In-use comparison of latex gloves in two high-risk units: surgical intensive care and acquired immunodeficiency syndrome

This study was designed to compare use patterns and leakage of gloves from two high-risk units: a surgical intensive care unit (SICU) and an acquired immunodeficiency syndrome (AIDS) unit. During a 3-month interval, the use of gloves during clinical procedures by nursing personnel was observed and recorded. A total of 2900 latex examination gloves were collected and tested in the laboratory by the watertight leakage test: 59% (1714) were from the SICU and 41% (1186) from the AIDS unit. Twenty-four percent (700) of all gloves leaked: 29% (500/1714) leaked when worn by staff in the SICU as compared with 17% (200/1186) leakage rate in the AIDS unit (chi-square = 57.32, p less than 0.05). This difference could be attributed in part to higher levels of stress to the gloves and longer wearing time in the SICU.

Effective hand degerming in the presence of blood

This study evaluated the effect of blood on the antimicrobial activity of several agents used for handwashing. Seventy-one healthy adult volunteers used 1 of 6 products (70% isopropyl alcohol [IPA]; liquid hand rinse containing 70% ethyl alcohol and 0.5% chlorhexidine gluconate [EA]; detergent containing 7.5% povidone-iodine [PI]; detergent containing 4% chlorhexidine gluconate [CHG]; a nonantimicrobial soap; and a control group that used no product) in two tests: with and without 1.2 mL of dried sterile sheeps' blood on the hands. In the presence of blood, the two alcohol products (IPA and EA) resulted in significantly greater reductions in numbers of colony-forming units than other products (P less than 0.001). When no blood was present, IPA was associated with significantly greater reductions, whereas soap and control groups had significantly lower reductions (P = 0.008). We conclude that hands are effectively degermed with a variety of products in the presence of blood, and that alcohols give greater initial reductions in colonizing flora. This is of particular relevance in emergency situations during which contamination with blood is likely and handwashing facilities are inaccessible.

Study of the definition of nosocomial infections (SDNI). Research Committee of the Association for Practitioners in Infection Control

If nosocomial infections are to be used as clinical indicators of quality, their definitions must be accurate. To assess validity and reliability of definitions of nosocomial infection, a study was conducted in two groups of U.S. hospitals. Group A consisted of a stratified, random sample of 715 hospitals and excluded those that are part of the National Nosocomial Infections Surveillance System. The 112 NNIS hospitals were surveyed separately in group B. Both groups used the same instrument, consisting of 36 case studies simulating patients' charts. Content and construct validity were formally tested and demonstrated. Six case studies were presented for each of the four major NI sites and for community-acquired or no infection. The pooled hospital response was 48% (396/827). The pooled number of individual responders whose data were used in the analysis was 469. Their overall mean score was 84%, and the score for correctly identifying any NI was 83%. Both groups were best at identifying urinary nosocomial infections (Group A = 92%, Group B = 93%) and poorest for no infection (Group A = 62%, Group B = 75%). Group A responders had significantly higher scores if they were certified, had a baccalaureate or higher degree, had taken a formal infection control course, had worked in infection control for greater than or equal to 2 years, or had worked full time in infection control in a greater than or equal to 200-bed hospital that was affiliated with a medical school (all p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Collaborative education regarding prevention of human immunodeficiency virus transmission in healthcare settings--Ghana

OBJECTIVE

To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission.

SETTING

Healthcare settings in Ghana.

METHODS

Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development. A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes.

RESULTS

At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p less than .0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p less than .01). In field observations, there was an overall 42% improvement in specific infection control practices.

CONCLUSIONS

A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.

A comparison of transparent adherent and dry sterile gauze dressings for long-term central catheters in patients undergoing bone marrow transplant

Patients undergoing bone marrow transplant (BMT) are at great risk of infection and sepsis. Long-term central catheters (LTCCs), required for IV therapy, can be a portal of entry for infectious agents. This randomized, prospective study compared two types of catheter dressings in 98 patients undergoing BMT: a dry sterile gauze dressing (DSGD) changed daily and a transparent adherent dressing (TAD) changed every four days. Study outcomes included incidence and severity of local and systemic complications, patient assessment of comfort, and calculation of nursing time. One case of catheter-related infection occurred during the study. No significant differences existed between the two dressings in the incidence of positive skin cultures or local complications with the exception of skin irritation. The TAD caused less skin irritation, was preferred by patients, cost less, and required less nursing time. The findings indicate that TADs provide a safe, comfortable, and cost-effective alternative to DSGDs for patients undergoing BMT and receiving antibiotic support during aplasia.

Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women

Health characteristics of neonates born to human immunodeficiency virus (HIV) seropositive (n = 63) and HIV seronegative (n = 57) women were compared. No significant differences were found between the two infant groups for sociodemographic characteristics, mode of delivery, Apgar scores, gestational age, growth parameters, or immunoglobulin levels. Furthermore, no differences were detected in a subgroup of infants later confirmed to have HIV infection (class P-2). Maternal HIV infection does not appear to affect newborn health characteristics.

Participation of older adults in health programs and research: a critical review of the literature

This collection of five papers evaluates the participation of older adults in clinical trials, health promotion/disease prevention initiatives, and health programs designed to maintain or improve the functioning of chronically ill older adults. Understanding the willingness or unwillingness of older adults to participate in these programs is critical to the development and implementation of health programs and policies for this population. In this introductory paper we briefly review illustrative literature to provide both an overview of the participation of older adults in health programs as well as background information relevant to the symposium papers.

Comparison of two schema for classifying nursing research

To examine trends in nursing research during the last five years of the 1980s and to test the reliability and validity of two taxonomic schemes to classify nursing research, 811 abstracts from three years of a national nursing research conference (Council of Nurse Researchers, 1983, 87, 89) were reviewed and classified independently by three investigators. Taxonomies were research topics as categorized in the Sigma Theta Tau International Directory of Nurse Researchers (STT) and the Classification of Nursing-Related Dissertations (DISSER). More than half of abstracts addressed clinical topics, and clinical research topics increased significantly over time (p less than .001). At least two of the three raters agreed on coding for 62.8 percent of abstracts with STT schemes, 70.9 percent with DISSER scheme (p less than .01). Additional testing and standardization of taxonomies for nursing research is needed to improve reliability and validity.

Northwick Park Infection Consultation Service. Part II. Contribution of the service to patient management: an analysis of results between September 1987 and July 1990

The establishment of Infectious Disease teams combining microbiological and clinical expertise has recently been recommended by a joint working part of the Royal College of Physicians and the Royal College of Pathologists. The Northwick Park Infection Consultation Service (ICS) has been operating on these lines since 1983; details are given in Part I. Part II assesses the contribution that the ICS has made to the management of infection in a study of 1038 patients undertaken between September 1987 and July 1990. The areas of patient diagnosis, treatment, investigation and isolation were examined to assess the appropriateness of the attending doctor's management of infection and the benefits resulting from recommendations made by the ICS. At the time of consultation the correct diagnosis had already been made or considered in 93% of patients, essential investigations needed to confirm or refute the diagnosis performed in 92%, and side-room isolation correctly instituted in 81% of patients requiring it. However, 41% of 776 infected patients were receiving suboptimal treatment: this was significantly more frequent in unsolicited consultations (P less than 0.05). Advice was given following consultation in 893 of 1038 patients (86%) and related to treatment (66%), investigation (41%), diagnosis (30%) and patient isolation (4%). Of 844 patients where receipt of advice could be accurately assessed, it was taken fully in 708 (84%), partly in III (13%), and went unheeded in 25 (3%). Advice on diagnosis or investigation enabled the correct diagnosis to be reached in 30% of consultations and in a further 47 patients (5%), the diagnosis was proposed by the ICS on initial consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of an automated sink on handwashing practices and attitudes in high-risk units

OBJECTIVE

To assess the effects of an automated sink on handwashing practices and attitudes of staff.

DESIGN

Quasi-experimental crossover design.

SETTING

Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals.

PARTICIPANTS

All patient care staff on study units; approximately 55 individuals.

INTERVENTIONS

An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the study's end.

RESULTS

One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p less than .001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period.

CONCLUSIONS

Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change.

Northwick Park Infection Consultation Service. Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990 [see comment]

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Evaluating the quality of caring: structure, process, and outcome

It may not be possible to attribute certain patient outcomes to the process of caring. However, there is progress in that direction. For example, the components and indicators of the process of caring, as perceived by the patient and the nurse, have been described in a number of recent studies, and several nursing leaders (eg, Benner, Watson) have suggested language and philosophic frameworks within which caring processes can be examined, studied, and tested. But more needs to be done. The individual nurse can no longer be held accountable for ensuring a caring relationship in the absence of educational, organizational, and professional structures that create a milieu in which caring is possible. Hence more attention to the structural components of caring is needed. Last, we must begin to think of caring as a process, not as an end in itself. As with all aspects of nursing practice, the relationship of care to patient outcomes deserves more attention. A first step is to define these patient outcomes and goals; then we can begin to link the caring process to them.

An update on nursing research and HIV infection

More than 16,000 citations related to AIDS and HIV infection between May 1987 and June 1990 (38 months) were surveyed to summarize nursing research related to HIV infection; 731 nonresearch and 54 research articles, averaging about 20/month, were found. However, only 20 of the research articles addressed the five topic areas set as priority by the National Center for Nursing Research Priority Expert Panel (physiological and psychosocial aspects of care, prevention of transmission, care delivery systems, and applied ethics). There is a continued gap in the research literature related to the care aspects of HIV infection. This gap needs to be filled by nursing investigation.

Preventing and treating human immunodeficiency virus infection in the homeless

The problem of human immunodeficiency virus infection in the homeless has received little attention in the literature but is a cause for serious concern. Nineteen health care agencies were studied to explore the types and outcomes of programs targeting this population, and factors associated with prevention and treatment strategies. The results showed that a variety of services were provided, but that little formal evaluation had been conducted. Factors identified were population variability, altered health status, daily survival, provider role conflicts and attributes, and a so-called nonsystem of care. The numerous gaps in knowledge about human immunodeficiency virus infection in the homeless inform future psychiatric nursing care and research.

Occurrence of infectious symptoms in children in day care homes

Transmission of enteric pathogens is facilitated in child day care centers, including family day care homes, by frequent and intimate exposure among susceptible hosts, with diaper changing as the highest-risk procedure for such transmission. The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period. Each of 24 family day care homes was randomly assigned to an intervention or control group. The intervention included four components: (1) a handwashing educational program and (2) use of vinyl gloves, (3) use of disposable diaper changing pads, and (4) use of an alcohol-based hand rinse by the day care provider. Symptoms of enteric disease (diarrhea and vomiting) were significantly reduced in intervention family day care homes (p less than or equal to 0.05), whereas respiratory symptoms were not significantly different between intervention and control family day care homes (p = 0.35). Diarrhea was reported in 1 of every 100 child care days, representing one diarrhea episode per month in a typical family day care home.

Clinical and laboratory findings in the Paul-Bunnell negative glandular fever-fatigue syndrome

Forty-one patients with recurrent fatigue were studied for evidence of symptom clustering, abnormal laboratory findings and infection with novel viruses. Symptom enquiry and investigations were repeated 4 months later. Four patients were found to have diseases compatible with their symptoms. In those remaining, an initial acute onset of symptoms was associated with an intermittent course, tender glands and a raised number of T suppressor lymphocytes. Raised numbers of T suppressor lymphocytes at follow-up correlated with resolution of symptoms. Antibodies to human herpesvirus 6 (HHV-6) were found in 75% of the patients as compared to 53% of a control group and more patients than controls were strongly seropositive. Some patients with chronic fatigue have a pattern of illness which suggests glandular fever, although acute infection with Epstein-Barr virus (EBV) is not demonstrated. Primary or reactivation infection with HHV-6 may have a role in this syndrome.

A case of resistant tuberculosis

We report a case of multiple drug-resistant pulmonary tuberculosis, in which treatment with two second line chemotherapy regimens was inadequate. Despite in-vitro sensitivity to ciprofloxacin the patient remained sputum positive with Mycobacterium tuberculosis after 11 months.

Patient experiences with research in a tertiary care setting

Data from a number of studies indicate that patients' understanding and recall of information presented during the informed consent process are poor. The purpose of this survey was to determine patients' attitudes about, desired knowledge of, and involvement in clinical research in a tertiary medical care setting. A self-report questionnaire was completed by 277 patients on the oncology, obstetrics/gynecology, medicine, neurosciences, surgery, and ophthalmology services of a large tertiary care facility. While most respondents had generally positive attitudes about research, relatively few were aware that human subjects approval processes existed or that nurses conducted research. Areas of additional knowledge needed included specific information about purposes of research and risks and benefits. Individuals with higher levels of education appeared more willing to participate in clinical research even when personal benefit was minimal.

Leakage of virus through used vinyl and latex examination gloves

A total of 480 examination gloves (240 vinyl and 240 latex) were stressed by using manipulations designed to mimic patient care. At the highest use level, 38 (63%) of 60 vinyl gloves leaked bacteriophage phi X174 compared with 4 (7%) of 60 latex gloves. At lower use levels, there was no statistically significant difference in leakage.