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128 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

Research vignette, Continued
treatment groups. Further, it is always possible that the group who the protocols were adhered to although data on intervention
were lost to follow up differed in some unknown way to those who fidelity was not provided. Ensuring those delivering the interven-
had complete baseline and day three CPIS values. tion were not involved in CPIS assessment and ensuring
those undertaking the CPIS assessments were blinded to group
The researchers acknowledge and explain several study limitations allocation are strengths of this study. The results were clearly
including how it was that patients with pneumonia were inadver- described with tables easy to understand. The research team
tently recruited into the study despite pneumonia being an was comprised of a number of nursing professors and a professor
exclusion criteria. They identify that the smaller samples on day of critical care medicine, and they received National Institutes of
five and seven did not allow conclusions about the effect of the Health funding, suggesting that peer review of the detailed
interventions on late-onset VAP. The researchers also describe research plan was undertaken and that the study was judged to
several difficulties in undertaking research with ICU patients. be of very high quality. Overall, the researchers should be com-
Overall, this study was carefully thought through. It had a powerful mended on the quality of their study and the limitations identified
design and was powered to detect a difference between groups. highlight the difficulties in conducting clinical trials in the ICU
The researchers carefully detailed the mouthcare interventions, population. Finally, and very importantly, other researchers inter-
although the meaning of usual care was not explained. Employing ested in this work could replicate the study because it was clearly
study staff to deliver the intervention made it more likely that described.

Learning activities

1. Review the patient hygiene products available in your unit. Do 7. State the evaluation tools used for pressure area risk assess-
you have a range of products suitable for your patient ment and the strategies implemented in your unit for pressure
population? sore prevention.
2. Can you identify, assess and plan definitive management spe- 8. Describe the risk evaluation and protocols for VTE prophylaxis
cific to skin tears, pressure ulcers and venous ulcers? in your unit.
3. A patient with a closed head injury has conjunctival oedema 9. What is the patient bowel management protocol for your unit,
and still needs frequent neurological assessment, including and is it effective? Why/why not?
assessment of pupil reactions. Outline the process to follow to 10. What are the protocols for surveillance, detection and manage-
ensure both eye assessment and eye protection. ment of influenza and nosocomial infections in your unit?
4. Describe the key components of good oral hygiene. 11. Outline the practices used to prevent ventilator-associated
5. Observe the positioning in bed of patients in your unit. Evalu- pneumonia and catheter-related sepsis in your unit.
ate the position for (a) patient comfort, (b) patient security, (c) 12. Review the key features of the beds and mattresses in use in
device and equipment safety, and (d) therapeutic benefit of your unit. Do you have scope to match specific patient require-
the position. ments for beds or pressure relief mattresses?
6. What prompts decisions for patients to sit out of bed or mobil- 13. Describe the preparation, equipment and monitoring of a ven-
ise in your unit? Do you have positioning, turning or mobilisa- tilated patient with multiple infusions for transfer from the ICU
tion protocol in your unit? to the imaging department.

ONLINE RESOURCES National Institute of Clinical Studies NICS, <http://www.nhmrc.gov.au/nics/
index.htm>
Therapeutics Goods Australia, <http://www.tga.gov.au/index.htm>
Australian Wound Management Association, <http://www.awma.com.au>
Australian Department of Health and Ageing, <http://www.health.gov.au> US Centers for Disease Control and Prevention, <http://www.cdc.gov>
Cochrane Collaboration, <http://www.cochrane.org> World Health Organization, <http://www.who.int/en/>
College of Intensive Care Medicine of Australia and New Zealand, <http://
www.cicm.org.au> FURTHER READING
Communicable Diseases Network Australia (CDNA), <http://www.nphp.gov.au/
workprog/cdna> College of Intensive Care Medicine of Australia & New Zealand. Minimum stan-
European Pressure Ulcer Advisory Panel, <http://www.epuap.org> dards for transport of critically ill patients IC-10. 2010. [Cited December 2010].
Hand Hygiene Australia, <http://www.hha.org.au> Available from: http://www.cicm.org.au/cmsfiles
Joint Faculty of Intensive Care Medicine, <http://www.jficm.anzca.edu.au> Khoury J, Jones M, Grim A, Dunne WM Jr, Fraser V. Eradication of methicillin-
National Health and Medical Research Council, <http://www.nhmrc.gov.au> resistant Staphylococcus aureus from a neonatal intensive care unit by active