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Hampshire, United Kingdom

Dailly S.,Royal Hampshire County Hospital
Nursing standard (Royal College of Nursing (Great Britain) : 1987)

Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided. Source

Dryden M.,Royal Hampshire County Hospital | Johnson A.P.,Public Health England | Ashiru-oredope D.,Public Health England | Sharland M.,Paediatric Infectious Diseases Unit
Journal of Antimicrobial Chemotherapy

Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. The objective should be to provide optimal patient care while at the same time seeking to minimize selective pressure that may result in the emergence and spread of antibiotic resistance. To this end, in 2008 the European Centre for Disease Control initiated the annual European Antibiotic Awareness Day (EAAD) to take place on 18 November, when Europe-wide activities are undertaken to highlight the critical importance of prudent antibiotic prescribing. This year activities in England will focus on the optimal management of infections in secondary care, and will have two inter-related aims. The first is to improve the quality of the initial decision to prescribe an antibiotic (including making an informed choice of empirical drug and dose) in particular ensuring rapid prescribing and administration in presumed sepsis. This is deliberately combined with a second focus on the critical importance of formally reviewing antibiotic therapy at 48 h, based on the patient's clinical response and the availability of microbiology test results. This should lead to a clear decision to stop, switch to oral, switch to outpatient antibiotic therapy (OPAT) or change antibiotic, if possible to a narrower spectrum. The EAAD campaign in England will highlight the need to 'Start Smart-Then Focus'. The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

Dryden M.S.,Royal Hampshire County Hospital
Journal of Antimicrobial Chemotherapy

Skin and soft tissue infections (SSTIs) are common, and complicated SSTIs (cSSTIs) are the more extreme end of this clinical spectrum, encompassing a range of clinical presentations such as deep-seated infection, a requirement for surgical intervention, the presence of systemic signs of sepsis, the presence of complicating co-morbidities, accompanying neutropenia, accompanying ischaemia, tissue necrosis, burns and bites. Staphylococcus aureus is the commonest cause of SSTI across all continents, although its epidemiology in terms of causative strains and antibiotic susceptibility can no longer be predicted with accuracy. The epidemiology of community-acquired and healthcare-acquired strains is constantly shifting and this presents challenges in the choice of empirical antibiotic therapy. Toxin production, particularly with Panton-Valentine leucocidin, may complicate the presentation still further. Polymicrobial infection with Gram-positive and Gram-negative organisms and anaerobes may occur in infections approximating the rectum or genital tract and in diabetic foot infections and burns. Successful management of cSSTI involves prompt recognition, timely surgical debridement or drainage, resuscitation if required and appropriate antibiotic therapy. The mainstays of treatment are the penicillins, cephalosporins, clindamycin and co-trimoxazole. β-Lactam/β-lactamase inhibitor combinations are indicated for polymicrobial infection. A range of new agents for the treatment of methicillin-resistant S. aureus infections have compared favourably with the glycopeptides and some have distinct pharmacokinetic advantages. These include linezolid, daptomycin and tigecycline. The latter and fluoroquinolones with enhanced anti-Gram-positive activity such as moxifloxacin are better suited for polymicrobial infection. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. Source

Aldington D.,Royal Hampshire County Hospital
Current Opinion in Supportive and Palliative Care

Purpose of review: The purpose of this review is to look at the options available for the management of pain in victims of conflict, from the point of wounding, through a chain of evacuation, to rehabilitation in the home country. This is relevant for all healthcare workers as any could find themselves treating veterans and having a clear understanding of what occurred will help. Recent findings: The article will discuss developments in the prehospital environment, the field hospital, during repatriation and back in the home country to include neurostimulation in cases of refractory pain. Evidence when available is provided and the difficulties in conducting research in this environment are touched upon. Summary: The current agents, routes and techniques found in any civilian medical service can be brought to bear with great benefit. However, the secret appears to lie in a robust approach to the importance of treating pain, encouraged in all healthcare professionals, and the recognition of the role of integrating the healthcare package throughout the chain of evacuation. Research remains difficult. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Dailly S.,Royal Hampshire County Hospital
Nursing older people

The use of indwelling urethral catheters has become a common aspect of patient care, but they can be a source of infection. Nurses can help to prevent catheter-associated urinary tract infections by using aseptic technique on insertion, following best practice in ongoing care and promptly removing catheters. The urinary catheter assessment and monitoring form (UCAM) is used at the Royal Hampshire County Hospital, Winchester, to remind staff of best practice and promote their early removal. Source

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