Catchy ideas

Infectious disease experts find plenty of roles for nurses in the latest research. 

In this edition of Nursing Review, we speak to three experts about the latest research in the field of infectious diseases and the impact findings will have on nurses.

The papers were presented at the Australasian Society for Infectious Diseases meeting held in Adelaide recently.

Antimicrobial stewardship

Antimicrobial stewardship (AMS) could be better implemented in private hospitals, and nurses in these facilities may not be aware of the important role they play, a new report states.

The study looked at the attitudes of nurses, surgeons, physicians, anesthetists, doctors and pharmacists towards the significance of antimicrobial resistance in their workplace, the benefits of AMS activities and the willingness to participate in these activities.

The study lead, National Health and Medical Research Council research fellow Os Cotta, said the impetus for the work was that doctors were often the focus of previous similar surveys but weren’t necessarily the ones running AMS in hospitals.

“Nurses are involved in the day-to-day management of patients and often they can help with prompting things [like] ceasing or de-escalating therapy of antibiotics, with a view of shortening therapy,” he said.

Despite this, of all kinds of professionals, nurses had the lowest response rate, at about 14 per cent. “That was concerning for us because we want them to get involved with antimicrobial stewardship. We think that they have a very important role,” Cotta said.

He said this could mean that nurses are not engaged with issues surrounding judicious use of antimicrobials in hospitals and don’t see themselves as a major player in the area. “When I spoke to nursing staff about doing the survey, a lot of them said, ‘I don’t really know why you sent that to us.’”

However, Cotta said there is enough evidence and literature that suggests nurses are a very important part of improving antimicrobial use. “The results of this survey really tell us that perhaps we need to get nurses more engaged in antimicrobial stewardship activities.”

Cotta added nurses were still found to be concerned about the effect of antimicrobial-resistance on patient care but weren’t engaged enough to say that they were willing to participate in AMS activities.

Previous qualitative focus group discussions with nursing staff and other health professionals revealed nurses in private hospitals play a huge role in patient management and act as the main conduit for relaying important information to other healthcare professionals. They tended to rely heavily on infectious disease consultants or pharmacists to give them advice and take control surrounding AMS.

Nurses are, however, interested in getting involved in antimicrobial use, Cotta said. “You will find nurses questioning the antimicrobial and antibiotic drugs just as much as they would question any other drug that they’re not familiar with,” he explained.

Cotta said just asking questions can sometimes be a catalyst for a doctor to switch IV therapy to oral, adding nurses are in the best position to flag this area and others. “They’re better equipped than the pharmacists and doctors because they manage the patient day in day out, so we feel they have a very valuable role in the rational use of antimicrobial therapy in private hospitals.”

Diarrhea illness

Researchers also pointed out that nurses have an important role in the management of diarrhea illness.

The poster presentations of lead researcher Belinda Lin, diseases registrar at Western Health, centred on diarrheal illness, with a focus on diagnosis, morbidity, mortality and its economic impact.

Researchers collected data on patients aged 16 and over who were admitted to three hospitals in Melbourne’s west over seven months.

Of the 210 patients enrolled, the mean length of stay in hospital was 7.7 days and the mean cost was $5605 per admission.

Based on the data, it was estimated the total annual cost of this issue reaches about $2 million annually for Western Health. The cost per year across Australia was estimated at $75 million.

“While there has not been much change over the years with respect to the infectious pathogens that cause diarrhea, the changes in our population – now an ageing population with high rates of multi-morbidity – mean that conditions such as diarrhea are having a much larger economic impact,” Lin said.

“The health service burden and costs of managing community-acquired diarrheal disease in our hospital system are high and likely to continue to increase as our population ages.”

Lin says all of these issues have implications for nurses. “With regards to diarrheal illness, nursing staff have an important role in the front line in identifying patients with onset of diarrheal illness and updating the clinical staff regarding patient’s changing clinical status, including signs of clinical deterioration,” she says. “Identification of these symptoms and signs speeds diagnosis, aids timely implementation of infection control measures and also optimises management.”

She says this helps reduce possible complications from diarrheal illness, something that is increasingly important in an ageing population. “Our poster shows that having multiple comorbidities, type 2 diabetes and chronic kidney disease increases the mortality risk with hazard ratio of 17, 5.2 and 8.3, respectively,” she said.

Staph infections

Staphylococcus Aureus bacteremia (SAB) is an important focus in Australian hospitals.

Peripherally inserted central catheters (PICCs) are being used increasingly to provide long-term central access. The aim of the study was to characterise the frequency of PICC-associated staph infections and determine what factors influence their development.

It also sought to establish the effect using chlorhexidinegluconate-impregnated sponges (CHGIS) had in reducing the rate of this infection.

“Using the sponge significantly decreased the rate of staph bacteremia due to peripherally inserted central lines,” co-author Rhonda Stuart from Monash Health said.

“The patches are already widely used in many parts of hospitals, so most hospitals now use it on all central lines already and some hospitals are using them on their dialysis catheters and some hospitals are already using it on PICC lines, but there hasn’t been any evidence to show that it actually was worthwhile in PICC lines,” Stuart said. “It’s kind of the first bit of evidence that shows that it’s worthwhile using.”

She says nurses are very involved in the care of PICC lines, especially in hospitals and the home.

The research looked at analyses of SABs within the Infection Prevention and Epidemiology Unit at Monash Health and included all SABs that were deemed to be associated with a PICC-line between January 2007 and December 2012.

During the time of the study, 42 PA-SABs were identified and the median time from PICC insertion to infection was 16.5 days. Thirty-five PA-SABs occurred from 2625 PICC insertions during the first four years of the study. After the introduction of CHGIS only 7 PA-SABs arose from 2522 inserted PICCs throughout the following two years.

The report also concluded that additional research is needed to establish whether the sponges also reduce PICC-associated infections from other organisms and whether the study results were applicable to other health services.

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