Nursing strategies for the mechanically ventilated patient

Optimizing infection control: Evaluating nurses' knowledge and practices for preventing infections in mechanically ventilated patients

INTRODUCTION

Infection control is crucial in healthcare, particularly in intensive care units (ICUs), where patients are at high risk of infection due to mechanical ventilation. Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections in ICUs, leading to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Nurses are essential in implementing infection control measures to prevent these infections. Evaluating their knowledge and practices is key to identifying areas for improvement.

AIM

This study assesses ICU nurses' knowledge and practices regarding infection control, particularly in preventing VAP in mechanically ventilated patients.

METHODS

A descriptive observational study was conducted at King Fahad Specialist Hospital in Saudi Arabia. Participants were selected using purposive sampling based on their experience and direct care responsibilities. Data were collected using a self-report questionnaire and an observational checklist. The questionnaire assessed knowledge across domains such as infection control principles and VAP prevention, while the checklist evaluated practices like hand hygiene and adherence to VAP bundles.

RESULTS

The study found that 61.2 % of nurses demonstrated satisfactory infection control practices, with hand hygiene showing the highest compliance (81.8 %). However, VAP bundle adherence was low (42.4 %). Knowledge gaps were also identified, especially in VAP prevention and oral care.

CONCLUSION

The findings suggest a need for targeted educational programs to improve infection control practices among ICU nurses. Enhanced training could address observed gaps in knowledge and practice, particularly in VAP prevention and oral care, ultimately improving patient outcomes.

Carbon Monoxide Poisoning: Diagnosis, Prognostic Factors, Treatment Strategies, and Future Perspectives

Carbon monoxide (CO) poisoning is a significant public health issue, with diagnosis often complicated by non-specific symptoms and limited access to specialised tools. Early detection is vital for preventing long-term complications. The review examines diagnostic challenges, prognostic factors, management strategies, and future advancements in CO poisoning. It highlights the limitations of current diagnostic techniques such as blood carboxyhaemoglobin levels and pulse CO-oximetry, while exploring emerging methods for rapid detection. Prognosis is influenced by exposure severity and delayed treatment, which increases the risk of neurological damage. Hyperbaric oxygen therapy (HBOT) remains the primary treatment but is not always accessible. Advances in portable CO-oximeters and biomarkers offer potential for improved early diagnosis and monitoring. Addressing resource limitations and refining treatment protocols are crucial for better patient outcomes. Future research should focus on personalised management strategies and the integration of modern technologies to enhance care.

Successful management of pulmonary edema secondary to accidental electrocution in a young dog

BACKGROUND

Human records describe pulmonary edema as a life-threatening complication of electric shock. Successful management requires prompt recognition and intensive care. However, in companion animals, electrocutions are rarely reported, even though domestic environments are full of electrical devices and there is always the possibility of accidental injury. Therefore, it is important for veterinarians to know more about this condition in order to achieve successful patient outcomes.

CASE PRESENTATION

A 3-month-old male Labrador Retriever was presented with a history of transient loss of consciousness after chewing on a household electrical cord. On admission, the puppy showed an orthopneic position with moderate respiratory distress. Supplemental oxygen via nasal catheter was provided, but the patient showed marked worsening of respiratory status. Point-of-care ultrasound exams suggested neurogenic pulmonary edema due to electrical shock close to the central nervous system and increased B-lines without evidence of cardiac abnormalities. Mechanical ventilation of the patient was initiated using volume-controlled mode with a tidal volume of 9 to 15 ml/kg until reaching an end-tidal carbon dioxide ≤ 40 mm Hg, followed by a stepwise lung-recruitment maneuver in pressure-controlled mode with increases of the peak inspiratory pressure (15 to 20 cm H2O) and positive end-expiratory pressure (3 to 10 cm H2O) for 30 min, and return to volume-controlled mode with a tidal volume of 15 ml/kg until reaching a peripheral oxygen saturation ≥ 96%. Weaning from the ventilator was achieved in six hours, and the patient was discharged two days after admission without neurological or respiratory deficits.

CONCLUSIONS

We present a rather unusual case of a neurogenic pulmonary edema subsequent to accidental electrocution in a dog. Timely diagnosis by ultrasound and mechanical ventilation settings are described. Our case highlights that pulmonary edema should be considered a potentially life-threatening complication of electrical shock in small animal emergency and critical care medicine.