Microsoft word - 2009 february did you know _2_.doc

The HSC Nursing Research Committee Asks
Evidence Based Bronchiolitis Practice
T’is the season and we don’t mean ‘to be jolly’. Every year in pediatrics we prepare for the bronchiolitis and dreaded RSV season. What other contagious respiratory disease has a full time committee of nurses, doctors, allied health personnel work together 12 months of the year just to be ready and have the ‘best evidence’ to support current practice? This contagious disease dramatically impacts Children’s Hospital patients, families and staff for months at a time. Just like Christmas and the holidays we are not always ready when bronchiolitis happens. This year we were pretty close. We predict the season for bronchiolitis based on the evidence provided by the cross Canada respiratory syncytcial virus (RSV) infection data; infections tend to start in the east and move slowly west. We never are really sure of accuracy, duration and the peak, we see it as early as pre-holiday rush or even as late as April or May. For those of you who follow the local media will already know, it has hit. What is bronchiolitis? Children’s Hospital has an excellent pamphlet called ‘Bronchiolitis and respiratory syncytcial virus’. We would suggest that any of you not practicing in pediatrics obtain a copy and educate your family and friends. Bronchiolitis is an infection of the small airways in the lungs. Most often is caused by RSV. RSV is the most frequent cause of serious respiratory infections in children under 2 years of age. Mild disease causes: a) runny stuffy nose, b) choking cough with lots of mucus and that may last more than 2 weeks, c) wheezing, d) fever, and e) ear infections. Bronchiolitis is passed through close contact with someone who has the infection. It can be picked up by coming in contact with sick person’s mucus from nose or mouth OR touching objects that have been coughed upon by the sick person. Two evidence-based strategies to control spread of infection are hand washing and ‘cover you cough’. Bronchiolitis can be very serious; young infants can develop pneumonia require admission to hospital and maybe even progress to respiratory failure and require pediatric intensive care. The infants may have to be placed on a ventilator as gas exchange is so severely comprised they can no longer breathe on their own. It is strongly suggested that sick children be kept at home and babies stay away from crowded places where they may unknowingly come in contact with sick persons. There is no treatment for RSV, the disease simply runs its’ course as the body must fight the virus on its own and the infant or child is supported until this occurs. The evidence supports the use of inhaled epinephrine as the medication of choice and use Ventolin only for those children where there is strong suggestion for asthma. Of note, first time wheezing in infants less than one year does not meet the definition of asthma. The evidence also suggests that the medications used to manage bronchiolitis do not alter the disease course and should only be used if there is clinical improvement. Children’s utilizes a bronchiolitis scoring tool to assess effectiveness and if there is no measured effect, the medication(s) should not be given. There is no evidence to support the use of chest physiotherapy for these patients and if fact it may cause harm. A lot of these infants require oxygen, IV therapy, suctioning and may not be able to feed by bottle as they are breathing so hard. Occasionally a secondary bacterial infection or pneumonia develops which is treated with antibiotics. There is some evolving evidence that with one of the other viruses that cause bronchiolitis called adenovirus, that a very large dose of steroids early in the illness may have some benefit in preventing development of chronic lung disease in a very specific patient population (first time wheezers, those who require intubation, less than one year of age and First Nations decent with no associated co-morbidities). We have seen a large number of positive RSV / other viruses at Children’s hospital. Of significant impact, are the ICU days required for this population – indicating the overall severity of the illness. This is not just a problem at Children’s Hospital; each and every one of us can try to do our part to prevent infection and control spread. Data of Children’s Hospital Bronchiolits Infections by Year
RSV infections
Other respiratory virus infections
* this is only a short time in the new season
SUBMITTED BY: Jannell Plouffe, RN, BScN, MN, PICU


SANDRA OUTLAW, PLAINTIFF-APPELLANT vs. SANDRA L. WERNER, M.D., ET AL., DEFENDANTS-APPELLEES No. 92297 COURT OF APPEALS OF OHIO, EIGHTH APPELLATE DISTRICT, CUYAHOGA COUNTY 2009 Ohio 2362 ; 2009 Ohio App. LEXIS 2004 May 21, 2009, Released PRIOR HISTORY: [**1] [*P2] On December 21, 2007, Outlaw originallyCivil Appeal from the Cuyahoga County Court offiled this action

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