Nursing2008 Volume 38, Number 3 NEWS I UPDATES I RESEARCH

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OCCUPATIONAL EXPOSURE Nursing: Hazardous to your health? In an online survey, researchers examined health risks to nurses who are regularly exposed to med- ications, cleaning and sterilization chemicals, and radiation. Focusing on 11 common expo- sure hazards, they polled 1,500 nurses from all 50 states working in various types of facilities. Here are some key findings: • Nurses exposed to any type of drug at least once a week for 10 years or more (considered high exposure) had a 14% increase in cancer incidence. • Nurses with a similar level of exposure to antineoplastic drugs had a 40% increase in cancer risk. • Nurses with high exposure to disinfecting and ster- ilizing chemicals and latex were 50% more likely to have asthma, compared with those with little or no Y E

S exposure. N I R

T • Pregnant nurses with high exposure to ethylene L E

A oxide (a sterilizing agent) and antineoplastic drugs H C I reported a 20% higher incidence of miscarriage. M Y B

S Pregnant nurses who had high exposure to sterilizing N O I

T agents and anesthetic gases and who carried to term were The survey was conducted by the Environmental Working A R T

S seven to nine times more likely to have children with muscu- Group (EWG) and Health Care without Harm. For more infor- U L L

I loskeletal birth defects. mation, visit EWG’s Web site, http://www.ewg.org.

DEFIBRILLATION data from a national registry teristics associated with de- hospital discharge: 22% for Delays cost lives of 369 hospitals. The registry layed defibrillation included delayed defibrillation versus included 6,789 cases of car- black race, a noncardiac ad- 39% for defibrillation within Almost one-third of hospital- diac arrest from ventricular mitting diagnosis, smaller 2 minutes. Every minute of ized patients who go into fibrillation or pulseless ven- hospitals (fewer than 250 delay was associated with cardiac arrest don’t receive tricular tachycardia. The beds), unmonitored hospital worsening survival chances. defibrillation within the overall median time to defi- units, weekends, and the pe- To speed up response times, recommended 2 minutes, brillation was 1 minute, but riod from 5 p.m. to 8 a.m. lead researcher Paul S. Chan, new study results show. Re- 2,045 patients (30%) experi- Delayed defibrillation was MD, recommends providing searchers tracked response enced delayed defibrillation linked to a significantly lower more automated external times and outcomes using (2 minutes or more). Charac- probability of surviving to defibrillators throughout hos-

www.nursing2008.com March | Nursing2008 | 27 R clinicalS O U N D pitals so nurses and other staff Researchers mailed a sur- SURVEY RESPONSES trained in basic life support vey to 119 Veterans Adminis- can readily use them. Using tration (VA) hospitals and 600 Double-checking drug calculations wireless technology to monitor other hospitals with an inten- Nurses who recently visited our Web site patients would also help. sive-care unit and 50 or more answered this question: Source: Chan PS, et al., Delayed time to hospital beds. Survey ques- Do you routinely have another nurse independently defibrillation after in-hospital cardiac arrest, tions explored practices to The New England Journal of Medicine, double-check your calculations before you January 3, 2008. prevent hospital-acquired administer a high-alert medication? UTIs and other device- associated infections. Yes 89 % PREVENTING UTIs In all, 56% of responding Hospitals lack hospitals had no system for No 11% monitoring which patients Total responses: 794 simple strategies had urinary catheters, and 74% of hospitals didn’t moni- Visit http://www.nursingcenter.com/poll to answer our monthly survey question and view results from other surveys. Researchers have found that tor the duration of catheter fewer than 10% of hospitals placement. Nearly one-third use a strategy proven to re- of hospitals didn’t track UTI der scanners, 30% VA facilities to use reminders duce rates of catheter-related rates in patients. • condom catheters, 14% to prompt removal of unneed- urinary tract infections Various practices that can • catheter removal reminders, ed catheters. (UTIs): a daily reminder for a be used to prevent UTIs were 9%. Researchers conclude that patient’s primary care pro- underutilized by the facilities Despite having a standard- despite the clear link between vider to consider removing surveyed, as follows: ized electronic medical order urinary catheters and UTIs, urinary catheters, which are • antimicrobial urinary entry system, VA hospitals no strategy has been widely strongly associated with UTIs. catheters and portable blad- were no more likely than non- adopted to address the prob- lem. They urge hospitalized patients with urinary catheters to ask their primary care ETHICAL DILEMMAS provider or nurse every day if “Moral distress” drives nurses from hospitals they still need it. Source: Saint S, et al., Preventing hospital- A quarter of nurses and social workers report when they can’t balance these and other fac- acquired urinary tract infections in the experiencing moral distress that tors with a hospital’s bottom line. United States: A national study, Clinical Infectious Diseases, January 15, 2008. makes them want to leave their Nurses also reported inade- current positions, according to a quate institutional support for study from the University of handling ethical decisions and Pennsylvania School of a perception of little respect NURSES IN THE MEDIA Nursing. In a survey of 1,215 for their profession. Only Tarnished images, nurses and social workers 58% of respondents report- plus a few gems from California, Maryland, ed that “my profession and Announcing its fifth annual Massachusetts, and Ohio, physicians respect each Golden Lamp Awards, the almost two-thirds of other.” Center for Nursing Advocacy respondents said they face Researchers suggest highlighted the best and worst media portrayals of ethical issues over which that facilities invest in nurses in 2007. Here are they have no control. Issues that ethics resources and work to some highlights. cause moral distress revolve around establish a climate of respect Worst portrayals protecting patients’ rights, support- for the contributions of nurs- • “Grey’s Anatomy” consis- ing them through end-of-life deci- es and social workers in ethical tently showed physicians giv- ing all significant health care sions, and fairly distributing decision making to help improve while nurses are peripheral resources. Nurses report feeling distress job satisfaction and reduce turnover. subordinates. Source: Ulrich C, et al., Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the • “Private Practice,” a new United States, Social Science and Medicine, October 2007. television drama featuring

28 | Nursing2008 | March www.nursing2008.com wide-eyed midwifery student can’t distinguish between Dell Parker, described as strains of staph bacteria. In ANTIMICROBIAL AGENTS perhaps the least knowl- 2 hours, the BD GeneOhm Has stainless steel lost its luster? edgeable major nurse char- StaphSR Assay can detect Laboratory research suggests that copper and copper alloys acter in recent prime-time both MRSA and S. aureus. In history. clinical trials at five locations, inhibit bacteria far better than stainless 1 • Kelly Ripa. In a broadcast the new test identified 100% steel at room temperature. Now, a feder- of “LIVE with Regis and of specimens infected with ally funded study will test the Kelly,” Ripa suggested that MRSA and more than 98% hypothesis in hospital settings. she would act as an erotic with S. aureus. A series of three trials will be “sponge bath nurse” to help The manufacturer, BD conducted at Memorial Sloan- cohost Regis Philbin recover Diagnostics, has submitted Kettering Cancer Center in from open-heart surgery. applications to expand rapid New York City and two Best portrayals testing to nasal swabs and facilities in • John Blanton, “There and wound specimens, and is Charleston, South Back Again.” Formerly an edi- developing rapid assays Carolina. tor for The Wall Street Journal, to identify vancomycin- Blanton resigned from the pa- resistant enterococ- The goal is per and became a nurse in a ci and the toxin to determine if post-9/11 search for meaning. gene associated replacing stainless His article focuses on the with Clostridium steel with copper, brass, and crushing workload and fear of difficile. bronze surfaces will inhibit error he experienced as a new microbial growth, decrease burn unit nurse. cross-contamination, and reduce • Rachel Gotbaum, “Nursing hospital-acquired infections. a Shortage: Inside Out.” In related news, two newly Broadcast on National Public approved products incorporate antimicro- Radio, this documentary ex- HEALTH TRENDS bial substances to prevent infections: amined the causes and effects GERD by the of the nursing shortage, as • The Agento IC silver-coated endotracheal tube (C.R. Bard, well as possible solutions. numbers Inc.) is indicated for patients who are intubated for more The Center gave an honor- New data show that total than 24 hours. The new tube elutes silver ions, inhibiting able mention to the televi- hospitalizations with either a microbial growth and reducing the risk of ventilator- sion drama “ER,” described primary or secondary gastro- associated pneumonia, according to the manufacturer. as the only drama to make a esophageal reflux disease • The V-link Luer-activated device with VitalShield protec- real effort to show what (GERD) diagnosis increased tive coating (Baxter) is the first needless intravenous con- nurses do. by 216% between 1998 and nector containing an antimicrobial coating. This device has To see all the 2007 Golden 2005. During the study pe- been shown to kill 99.9% of common pathogens known to Lamp Awards, go to http:// riod, adult hospitalizations cause bloodstream infections, including MRSA, according to www.nursingadvocacy.org. for primary GERD decreased the manufacturer. by 2.4%, but pediatric stays 1. Noyce JO, et al. Potential uses of copper surfaces to reduce survival of epi- with a primary GERD diagno- demic methicillin-resistant Staphylococcus aureus in the healthcare environ- sis increased by 42% for in- ment. Journal of Hospital Infection. July 2006. FAST NEW TEST fants and 84% for children Detecting MRSA in ages 2 to 17. Researchers speculate that just 2 hours the decrease in adult hospital- is the increase in obesity, Quality used data from the The first rapid blood test to izations may reflect wider use which has been linked to Healthcare Cost and detect methicillin-resistant of medications to manage GERD. Between 1996 and Utilization Project 1998 and Staphylococcus aureus (MRSA) GERD in adults. For example, 2004, the number of hospital- 2005 Nationwide Inpatient received Food and Drug Ad- in 2004, 27% of older adults izations with obesity diag- Sample.‹› ministration approval in Jan- on Medicare were using GERD noses increased by 112%. Source: Zhao Y, Encinosa W, Gastro- esophageal reflux disease (GERD) hospital- uary. Previously available medications, such as antacids To conduct this study, izations in 1998 and 2005, Statistical brief tests take between 24 and and antisecretory agents. researchers from the Agency #44, Healthcare cost and utilization pro- ject, Agency for Healthcare Research and 72 hours to yield results and A countervailing influence for Healthcare Research and Quality, January 2008. www.nursing2008.com March | Nursing2008 | 29