الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 197 |  |  |
| | | from | 197 | | |
Abstract
Lower Respiratory Tract Infections (LRTIs) are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of Disability-adjusted Life-Years (DALYs). At the global level, the burden of LRIs the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to reducing the global burden of LRI.
Aim of the Study:
This study aimed to test the validity of bedside nursing assessment tool for early detection of lower respiratory tract infection.
Research Hypothesis:
The bedside nursing assessment tool will be valid for early detection of lower respiratory tract infection.
Subjects and Methods:
Research design: A quasi-experimental design was utilized to conduct this study to assess validity of bedside nursing assessment in detecting lower respiratory tract infection.
Setting:
The study was conducted at Intensive Care Unit, outpatient department (Respiratory Clinic) / El-Demerdash Hospital, which affiliated to Ain Shams University Hospitals.
Intensive Care Unit / El-Demerdash Hospital, which affiliated to Ain Shams University Hospitals. It receives surgical critical patients with neurological and general surgery diagnoses. Its capacity can accommodate for about 34 patient and it is supplied with necessary devices (such as monitors, ventilators, suction apparatuses, DC shock car, syringe pumps, etc.). It also includes portion for isolated patients, it has 5 isolated beds.
Outpatient department (Respiratory Clinic) / El-Demerdash Hospital, which affiliated to Ain Shams University Hospitals. It opens to receive patients at Monday and Wednesday per week. It receives all patients who have respiratory diseases.
Subjects:
A purposive sample of adult patients with different types of chest infection was recruited in this study. The total number was 100 patients. Only 36 were recruited from outpatient department (respiratory clinic) and 64 of patients were recruited from intensive care unit / El-Demerdash Hospital.
Inclusion criteria newly diagnosed patients who have cough, shortness of breathing and symptoms of acute exacerbation irrelevant of fever, leukocytosis, and/or X-Ray infiltration.
Exclusion criteria: patient who received antibiotics, with bloody sputum, and those are not willing to participate
Tools for data collection:
Data was collected through three tools:
1. Patient Assessment Tool.
2. A-Dipstick Sputum Collection Checklist.
2. Q-Slap 10 of Reagent Strips from Biotec Diagnostics .
1. Patient assessment Tool:
It was designed by the researcher after reviewing the literature (Janvset, Weber, Jane, and Kelen, 2010; Longmore, Wilkinson, Baldwin, and Wallin, 2014; Duncan, 2017; Preston and Kelen, 2017). It filled by the researcher and composed of four parts as following:
- First Part: concerns with demographic characteristics of the studied subjects regarding age, gender, medical diagnosis, admission status, co-morbid disorders, present medical history (including chief complain on admission, associated signs and symptoms, it’s onset, duration and frequency, predisposing factors, relieving measures and current medications), and past medical history (including surgical history, medication history, history of antibiotic resistance. Allergy history and family history).
- Second Part: includes recording of patient baseline data related to physical signs. It was used to assess vital signs and all items of respiratory assessment, which includes pulse Oxmitery, characteristics’ cough & sputum, oxygen supply, respiratory rate, respiratory effort, respiratory rhythm and breath sounds.
-Third part: included recording the results of clinical laboratory tests regarding CBC, pulmonary function test, chest X-Ray other laboratory and diagnostic investigations.
-Fourth part: included recording of dipstick parameters in relation to leukocytes, sputum gram stain and culture.
-Fifth part: including recording of patient assessment changes after one day from collecting the sputum culture to detect the deteriorating chances that were occurred to studied patient while waiting the laboratory sputum culture’s results.
2. A- Dipstick Sputum Collection Checklist:
It was adapted from (Marjorie, 2014) and modified by the researcher to include pre-procedure preparation, then procedural steps that were followed by the researcher to instruct the patient, collect the sputum sample, and record the characteristics of the sputum sample.
2. B- Q-Slap 10 of Reagent Strips from Biotec Diagnostics :
It was designed by the researcher, to include pre-procedure preparation, then procedural steps that were followed by the researcher to perform the sputum dipstick test, note the color
changes on the strip and record the results.
Dipstick (reagent strip) test technique that is utilized in this study to detect leukocytes in sputum of patients with lower respiratory tract infection. The principle behind the mechanism of action is that granulocytic leukocytes contain esterase (LE) that catalyze the hydrolysis of the derivative pyrrole amino acid ester to liberate 3-hydroxy-5-phenyl pyrrole. This pyrrole then reacts with diazonium salt, giving a color change (MACHEREY-NAGEL Company, 2015).
Results:
The important findings from the study can be summarized as following:
• Approximately half of patients under the study aged between 50 and 69 years. 64% representing patients under the study were recruited from intensive care units.
• Regarding positive predictive value of dipstick test validity for sputum leukocytes of patients under the study was 96%.
• In relation to negative predictive value of dipstick test validity for sputum leukocytes of patients under the study was 81%.
• Concerning the dipstick leukocytes test’s sensitivity, it was 92% for patients under the study.
• Regarding the dipstick sputum leukocytes test’s specificity was 89%. Also the dipstick sputum leukocytes test’s diagnostic accuracy was 91%.
• More than two thirds of gram stain results were obtained after more than two days from the date of sputum culture collection, on the other hand all sputum dipsticks’ results appeared at the same time of the test.
Conclusion
Based on the results of the present study, it can be concluded that:
• Dipstick (rapid strip) test, which was originally designed to analyze urine, can be used as a rapid cheap screening test for evaluating lower respiratory tract infection using Leukocytes Esterase enzyme activity. The rapid agent strip has been shown to be a sensitive test for the detection of leukocyte in the sputum.
• High sputum dipstick test validity with positive predictive Value 96% and negative predictive Value 81%.
• That sputum dipstick test was valid as detecting technique with a sensitivity of 92%, specificity 89% and diagnostic accuracy 91%.
• More than two thirds of gram stain results were obtained after more than two days from the date of sputum culture collection, on the other hand all sputum dipsticks’ results appeared at the same minute of sputum sample’s collection.
• More than two quarters of patients under the study had deterioration in the consistency of their sputum after one day from collecting sputum culture while waiting the sputum culture’s results. Also, more than half of assessed patients had deterioration in their breath sounds, respiratory effort and the color of the sputum.
Recommendations
The important recommendations inferred from the study results were:
In the light of the study results, the following is recommended:
• Replication of the current study on a larger probability sample is recommended to achieve generalization of the results.
• Future researches are needed to validate other dipstick reagent in semi quantitative analysis of sputum, and other body fluids in different diseases regarding its potential implications.
• Strengthen the utilization of bedside nursing respiratory assessment including sputum dipstick test in hospital acquired infection, emergency department as well as community settings as a screening for infection in lower respiratory tract, monitoring the patient response to therapy.
• Reinforcement is needed form medical supplies companies to manufacture special reagent strip for leukocytes detection in sputum.
• The appropriate and accurate (Regarding following infection control measures) procedure of sputum dipstick test should be informed to all health care giver, once sputum dipstick test becomes certified.
• The appropriate nursing care and infection control measures must be applied once the result of the tool is positive.