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Ghorbanmovahhed S, Shahbazi S, Gilani N, Ostadi A, Shabanloei R, Gholizadeh L. Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study. BMC MEDICAL EDUCATION 2023; 23:265. [PMID: 37076871 PMCID: PMC10116755 DOI: 10.1186/s12909-023-04208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Standard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses. METHODS A quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size. RESULTS After developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (β = 5.18; 95% CI= -0.3-10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (β = 20.82; 95% CI 16.40-25.25, p < 0.001). CONCLUSIONS Given the continuing level of interest that exists in improving health care workers' hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.
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Affiliation(s)
- Shamsi Ghorbanmovahhed
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, PO Box 5138947-977, Tabriz, Iran
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Ostadi
- Department of Internal Medicine, Sina Educational, Research and Treatment Center, faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Shabanloei
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Boamah SA, Hamadi HY, Spaulding AC. Hospital-Acquired Conditions Reduction Program, Racial and Ethnic Diversity, and Magnet Designation in the United States. J Patient Saf 2022; 18:e1090-e1095. [PMID: 35532988 DOI: 10.1097/pts.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A key quality indicator in any health system is its ability to reduce morbidity and mortality. In recent years, healthcare organizations in the United States have been held to stricter measures of accountability to provide safe, quality care. This study aimed to explore the contextual factors driving racial disparities in hospital-acquired conditions incident rates among Medicare recipients in Magnet and non-Magnet hospitals. METHODS A cross-sectional observational study was performed using data from Hospital-Acquired Condition Reduction Program. Performance from 1823 hospitals were used to examine the association between Magnet recognition and community's racial and ethnic differences in hospital performance on the Hospital-Acquired Condition Reduction Program. The unit of analysis was the hospital level. A propensity score matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. The outcome measures were risk-standardized hospital performance on the Hospital-Acquired Condition Reduction Program domains and overall performance. RESULTS Study findings show that Magnet hospitals had decreased methicillin-resistant Staphylococcus aureus (MRSA) rate (β = -0.22; 95% confidence interval, -0.36 to -0.08) compared with non-Magnet hospitals. No other statistical difference was identified. CONCLUSIONS Results from this study show community's racial and ethnic differences in hospital-acquired conditions occurrence differ between Magnet and non-Magnet hospitals for MRSA, indicating its association with nursing practice. However, because this improvement is limited to only MRSA, there are likely opportunities for Magnet hospitals to continue process improvements focused on additional Hospital-Acquired Condition Reduction Program measures.
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Affiliation(s)
- Sheila A Boamah
- From the School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
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Yang Y, Tang TT, Lin J, Gan CL, Huang WZ, Fang Y. The effect of a full-time infection control nursing service in the prevention of multidrug-resistant organism in the orthopedic ward. BMC Infect Dis 2022; 22:348. [PMID: 35392833 PMCID: PMC8991496 DOI: 10.1186/s12879-022-07331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/31/2022] [Indexed: 02/08/2023] Open
Abstract
Background Our aim was to evaluate the effect of setting up a full-time infection control nursing service on reducing the prevalence of multidrug-resistant organism (MDRO) in the orthopedic ward. Methods From January 2015 to March 2019, routine prevention and control measures were taken for patients infected/colonized with MDRO in this ward, which was set as the pre-intervention period. The intervention period was from April 2019 to June 2021. The study was designed to evaluate whether the establishment of a full-time infection control nursing service could reduce the positive density of MDRO in the hospital by using an interrupted time-series model of a quasi experimental study. Results There were 11,759 patients during pre-intervention period and 8142 patients during intervention period. The total number of MDRO isolated before intervention was 177, of which 145 were obtained in hospital and 32 were brought in from outside hospital. The total number of MDRO isolated after intervention was 47, of which 29 were obtained in hospital and 18 were brought in from outside hospital. Before intervention, the positive density of MDRO in the orthopedic ward showed an increasing trend (β1 = 0.02, P = 0.003). After intervention, the positive density of MDRO showed a downward trend (β3 = − 0.05, P = 0.018). Conclusions The establishment of the full-time infection control nursing service in the orthopedic ward can effectively reduce the nosocomial prevalence of MDRO.
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Affiliation(s)
- Yun Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ting-Ting Tang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ji Lin
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Chun-Lan Gan
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen-Zhi Huang
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Vuichard-Gysin D, Nueesch R, Fuerer RL, Dangel M, Widmer A. Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study. BMJ Open 2022; 12:e044639. [PMID: 35314467 PMCID: PMC8938694 DOI: 10.1136/bmjopen-2020-044639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Isolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed at evaluating the psychological impact of IP in adult patients in isolation using a novel psychological assessment tool. STUDY DESIGN Prospective matched cohort study. SETTING Tertiary care centre in Switzerland. PARTICIPANTS Hospitalised patients under IP and non-isolated patients were matched by ward, age and illness severity. OUTCOME MEASURES We measured surrogates of mental and social well-being by using the Pictorial Representation of Illness and Self Measure (PRISM) instrument once during hospitalisation. PRISM is a visual psychometric instrument that has been validated as a quantitative measure of suffering. Smaller distance in self-to-illness separation (SIS) signifies higher importance for a patient. RESULTS 156 patients agreed to participate of which 63 were under IP and 93 were matched controls. Median (IQR) duration of isolation was 5 days (2-10). The median SIS (IQR) for perceived inferior nurses' care was 22.8 (18.5-24.3) and 23.8 (23.3-25.5) for isolated and non-isolated patients, respectively (p<0.001). Similarly, median SIS (IQR) was significantly smaller in isolated than non-isolated patients for avoidance by visitors with 17.5 (7.7-22.0) and 22.2 (21.8-22.6), for loneliness with 7.5 (3.6-16.0) and 18 (10.2-21.6) and for feeling impure with 19 (17.0-21.5) and 21.5 (18.9-22.1), respectively (all p values<0.05). CONCLUSIONS IP to prevent transmission of pathogens may negatively impact mental and social well-being. Measures to alleviate adverse effects of IP should be taken routinely.
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Affiliation(s)
- Danielle Vuichard-Gysin
- Internal Medicine, Spital Thurgau AG, Muensterlingen, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Reto Nueesch
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
- Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
| | | | - Marc Dangel
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Panknin HT. Ein Aufgabenkatalog ist für die Etablierung sinnvoll. PROCARE : DAS FORBILDUNGSMAGAZIN FUR PFLEGEBERUFE 2022; 27:16-19. [PMID: 35250188 PMCID: PMC8882353 DOI: 10.1007/s00735-022-1517-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fiveash JM, Smith ML, Moore AK, Jandarov R, Sopirala MM. Build upon basics: An intervention utilizing safety huddles to achieve near-zero incidence of catheter associated urinary tract infection at a department of Veterans Affairs long-term care facility. Am J Infect Control 2021; 49:1419-1422. [PMID: 33798629 DOI: 10.1016/j.ajic.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND When traditional interventions are used in long term care for catheter associated urinary tract infection (CAUTI) prevention, residual rates are still high despite a decrease. We conducted a quality improvement study focusing our interventions on patient and staff behavioral patterns identified through a structured huddle process to improve upon the basics for CAUTI prevention. METHODS Baseline was from January 2016 to March 2017; the intervention period was from April 2017 to June 2020. We implemented a systematic huddle to determine root cause of each CAUTI and applied lessons throughout the facility. We measured the monthly CAUTI incidence per 1000 urinary catheter days and analyzed the reduction in CAUTI during the intervention period. RESULTS CAUTI decreased by 73% during the intervention period compared to the baseline period, with an IRR of 0.27 (95% confidence interval [CI]: 0.11-0.66; P = .004). The number of catheter days per month increased by 4% in the intervention period (17,407 in 39 months) compared to the baseline period (6,440 in 15 months) with IRR of 1.04 (95% confidence interval [CI]: 1.01-1.07; P = .008). No patterns were noted in organisms responsible for CAUTI. CONCLUSIONS Our findings stress the importance of looking beyond the traditional interventions for CAUTI prevention in long term care population. By doing this, interventions can be customized for this special population to achieve optimal outcomes.
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Pakyz AL, Wang H, Ozcan YA, Edmond MB, Vogus TJ. Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals. J Patient Saf 2021; 17:445-450. [PMID: 28452915 DOI: 10.1097/pts.0000000000000378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital's safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs. METHODS Ordered probit regression analyses tested associations between Safety Score, Magnet status, and standardized infection ratios, depicting whether a hospital had a Clostridium difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection standardized infection ratio that was "better," "no different," or "worse" than a National Benchmark as per Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. RESULTS Accounting for confounders, relative to "A" hospitals, "B" and "C" hospitals had significant and negative relationships with CDI (-0.16, P < 0.01, and -0.14, P < 0.05, respectively) but not MRSA bacteremia. Magnet hospitals had a significant and positive relationship with MRSA bloodstream infections (0.74, P < 0.001) but a significant negative relationship with CDI (-0.21, P < 0.01) compared with non-Magnet. CONCLUSIONS A hospitals performed better on CDI but not MRSA bloodstream infections. In contrast, Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results indicate that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs, suggesting the need for more precise organizational measures of safety and more nuanced approaches to infection prevention and reduction.
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Affiliation(s)
- Amy L Pakyz
- From the Departments of Pharmacotherapy and Outcomes Science, School of Pharmacy
| | - Hui Wang
- Biostatistics, School of Medicine
| | - Yasar A Ozcan
- Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Michael B Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
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McGuire R, Bagallon G. Development and evaluation of an intravascular link nurse network to sustain improvements in practice. ACTA ACUST UNITED AC 2021; 30:S16-S22. [PMID: 33529101 DOI: 10.12968/bjon.2021.30.2.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Link nurses have been used to support many areas of specialist nursing practice since the 1980s. They add value as they provide a practical and timely way of sharing information and knowledge and raising awareness with the wider multidisciplinary team. One strategy to improve standards and sustain improvements in the care of vascular access devices was to develop an intravascular link nurse network: 'Finding the missing link'. The link nurses are supported to attend quarterly masterclasses underpinned by the current evidence base. The masterclasses provide forums and workshops for learning, sharing initiatives, processes, progress and feedback. Results from the 2018/2019 sessions evaluation showed that 80% of the link nurses scored the workshops as excellent, 14% good, less than 1% fair and poor, and 4% did not provide an answer. Overall, 87% of link nurses were extremely likely to recommend the programme, 13% were likely to recommend it, and 93% found it helpful in their personal and professional growth. The network with supporting masterclasses has proven to be an effective strategy within the Trust.
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Affiliation(s)
- Rose McGuire
- Senior Intravascular Practitioner, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London
| | - Geralyn Bagallon
- Intravascular Practitioner, King's College Hospital NHS Foundation Trust, London
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Damayanti M, Handiyani H. Low compliance, limited facilities, and insufficient budget funds become obstacles in the implementation of infection and prevention control programs: A phenomenology study. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 PMCID: PMC9585124 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Background There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. Methods CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common. Conclusion Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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Donati D, Miccoli GA, Cianfrocca C, Di Stasio E, De Marinis MG, Tartaglini D. Effectiveness of implementing link nurses and audits and feedback to improve nurses' compliance with standard precautions: A cluster randomized controlled trial. Am J Infect Control 2020; 48:1204-1210. [PMID: 32178856 DOI: 10.1016/j.ajic.2020.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND To prevent health care-associated infections, health organizations recommend that health care workers stringently observe standard precautions (SPs). Nevertheless, compliance with SPs is still suboptimal, emphasizing the need for improvement interventions. METHODS A cluster randomized controlled trial with a pretest-post-test design was conducted with 121 clinical nurses who worked in different wards of a university hospital. The intervention group (n = 61) had 3 infection control link nurses nominated and attended systematic audits and feedback. The control group (n = 60) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of SPs compliance was performed via the World Health Organization observational hand hygiene form and Compliance with Standard Precaution Scale Italian version. RESULTS At the post-test, nurses in the intervention group reported significantly increased compliance with hand hygiene, whereas no significant improvement was found in the control group. Nurses in both groups reported significantly increased Compliance with Standard Precaution Scale Italian version scores; however, a higher increase and practical significance was observed in the intervention group. Participants who improved their scores were also compared between groups, showing a significantly greater increase of individual scores in intervention group compared to the control group. CONCLUSIONS The findings of this study provide significant practical implications for hospitals seeking to improve compliance with SPs among nurses, showing the effectiveness of using infection control link nurses combined with systematic audits and feedback.
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Affiliation(s)
- Daniele Donati
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
| | | | - Claudia Cianfrocca
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Tartaglini
- Research Unit Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
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Mousavi-Roknabadi RS, Momennasab M, Askarian M, Haghshenas A, Marjadi B. Causes of medical errors and its under-reporting amongst pediatric nurses in Iran: a qualitative study. Int J Qual Health Care 2020; 31:541-546. [PMID: 30272214 DOI: 10.1093/intqhc/mzy202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/20/2018] [Accepted: 09/07/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. DESIGN A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. SETTINGS The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. PARTICIPANTS The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital's ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. MAIN OUTCOME MEASURE(S) Pediatrics nurses' views on the causes of ME and under-reporting. RESULTS We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. CONCLUSION Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.
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Affiliation(s)
| | - Marzieh Momennasab
- Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Askarian
- Department of Community Medicine, Natural and Medicinal Chemistry Research Center, Shiraz University of Medical Sciences, School of Medicine, Karimkhan-e-Zand Avenue, Shiraz, IR Iran
| | - Abbas Haghshenas
- Adjunct, School of Health Sciences, University of Technology of Sydney, 15 Broadway, Ultimo, Sydney, New South Wales, Australia
| | - Brahmaputra Marjadi
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith NSW, Australia
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Dekker M, van Mansfeld R, Vandenbroucke-Grauls C, de Bruijne M, Jongerden I. Infection control link nurse programs in Dutch acute care hospitals; a mixed-methods study. Antimicrob Resist Infect Control 2020; 9:42. [PMID: 32106884 PMCID: PMC7047353 DOI: 10.1186/s13756-020-0704-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Infection control link nurse programs show considerable variation. We report how Dutch link nurse programs are organized, how they progress, and how contextual factors may play a role in the execution of these programs. Methods This mixed-methods study combined a survey and semi-structured interviews with infection control practitioners, based on items of the Template for Intervention Description and Replication (TIDieR) checklist. Results The Netherlands has 74 hospitals; 72 infection control practitioners from 72 different hospitals participated in the survey. Four of these infection control practitioners participated in interviews. A link nurse program was present in 67% of the hospitals; responsibility for 76% of these programs lied solely with the infection prevention and control team. The core component of most programs (90%) was education. Programs that included education on infection prevention topics and training in implementation skills were perceived as more effective than programs without such education or programs where education included only infection prevention topics. The interviews illustrated that these programs were initiated by the infection prevention team with the intention to collaborate with other departments to improve practice. Content for these programs was created at the time of their implementation. Infection control practitioners varied in their ability to express program goals and to engage experts and key stakeholders. Conclusions Infection control link nurse programs vary in content and in set up. Programs with a clear educational content are viewed as more successful by the infection control practitioners that implement these programs.
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Affiliation(s)
- Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, room PK1X132, 1081, HV, Amsterdam, The Netherlands.
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, room PK1X132, 1081, HV, Amsterdam, The Netherlands
| | - Christina Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, room PK1X132, 1081, HV, Amsterdam, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Liao S, Rhodes J, Jandarov R, DeVore Z, Sopirala MM. Out of Sight-Out of Mind: Impact of Cascade Reporting on Antimicrobial Usage. Open Forum Infect Dis 2020; 7:ofaa002. [PMID: 32055636 PMCID: PMC7008474 DOI: 10.1093/ofid/ofaa002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background There is a paucity of data evaluating the strategy of suppressing broader-spectrum antibiotic susceptibilities on utilization. Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary (eg, broader-spectrum, costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. Our objective was to evaluate the impact of ceftriaxone-based cascade reporting on utilization of cefepime and clinical outcomes in patients with ceftriaxone-susceptible Escherichia and Klebsiella clinical cultures. Methods We compared post-CR (July 2014-June 2015) with baseline (July 2013-June 2014), evaluating utilization of cefepime, cefazolin, ceftriaxone, ampicillin derivatives, fluoroquinolones, piperacillin/tazobactam, ertapenem, and meropenem; new Clostridium difficile infection; and length of stay (LOS) after the positive culture, 30-day readmission, and in-hospital all-cause mortality. Results Mean days of therapy (DOT) among patients who received any antibiotic for cefepime decreased from 1.229 days during the baseline period to 0.813 days post-CR (adjusted relative risk, 0.668; P < .0001). Mean DOT of ceftriaxone increased from 0.864 days to 0.962 days, with an adjusted relative risk of 1.113 (P = .004). No significant differences were detected in other antibiotics including ertapenem and meropenem, demonstrating the direct association of the decrease in cefepime utilization with CR based on ceftriaxone susceptibility. Average LOS in the study population decreased from 14.139 days to 10.882 days from baseline to post-CR and was found to be statistically significant (P < .0001). Conclusions In conclusion, we demonstrated significant association of decreased cefepime utilization with the implementation of a CR based on ceftriaxone susceptibility. We demonstrated the safety of deescalation, with LOS being significantly lower during the post-CR period than in the baseline period, with no change in in-hospital mortality.
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Affiliation(s)
- Siyun Liao
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Judith Rhodes
- Department of Pathology, University of College of Medicine, Cincinnati, Ohio, USA
| | - Roman Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zachary DeVore
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Madhuri M Sopirala
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Errecaborde KM, Macy KW, Pekol A, Perez S, O’Brien MK, Allen I, Contadini F, Lee JY, Mumford E, Bender JB, Pelican K. Factors that enable effective One Health collaborations - A scoping review of the literature. PLoS One 2019; 14:e0224660. [PMID: 31800579 PMCID: PMC6892547 DOI: 10.1371/journal.pone.0224660] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 10/18/2019] [Indexed: 11/18/2022] Open
Abstract
Advocates for a One Health approach recognize that global health challenges require multidisciplinary collaborative efforts. While past publications have looked at interdisciplinary competency training for collaboration, few have identified the factors and conditions that enable operational One Health. Through a scoping review of the literature, a multidisciplinary team of researchers analyzed peer-reviewed publications describing multisectoral collaborations around infectious disease-related health events. The review identified 12 factors that support successful One Health collaborations and a coordinated response to health events across three levels: two individual factors (education & training and prior experience & existing relationships), four organizational factors (organizational structures, culture, human resources and, communication), and six network factors (network structures, relationships, leadership, management, available & accessible resources, political environment). The researchers also identified the stage of collaboration during which these factors were most critical, further organizing into starting condition or process-based factors. The research found that publications on multisectoral collaboration for health events do not uniformly report on successes or challenges of collaboration and rarely identify outputs or outcomes of the collaborative process. This paper proposes a common language and framework to enable more uniform reporting, implementation, and evaluation of future One Health collaborations.
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Affiliation(s)
- Kaylee Myhre Errecaborde
- Veterinary Population Medicine Department, One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Veterinary Population Medicine Department, Center for Animal Health and Food Safety, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Katelyn Wuebbolt Macy
- Veterinary Population Medicine Department, One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Amy Pekol
- Veterinary Population Medicine Department, One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Sol Perez
- Veterinary Population Medicine Department, Center for Animal Health and Food Safety, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Mary Katherine O’Brien
- Veterinary Population Medicine Department, Center for Animal Health and Food Safety, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Ian Allen
- Veterinary Population Medicine Department, One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Francesca Contadini
- Department of Veterinary Epidemiology and Public Health, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Julia Yeri Lee
- City of Minneapolis Health Department, Food, Lodging and Pools, Minneapolis, Minnesota, United States of America
| | - Elizabeth Mumford
- One Health Country Operations Team, Department of Country Health Emergency Preparedness and IHR, World Health Organization, Geneva, Switzerland
| | - Jeff B. Bender
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Katharine Pelican
- Veterinary Population Medicine Department, One Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
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Asmara A, Hariyati RTS, Handiyani H, Avia I. Analysis of Infection Prevention Control Nurse performance: A descriptive study. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGuire R, Norman E, Hayden I. Reassessing standards of vascular access device care: a follow-up audit. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S4-S12. [PMID: 31002548 DOI: 10.12968/bjon.2019.28.8.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports on the findings of a repeat audit of vascular access devices (VADs) in a district general hospital undertaken 4 years after a previous audit. The first demonstrated poor standards of care and low compliance with evidence-based guidelines, indicating that a change in practice was necessary. A strategy of training, education and standardisation for intravenous devices was introduced, with the goal of transforming practice to raise standards and improve compliance. The findings of the follow-up audit show that the strategy has been successful in raising standards of care and reducing infections.
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Affiliation(s)
- Rose McGuire
- Senior Intravascular Practitioner, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London
| | - Ellen Norman
- Intravascular Practitioner, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London
| | - Iain Hayden
- Microbiology Senior Infection Surveillance Analyst, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London
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Sreeramoju P. Reducing Infections "Together": A Review of Socioadaptive Approaches. Open Forum Infect Dis 2019; 6:ofy348. [PMID: 30740469 PMCID: PMC6359910 DOI: 10.1093/ofid/ofy348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Abstract
Reducing healthcare-associated infections often requires the use of both technical and adaptive strategies. The experiences of Semmelweis and Nightingale teach us the importance of social adaptation of technical interventions. Because most infection prevention interventions require widespread participation by healthcare personnel, it is helpful for infectious diseases physicians to learn principles of diffusion of innovations theory and apply them to influence different groups. Comprehensive unit-based program has been successful in reducing device-associated infections. Positive deviance as a socioadaptive approach may be promising. These and other approaches such as social network analysis, relational coordination, link nurses, and stop the line policies need to be further evaluated in future studies. Future research on socioadaptive interventions needs to focus on developing tools and strategies for diagnosing local context and study how these interventions might influence culture of safety. Strategies to sustain momentum of improvement efforts in different healthcare settings need to be refined and further developed through additional research.
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Affiliation(s)
- Pranavi Sreeramoju
- Division of Medicine-Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
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19
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Dekker M, Jongerden IP, van Mansfeld R, Ket JCF, van der Werff SD, Vandenbroucke-Grauls CMJE, de Bruijne MC. Infection control link nurses in acute care hospitals: a scoping review. Antimicrob Resist Infect Control 2019; 8:20. [PMID: 30705754 PMCID: PMC6348687 DOI: 10.1186/s13756-019-0476-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background Involving link nurses in infection prevention and control is a strategy to improve clinical practice that has been implemented in hospitals worldwide. However, little is known about the use, the range and benefits of this strategy. We aimed to identify key concepts of infection control link nurses (ICLN) and ICLN programs, to evaluate the effect of such programs, and to identify gaps in the evidence base. Methods In a scoping review, we searched PubMed, CINAHL, Google and Google Scholar for manuscripts on ICLN in acute care hospitals. We included research- and opinion-based papers, abstracts, reports and guidelines. Results We included 29 publications and identified three key concepts: the profile of ICLN, strategies to support ICLN, and the implementation of ICLN programs. The majority of included studies delineates the ICLN profile with accompanying roles, tasks and strategies to support ICLN, without a thorough evaluation of the implementation process or effects. Few studies report on the effect of ICLN programs in terms of patient outcomes or guideline adherence, with positive short term effects. Conclusion This scoping review reveals a lack of robust evidence on the effectiveness of ICLN programs. Current best practice for an ICLN program includes a clear description of the ICLN profile, education on infection prevention topics as well as training in implementation skills, and support from the management at the ward and hospital level. Future research is needed to evaluate the effects of ICLN on clinical practice and to further develop ICLN programs for maximal impact. Electronic supplementary material The online version of this article (10.1186/s13756-019-0476-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mireille Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, De Boelelaan 1118, room PK1X132, 1081 HV Amsterdam, The Netherlands
| | - Irene P Jongerden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Rosa van Mansfeld
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, De Boelelaan 1118, room PK1X132, 1081 HV Amsterdam, The Netherlands
| | - Johannes C F Ket
- 3Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, Amsterdam, The Netherlands
| | - Suzanne D van der Werff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, De Boelelaan 1118, room PK1X132, 1081 HV Amsterdam, The Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, De Boelelaan 1118, room PK1X132, 1081 HV Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Sopirala MM, Syed A, Jandarov R, Lewis M. Impact of a change in surveillance definition on performance assessment of a catheter-associated urinary tract infection prevention program at a tertiary care medical center. Am J Infect Control 2018; 46:743-746. [PMID: 29551201 DOI: 10.1016/j.ajic.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In January 2015, the Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) changed the definition of catheter-associated urinary tract infection (CAUTI). We evaluated the outcomes of a robust CAUTI prevention program when we performed surveillance using the old definition (before 2015) versus the new definition (after 2015). This is the first study to evaluate how the change in CDC/NHSN definitions affected the outcomes of a CAUTI reduction program. METHODS Baseline was from January 2012 to September 2014; the intervention period was from October 2014 to February 2016. Staff nurses were trained to be liaisons of infection prevention (Link Nurses) with clearly defined CAUTI prevention goals and with ongoing monthly activities. CAUTI incidence per 1000 catheter days was compared between the baseline and intervention periods, using the 2 definitions. RESULTS With the new definition, CAUTIs decreased by 33%, from 2.69 to 1.81 cases per 1000 catheter days (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI]: 0.48-0.93; P < .016). With the old definition, CAUTIs increased by 12%, from 3.38 to 3.80 cases per 1000 catheter days (IRR = 1.12; 95% CI: 0.88-1.43; P = .348). CONCLUSION We aggressively targeted CAUTI prevention, but a reduction was observed only with the new definition. Our findings stress the importance of having a reasonably accurate surveillance definition to monitor infection prevention initiatives.
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Affiliation(s)
| | - Asma Syed
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Roman Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
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Strategies to promote infection prevention and control in acute care hospitals with the help of infection control link nurses: A systematic literature review. Am J Infect Control 2018; 46:207-216. [PMID: 29413157 DOI: 10.1016/j.ajic.2017.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infection control link nurses (ICLNs) are important backup personnel for the prevention and control of infections in hospitals. To identify facilitators and barriers for the implementation of and long-term collaboration with ICLNs. METHODS We conducted a systematic literature review, following the preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria were defined as description of de novo implementation of an ICLN system, strengthening of an existing ICLN system, or analysis of an ICLN system. RESULTS In 10 publications, facilitators and barriers were identified for mode of selection of ICLN candidates, characteristics and responsibilities of ICLNs, composition of a training curriculum, educational strategies, and external influencing factors. Experienced nurses with an interest in infection control seemed appropriate candidates. The importance of psychological skills in addition to technical knowledge was emphasized. A clear definition of responsibilities was important. Viable tasks for ICLNs included surveillance and teaching activities and the implementation of prevention measures. Ongoing teaching was superior to a single course. Management support was pivotal for success. CONCLUSION Research on ICLNs is scarce. The potential to decrease health care-associated infections with the help of ICLNs has been demonstrated. The training in psychological skills in addition to technical knowledge deserves more attention.
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Gould DJ, Moralejo D, Drey N, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2017; 9:CD005186. [PMID: 28862335 PMCID: PMC6483670 DOI: 10.1002/14651858.cd005186.pub4] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. OBJECTIVES To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. SEARCH METHODS We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. MAIN RESULTS This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. AUTHORS' CONCLUSIONS With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.
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Affiliation(s)
- Dinah J Gould
- Cardiff UniversitySchool of Healthcare SciencesEastgate HouseCardiffWalesUK
| | - Donna Moralejo
- Memorial UniversitySchool of NursingH2916, Health Sciences Centre300 Prince Philip DriveSt. John'sNLCanadaA1B 3V6
| | - Nicholas Drey
- City, University of LondonCentre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Jane H Chudleigh
- City, University of LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Monica Taljaard
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ Civic Campus1053 Carling Ave, Box 693OttawaONCanadaK1Y 4E9
- University of OttawaSchool of Epidemiology, Public Health and Preventive MedicineOttawaONCanada
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Gould DJ, Navaie D, Purssell E, Drey NS, Creedon S. Changing the paradigm: messages for hand hygiene education and audit from cluster analysis. J Hosp Infect 2017; 98:345-351. [PMID: 28760636 DOI: 10.1016/j.jhin.2017.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hand hygiene is considered to be the foremost infection prevention measure. How healthcare workers accept and make sense of the hand hygiene message is likely to contribute to the success and sustainability of initiatives to improve performance, which is often poor. METHODS A survey of nurses in critical care units in three National Health Service trusts in England was undertaken to explore opinions about hand hygiene, use of alcohol hand rubs, audit with performance feedback, and other key hand-hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. RESULTS Three main clusters of opinion were visualized, each forming a significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. CONCLUSION Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation for behaviour. Healthcare workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively, cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting.
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Affiliation(s)
- D J Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - D Navaie
- University Hospital Lewisham, London, UK
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Promoting health workers' ownership of infection prevention and control: using Normalization Process Theory as an interpretive framework. J Hosp Infect 2016; 94:373-380. [DOI: 10.1016/j.jhin.2016.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/16/2016] [Indexed: 11/18/2022]
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Gould DJ, Gallagher R, Allen D. Leadership and management for infection prevention and control: what do we have and what do we need? J Hosp Infect 2016; 94:165-8. [PMID: 27520488 DOI: 10.1016/j.jhin.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - D Allen
- Cardiff University, Cardiff, UK
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Wentzel J, van Drie-Pierik R, Nijdam L, Geesing J, Sanderman R, van Gemert-Pijnen JEWC. Antibiotic information application offers nurses quick support. Am J Infect Control 2016; 44:677-84. [PMID: 26905792 DOI: 10.1016/j.ajic.2015.12.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses can be crucial contributors to antibiotic stewardship programs (ASPs), interventions aimed at improving antibiotic use, but nurse empowerment in ASPs adds to their job complexity. Nurses work in complex settings with high cognitive loads, which ask for easily accessible information. An information application (app) was developed to support nurses in ASPs. The efficiency, effectiveness, and user satisfaction regarding this antibiotic app were tested in a pilot study. METHODS The app was introduced into 2 lung wards of a local teaching hospital. During the 8-month pilot study, the 62 nurses of the wards had access to the app. Changes in user satisfaction regarding information support, safety attitudes, and ASP behavior were assessed with a questionnaire. At baseline, 28 nurses completed the (e-mail) questionnaire; after the study, 18 nurses participated. Scenario-based tests were done to assess app efficiency and effectiveness at baseline (n = 16) and in a randomized control (without the app, n = 17) and intervention condition (with the app, n = 17). RESULTS Significant improvements were found regarding task support (P = .041), reliability (P = .004), unobtrusiveness (P = .000), relevance (P = .002), user friendliness (P = .000), speed, and hyperlinks (P = .001). An improvement in communication was observed regarding nurse-physician understanding (P = .034). With the app, nurses solved the scenarios faster than without it. CONCLUSIONS The human-centered design approach and persuasive strategy of task support were effective in reducing time needed to find information. Stewardship-related behaviors need active education strategies.
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Affiliation(s)
- Jobke Wentzel
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management and Social Sciences, Universitity of Twente, Enschede, The Netherlands.
| | | | - Lars Nijdam
- Department of Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jos Geesing
- Department of Pulmonary Medicine, Medisch Spectrum, Enschede, The Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management and Social Sciences, Universitity of Twente, Enschede, The Netherlands; Health Psychology Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Julia E W C van Gemert-Pijnen
- Department of Psychology, Health, and Technology, Faculty of Behavioural, Management and Social Sciences, Universitity of Twente, Enschede, The Netherlands; Department of Clinical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
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Kuroda T, Kinoshita Y, Niwa H, Shinzaki Y, Tamura N, Hobo S, Kuwano A. Meticillin-resistant Staphylococcus aureus colonisation and infection in Thoroughbred racehorses and veterinarians in Japan. Vet Rec 2016; 178:473. [PMID: 27114407 DOI: 10.1136/vr.103576] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 11/04/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) infections have been confirmed in hospitalised Thoroughbred racehorses at the hospitals of two training centres in Japan since 2009. To investigate the source of infection, the authors examined the rate of nasal MRSA colonisation in 600 healthy Thoroughbred racehorses, 53 veterinarians and 16 office staff at the racehorse hospitals of the two training centres. MRSA was not isolated from healthy Thoroughbred racehorses or hospital office staff. However, MRSA was isolated from 16 veterinarians (30.1 per cent), and the colonisation rate was significantly higher in veterinarians than in the office staff of the same hospitals. Also, 10 of the 16 MRSA strains (62.5 per cent) isolated from veterinarians were classified as type II by staphylococcal cassette chromosome mec (SCCmec) typing and ST5 by multilocus sequence typing. Pulsed-field gel electrophoresis analysis demonstrated that these 10 MRSA strains of SCCmec type II and ST5 were genetically identical or very similar to 9 MRSA strains isolated from infected horses hospitalised at these hospitals between 2009 and 2013. These results indicate that SCCmec type II and ST5 MRSA strains were probably transmitted between veterinarians and infected horses.
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Affiliation(s)
- T Kuroda
- Clinical Science & Pathobiology Division, Equine Research Institute, Japan Racing Association, Tokami-Cho 321-4, Utsunomiya, Tochigi 320-0856, Japan
| | - Y Kinoshita
- Microbiology Division, Epizootic Research Center, Equine Research Institute, Japan Racing Association, Shiba 1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | - H Niwa
- Microbiology Division, Epizootic Research Center, Equine Research Institute, Japan Racing Association, Shiba 1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | - Y Shinzaki
- Racehorse Clinic, Ritto Training Center, Japan Racing Association, Misono 1028, Ritto, Shiga 520-3085, Japan
| | - N Tamura
- Clinical Science & Pathobiology Division, Equine Research Institute, Japan Racing Association, Tokami-Cho 321-4, Utsunomiya, Tochigi 320-0856, Japan
| | - S Hobo
- Department of Domestic Animal Internal Medicine, Clinical Veterinary Science, Veterinary Medicine, Joint Faculty of Veterinary Medicine, Kagoshima University, Korimoto 1-21-24, Kagoshima, Kagoshima 890-0065, Japan
| | - A Kuwano
- Clinical Science & Pathobiology Division, Equine Research Institute, Japan Racing Association, Tokami-Cho 321-4, Utsunomiya, Tochigi 320-0856, Japan
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Could a Coagulation Nurse Liaison Improve Compliance With Venous Thromboembolism Prophylaxis in Medical Patients? J Nurs Care Qual 2015; 31:E11-5. [PMID: 26488825 DOI: 10.1097/ncq.0000000000000154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical patients worldwide are undertreated with venous thromboembolism prophylaxis. Our hypothesis was that the rate of prophylactic anticoagulation therapy for high-risk patients would improve with the use of a coagulation nurse liaison. Six months after appointing a nurse for this role, prophylaxis rates significantly improved, and patients were more likely to receive appropriate thromboprophylaxis. A coagulation nurse liaison substantially improves thromboprophylaxis in a medical ward.
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Amissah NA, Chlebowicz MA, Ablordey A, Sabat AJ, Tetteh CS, Prah I, van der Werf TS, Friedrich AW, van Dijl JM, Rossen JW, Stienstra Y. Molecular Characterization of Staphylococcus aureus Isolates Transmitted between Patients with Buruli Ulcer. PLoS Negl Trop Dis 2015; 9:e0004049. [PMID: 26360794 PMCID: PMC4567303 DOI: 10.1371/journal.pntd.0004049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/11/2015] [Indexed: 12/18/2022] Open
Abstract
Background Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans. The wounds of most BU patients are colonized with different microorganisms, including Staphylococcus aureus. Methodology This study investigated possible patient-to-patient transmission events of S. aureus during wound care in a health care center. S. aureus isolates from different BU patients with overlapping visits to the clinic were whole-genome sequenced and analyzed by a gene-by-gene approach using SeqSphere+ software. In addition, sequence data were screened for the presence of genes that conferred antibiotic resistance. Principal Findings SeqSphere+ analysis of whole-genome sequence data confirmed transmission of methicillin resistant S. aureus (MRSA) and methicillin susceptible S. aureus among patients that took place during wound care. Interestingly, our sequence data show that the investigated MRSA isolates carry a novel allele of the fexB gene conferring chloramphenicol resistance, which had thus far not been observed in S. aureus. Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans. The wounds of most BU patients are colonized with different microorganisms, including Staphylococcus aureus. This study investigated patient-to-patient transmission events during wound care in a health care center. S. aureus isolates from patients who visited the health center at the same time points were analyzed using whole-genome sequencing. Analysis of sequence data confirmed transmission of methicillin resistant S. aureus and methicillin susceptible S. aureus among patients that took place during wound care.
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Affiliation(s)
- Nana Ama Amissah
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- * E-mail:
| | - Monika A. Chlebowicz
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anthony Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Artur J. Sabat
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Caitlin S. Tetteh
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Isaac Prah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - John W. Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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