Wednesday, January 21, 2009
Competency For RN's only
After you complete the questions return to Vilma-some of you may have the packets in your mailbox or received them at this week's staff meetings, some are missing questions 5 & 6 so here is the complete Power Point that you can review anytime.
Thank you!
More on Silver Coated ET tubes
Protection Against Ventilator-Associated Pneumonia by Silver-Coated Endotracheal Tubes: An Unresolved Issue
Tamar F. Barlam, M.D.; Dennis L. Kasper, M.D.
AccessMedicine from McGraw-Hill. 2008; ©2008 The McGraw-Hill CompaniesAll rights reserved. From Tintinalli's Emergency Medicine
Posted 01/12/2009
Ventilator-associated pneumonia (VAP) is a major nosocomial infection that results in significant morbidity, mortality, and health care costs. Most strategies to reduce VAP attempt to decrease rates of colonization of the aerodigestive tract and aspiration of infected secretions. Silver has antimicrobial properties in vitro and may reduce biofilm formation on and bacterial adherence to the endotracheal tube. Kollef and colleagues (2008) conducted a prospective, randomized, multicenter, single-blind, controlled study in patients requiring >24 h of intubation to determine whether silver-coated endotracheal tubes can reduce the incidence of microbiologically confirmed VAP.
Patients recruited from December 2002 to March 2006 at 54 centers in North America were assigned to treatment groups in a 1:1 ratio, using block randomization by site. Each patient was intubated with either the experimental silver-coated tube or a control tube (Hi-Lo endotracheal tube; Mallinckrodt, St. Louis). Apart from the silver coating, the two types of tubes were similar. Bronchoalveolar lavage (BAL) fluid was subjected to quantitative culture if VAP was suspected. The primary outcome was VAP incidence, which was defined as a quantitative BAL fluid culture with ≥104 colony-forming units (CFU)/mL after intubation for ≥24 h. Secondary outcomes were time to occurrence of VAP; duration of endotracheal intubation, intensive care unit (ICU) stay, and hospital stay; and mortality rate.
Of 2003 patients randomized, 968 received the experimental tube and 964 received the control tube; 423 patients were intubated for <24 p =" .007)." p =" .03).">90% of these patients were taking antibiotics at the time of BAL. Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae were the most common pathogens. In patients with silver-coated tubes, the relative risk of VAP incidence within 10 days of intubation was reduced and the occurrence of VAP was delayed (p = .005) in comparison with the control group; however, other secondary outcomes—mortality rate and duration of intubation, ICU stay, or hospital stay—did not differ between the two groups. The frequency and severity of adverse events were similar for the two types of endotracheal tubes.
The authors conclude that, compared with the uncoated tube, the silver-coated endotracheal tube is associated with a significant reduction in the incidence of VAP and a delay in VAP occurrence. They note that the silver-coated tube offers a unique approach to VAP prevention because it is user-independent after intubation and requires no further action on the part of the clinician. In an accompanying editorial, Chastre (2008) discusses the limitations of the study and the lack of robustness of the results. Only three more cases of VAP in the coated-tube group would have rendered the study statistically inconclusive. In addition, BAL culture results were probably affected by antibiotic use, which was not further described in the study, and the greater proportion of patients with COPD in the control group could have biased the results. Thus, although the silver-coated endotracheal tube may be appropriate for patients at very high risk of developing early-onset VAP (e.g., trauma patients), its use should not be viewed as definitively beneficial for VAP prevention until further data confirm its efficacy and cost benefit.
References
Chastre J: Preventing ventilator-associated pneumonia: Could silver-coated endotracheal tubes be the answer? (editorial) JAMA 300:842, 2008
Kollef MH et al: Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial. JAMA 300:805, 2008
Tamar F. Barlam, M.D., Associate Professor of Medicine, Boston University School of Medicine, Boston.Dennis L. Kasper, M.D., William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston.
Tamar F. Barlam, M.D.; Dennis L. Kasper, M.D.
AccessMedicine from McGraw-Hill. 2008; ©2008 The McGraw-Hill CompaniesAll rights reserved. From Tintinalli's Emergency Medicine
Posted 01/12/2009
Ventilator-associated pneumonia (VAP) is a major nosocomial infection that results in significant morbidity, mortality, and health care costs. Most strategies to reduce VAP attempt to decrease rates of colonization of the aerodigestive tract and aspiration of infected secretions. Silver has antimicrobial properties in vitro and may reduce biofilm formation on and bacterial adherence to the endotracheal tube. Kollef and colleagues (2008) conducted a prospective, randomized, multicenter, single-blind, controlled study in patients requiring >24 h of intubation to determine whether silver-coated endotracheal tubes can reduce the incidence of microbiologically confirmed VAP.
Patients recruited from December 2002 to March 2006 at 54 centers in North America were assigned to treatment groups in a 1:1 ratio, using block randomization by site. Each patient was intubated with either the experimental silver-coated tube or a control tube (Hi-Lo endotracheal tube; Mallinckrodt, St. Louis). Apart from the silver coating, the two types of tubes were similar. Bronchoalveolar lavage (BAL) fluid was subjected to quantitative culture if VAP was suspected. The primary outcome was VAP incidence, which was defined as a quantitative BAL fluid culture with ≥104 colony-forming units (CFU)/mL after intubation for ≥24 h. Secondary outcomes were time to occurrence of VAP; duration of endotracheal intubation, intensive care unit (ICU) stay, and hospital stay; and mortality rate.
Of 2003 patients randomized, 968 received the experimental tube and 964 received the control tube; 423 patients were intubated for <24 p =" .007)." p =" .03).">90% of these patients were taking antibiotics at the time of BAL. Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae were the most common pathogens. In patients with silver-coated tubes, the relative risk of VAP incidence within 10 days of intubation was reduced and the occurrence of VAP was delayed (p = .005) in comparison with the control group; however, other secondary outcomes—mortality rate and duration of intubation, ICU stay, or hospital stay—did not differ between the two groups. The frequency and severity of adverse events were similar for the two types of endotracheal tubes.
The authors conclude that, compared with the uncoated tube, the silver-coated endotracheal tube is associated with a significant reduction in the incidence of VAP and a delay in VAP occurrence. They note that the silver-coated tube offers a unique approach to VAP prevention because it is user-independent after intubation and requires no further action on the part of the clinician. In an accompanying editorial, Chastre (2008) discusses the limitations of the study and the lack of robustness of the results. Only three more cases of VAP in the coated-tube group would have rendered the study statistically inconclusive. In addition, BAL culture results were probably affected by antibiotic use, which was not further described in the study, and the greater proportion of patients with COPD in the control group could have biased the results. Thus, although the silver-coated endotracheal tube may be appropriate for patients at very high risk of developing early-onset VAP (e.g., trauma patients), its use should not be viewed as definitively beneficial for VAP prevention until further data confirm its efficacy and cost benefit.
References
Chastre J: Preventing ventilator-associated pneumonia: Could silver-coated endotracheal tubes be the answer? (editorial) JAMA 300:842, 2008
Kollef MH et al: Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial. JAMA 300:805, 2008
Tamar F. Barlam, M.D., Associate Professor of Medicine, Boston University School of Medicine, Boston.Dennis L. Kasper, M.D., William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston.
Thursday, January 8, 2009
Saturday, January 3, 2009
Saturday, December 27, 2008
Sunday, December 21, 2008
Merry Christmas Every One!
As the year ends I want to take the time to thank each of you for all that you do every shift.
The little things that make the job so much more than a job-we develop friends but we all strive to make the patients and their families lives better by what you choose to do.This nursing thing is a vocation and you each bring a little (and sometimes, alot) of yourselves to it each time you interact with a patient~Thank you for choosing our units to do that-I appreciate how tough this can be and that sometimes you leave that little bit of your self with a patient too-I hope that you come away from this year knowing that you make a difference, to me, your coworkers, but mostly to the community we serve. So no matter what happens in the year to come, please remember that our team has had it's challenges (what's life without them?) but that you each contribute to what makes our team great.
Have a Merry Christmas! ~tracy
Deana~you are important so I couldn't not post a pix of you-Thank you!
And even though I have not captured each of you in photos here please know that I appreciate that something that you bring to work each day-we couldn't do the jobs we do without each of you.
The little things that make the job so much more than a job-we develop friends but we all strive to make the patients and their families lives better by what you choose to do.This nursing thing is a vocation and you each bring a little (and sometimes, alot) of yourselves to it each time you interact with a patient~Thank you for choosing our units to do that-I appreciate how tough this can be and that sometimes you leave that little bit of your self with a patient too-I hope that you come away from this year knowing that you make a difference, to me, your coworkers, but mostly to the community we serve. So no matter what happens in the year to come, please remember that our team has had it's challenges (what's life without them?) but that you each contribute to what makes our team great.
Have a Merry Christmas! ~tracy
Nikki-welcome and we love seeing that smile!
Deana~you are important so I couldn't not post a pix of you-Thank you!
Sandi spreading the hugs to Nicole-we all need that sometimes.
Shannon-go to girl-study hard-May will be here before you know it!
Sandi-I'll make you charge material yet!
And even though I have not captured each of you in photos here please know that I appreciate that something that you bring to work each day-we couldn't do the jobs we do without each of you.
Saturday, November 29, 2008
New Fall Prevention Policy and Procedure-SEE EDUCATION BOARD IN PCU BREAKROOM TO SIGN OFF ON
You may have already seen the new yellow wrist bands on patients and signs outside patient rooms. On the Bulletin Board in the PCU break room there is a review of the new Policy and Procedure as well as a sign off/attendance sheet that you all need to sign. The Board is generally changed monthly by educational services so time is of the essence. This is all part of best practice for our patients, new to the policy is the HOMESAFEHOME Tips to Improve Home Safety that will will provide at discharge to patients so this is a slight change to our current practice but the items on the sheet are things that all of us review but there is no written education provided for discharge...problem solved. Thanks for all each of you do to give good care.
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