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Issue 167 - 26 Jan 2011

Have you recently completed a thesis or dissertation related to practice of nursing, nursing education, nursing policy or nursing management? Send a copy of your work to the NZNO library for inclusion in the Nursing Research Index.

Articles - Journal of Infection Prevention

1. Should nurses be more involved in antimicrobial management?
By Rachel Edwards, H. Loveday, L.N. Drumright, and A. Holmes
Journal of Infection Prevention, January 2011 12: 4-5
European Antibiotic Awareness Day (EAAD) in November 2010 focused on the prudent prescribing of antibiotics in hospital settings. This annual initiative centres on creating international awareness of the diminishing pharmacological options to treat infection and the impact of prescribing behaviours on the emergence of micro-organisms increasingly resistant to antimicrobials. Although there has been growing international concern about prescribing behaviours, the nurses’ role in preventing the development of antimicrobial resistance (AMR) has been relatively unexplored in the UK, Europe or the United States.

2. Covering more territory to fight resistance: considering nurses’ role in antimicrobial stewardship
By Edwards, R; Drumright, L N; Kiernan, M and Holmes, A.
Journal of Infection Prevention, January 2011 12: 6-10
The potential contribution nurses can make to the management of antimicrobials within an in-patient setting could impact on the development of antimicrobial resistance (AMR) and healthcare associated infections (HCAIs). Current initiatives promoting prudent antimicrobial prescribing and management have generally failed to include nurses, which subsequently limits the extent to which these strategies can improve patient outcomes. For antimicrobial stewardship (AS) programmes to be successful, a sustained and seamless level of monitoring and decision making in relation to antimicrobial therapy is needed. As nurses have the most consistent presence as patient carers, they are in the ideal position to provide this level of service. However, for nurses to truly impact on AMR and HCAIs through increasing their profile in AS, barriers and facilitators to adopting this enhanced role must be contextualised in the implementation of any initiative.

3. Controlling legionella risk in a newly commissioned hospital building
By Sumati Srivastava, Alaric Colville, Mike Odgers, Lee Laskey, and Trevor Mann
Journal of Infection Prevention, January 2011 12: 11-16
We describe the risk assessment and interventions used for Legionella spp. in potable water in a new building commissioned in 2007. Water systems were designed to be compliant with Health Technical Memoranda 04-01 and the approved Code of Practice and Guidance for the control of legionella bacteria in water systems, known as L8. Monitoring of cold-water outlets showed temperature greater than 20°C. Water samples were cultured for legionella. Control measures used increased flushing and a copper—silver ionization system. Nocturnal heat gain was noticed in the cold-water system. Legionella pneumophila serogroup 1 was cultured from one representative outlet. The copper— silver ionization system reduced legionella colony counts. Water consumption was 71% of the original design estimate. No clinical cases due to Legionella spp. were detected. Reduced water consumption may lead to heat gain even in well-insulated systems, thus breaching control guidance. Additional control methods will then be required.

4. Does the use of a theoretical approach tell us more about hand hygiene behaviour? The barriers and levers to hand hygiene
By Judith Dyson, Rebecca Lawton, Cath Jackson, and Francine Cheater
Journal of Infection Prevention, January 2011 12: 17-24
Despite many strategies employed to improve hand hygiene, compliance remains low at around 50%. Two reasons have been identified for this. First, implementation strategies are rarely tailored according to assessed barriers and levers to best practice. Secondly there is a lack of explicit theoretical basis for the assessment of these barriers and levers to practice.
Aim: This paper reports barriers and levers to hand hygiene and an evaluation of the use of theory in assessing barriers and levers to hand hygiene. Methods: Identification of barriers and levers occurred through interviews, questionnaires and focus groups. In each case two different question schedules were used, one based on psychological theory and the other with no explicit theoretical underpinning.
Results: Although there was considerable overlap in the barriers and levers identified using the two schedules there were also marked differences.
Conclusions: Identification of further barriers and levers may help us address lack of compliance with hand hygiene. Using a theoretical framework may prompt the identification of barriers that people may not ordinarily report but which have an important impact on behaviour, particularly emotion

5. Healthcare associated infection in care homes for older people in Scotland: results from a pilot survey
By Abigail Mullings, Fiona Murdoch, Audrey MacKenzie, Shona Cairns, and Jacqui Reilly
Journal of Infection Prevention, January 2011 12: 26-30
The prevalence of infection in Scottish care homes is currently unknown. The aim of this survey was to estimate the prevalence of infection within a small sample of care homes for older people and to develop and test a methodology for point prevalence surveys which would allow local care home staff to monitor infection in care homes for older people that employ trained nurses. The pilot survey was undertaken by Health Protection Scotland (HPS) in collaboration with the Care Commission and two volunteer service providers. Data collection within 18 volunteer care homes was undertaken between 6 April 2009 and 1 May 2009. A total of 922 residents from 18 care homes were included. On the day of survey, 87 infections were identified in 86 residents. The prevalence of infection was 9.3%. The most common infections types were urinary tract infections and respiratory tract infections. The results from this small survey of volunteer care homes have provided valuable insight into the previously unmeasured prevalence of infection in Scottish care homes for older people. It is hoped that the rollout of a larger scale survey that includes a representative sample of all Scottish care homes can be implemented.

6. Catheter associated urinary tract infection within care of the elderly facilities: results from a Scottish pilot study
By Abigail Mullings, Fiona Murdoch, and Jacqui Reilly
Journal of Infection Prevention, January 2011 12: 32-36
Following a review of the current methodology for catheter associated urinary tract infection (CAUTI) surveillance in Scotland a protocol was developed by Health Protection Scotland incorporating infection definitions based on clinical signs and symptoms rather than microbiology criteria. These definitions are recommended by the European Centre for Disease Prevention and Control for use in care of the elderly facilities as they hope to reduce the overestimation of urinary tract infections by excluding asymptomatic bacteriuria. In 2009, a pilot study of the protocol was carried out in volunteer care of the elderly facilities across Scotland. A total of 659 patients admitted to the care of the elderly facilities participated in CAUTI surveillance in six pilot hospitals and a total of 122 catheters were inserted. During the study period a total of 19 urinary tract infections were identified of which 15 met the criteria for CAUTI. The CAUTI surveillance protocol and data definitions appeared to be robust. The study was therefore able to provide valuable data about catheter use and CAUTI incidence rates. The surveillance protocol and collection tool can be easily adapted for use in care home settings thus providing a valuable surveillance tool for these resident populations.

7. Nosocomial bacterial infections in a tertiary hospital in Ethiopia
By Nigatu Endalafer, Solomon Gebre-Selassie, and Berhanu Kotiso
Journal of Infection Prevention, January 2011 12: 38-43
The aim of this study was to determine the magnitude of nosocomial infection and isolate the bacterial aetiologic agents in a tertiary hospital. A total of 215 patients admitted to surgical wards and intensive care unit were followed prospectively. Specimens from patients were determined using standard techniques. Of the patients observed, 77 (35.8%) had 84 (39.1%) nosocomial infections. The overall incidence of nosocomial infections was 35.8/100 patients. Surgical site, urinary tract and blood stream infections comprised 38 (49.4%), 23 (29.8%) and 16 (20.8%), respectively. Of the bacterial isolates, 58/84 (69.0%) were Gram negative and 26/84 (31.0%) Gram positive. Pseudomonas aeruginosa (22.7%) and Escherichia coli (45.8%) were the major causes of surgical site and urinary tract infections, respectively. Staphylococcus aureus was isolated in 37.5% of the blood stream infections. The incidence of nosocomial infection in the hospital was high. There is a need to reduce the problem with continuous surveillance and the implementation of infection prevention strategies.

8. Surgical site infection following hip fracture surgery - the role of wound surveillance
By David Thyagarajan, Dakshinamurthy Sunderamoorthy, Samarthjoy Haridas, Sue Beck, Pathmanaban Praveen, and Anthony Johansen
Journal of Infection Prevention, January 2011 12: 44-47
In a prospective study we assessed 440 patients, sequentially admitted to the trauma unit with hip fracture. The superficial infection rate was 7.7% and the deep infection was 1.8%. The commonest organism responsible for surgical site infection was MRSA (47.6%). 45.2% of the patients with SSI and 50 % of the patients with MRSA wound infection were admitted from institutional care or other hospital. The high prevalence of MRSA wound infection and increased mortality rate in this subgroup highlights the need for a good surveillance programme in place, to monitor trends and identify risk factors with an emphasize on minimising infection rates. Using the National Hip Fracture Database (NHFD) to make surveillance for surgical site infection a routine part of hip fracture care would be best practice in monitoring the trend and comparing care and outcomes against national benchmarks and quality standards. We recommend a close surveillance of wound in this vulnerable group

Journals - Table of Contents

9. From The New England Journal of Medicine, January 20, 2011
9A. Nurses for the Future [IOM recommends boosting the proportion of U.S. nurses holding at least a bachelor's degree from 50% to 80% by 2020. With many nurses reaching retirement age even as demand for advanced-practice nurses expands, nursing-education patterns must change
9B. Broadening the Scope of Nursing Practice [To bridge the gap between demand for primary care and available primary care practitioners and establish new approaches to care delivery, health care providers should be able to practice to the fullest extent of their knowledge and competence. This means establishing a broadened scope of practice for nurse practitioners
9C. Iniparib plus Chemotherapy in Metastatic Triple-Negative Breast Cancer [In this phase 2 study, the use of gemcitabine and carboplatin plus iniparib, as compared with gemcitabine and carboplatin alone, resulted in a significantly higher rate of response and increased the progression-free survival
9D. A Genetic Basis for Functional Hypothalamic Amenorrhea [The authors hypothesized that mutations in genes involved in idiopathic hypogonadotropic hypogonadism would be associated with functional hypothalamic amenorrhea, a reversible disorder commonly triggered by stress. Variants in such genes were detected in patients with hypothalamic amenorrhea
9E. A Prospective Natural-History Study of Coronary Atherosclerosis [In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and imaging after PCI. Of 132 subsequent major adverse cardiovascular events, approximately half occurred at the site of the previous culprit lesion
9F. Nucleic Acid Testing to Detect HBV Infection in Blood Donors [In this study involving 3.7 million blood donors, nucleic acid testing identified 9 donors with HBV infection who were not identified by routine serologic testing. The single triplex assay also identified 2 donors with HIV and 15 with HCV
9G. Vitamin D Insufficiency [The author reviews data supporting the recommendation to maintain a serum concentration of vitamin D above 20 ng per milliliter and notes the lack of evidence to support a higher target level. He reviews the limitations of data linking vitamin D insufficiency to chronic disease risk
9H. Medical Progress: Necrotizing Enterocolitis [Necrotizing enterocolitis, one of the most common and devastating diseases in neonates, typically manifests with feeding intolerance, abdominal distention, and bloody stools. This article discusses the current knowledge and treatment of this difficult-to-treat condition
9I. Cholesterol Emboli after Coronary Bypass Surgery [Five weeks after uneventful coronary-artery bypass grafting, an 81-year-old woman presented to the hospital with a serum creatinine level of 493 μmol per liter (5.6 mg per deciliter). Her kidney function had remained stable throughout her hospital stay
9J. Palmar–Plantar Rash with Cytarabine Therapy [A 52-year-old man with acute myeloid leukemia underwent induction chemotherapy consisting of a 7-day intravenous infusion of cytarabine plus daunorubicin on days 1 through 3. Bone marrow biopsy performed on day 14 revealed that blast cells still accounted
9K. Case 2-2011 — A 30-Year-Old Woman with Shock after Treatment of a Furuncle [A 30-year-old woman was transferred to this hospital because of hypotension and respiratory failure. One month earlier, cultures of an abscess on her leg grew MRSA; antibiotics were prescribed and the abscess resolved. On the day of admission, the patient was found unresponsive at home

NZNO Medico-Legal Forums

10. Medico Legal Issues in Nursing/Midwifery Practice 2011
Date: 16 May, 2011  Balmarino Room
Venue: Riccarton Park, Christchurch

11. Medico Legal Issues in Nursing/Midwifery Practice 2011
Date: 18 May, 2011 Waipuna Hotel & Conference Ctr
Venue: 58 Waipuna Road, Mt Wellington, Auckland

12. Medico Legal Issues in Nursing/Midwifery Practice 2011
Date: 19 May, 2011  Convention Centre
Venue: 354 Main Street, Palmerston North

13. Medico Legal Issues in Nursing/Midwifery Practice 2011
Date: 26 May, 2011  Conference Centre,
Venue: Hamilton Airport, Hamilton

To register: (closing date 6th of May 2011 - Numbers Limited)
Christchurch - Philippa Ireland (
Auckland - Sue Kahaki (
Palmerston North - Angela Southee (
Hamilton - Robyn Prentice (

News - National

14. Increase in workplace drug testing
ODT By Chris Morris on Sat, 8 Jan 2011
More southern employers are opting to drug-test their staff, and the New Zealand Drug Detection Agency said business is booming in Otago and Southland.  Workers for about 80 companies in Otago - the majority in Dunedin - now faced drug tests using NZDDA services as part of their employment.

15. DCC drug search plan worries union
By Chris Morris on Thu, 6 Jan 2011
A union representing hundreds of Dunedin City Council workers is concerned about covert surveillance and search powers proposed in a new drugs policy for council staff. Amalgamated Workers' Union New Zealand (Southern) assistant secretary Peter Costello, of Dunedin, said he planned to discuss the proposed policy with council union delegates next week

16. DCC proposal for random drug testing
ODT - 4 Jan 2011
By Chris Morris on Tue, 4 Jan 2011

News - International

17. Liberating the NHS – Developing the Healthcare Workforce
This consultation document sets out proposals to establish a new framework for developing the healthcare workforce and seeks views on the systems and processes that will be needed to support it. The final date for responses is 31st March 2011, but earlier expressions of view would be helpful.
Released on - 19/01/2011

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