Validation of Bedside Nursing Assessment Test for Rapid Detection of Lower Respiratory Tract Infection

Abstract

Background: Nosocomial infections continue to be a burden to the healthcare system. The American Thoracic Society reported that lower respiratory tract infection (LRTI) represents 12% -20% of all nosocomial infections, and cause considerable morbidity and mortality. For critically ill patients, hospital-acquired (LRTI) remains difficult to prevent and expensive to treat. The challenge of cost-effective health care encourages practitioners to rely on basic assessment and to be selective about expensive diagnostic tests. A significant low cost and time saving test has to be advocated for detection of infection as a proactive nursing role in community and hospital acquired infection. To do this, the current study took insight on using a simple approach, the dipstick, as rapid bedside test in detecting lower respiratory tract infection. Aims of the study: The study has strived to: Verify the sensitivity, specificity, positive predictive value and negative predictive value of dipstick test for detection of leukocytes in sputum of patient with lower respiratory tract infection. Research design: A survey research design was utilized in this study to assess the validity of dipstick testing in detecting lower respiratory tract infection. Research setting: The study was conducted at Intensive Care Unit, outpatient department (respiratory clinic), King Abdul-Aziz Air Base Hospital. Dhahran. Kingdome of Saudi Arabia. Subjects: Fifty patients with different types of chest infections were recruited in the present study conveniently. Tools of the study: 4. Patient data sheet: It was designed by the researchers to encompass demographic characteristics of the studied subjects; patient baseline assessed data; results of clinical laboratory tests; and results dipstick, gram stain, and culture. 2. Multistix and 10 SG reagent strips from Siemens diagnostics it was utilized in this study to detect leucocytes in sputum of patients with lower respiratory tract infection. Results: The study reveals dipstick test sensitivity 80.5%, specificity 77.8%, positive predictive value 94.3%, and negative predictive value 46.7% compared to gram stain, with a test accuracy of 80%. Conclusion Dipstick (rapid strip) test, which was originally designed to analyze urine, can be used as a rapid screening test for evaluating lower respiratory tract infection using LE enzyme activity. The rapid agent strip has been shown to be a sensitive test for the detection of leukocyte in the sputum.

Recommendations: Strengthen dipstick test utilization in hospital acquired infection as well as community settings as a screening for infection in lower respiratory tract, monitoring the patient response to therapy, differentiation between infections and colonization and discriminating bacterial from other “atypical infection”.