nursing.elitecme.com Page 145 Complete Your CE Test Online - Click Here Inpatient nurses Patients admitted to the intensive care unit directly from the emergency department with a severe form of sepsis have a 26% mortality rate, compared to a 40.3% mortality rate when admitted from the floor (Levy et al., 2014). These facts demonstrate the need for better and more frequent screening to identify sepsis in patients who have been admitted to the floor rather than the intensive or coronary care unit. The difference in mortality rates between those patients admitted directly to the ICU versus those transferred from the floor may be secondary to a more complex clinical picture that includes surgical or comorbid medical conditions that may make diagnosis more challenging (Yealy et al., 2015). The nurse-to-patient ratio on the floor may also be a factor, as caring for more patients makes it difficult for the nurse to closely monitor the patient and recognize early changes in the patient and respond in a timely fashion. Screening tools can be useful for all nurses to help identify the development of sepsis and may be helpful to remind nurses to be aware of signs and symptoms of infection, worsening infection, and sepsis. Programs that promote the importance of routine daily monitoring for infection that may eventually lead to sepsis can also be of value. It is useful for nurses to perform a daily or per shift assessment for the presence of a productive cough and infection of common sites, including invasive sites, surgical sites, and wounds (Schorr et al., 2016). Floor nurses who have aides collecting vital signs need to make sure that abnormal vital signs are reported to the nurse immediately. Nurses should monitor daily for improvement or deterioration of health status for a patient with a known infection (Schorr et al., 2016). Nurses who are aware, educated, and vigilant about screening for sepsis in their patients may help reduce the mortality associated with later diagnosis and treatment. Responsibilities of inpatient nurses ● ● Monitor for infection. ● ● Report signs and symptoms of infection or worsening infection. ● ● Ensure that aides who collect vital signs report abnormalities directly to the nurse. ● ● Be aware, educated, and vigilant about sepsis. EBP alert! It is important for all nurses to know if their place of employment has a protocol in place for the screening and treatment of sepsis. Studies have shown a significant decrease in mortality related to early recognition of sepsis using a screening tool (Moore et al., 2009; Sawyer et al., 2011). Responsibilities of all nurses ● ● Become familiar with personal stories of sepsis that can be found at https://rorystauntonfoundationforsepsis.org/our-sepsis-stories/. ● ● Be educated on sepsis signs and symptoms and updates on treatments. ● ● Spread awareness of sepsis to coworkers and the community. ● ● Communicate effectively with other members of the health care team. If there is a concern about a patient, express that concern with the physician, nurse manager, or other nurses during a shift change. Be the patient’s advocate; tell the team you are concerned about sepsis in the patient. ● ● Ensure proper precautions are followed to help prevent the spread of nosocomial infections. ● ● Educate patients, families, and community members about sepsis. Prevention of nosocomial or health care-associated infection Nurses are a crucial force in the prevention of sepsis and can help to decrease the incidence of nosocomial or health care-associated infections by using universal precautions and by educating patients, families, and coworkers on ways to prevent infection and the spread of infection. Following are general recommendations for prevention of the spread of nosocomial infections (Mehta et al., 2014): ● ● Assess patients for the need for isolation precautions; all ICU patients should be screened for the following: ○ ○ Neutropenic or immunological disorder. ○ ○ Diarrhea. ○ ○ Skin rashes. ○ ○ Known communicable diseases. ○ ○ Known carriers of an epidemic bacteria—such as methicillin- resistant staphylococcus aureus, vancomycin-resistant Enterococci, glycopeptide-resistant staphylococcus aureus, extended-spectrum lactamase producing enterobacteriaceae, multidrug-resistant nonfermenting gram-negative bacteria, and clostridium difficile—may pose a potential threat to patients in their vicinity. ● ● Identify patients who are at risk for developing nosocomial infection including those patients who have the following: ○ ○ Age older than 70 years. ○ ○ Shock. ○ ○ Major trauma. ○ ○ Acute renal failure. ○ ○ Coma. ○ ○ Prior antibiotics. ○ ○ Mechanical ventilation. ○ ○ Drugs affecting the immune system (steroids, chemotherapy). ○ ○ Indwelling catheters. ○ ○ Prolonged ICU stay (> 3 days). Standard precautions should be followed with every patient (Mehta et al., 2014). Gloves ● ● Sterile gloves should be worn after hand hygiene procedure while touching mucous membranes and nonintact skin and performing sterile procedures, such as arterial, central line, and Foley catheter insertion. ● ● Clean nonsterile gloves are safe for touching blood, other body fluids, contaminated items, and any other potentially infectious materials. ● ● Change gloves between tasks and procedures in the same patient, especially when moving from a contaminated body area to a clean body area. ● ● Never wear the same pair of gloves for the care of more than one patient. ● ● Remove gloves after caring for a patient. ● ● Practice hand hygiene whenever gloves are removed. Gown ● ● Wear a gown to prevent soiling of clothing and skin during procedures likely to generate splashes of blood, body fluids, secretions, or excretions. ● ● The sterile gown is required only for aseptic procedures; for the rest, a clean nonsterile gown is sufficient. ● ● Remove the soiled gown as soon as possible, with care to avoid contamination.