Universal Treatment for MRSA in ICUs Is More Effective in Preventing Infections

A study published online this week in the New England Journal of Medicine finds that treating all patients in intensive care units (ICU) for drug-resistant MRSA is more effective in preventing bloodstream infections than screening all patients and isolating those who test positive, which is the most common practice.

The study included nearly 75,000 patients in 74 ICUs in 43 hospitals. Researchers found that treating all patients (universal deconolonization) reduced all bloodstream infections, including those caused by bacteria other than MRSA, by 44 percent. The group of patients who were first screened and isolated if they tested positive for MRSA showed no significant decrease in infections and the gruop of patients who were screened and treated for MRSA if they tested positive showed only a 22 percent reduction in infections.

The treatment involved washing patients with cloths containing antimicrobial soap chlorhexidine and giving them mucipirocin, a nasal antibiotic ointment.

The 43 hospitals in the study were all part of Hospital Corporation of America, which is now implementing the protocol in all its hospital ICUs.

The study notes that widespread use of chlorhexidine and mupirocin could engender resistance.

An INQRI-funded study led by David Thompson and Jill Marsteller, published in Critical Care Medicine found that combining several tested and proven practicies for preventing central line associated bloodstream infections (CLABSIs) with a program to improve safety, teamwork and communications, dramatically reduced infection rates.

New Survey: Physicians, Nurse Practitioners Disagree on Nurses’ Role in Providing Primary Care

By Lori Melichar Gadkari, PhD, MA

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit and the program officer for INQRI.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

Solving Many of the United States' Primary Care Challenges

With the Affordable Care Act being upheld earlier this summer, there will a large flux on individuals with insurance coverage that require primary care. As many of our previous blog posts have already discussed, there is already a primary care provider shortage and this shortage is expected to grow even further after 2014.

The most recent Charting Nursing's Future, published by the Robert Wood Johnson Foundation, highlighted how nurses can help solve many of primary care’s most pressing challenges, including access and cost.

Gene Steuerle, writing for his own blog, The Government We Deserve, also focused on the role of nurses in reducing costs while providing the same level, or even better care than physicians for many basic services. Mr. Steuerle, who is a renowned economic and tax expert, argued that the current primary care provider shortage is a result of an uncompetitive industry unwilling to relinquish control over services that many non-physicians have the training and education to provide.

Finally, a collaborative group of scholars published a thorough article in the New England Journal of Medicine, highlighting how our health system can reduce costs while improving care. The utilization of nurses and other allied health professionals was highlighted by the authors as an integral piece of reforming our broken health system.

RN Labor Supply Bubble: What Does it Mean for Rural Health Care?

Over the past year, many studies have predicted that a temporary employment bubble is approaching for Registered Nurses in many urban areas. In response to one of the more recent articles discussing this trend, authored by Staiger, Auerbach, & Buerhaus and appearing in the April edition of the New England Journal of Medicine, the Online Journal of Rural Nursing and Health Care's editor, Pamela Stewart Fahs, DSN, RN, brought up the important question as to how this trend will effect rural nursing. Dr. Fahs discussed how the upcoming labor supply bubble may actually improve rural nursing by making these health care facilities more competitive with their urban counterparts. By having a tougher job market, new nurse graduates may be more willing to relocate than they have been in the past.

To read Dr. Fahs' editorial, click here.

To read more blogposts relating to nursing workforce issues, click here.

Nursing Shortage Is Temporarily Over in U.S. Until 2020

A study recently published in the New England Journal of Medicine has found that the nursing shortage in the United States that led to a decade-long push for more nursing graduates is temporarily over. The study, which was led by Douglas Staiger, an economist at Dartmouth College, highlighted the fact that between 2005 & 2010, the increase in the nursing workforce was the largest of any five-year period during the last 40 years. However, the authors also warn that even larger shortages than previously experienced are projected for 2020 and beyond.

Nicole Ostrow, of Bloomberg News, wrote in great detail about this topic, including interviews with Dr. Staiger and other respected scholars in the nursing workforce field.

Click here to read Ms. Ostrow's article.

Click here to read Dr. Staiger & colleagues' article in NEJM (subscription required).

Click here to read other blogposts relating to nursing shortages.

Nursing Recommendations Highlighted in the New England Journal of Medicine

It is with great pleasure to share two articles featured on the New England Journal of Medicine's website discussing how implementing recommendations made by the IOM's report: "The Future of Nursing: Leading Change, Advancing Health," will have a tremendous impact on how care is delivered in the United States. One of these articles was written by Linda H. Aiken, Ph.D., R.N., an INQRI NAC member.

Dr. Aiken's piece titled, "Nurses for the Future," addresses the importance of both current and future nurses obtaining advanced degrees in order fill the pending gap in nurse faculty, instructors and leadership roles.

Julie A. Fairman, Ph.D., R.N, et al.'s essay titled, "Nurses' Scope of Practice," explains how broadening the scope of nursing practice will increase the effectiveness of primary care while lowering costs.

Click here to access the Intiative for the Future of Nursing website.

Click here to access Monday's blogpost which summarizes recent news stories from around the country regarding the IOM's report.