ASSESSMENT OF ASEPTIC TECHNIQUE AMONG NURSES IN MANAGEMENT OF BURNS PATIENTS AT KENYATTA NATIONAL HOSPITAL

Background: Nurses are at greater risk of acquiring and transmitting Health Care Acquired Infections (HCAI) in the course of delivering nursing care; measures to prevent the transmissions are therefore a significant core nursing care. Aseptic Technique among nurses in infection control during management of burns plays a vital role in reducing their morbidity and mortality and hence cost of burn wound management at individual and national level. Therefore, HCAI is the most serious complication of burns with sepsis being the main cause of death. Adherence to the standard operating procedures on burns management put in place by KNH on aseptic techniques assist in preventing infection spread. The aim of this study was to assess aseptic technique among nurses in management of burns patients at KNH. Methods: A cross sectional descriptive study design was employed to obtain a sample size of 59 nurses working in the burns wards, Kenyatta National Hospital. A self administered questionnaire and structured observational checklist was used to collect data. Data was coded and analyzed using SPSS version 21, descriptive statistics such as median, mean and frequency distribution were applied and categorical data was analyzed using chi-square. Measurements of association between the independent variables with key dependent variable were ascertained through logistical regression modeling. Results: 42.9% of the participants did not wash their hands properly before, during and after the dressing procedure while 88.1% had good knowledge on aseptic technique , however 14.6% of the participants maintained the aseptic technique practice throughout the procedure while 85.4% did not. Statistical significance was found between barriers to aseptic technique and adequate water supply in the taps and soap at P=0.038(OR=4.5).70.7% of the rooms lacked standard operating procedures on infection prevention. Presences of segregation posters were present at 31.6 % of the rooms. Barriers to aseptic technique implementation were noted by 54.8% of the nurse’s in hindering application of knowledge to practice. RECOMENDATION: This results suggest that nurses in the specialized wards need to be re -trained on aseptic technique procedures by the institution and institutional policies be availed to the respective ward departments, in addition to adequate logistics on supplies and equipments Infection prevention surveillance needs to be improved from the managerial to the ward level to maintain the Standard Operating Procedure

The management of burn wounds by nurses

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2015A standardised approach to wound care is vital if a positive outcome is expected. The positive outcomes of standardisation and evidence based wound care protocols have been well documented, yet nurses in South Africa do not have a standard that informs burn wound management. The purpose of this study is to describe the best available evidence for management of burn wounds and to explore nurses’ current practices in a single burns unit with the aim of developing guidelines to inform nursing practices. A QUAN (quantitative dominant) QUAN+ QUAL (quantitative and quantitative concurrently), a non- experimental explanatory sequential descriptive design was used. The process was divided into three phases: Phase One involved the search for quality evidence through an integrative review. The main review question was: “What new knowledge or information related to non-surgical management of burn wounds has emerged in the literature between 2000 and 2014?” Eleven sub questions were used to guide the literature search according to the themes of the nursing process of: Assessment, Diagnosis, Intervention, Outcome and Evaluation. The review process included a problem identification stage, literature search stage, data evaluation stage, data analysis stage and presentation stage. The included literature was based on a hierarchy of evidence. The search strategy included: multiple electronic databases, hand searching, reference lists of relevant articles, comments of experts, textbook chapters compiled by experts and guidelines. The final sample consisted of n= 354 studies. A qualitative descriptive approach was used to synthesise the research findings. Phase Two involved the study of current practice through structured observation and semi-structured interviews. The purpose of Phase Two was to obtain first-hand information in a naturally occurring situation to identify the strengths, weaknesses and gaps in current practices. Purposive sampling was undertaken and included all nurses providing care to patients with superficial to partial thickness burn wounds. A total of n= 303 dressings were observed and eight interviews were conducted. Phase Three was the verification of findings from Phases One and Two by experts in the field using the AGREE II instrument. Conclusions drawn from observations and interviews were integrated and synthesised with the conclusions from the integrative review. These conclusions were used to develop guidelines for the management of burn wounds by nurses

Protocol for an open randomised controlled trial investigating Fibrin Glue in Skin grafts for Skin cancer (FiGSS)

Introduction: Skin cancer is a common disease in the tropics, and oncological resection typically requires reconstruction with skin grafts. Fibrin glue, initially established as a haemostatic agent, has been studied extensively as an adhesive for skin grafts in burns. This study aims to investigate the use of fibrin as an adhesive for split skin grafts in skin cancers. Methods and analysis: The study design is a prospective randomised controlled trial with the aim of investigating the impact of two different methods of split skin graft fixation. The intervention of fibrin glue will be compared with the control of staples or sutures. The trial will be conducted at two sites, a public hospital and a private hospital in Townsville, Australia, over a 24-month period with 334 participants to be recruited. Consecutive patients presenting for skin excisions and grafting will be eligible to participate in this study. Randomisation will be on the level of the patient. The primary outcome is graft take based on wound healing at 1 month. Secondary outcomes will be pain on dressing changes and operative time. Ethics and dissemination: The study has been approved by The Townsville University Hospital Human Research Ethics Committee. Findings will be disseminated in conference presentations and journals and through online electronic media

Point-of-Care Detection Devices for Healthcare

With recent technological advances in multiple research fields such as materials science, micro-/nano-technology, cellular and molecular biology, bioengineering and the environment, much attention is shifting toward the development of new detection tools that not only address needs for high sensitivity and specificity but fulfil economic, environmental, and rapid point-of-care needs for groups and individuals with constrained resources and, possibly, limited training. Miniaturized fluidics-based platforms that precisely manipulate tiny body fluid volumes can be used for medical, healthcare or even environmental (e.g., heavy metal detection) diagnosis in a rapid and accurate manner. These new detection technologies are potentially applicable to different healthcare or environmental issues, since they are disposable, inexpensive, portable, and easy to use for the detection of human diseases or environmental issues—especially when they are manufactured based on low-cost materials, such as paper. The topics in this book (original and review articles) would cover point-of-care detection devices, microfluidic or paper-based detection devices, new materials for making detection devices, and others

The Role of the Inflammatory Response in Burn Injury

Burns are characterised by significant local swelling and redness around the site of injury, indicative of acute inflammation. Whilst the inflammatory response is fundamental to the healing process, triggering a cascade of cytokines and growth factors to protect against the risk of infection, it is clear that prolonged inflammation can be detrimental and lead to scarring and fibrosis. Severe burns may display chronic, persistent inflammation long after the initial burn injury and may even result in multiple organ failure (MOF) due to systemic inflammatory response syndrome (SIRS). Excessive inflammation in the early stages of healing has been identified as a causative factor in the formation of scars which can be disfiguring, functionally restrictive and may require revisionary surgeries. Therefore, it is imperative that inflammation is effectively managed following burn injuries in order to optimise the benefits it provides whilst actively preventing the complications of inflammation including SIRS, multiple organ failure (MOF) and the development of scarring and fibrosis. Reviewing the current knowledge about the role of the inflammatory response in burns and the treatments available for the management of inflammation during wound healing, highlights the importance of continued research into understanding and developing new approaches to regulate inflammatory responses post-burn injuries

2019 Graduate Medical Education Research Day Compendium

Anyone engaged in research knows that the process can be daunting. Add the rigors of training in a graduate medical education program to this, and it might seem all but impossible to accomplish anything meaningful. However, the individuals highlighted in our 2019 Graduate Medical Education Research Day Compendium were able to overcome those odds. Their abstracts are showcased here and their efforts to advance the collective knowledge in their respective fields are commendable. We thank these Resident and Fellow Physicians and all who have supported them in their endeavors to reach this point with their research. Most of all, we encourage their great work to continue in the spirit of intellectual curiosity that will lead everyone into a better tomorrow

Quality Assurance Project to Implement Audiovisual Distraction in Pediatric Radiation Oncology

abstract: Approximately 15,270 children were diagnosed with cancer last year and a common treatment includes daily radiation therapy. Children must remain immobilized for the planning and treatment to ensure the radiation beam precisely delivers radiation to the tumor and reduces exposure to the normal surrounding tissue. Radiation therapy may last several weeks, which requires children to be put under daily anesthesia for an extended length of time to ensure immobilization. The risks for anesthesia include airway obstruction, broncho/laryngospasm, oxygen desaturation, apnea, nausea/vomiting, hypothermia, hypotension, hypoxia, cardiac arrest, sepsis due to central line access, and death. The relationship between daily anesthesia administration and neurotoxicity is currently unclear. The purpose of audiovisual distraction (AVD) during radiation therapy was to decrease anesthesia exposure, improve quality of life, and decrease anxiety of patients and families. A plan to implement an AVD device at the time of radiation planning and during daily treatments was conducted in a large pediatric radiation oncology practice in Arizona. Inclusion criteria were children needing radiation, between the ages of 5 and 15, who do not have history or complaint of visual impairment, who have the ability to follow directions for AVD, and were deemed candidates by the Radiation Oncologist and Child Life Specialist through physical and mental assessment. Data collection included anesthesia requirements, heart rate, PedsQL Tool, and time in treatment room gathered at the planning session and at the end of treatment. Microsoft SPSS was used for data analysis. Descriptive statistics were used to describe the sample and outcome variables. The aggregated data was analyzed to ascertain if the number of children in the inclusion age range had a decreased need for anesthesia, decreased anxiety, and increased quality of life. The primary outcome for the AVD was: all four children who participated were able to undergo radiation therapy without the need for anesthesia . The children were able to remain awake for treatment could attend school, as permissible, eat before treatment, and spend significantly less time at the treatment facility. The concern of repetitive anesthesia and neurotoxicity will not be a factor in the child’s long term late effects of treatment. The reduction of need on anesthesia staff and nursing staff was estimated to save over 500,000 dollars for the 89 treatments the four children underwent with the AVD. The benefits of the intervention not only provided a better treatment experience for all children, but it allowed the facility to utilize the treatment machine more efficiently, providing radiation therapy as an option to even more patients

The Impact of Diabetes Mellitus on Burns and Standard Burn Treatments

Burns are complex injuries that trigger the stress response and result in increased blood glucose. Diabetes mellitus, an endocrine disorder with abnormal glucose regulation, can significantly alter the risk for burns and the treatment of burns. Pre-existing diabetes mellitus complicates burn treatments and healing ability. Diabetes mellitus may also develop directly from an unregulated stress response to the burn. The consideration of diabetes mellitus affects wound care, medications, and nutrition for burn patients. As patient advocates, nurses are responsible for caring for burn patients with awareness of endocrine complications. This paper provides a detailed overview of the pathophysiology, complications, and treatments of burns in relation to the adult population with diabetes mellitus to provide evidence-based care to critically ill patients

Identification of nursing problems of maintenance of oxygen supply and fluid and electrolyte balance

Thesis (M.S.)--Boston Universit

Therapeutic touch for healing acute wounds

Background Therapeutic Touch (TT) is an alternative therapy that has gained popularity over the past two decades for helping wounds to heal. Practitioners enter ameditative state and pass their hands above the patient’s body to find and correct any imbalances in the patient’s ’life energy’ or chi. Scientific instruments have been unable to detect this energy. The effect of TT on wound healing has been expounded in anecdotal publications. Objectives To identify and review all relevant data to determine the effects of TT on healing acute wounds. Search methods For this fourth update, we searched The Cochrane Wounds Group Specialised Register (searched 27 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1); Ovid MEDLINE (2010 to January Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 26, 2012); Ovid EMBASE (2010 to 2012 Week 03); and EBSCO CINAHL (2010 to January 6 2012). Selection criteria All randomised or quasi-randomised controlled trials, which compared the effect of TT with a placebo, another treatment, or no treatment control were considered. Studies which used TT as a stand-alone treatment, or as an adjunct to other therapies, were eligible. Data collection and analysis One author (DO’M) determined the eligibility for inclusion of all trials in the review. Both authors conducted data extraction and evaluation of trial validity independently. Each trial was assessed using predetermined criteria. Main results No new trials were identified for this update. Four trials in people with experimental wounds were included. The effect of TT on wound healing in these studies was variable. Two trials (n = 44 & 24) demonstrated a significant increase in healing associated with TT, while one trial found significantly worse healing after TT and the other found no significant difference. All trials are at high risk of bias. Authors’ conclusions There is no robust evidence that TT promotes healing of acute wounds