policies vary dramatically, study finds. HealthDay News. December 28, 2015.