Nursing care of patients on corticosteroid pulse therapy

Introduction: Intravenous pulse therapy with corticosteroidinvolves administration of high doses (starting from 1 g /day), givenon three or more consecutive days. Because of possible adverseeffects, it is recommended that patients stay at hospital duringadministration of pulse therapy. Monitoring of vital signs can earlyidentify these adverse effects and allow efficient interventionassuring patient’s safety. Uniform nursing care is necessaryconsidering the responsibility of the nursing team regarding drugadministration and follow-up of patients. Objective: To identifythe most important nursing care issues to inpatients undergoingcorticosteroid pulse therapy. Methods: Bibliographic searchin databases, books, articles in endocrinology, pharmacy andnursing journals; discussions with experts in neurology, transplantand pharmacy. Results: Side effects during corticosteroid pulsetherapy may occur as soon as infusion starts. An instrument wasdesigned to monitor such effects and systematize nursing care.Conclusions: Systematized nursing care during corticosteroidpulse therapy leads to early identification of possible complicationsand intervention to minimize them

Low compliance with alcohol gel compared with chlorhexidine for hand hygiene in ICU patients: results of an alcohol gel implementation program

Although the introduction of alcohol based products have increased compliance with hand hygiene in intensive care units (ICU), no comparative studies with other products in the same unit and in the same period have been conducted. We performed a two-month-observational prospective study comparing three units in an adult ICU, according to hand hygiene practices (chlorhexidine alone-unit A, both chlorhexidine and alcohol gel-unit B, and alcohol gel alone-unit C, respectively). Opportunities for hand hygiene were considered according to an institutional guideline. Patients were randomly allocated in the 3 units and data on hand hygiene compliance was collected without the knowledge of the health care staff. TISS score (used for measuring patient complexity) was similar between the three different units. Overall compliance with hand hygiene was 46.7% (659/1410). Compliance was significantly higher after patient care in unit A when compared to units B and C. On the other hand, compliance was significantly higher only between units A (32.1%) and C (23.1%) before patient care (p=0.02). Higher compliance rates were observed for general opportunities for hand hygiene (patient bathing, vital sign controls, etc), while very low compliance rates were observed for opportunities related to skin and gastroenteral care. One of the reasons for not using alcohol gel according to health care workers was the necessity for water contact (35.3%, 12/20). Although the use of alcohol based products is now the standard practice for hand hygiene the abrupt abolition of hand hygiene with traditional products may not be recommended for specific services