1. Eschiti, Valerie S. PhD, RN, CHTP, AHN-BC

Article Content


Morritt ML, Harrod ME, Crisp J, et al. Aust Crit Care. 2006;19:15-21.


A cross-sectional, descriptive, self-report survey regarding handwashing practices surrounding central venous catheter (CVC) care. Nurses in pediatric hospitals in Australia and New Zealand working in pediatric intensive care units were included in the survey.


In 2001, a total of 30 nurses from 7 hospitals completed a survey consisting of 4 sections: demographic information, clean and aseptic handwashing, variation between handwashing practices and policies, and handwashing procedures with different types of CVCs. The nurses worked with all types of CVCs, but mainly temporary CVCs (90%) and peripherally inserted central catheters (43%), which were the focus of this study.


Most nurses reported washing for 30 seconds or less for a clean wash, washing only the hands and wrists with antimicrobial solutions or alcohol-based solutions, and drying with paper towels. For the aseptic wash, nurses washed from 30 seconds to 3 minutes, with the extent of wash ranging from the hands to the elbow using antimicrobial solutions or alcohol-based solutions and drying with sterile towels.


When comparing nurses' clean handwashing practices to hospital policy, the percentage of nurses who performed according to policy ranged from 17% to 100%. For aseptic handwashing, performance in accordance with policy ranged from 10% to 100%. The longer the required duration of handwashing, the less likely the nurse was to comply. For instance, if 1 minute was required, there were 17% of nurses who reported washing for less time. If 2 minutes was required, 75% were noncompliant, and for 3 minutes, 100% were noncompliant.


It was discovered that the closer the procedure was to the insertion site of the CVC, the more likely the nurses reported aseptic handwashing. Similarly, the further away the procedure from the CVC insertion site, the more likely the nurses reported using clean handwashing.


The authors note the large amount of variation in the handwashing practices of these nurses, noting that healthcare-associated infections are a cause of poor patient outcomes. They identify a need for standardized guidelines in pediatric intensive care units in Australia and New Zealand, such as the Centers for Disease Control and Prevention recommendations of a 15-second alcohol hand rub before all CVC procedures.



Rodriguez-Nunez A, Lopez-Herce J, Garcia C, et al. CritCare. 2006;10:R113.


A secondary data analysis from a prospective study of pediatric patients in Spain who experienced cardiopulmonary arrest and required defibrillation.


Of 241 children aged 1 month to 16 years who experienced pediatric cardiac arrest in or out of the hospital in 1998-1999, 44 were treated with manual defibrillation. Cardiac disease was the major cause of arrest in these children.


Termination of ventricular fibrillation or pulseless ventricular tachycardia after an initial monophasic defibrillation dose (2 J/kg) was achieved in only 18.1% of patients. Children with initial rhythms of ventricular fibrillation or pulseless ventricular tachycardia had better return of spontaneous circulation, initial survival, and survival at 1 year than those who developed the rhythms subsequently.


The researchers note that an initial shock dose of 2 J/kg is not effective for most pediatric patients, and they advise using a higher dose. They state that biphasic defibrillators are more efficacious and are now recommended. They conclude that prospective studies are needed to know the optimal pediatric defibrillation dose.