Nursing considerations to complement the Surviving Sepsis Campaign guidelines

Abstract

This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent repository link Financial supportThis project was conducted under the auspices of the World Federation of Critical CareNurses (WFCCN), and no sponsorship or funding was received for this project. NURSING CONSIDERATIONS TO COMPLEMENT THE SURVIVING SEPSIS CAMPAIGN GUIDELINES ABSTRACTObjective: To provide a series of recommendations, based on the best available evidence, to guide clinicians providing nursing care to patients with severe sepsis.Design: Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among entire group to achieve consensus.Methods: We used the Surviving Sepsis Campaign Guidelines (SSC) as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade1indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors a process of electronic discussion of all evidence was undertaken until consensus was reached.This process was conducted independently of any funding.Results: Sixty-three recommendations relating to the nursing care of severe sepsis patients are

Implications of the New International Sepsis Guidelines for Nursing Care

“…Infection prevention measures relate to accountability, education, surveillance of nosocomial infection, hand hygiene, and prevention of respiratory, central catheter-related, surgical site, and urinary tract infections. 17 Although the literature indicates that the incidence of antimicrobial resistance does not change appreciably with current selective digestive decontamination regimens, [18][19][20] the use of oral chlorhexidine gluconate is relatively easy, decreases the risk of nosocomial infection, and reduces potential concern over promotion of antimicrobial resistance by selective digestive decontamination regimens. …”

“…In addition, oropharyngeal decontamination with oral chlorhexidine gluconate is suggested to reduce the risk of ventilator-associated pneumonia in ICU patients with severe sepsis (grade 2B). 1 An outline of infection prevention measures as a prime area of focus of nursing care in patients at risk for infection potentially leading to sepsis has been provided in "Nursing Considerations to Complement the surviving sepsis Campaign," 17 the companion document to the 2008 surviving sepsis Campaign guidelines. Critically ill patients are at high risk of acquiring a hospital-associated infection because of the presence of invasive catheters and tubing, drains and tubes, wounds, and other complex therapies they receive.…”

Sepsis: implication for nursing

“…Endotracheal suctioning (if necessary) hurts, prolonged immobilization and routine care are painful, and general intense discomfort of vague origin is common in critical illness; 19,20 pain is one of major issue in sepsis and requires a continuous monitoring; 8 v) observing the patient: to perform halfhourly observations of vital signs and hourly measurement of urinary output; 5,7 vi) considering patient and family comfort/care: to promote patient comfort/pain relief/sedation/turning/skin care; provide patient and family teaching; address needs of families of critically ill patients. 2 We can also consider these recommendations like the interventions for the main nursing diagnoses identified in patients with sepsis in 2014: 21 the main nursing diagnoses, described according to the NANDA-I taxonomy are: risk for infection, risk for aspiration, risk for impaired skin integrity, impaired skin integrity, impaired spontaneous ventilation, impaired gas exchange.…”

“…Expert nurses with advanced skills are needed to identify patients with deterioration of clinical status and to ensure appropriate assistance to patients with sepsis. 2 A study performed in 2011, 2 identified sixty-three recommendations to guide clinical nurses who care for patients with sepsis. The macro subjects are: -Prevention of infection: the subject is education of staff which happens to be the first step (fundamental) to raise awareness of the problem and implement strategies for preventing infection, the accountability which results in the promotion of a culture of patient safety, the continuous surveillance of nosocomial infections, washing hands as evidence suggests that a proper hand washing reduces the rate of infections or alternatively the use of hydro-alcoholic gel and the proper use of those devices that can be vehicles of infection (e.g., mechanical ventilation patients, venous catheter-related infections, surgical-site infections and urinary tract infections).…”

Recent Advances in Multidisciplinary Critical Care

“…[58][59][60][61] It has been hypothesized, however, that semirecumbent positioning puts patients at risk for pressure ulcers. In an open, prospective, randomized cross-over trial, the interface pressure was measured over distinct body positions by using a pressure-mapping device.…”