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Environment and Patient Safety in Intensive Care Units

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 34330

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Prof. Dr. Wioletta Mędrzycka-Dąbrowska

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Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
Interests: pain; delirium; ICU; resuscitation; sleep; safety
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Special Issue Information

Dear Colleagues,

According to the World Health Organization statistics, one in ten patients admitted to health care centers suffers health damage that may be caused by a wide range of errors or adverse events.

Improving the quality and safety of intensive care unit (ICU) care worldwide is an important challenge for the future.

Knowledge of the safe handling of medical equipment extensively used in ICU will minimize the risk of mistakes. This includes, in particular, monitoring devices, thanks to which we can control vital parameters and observe a patient's condition. Conscious management of technology and discussing errors associated with it will increase the quality of care. Collection of adverse events through rigorous analysis is vital in order to identify and correct systematic errors.

The monitoring of patient safety has the purpose of ensuring proper management and achieving the best outcomes. Among the essential steps to improve patient safety is the development of patient safety culture.

The complexity of care within the ICU requires health care professionals to exhibit a transdisciplinary level of competency. Critical care teams should follow evidence-based guidelines that encourage the use of standardized process measures for managing ICU patient populations. The appropriate ICU environment allows for faster patient regeneration. Environmental factors may trigger sleep disorders and the occurrence of delirium, which in turn prolong a patient's stay in the ICU. This affects the occurrence of complications resulting from long-term immobilization and slows down the process of returning to life from before the disease.

This Special Issue is open to all patient-related topics in the intensive care unit. We are particularly interested in original research and systematic reviews that address insufficiently researched problems concerning the patient environment in the ICU.

Dr. Wioletta Mędrzycka-Dąbrowska
Guest Editor

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Keywords

care bundles
infection control
sleep
delirium
resuscitation
medical device safety
conflict

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Published Papers (8 papers)

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Research

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15 pages, 537 KiB

Open AccessArticle

The Perception of the Patient Safety Climate by Health Professionals during the COVID-19 Pandemic—International Research

by Justyna Kosydar-Bochenek, Sabina Krupa, Dorota Religa, Adriano Friganović, Ber Oomen, Elena Brioni, Stelios Iordanou, Marcin Suchoparski, Małgorzata Knap and Wioletta Mędrzycka-Dąbrowska

Int. J. Environ. Res. Public Health 2022, 19(15), 9712; https://doi.org/10.3390/ijerph19159712 - 6 Aug 2022

Cited by 7 | Viewed by 3168

Abstract

The patient safety climate is a key element of quality in healthcare. It should be a priority in the healthcare systems of all countries in the world. The goal of patient safety programs is to prevent errors and reduce the potential harm to patients when using healthcare services. A safety climate is also necessary to ensure a safe working environment for healthcare professionals. The attitudes of healthcare workers toward patient safety in various aspects of work, organization and functioning of the ward are important elements of the organization’s safety culture. The aim of this study was to determine the perception of the patient safety climate by healthcare workers during the COVID-19 pandemic. Methods: The study was conducted in five European countries. The Safety Attitude Questionnaire (SAQ) short version was used for the study. A total of 1061 healthcare workers: physicians, nurses and paramedics, participated in this study. Results: All groups received the highest mean results on the stress recognition subscale (SR): nurses 98.77, paramedics 96.39 and physician 98.28. Nurses and physicians evaluated work conditions (WC) to be the lowest (47.19 and 44.99), while paramedics evaluated perceptions of management (PM) as the worst (46.44). Paramedics achieved statistically significantly lower scores compared to nurses and physicians in job satisfaction (JS), stress recognition (SR) and perception of management (PM) (p < 0.0001). Paramedics compared to nurses and physicians rank better in working conditions (WC) in relation to patient safety (16.21%). Most often, persons of lower seniority scored higher in all subscales (p = 0.001). In Poland, Spain, France, Turkey, and Greece, healthcare workers scored highest in stress recognition (SR). In Poland, Spain, France, and Turkey, they assessed working conditions (WC) as the worst, while in Greece, the perception of management (PM) had the lowest result. Conclusion: Participant perceptions about the patient safety climate were not at a particularly satisfactory level, and there is still a need for the development of patient safety culture in healthcare in Europe. Overall, positive working conditions, good management and effective teamwork can contribute to improving employees’ attitudes toward patient safety. This study was carried out during the COVID-19 pandemic and should be repeated after its completion, and comparative studies will allow for a more precise determination of the safety climate in the assessment of employees. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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16 pages, 754 KiB

Open AccessArticle

Development of a Tool for Measuring Ventilator-Associated Pneumonia Prevention Behaviors of Intensive Care Unit Nurses

by Sungjung Kwak and Sujeong Han

Int. J. Environ. Res. Public Health 2022, 19(14), 8822; https://doi.org/10.3390/ijerph19148822 - 20 Jul 2022

Cited by 2 | Viewed by 4937

Abstract

Introduction: Ventilator-associated pneumonia (VAP) lengthens intensive care unit (ICU) stays and increases medical expenses and mortality risk. Aim: We aimed to develop and validate a tool for measuring VAP prevention behaviors among ICU nurses. Method: This is a methodological study that included a tool development step, based on the procedure suggested by DeVellis, and a tool verification step. Results: Through a literature review and focus interviews, 35 preliminary items were selected. After a content validity examination by experts and a pre-test, 30 items were chosen for this study. In the testing phase of the main survey, the final version tool was used on 452 ICU nurses to assess validity and reliability. From factor analysis, 7 factors and 17 items were selected. The factors included aspiration prevention, ventilator management, oral care, suction system management, subglottic suction, spontaneous awakening trials and spontaneous breathing trials, and standard precautions. The total determination coefficient was 71.6%. These factors were verified using convergent, discriminant, and concurrent validity tests. Internal consistency reliability was acceptable (Cronbach’s α = 0.80); thus, the VAP prevention behavior measurement tool was proven valid and reliable. Conclusions: This tool can be used with ICU nurses to measure behaviors associated with VAP prevention and, in turn, VAP prevention measures can be improved. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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10 pages, 1321 KiB

Open AccessArticle

Feasibility of Chest Wall and Diaphragm Proprioceptive Neuromuscular Facilitation (PNF) Techniques in Mechanically Ventilated Patients

by Tomasz Zwoliński, Magdalena Wujtewicz, Jolanta Szamotulska, Tomasz Sinoracki, Piotr Wąż, Rita Hansdorfer-Korzon, Andrzej Basiński and Rik Gosselink

Int. J. Environ. Res. Public Health 2022, 19(2), 960; https://doi.org/10.3390/ijerph19020960 - 15 Jan 2022

Cited by 5 | Viewed by 4836

Abstract

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to verify whether the technique using resistance during the patient’s inhalation will have a different effect than the technique used to teaching the correct breathing patterns. Methods: Patients admitted to tertiary ICU were enrolled in this study, randomly divided into two groups, and received four 90-second manual breathing stimulations each. The following vital signs were assessed: HR, SBP, DBP, and SpO₂. Results: 61 MV ICU adult patients (mean age 67.8; 25 female and 36 male) were enrolled in this study. No significant differences in HR, SBP, and DBP were observed both for two techniques measured separately and between them. Statistically significant differences were noticed analysing SpO₂ in the rhythmic initiation technique (RIT) group (p-value = 0.013). Conclusions: Short-term PNF interventions did not influence clinically relevant vital parameters among MV patients and seem to be feasible in this group of ICU patients. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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11 pages, 852 KiB

Open AccessArticle

Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial

by Magdalena Napiórkowska-Orkisz, Aleksandra Gutysz-Wojnicka, Mariola Tanajewska and Iwona Sadowska-Krawczenko

Int. J. Environ. Res. Public Health 2022, 19(2), 870; https://doi.org/10.3390/ijerph19020870 - 13 Jan 2022

Cited by 14 | Viewed by 4548

Abstract

Aim: The aim of the study was to assess the severity of pain experienced by a newborn during a heel puncture for screening using the Newborn Pain Scale (NIPS), measure the heart rate and compare the effectiveness of non-pharmacological methods of pain control. Design: Randomized clinical trial. No experimental factors. The test was performed during routine screening. Surroundings: Provincial Specialist Hospital in Olsztyn. Patients/Participants: Pain was assessed in 90 full-term newborns. The newborns were rooming in with their mothers in the hospital. Interventions: Newborns were divided into three groups. Three different methods of pain relief were used: breastfeeding, 20% glucose administered orally and non-nutritional sucking. Main Outcome Measures: The primary pain outcome was measured using the NIPS and the secondary pain outcome measures (heart rate, oxygen saturation) were measured using a pulse oximeter. Results: During capillary blood sampling from the heel, most newborns, n = 56 (62.2%), experienced no pain or mild discomfort, severe pain occurred in n = 23 (25.6%) and moderate pain occurred in n = 11 (12.2%). No significant statistical differences were found between the degree of pain intensity and the intervention used to minimize the pain p = 0.24. Statistically significant relationships were demonstrated between heart rate variability and the degree of pain intensity (p = 0.01). There were no statistically significant differences between the newborn’s pain intensity and the mother’s opinion on the effectiveness of breastfeeding in minimizing pain. Conclusions: This study did not answer the question of which pain management method used during the heel prick was statistically more effective in reducing pain. However, the results indicate that each of the non-pharmacological interventions (breastfeeding, oral glucose dosing and non-nutritive sucking) applied during heel puncture resulted in effective pain management in most of the newborns enrolled in the study. The relationship between heart rate variability and the severity of pain was confirmed. Mothers of newborns in the breastfeeding group were satisfied with the pain relief methods used in the child and the opportunity to console their newborn during painful procedures in a technologically invasive environment. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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9 pages, 318 KiB

Open AccessArticle

Assessment of Knowledge on the Prevention of Central-Line-Associated Bloodstream Infections among Intensive Care Nurses in Poland—A Prospective Multicentre Study

by Danuta Dyk, Agata Matusiak, Edyta Cudak, Aleksandra Gutysz-Wojnicka and Wioletta Mędrzycka-Dąbrowska

Int. J. Environ. Res. Public Health 2021, 18(23), 12672; https://doi.org/10.3390/ijerph182312672 - 1 Dec 2021

Cited by 5 | Viewed by 4183

Abstract

The presence of a central venous catheter (CVC) leads to a high risk of blood infections, which are considered major causes of morbidity, mortality and high medical costs. The aim of this study was to assess the knowledge of nursing staff working in intensive care units (ICUs) regarding the prevention of central-line-associated bloodstream infections (CLABSIs). A nationwide survey was conducted among ICU nurses from August 2016 to April 2017. A modified Polish version of the questionnaire developed by Labeau et al. was used to assess the nurses’ knowledge. Of the 750 questionnaires distributed, 468 were returned. Women accounted for 95.73% of all respondents, and over 80% were university educated. Most of the nurses surveyed (85.9%) had previously received training in CVC guidelines, and thus over 82% rated their knowledge as good or very good. The guidelines introduced in hospitals were the main declared sources of information. In addition, more than half (68%) of respondents also knew the international guidelines. The knowledge of nursing staff in the study area is not sufficient. Studies show that the guidelines for the prevention of CLABSIs in ICUs should be standardized, and continuous training of personnel in this field should be provided. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

11 pages, 340 KiB

Open AccessArticle

The Polish Version of the Nursing Delirium Screening Scale (NuDESC PL)-Experience of Using in Nursing Practice in Cardiac Surgery Intensive Care Unit

by Sabina Krupa, Ozga Dorota, Adriano Friganovic, Wioletta Mędrzycka-Dąbrowska and Krzysztof Jurek

Int. J. Environ. Res. Public Health 2021, 18(19), 10108; https://doi.org/10.3390/ijerph181910108 - 26 Sep 2021

Cited by 2 | Viewed by 2479

Abstract

Introduction: Delirium is a common complication of patients hospitalized in Intensive care units (ICU). The risk of delirium is estimated at approximately 80% in intensive care units. In the case of cardiac surgery ICU, the risk of delirium increases due to the type of procedures performed with the use of extracorporeal circulation. The aim of this study was to provide an official translation and evaluation of Nursing Delirium Screening Scale (NuDESC) into Polish. The NuDESC scale is a scale used by nurses around the world to detect delirium at an early stage in treatment. Methods: The method used in the study was the NuDESC tool, which was translated into Polish. The study was conducted by Cardiac ICU nurses during day shift (at 8 a.m.), night shift (at 8 p.m.) and in other situations where the patients showed delirium-like symptoms. Results: Statistically significant differences were observed between the first and second day in the studied group of patients in the case of illusions/hallucinations. Delirium occurred more frequently during the night, but statistical significance was demonstrated for both daytime and nighttime shifts. It was not demonstrated in relation to the NuDESC scale in the case of insomnia disorders. The diagnosis of delirium and disorientation was the most common diagnosis observed in patients on the first day of their stay in the ICU, followed by problems with communication. Delirium occurred on the first day, mainly at night. On the second day, delirium was much less frequent during the night; the biggest problem was disorientation and problems with communication. Conclusion: This study contributed to the development of the Polish version of the scale (NuDESC PL) which is now used as the Polish screening tool for delirium detection. The availability of an easy-to-use nurse-based delirium instrument is a prerequisite for widespread implementation. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

10 pages, 1449 KiB

Open AccessArticle

Evaluation of Capillary Blood Gases in Medical Personnel Caring for Patients Isolated Due to SARS-CoV-2 in Intensive Care Units before and after Using Enhanced Filtration Masks: A Prospective Cohort Study

by Wioletta Mędrzycka-Dąbrowska, Daniel Ślęzak, Marlena Robakowska, Przemysław Żuratyński, Kamil Krzyżanowski, Anna Małecka-Dubiela, Sebastian Dąbrowski, Katarzyna Zorena, Katarzyna Lewandowska, Dorota Ozga, Karina Chmielarz, Paulina Buca and Lucyna Tomaszek

Int. J. Environ. Res. Public Health 2021, 18(18), 9425; https://doi.org/10.3390/ijerph18189425 - 7 Sep 2021

Cited by 3 | Viewed by 2210

Abstract

The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs; (2) adverse symptoms reported by medical personnel after leaving the isolation zone. Design: A Prospective Cohort Study. Methods: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. Results: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p > 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%; p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6; Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05; Cl 95%: 1.01 to 1.08). Conclusion: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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Review

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12 pages, 2938 KiB

Open AccessReview

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

by Marek Szamborski, Jarosław Janc, Joanna Rosińczuk, Jędrzej Jerzy Janc, Patrycja Leśnik and Lidia Łysenko

Int. J. Environ. Res. Public Health 2022, 19(14), 8696; https://doi.org/10.3390/ijerph19148696 - 17 Jul 2022

Cited by 4 | Viewed by 5405

Abstract

Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel. Full article

(This article belongs to the Special Issue Environment and Patient Safety in Intensive Care Units)

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