Gülzade Uysal

Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial

PURPOSE: The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study. METHODS: Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI. RESULTS: CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05). CONCLUSION: We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.

The Effects of Bundles on Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit.

Background: There are few studies in the literature from developing countries regarding the rates of catheter-associated urinary tract infection (CAUTI), which is frequently encountered in pediatric intensive care units (PICUs). Aim: The aim of this study is to evaluate the 2-year rates of CAUTI in a PICU where a CAUTI Prevention Bundle was implemented. Design: This was an interventional prospective study. Methods: The study was conducted with 390 patients in the PICU of Istanbul Faculty of Medicine, Turkey, from July 2013 to July 2015. The patients were selected based on the diagnostic criteria of the Centers for Disease Control and Prevention. Results: Urinary colonization occurred in 8 (2.2%) patients in the prebundle group and 3 (0.8%) patients in the postbundle group, and contamination occurred in 10 (2.8%) patients in the prebundle group and 6 (1.5%) patients in the postbundle group. The CAUTI incidence and rates were 5.8% and 6.1 per 1000 urinary catheter days and 1.5% and 1.8 per 1000 urinary catheter days prebundle and postbundle, respectively. There was a statistically significant difference between the prebundle and postbundle CAUTI rates. Conclusion: Our findings support that clinical nurse specialists in developing countries should consider the use of CAUTI bundles to prevent CAUTIs.

The Effect of Oral Care Using an Oral Health Care Guide on Preventing Mucositis in Pediatric Intensive Care

Objectives To evaluate the effectiveness of standard‐of‐care oral care guides developed specifically for children in intensive care to prevent mucositis. Design and Methods This prospective, interventional and single‐group study design was performed in the pediatric intensive care unit of a university hospital in Istanbul between January and December 2014. Daily oral care was implemented to pediatric patients in the study group in line with an oral care guide developed by the researchers. Data were collected using the data collection form and oral mucositis assessment scale published by the World Health Organization (WHO). Results Oral mucositis occurred in 16 (5.2%) patients in the pre‐intervention group and 7 (2.5%) in the post‐intervention group, 10 patients had grade 1, and 6 patients had grade 2 oral mucositis in the pre‐intervention group, and in the post‐intervention group, three patients had grade 1, and four patients had grade 2 oral mucositis. Although more patients in the pre‐intervention group had mucositis than in the post‐intervention group, the differences were not statistically significant (P = 0.067). Conclusions Oral mucositis can be reduced through the practice of administering oral care in accordance with oral healthcare guidelines. Practice Implications Oral care implemented in line with an evidence‐based oral care guide and frequent observation of patients are the most important steps in preventing oral mucositis. HighlightsThe number of studies conducted towards preventing oral mucositis in children in intensive care is limited.Nurses in intensive care units have an important role in the prevention or reduction of mucositis.Oral care implemented was effective in preventing mucositis and reducing oral health assessment scores.

Umbilical Cord Care and Infection Rates in Turkey

Objective: To compare the efficacy of umbilical cord sponging with 70% alcohol, sponging with 10% povidone–iodine, and dry care on the time to umbilical cord separation and bacterial colonization. Design: Prospective, interventional experimental study design. Setting: Three different family health centers in Istanbul, Turkey. Participants: In total, 194 newborns were enrolled in one of three study groups: Group 1, 70% alcohol (n = 67); Group 2, 10% povidone–iodine (n = 62); and Group 3, dry care (n = 65). Methods: Data were collected between January 2015 and July 2015. Umbilical separation time and umbilical cord bacterial colonization were considered as the study outcomes. Results: The most commonly isolated bacteria were Staphylococcus aureus, Escherichia coli, and enterococci. There was no significant difference among the groups for umbilical cord separation times (p > .05). Conclusion: Dry care may be perceived as an attractive option because of cost benefits and ease of application.

Yoğun Bakımdaki Çocuklarda Oral Mukozit Gelişme Durumu

Amac: Arastirma, yogun bakimindaki cocuklarda oral mukozit gelisme durumunu degerlendirmek amaciyla yapildi. Yontem: Arastirma, Ocak-Aralik 2015 tarihleri arasinda Istanbul’da bir universite hastanesinin cocuk yogun bakim unitesine yatisi yapilmis olan 181 cocugun Mart -Nisan 2016 tarihleri arasinda hasta dosyalari taranarak retrospektif olarak gerceklestirilmistir. Arastirma verileri, hasta dosyalarinda yer alan bilgiler taranarak arastiricilar tarafindan toplanmistir. Bulgular: Hasta dosyalarindan elde edilen veriler degerlendirildiginde; cocuklarin yas ortalamalarinin 48.69±3.29 ay oldugu, %37.5’inin solunum sistemi hastaligi tanisi ile yogun bakimda yattigi, %92.2’sinin oral beslenemedigi, %86.1’inin oksijen tedavisi ve %77.3’unun steroid tedavisi aldigi goruldu. Hastalarin %2.7’sinde oral mukozit olustugu, oral mukozit gelisen hastalarin ucunun yogun bakimdan taburcu olmadan iyilestigi, ikisinin ise 1. evre oral mukozit ile taburcu edildigi belirlendi. Sonuc: Calismanin yurutuldugu yogun bakimdaki cocuklarda, risk faktorlerine ragmen, oral mukozit oraninin dusuk oldugu belirlendi.