CHLORHEXIDINE-IMPREGNATED DRESSINGS AND PREVENTION OF CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS IN A PEDIATRIC INTENSIVE CARE UNIT
Dunkaya DS, Sahiner NC, Uysal G, Citak A. Crit Care Nurse. 2016;36(6):e1-e7.
In this randomized controlled experimental study, the researchers sought to compare the effectiveness of chlorhexidine-impregnated dressings with standard dressings with povidone-iodine for catheter care in a pediatric intensive care unit (PICU) for preventing catheter-related bloodstream infections (CRBSIs). The researchers state that bloodstream infections are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. Study participants (n = 100) were equally divided into 2 groups of 50: a chlorhexidine group and a standard group. Inclusion criteria were patients aged 1 to 18 years, with no CRBSIs at the time of admission to the hospital, who had a central venous catheter in place for more than 72 hours, who were not receiving any neuromuscular blockers, and who had given written consent for the study.
The researchers found that catheter colonization occurred in 4 patients in the standard group (8%) and 1 patient in the chlorhexidine group (2%). Catheter-related bloodstream infections occurred in 5 patients in the standard group (10%) and 1 patient in the chlorhexidine group (2%). The researchers concluded that the infection rates between the 2 groups were not significant (P = .07). However, the researchers recommend the use of 2% chlorhexidine-impregnated sterile dressings for catheter care in the PICU to prevent CRBSIs or to reduce the rate of infections.
PARENTAL PERCEPTIONS OF TRANSITION FROM INTENSIVE CARE FOLLOWING A CHILD'S CARDIAC SURGERY
Obas KA, Leal JM, Zegray M, Rennick JE. Nurs Crit Care. 2015;21(3):e1-e9.
The aim of this qualitative descriptive design study using semistructured interviews was to explore parents of children with congenital heart disease, who have undergone a cardiac surgery, and the perceptions of a transfer experience from the PICU to a surgical ward. The researchers state that this is a challenging time for parents who are experiencing a high level of stress related to their child's illness. Inclusion criteria included ages of child between 0 and 18 years, first time transferring their child from a PICU to a surgical ward after cardiac surgery, and ability to speak English or French. One parent for each child (N = 9) were included in this study.
The researchers found that parents have mixed feelings of happiness and uncertainty upon learning that their child would be transferred to a surgical unit. Happiness was perceived because the transfer was a sign that their child was getting healthier and closer to returning home, whereas uncertainly was the change of environment (although parents had been given a tour of the unit before surgery), loss of one-on-one care, loss of relationship with PICU nurse, and change of role expectations. An unexpected transfer to the surgical unit related to staffing or other patient issues was found to cause increased stress as well.
The authors concluded that theses parents did not experience feelings of isolation related to transition as found in other studies. They also identified the timing of transfer as a potential source of stress for the parents. The parents also identified key nursing interventions that helped them to prepare for transfer and come to terms with the new challenges in their new environment.