The results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.

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The aim and the method of the study were explained to the participants and they were also informed by a standard written information form. Written informed consent was obtained from participants prior to inclusion in the study to ensure that the participation was voluntary (Declaration of Helsinki 2013).Funding: This research has been supported by a grant from Business Finland as part of a project called "Intelligent Customer-driven Solution for Orthopedic and Pediatric Surgery Care". The funder has not influenced the design, conduct, analysis or reporting of the study.

Background: Endotracheal-suctioning (ETS) is a procedure that may constitute a risk factor for ventilator-associated pneumonia (VAP) by increasing microbial colonization of the lower airway. Unsafe ETS practices have been observed worldwide during recent years. Because of adverse reactions, practioners need to take all necessary precautions to ensure patient safety and a high quality of nursing care. The aim of the present study was to evaluate critical-care nurses' performance in relation to current recommendations in their daily practice prior to, during and post ETS events. Methods:A structured, non-participatory, observational study (n=40) was conducted using a 25-item best-practice information sheet to assess critical-care nurses' ETS practices in a mixed medical-surgical intensive-care unit. Onesample-and independent-samples t-tests were used to compare critical-care nurses' ETS performance against current recommendations within different ICU experience groups.Results: The quality of observed ETS practices was significantly lower than the required quality of care (p<0.001). The most significant discrepancies were observed in ETS practices related to infection-control practices. Conclusion:Critical-care nurses are currently not following current ETS recommendations. Significant discrepancies, which may constitute a risk factor for VAP by increasing microbial colonization of the lower airway, were identified. Unsafe ETS practices may jeopardize patient safety, and thus the quality of nursing care. Educational interventions, clinical guidelines and adequate support need to be provided to critical-care nurses to assess and improve their professional capabilities and current practice. Regular auditing and prompt feedback would be beneficial.

After a single simulation education session, critical care nurses' knowledge of and adherence to current HH guidelines remained below targeted behavior rates.

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Introduction As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. Methods A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. Results Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. Discussion Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.