Hand Hygiene in Intensive Care Units: A Matter of Time?

Stahmeyer, J.T. The Journal of Hospital Infection. Published online: January 28, 2017


Background: Healthcare-associated infections are a frequent threat to patient safety and cause significant disease burden. The most important single preventive measure is hand hygiene (HH). Barriers to adherence with HH recommendations include structural aspects, knowledge gaps, and organizational issues, especially a lack of time in daily routine.

Conclusion: Complying with guidelines is time consuming. Sufficient time for HH should be considered in staff planning.

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Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians.

Schwarzkopf, D. et al. Critical Care Medicine. Published online: October 21 2016

businessman-150451_960_720Objectives: Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.

Design: Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.

Setting: Convenience sample of 23 German ICUs.

Subjects: ICU nurses and physicians.

Interventions: None.

Measurements and Main Results: A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived “sometimes.” Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p <= 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p <= 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p <= 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p <= 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p <= 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06-0.18]).

Conclusions: Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.

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Moral distress: an inevitable part of neonatal and paediatric intensive care?

Field. D. et al. Archives of Disease in Childhood. doi:10.1136/archdischild-2015-310268

The paper by Prentice et al reports a systematic review of moral distress occurring in neonatal and paediatric intensive care units. This term, which may be unfamiliar to many readers, has been defined as the anguish experienced when a health professional makes a clear moral judgement about what action he/she should take but is unable to act accordingly due to constraints (societal, institutional or contextual).2 In a situation of moral distress, the health professional can see, from their point of view, that there is an ethically correct action but is powerless to act, a situation that will be familiar to all those who work in neonatal or paediatric intensive care teams.

Moral distress is not a new phenomenon, although the scenarios where it arises may have changed due to developments in society’s beliefs and the healthcare system and dramatic improvements in technology. Perhaps the most clear UK example of how the views of society at large have changed in this context over time comes from the trial of Dr Leonard Arthur (https://en.wikipedia.org/wiki/Leonard_Arthur; accessed 21 March 2016). In 1981, Dr Arthur, a paediatrician based in the English Midlands, was tried for attempted murder following the death of a newborn baby with Down’s syndrome whom he had prescribed ‘nursing care only’ and sedatives.

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The critical care nurse work environment, physician staffing, and risk for ventilator-associated pneumonia

Costa, D.K. et al. American Journal of Infection Control. Published online: 12 May 2016

11556-2We examined the relationship between intensivist physician staffing, nurse work environment, and ventilator-associated pneumonia (VAP) in 25 intensive care units. We found a significant interaction between the nurse work environment, intensivist physician staffing, and VAP. Future work may need to focus on fostering organizational collaboration between nursing and medicine to leverage skills of both clinician groups to reduce risk for VAP in critically ill patients.

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