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Tsao H, Macdonald R, Dwyer D, Harper T, Rutz D, Sutherland J. Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study. Emerg Med Australas 2023; 35:213-217. [PMID: 36184077 DOI: 10.1111/1742-6723.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
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Affiliation(s)
- Henry Tsao
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Rachel Macdonald
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Damien Dwyer
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Tracey Harper
- Infection Control, Redland Hospital, Brisbane, Queensland, Australia
| | - Dominik Rutz
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - John Sutherland
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
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2
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Issa M, Dunne SS, Dunne CP. Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review. Ir J Med Sci 2022; 192:871-899. [PMID: 35435564 PMCID: PMC10066077 DOI: 10.1007/s11845-022-03004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Background
In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered.
Aim
Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs.
Methods
Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED.
Results
One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8–89.7%).
Conclusion
Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.
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Affiliation(s)
- M Issa
- School of Medicine, University of Limerick, Master's in Public Health Programme, Limerick, Ireland
| | - S S Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland.
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dos Santos Oliveira BA, Rigonato EM, de Sousa AFL, Ferreira AM, da Silva Barcelos L, Furlan MCR, Rigotti MA, Schneider G, de Andrade D, Lapão LV, dos Santos Junior AG. Correlation Between Surface Cleaning and Disinfection Methods in an Emergency Room. Open Nurs J 2021. [DOI: 10.2174/1874434602115010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
To evaluate the correlation between microbiological culture, ATP tests by bioluminescence and visual inspection for monitoring the surface cleaning and disinfection in an emergency room.
Methods:
This is a prospective, analytical study with a quantitative approach. Data analysis was guided by the following tests: Spearman’s correlation, Fisher ‘s exact test and receiver operating characteristic (ROC) curve.
Results:
There was a correlation between ATP quantification methods and microbial count for the women’s bathroom door handle (ρ = 0.526; p= 0.008). In this study, considering the ROC curve, the ATP value below 20 RLU is suggested to classify surfaces as approved in the emergency room.
Conclusion:
Using different methods of monitoring the cleaning and disinfection process is essential, considering that each method has a different purpose.
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Factors Influencing Emergency Department Nurses' Compliance with Standard Precautions Using Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116149. [PMID: 34200231 PMCID: PMC8201175 DOI: 10.3390/ijerph18116149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022]
Abstract
Standard precautions protect patients and nurses from infection. Nevertheless, compliance with standard precautions is lower among emergency department nurses than other nurses. We examined the individual and organizational factors that influence emergency department nurses’ compliance with standard precautions via a cross-sectional study. A self-reported questionnaire survey was administered to 140 nurses working in nine emergency departments in South Korea. It included items regarding ethical awareness and standard precaution self-efficacy at the individual level as well as safety environment, organizational culture for infection control, and degree of compliance with standard precautions at the organizational level. Individual and organizational predictors were identified using a multilevel analysis. The results indicated that 81.1% of nurses’ compliance with standard precautions was influenced by individual differences, while only 18.9% was influenced by organizational differences. Individual- and organizational-level predictors explained 46.7% and 55.4% of the variance in emergency department nurses’ compliance with standard precautions, respectively. Emergency department nurses’ compliance with standard precautions was predicted by ethical awareness and standard precaution self-efficacy at the individual level and by organizational culture for infection control at the organizational level. Our findings provide evidence for the need to improve facilities and human resource management as well as the organizational culture for infection control.
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5
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Lam SKK, Kwong EWY, Hung MSY, Chien WT. Emergency nurses' perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency departments. Int J Qual Stud Health Well-being 2020; 15:e1718468. [PMID: 31975652 PMCID: PMC7034460 DOI: 10.1080/17482631.2020.1718468] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: Emerging infectious diseases are considered as a pressing challenge to global public health. Throughout public health response to emerging infectious diseases, emergency nurses are situated at the forefront of the healthcare system. The present study has explored emergency nurses’ perceptions regarding the risks appraisal of the threat of the emerging infectious disease situation in emergency department context. Methods: The present study used a qualitative descriptive approach. A purposive sampling method was employed to recruit emergency nurses who worked in public hospitals in Hong Kong. Semi-structured interviews were conducted to 24 emergency nurses. The data were interpreted using a thematic analysis strategy. Results: Five overarching themes emerged from the data: (1) the novelty of an emerging infectious disease, (2) the severity of an emerging infectious disease, (3) the proximity to an emerging infectious disease, (4) the complexity of an emerging infectious disease situation, and (5) the response levels towards an emerging infectious disease situation. Conclusion: It is anticipated that the information may help to predict the attitudes and behaviours of emergency nurses in future impending epidemic events, enhancing emergency nurses’ preparedness towards in such situations. Abbreviations: EID: Emerging infectious disease; ED: Emergency department; SARS: Severe acute respiratory syndrome; MERS: Middle East respiratory syndrome; WHO: World Health Organization; RN: Registered nurse; APN: Advanced practice nurse; NO: Nursing officer
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Affiliation(s)
| | | | | | - Wai Tong Chien
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong
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6
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Al Bshabshe A, Al-Hakami A, Alshehri B, Al-Shahrani KA, Alshehri AA, Al Shahrani MB, Assiry I, Joseph MR, Alkahtani A, Hamid ME. Rising Klebsiella pneumoniae Infections and Its Expanding Drug Resistance in the Intensive Care Unit of a Tertiary Healthcare Hospital, Saudi Arabia. Cureus 2020; 12:e10060. [PMID: 32999783 PMCID: PMC7520404 DOI: 10.7759/cureus.10060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Nosocomial infections caused by Klebsiella pneumoniae and other Gram-negative organisms have emerged as a significant health problem especially in intensive care units (ICU). This study aims to examine K. pneumoniae infections in the ICU of Aseer Central Hospital and to determine their antimicrobial susceptibility and their relationship to patients' clinical outcomes. This is a retrospective observational study done in a tertiary care center in the Aseer region in Saudi Arabia. The study spanned from January 2018 to December 2019. Demographic, microbiologic, and patient outcomes were collected from 276 patients with various infections. Identification of isolates and in vitro susceptibility to 32 antimicrobial agents were done by the Vitek 2 automated system (bioMérieux, Marcy-l'Étoile, France). Prevalence of K. pneumoniae bacteria, their susceptibility to antimicrobials, and effect on clinical outcome were studied. Two hundred seventy-six K. pneumoniae were recovered from ICU patients with various infections. K. pneumoniae isolates (n=276) were collected mainly from the respiratory tract (61%) and K. pneumoniae represented 39% of the major causal agents of ICU infections, followed by Acinetobacter spp. (30%), Pseudomonas aeruginosa (10.0%), Escherichia coli (7%), and others (14%). The mortality among the 276 ICU patients was 33.3%; K. pneumoniae was connected to 42% of the cases and 67% of the total deaths were between 50 and 90 years of age. K. pneumoniae demonstrated high sensitivity and hence can be recommended for in vivo treatment for tigecycline (81%), cefazolin (77.2%), colistin (64.9%), and to a lesser extent norfloxacin (60%) and imipenem (55.5%). High resistance was detected for ampicillin (100%), extended-spectrum β-lactamases-sulbactam (ESBL-SCM) (100%), piperacillin (100%), and ceftazidime (92.5%). Resistance to carbapenems was elevated in ertapenem (65.2%) and meropenem (61.7%). The increase of K. pneumoniae represents a threat to ICU patients, although K. pneumoniae infections were results rather than the causes, as it was connected to almost half of the ICU mortalities. Tigecycline alone or in combination with colistin on high-dose regimens could be a more effective therapy for treating carbapenem-resistant K. pneumoniae infections.
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Affiliation(s)
| | - Ahmed Al-Hakami
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
| | | | | | | | | | | | - Martin R Joseph
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
| | - Abdullah Alkahtani
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
| | - Mohamed E Hamid
- Department of Clinical Microbiology and Parasitology, King Khalid University, Abha, SAU
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Seo HJ, Sohng KY, Chang SO, Chaung SK, Won JS, Choi MJ. Interventions to improve hand hygiene compliance in emergency departments: a systematic review. J Hosp Infect 2019; 102:394-406. [PMID: 30935982 DOI: 10.1016/j.jhin.2019.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
The emergency department (ED) is where hand hygiene problems are significant as the procedures in the ED are often high risk and invasive. To date, there have been no comprehensive reviews on hand hygiene in EDs. The aim of this study was to investigate hand hygiene compliance (HHC) rate, factors affecting the HHC rate, and intervention strategies to improve HHC in EDs. Electronic databases were used to search for research published from 1948 to January 2018. The databases included ovidMEDLINE, ovidEMBASE, the Cochrane Library, CINAHL, Koreamed, and Kmbase. All study designs were included. Two reviewers independently extracted the data and assessed the bias risk using reliable and validated tools. A narrative synthesis was performed. Twenty-four studies, including 12 cross-sectional surveys and 12 interventional studies, were included. Of the 12 interventional studies reviewed, only 33% (N = 4) reported HHC rates of more than 50%. Factors that influenced HHC included types of healthcare worker, hand hygiene indication, ED crowding, positive attitudes towards HHC, patient location, auditing hand hygiene, and type of shift. Almost all of the studies (83.3%) applied multimodal or dual interventions to improve HHC. A range of strategies, including education, monitoring and providing feedback, campaigns, and cues, effectively improved HHC. The review findings indicate that there is a room for improvement in HHC in EDs. Future randomized controlled trials are necessary to determine which intervention modalities are most effective and sustainable for HHC improvement.
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Affiliation(s)
- H-J Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - K-Y Sohng
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
| | - S O Chang
- College of Nursing, Korea University, Seoul, South Korea
| | - S K Chaung
- Department of Nursing, Semyung University, Jecheon, South Korea
| | - J S Won
- College of Nursing, Eulji University, Sungnam, South Korea
| | - M-J Choi
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
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Zarei E, Karimi S, Mahfoozpour S, Marzban S. Assessing hospital quality management systems: evidence from Iran. Int J Health Care Qual Assur 2019; 32:87-96. [PMID: 30859868 DOI: 10.1108/ijhcqa-11-2017-0208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A quality management system (QMS) is defined as interacting activities, methods and procedures used to monitor, control and improve service quality. The purpose of this paper is to describe the QMS status using the Quality Management System Index (QMSI) in hospitals affiliated to Shahid Beheshti Medical Sciences University in Tehran, Iran. DESIGN/METHODOLOGY/APPROACH In this cross-sectional study, 28 hospitals were investigated. A validated 46-item questionnaire was used for data collection. Data were analyzed using descriptive statistics, Pearson correlation, independent student's t-test and regression analysis. FINDINGS The mean QMSI score was 18.4: 15.3 for public and 20.9 for non-public hospitals ( p=0.001). The lowest (1.96) and the highest (2.14) scores related to "Quality policy documents" and "Quality monitoring by the board," respectively. The difference between public and non-public hospitals was significant in all nine QMSI dimensions ( p=0.001). The QMSI score was higher in non-public and small hospitals than in public and large ones ( p=0.05). ORIGINALITY/VALUE Most QMS studies come from developed countries, and there is no systematic information about the mechanisms and processes involved in implementing QMS in developing countries like Iran. This is the first study on Iranian hospital QMS using a newly developed tool (QMSI), and results showed that QMS maturity in these hospitals was relatively good, but the non-public hospitals status (private and charity) was far better than public hospitals.
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Affiliation(s)
- Ehsan Zarei
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Soghra Karimi
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Soad Mahfoozpour
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Sima Marzban
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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9
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Liang SY, Riethman M, Fox J. Infection Prevention for the Emergency Department: Out of Reach or Standard of Care? Emerg Med Clin North Am 2018; 36:873-887. [PMID: 30297010 PMCID: PMC6203442 DOI: 10.1016/j.emc.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110, USA.
| | - Madison Riethman
- Communicable Disease, Clark County Public Health, Center for Community Health, 1601 East Fourth Plain Boulevard, Building 17, PO Box 9825, Vancouver, WA 98666, USA
| | - Josephine Fox
- Infection Prevention, Barnes-Jewish Hospital, Mailstop 90-75-593, 4590 Children's Place, St Louis, MO 63108, USA
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Kudo D, Sasaki J, Ikeda H, Shiino Y, Shime N, Mochizuki T, Morita M, Soeda H, Ohge H, Lee JJ, Fujita M, Miyairi I, Kato Y, Watanabe M, Yokota H. A survey on infection control in emergency departments in Japan. Acute Med Surg 2018; 5:374-379. [PMID: 30338085 PMCID: PMC6167398 DOI: 10.1002/ams2.360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/12/2018] [Indexed: 11/09/2022] Open
Abstract
Aim Infection control in the emergency department is important for hospital risk management; however, few clinical guidelines have been established. This study aimed to determine whether hospitals in Japan have infection control manuals, and investigate the contents of manuals, consulting systems, and isolation facilities for emergency departments. Methods A total of 517 hospitals certified as educational institutions for board‐certified acute care physicians in Japan were requested between March and May 2015 to provide a written evaluation of the infection control in the emergency department. Results A total of 51 of 303 (16.8%) hospitals had no manuals regarding infection control in the emergency department. Among 250 hospitals having emergency department manuals, 115 (46.0%) did not include contents regarding disinfection and sterilization for imaging examination rooms, and only 44 (17.6%) had criteria for contacting the emergency medical service when patients are suspected of, or diagnosed with, communicable diseases. Of the 303 hospitals, 277 (91.4%) prepared specific manuals for the 2009 pandemic influenza. Of the 303 hospitals, 80 (26.4%) did not prepare manuals for the Ebola virus disease outbreak in West Africa in 2014. Furthermore, 92 (30.4%) of the 303 hospitals did not have any negative‐pressure isolation rooms. Conclusions Practices and guidelines necessary for infection control in the emergency department were not sufficiently covered in the hospitals studied. Education, information sharing, and a checklist for preparing manuals are needed to establish better infection control systems in emergency departments.
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Affiliation(s)
- Daisuke Kudo
- Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan
| | - Hiroto Ikeda
- Department of Emergency Medicine Teikyo University School of Medicine Tokyo Japan
| | - Yasukazu Shiino
- Department of Acute Medicine Kawasaki Medical School Kurashiki Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine Graduate School of Biochemical and Health Sciences Hiroshima University Hospital Hiroshima Japan
| | - Toru Mochizuki
- Infection Control Team Nippon Medical School Musashi Kosugi Hospital Kawasaki Japan
| | - Masanori Morita
- Critical Care Medical Center Sakai City Medical Center Sakai Japan
| | - Hiroshi Soeda
- Department of Pharmacy Tokyo Medical University Hospital Tokyo Japan
| | - Hiroki Ohge
- Department of Infectious Diseases Hiroshima University Hospital Hiroshima Japan
| | - Jong Ja Lee
- Japanese Society for Infection Prevention and Control Tokyo Japan
| | - Masahisa Fujita
- Infection Control Team Nippon Medical School Hospital Tokyo Japan
| | - Isao Miyairi
- Division of Infectious Diseases National Center for Child Health and Development Tokyo Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center National Center for Global Health and Medicine Tokyo Japan
| | - Manabu Watanabe
- Department of Surgery Toho University Ohashi Medical Center Tokyo Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
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11
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Zottele C, Magnago TSBDS, Dullius AIDS, Kolankiewicz ACB, Ongaro JD. Hand hygiene compliance of healthcare professionals in an emergency department. Rev Esc Enferm USP 2017; 51:e03242. [PMID: 28902323 DOI: 10.1590/s1980-220x2016027303242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze compliance with hand hygiene by healthcare professionals in an emergency department unit. METHOD This is a longitudinal quantitative study developed in 2015 with healthcare professionals from a university hospital in the state of Rio Grande do Sul. Each professional was monitored three times by direct non-participant observation at WHO's five recommended moments in hand hygiene, taking the concepts of opportunity, indication and action into account. Descriptive and analytical statistics were used. RESULTS Fifty-nine healthcare professionals participated in the study. The compliance rate was 54.2%. Nurses and physiotherapists showed a compliance rate of 66.6% and resident physicians, 41.3%. When compliance was compared among professional categories, nurses showed greater compliance than resident physicians (OR = 2.83, CI = 95%: 1.09-7.34). CONCLUSION Hand hygiene compliance was low. Multidisciplinary approaches could be important strategies for forming partnerships to develop learning and implementation of hand hygiene practices. OBJETIVO Analisar a adesão à higienização das mãos dos profissionais de saúde em unidade de Pronto-Socorro. MÉTODO Estudo quantitativo longitudinal desenvolvido com profissionais de saúde de um Hospital Universitário do Rio Grande do Sul, em 2015. Para cada profissional, realizaram-se três acompanhamentos com observação direta não participante nos cinco momentos preconizados para higienização das mãos, levando-se em conta os conceitos de Oportunidade, Indicação e Ação. Utilizou-se da estatística descritiva e analítica. RESULTADOS Participaram do estudo 59 profissionais de saúde. A taxa de adesão foi de 54,2%. Os enfermeiros e fisioterapeutas obtiveram a taxa de adesão de 66,6% e os médicos residentes, de 41,3%. Ao ser comparada a adesão entre as categorias profissionais, os enfermeiros tiveram maior aderência do que os médicos residentes (RC=2,83; IC=95%:1,09-7,34). CONCLUSÃO A adesão à higienização das mãos foi baixa. Abordagens multidisciplinares podem ser estratégias importantes para formar parcerias que desenvolvam a aprendizagem e a efetivação de práticas de HM.
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Affiliation(s)
- Caroline Zottele
- Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Juliana Dal Ongaro
- Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil
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12
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Lam SK, Kwong EW, Hung MS, Pang SM. Bridging the gap between guidelines and practice in the management of emerging infectious diseases: a qualitative study of emergency nurses. J Clin Nurs 2016; 25:2895-905. [PMID: 27507678 PMCID: PMC7166687 DOI: 10.1111/jocn.13343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the difficulties and strategies regarding guideline implementation among emergency nurses. BACKGROUND Emerging infectious diseases remain an underlying source of global health concern. Guidelines for accident and emergency departments would require adjustments for infectious disease management. However, disparities between guidelines and nurses' practice are frequently reported, which undermines the implementation of these guidelines into practice. This article explores the experience of frontline emergency nurses regarding guideline implementation and provides an in-depth account of their strategies in bridging guideline-practice gaps. DESIGN A qualitative descriptive design was used. METHODS Semi-structured, face-to-face, individual interviews were conducted between November 2013-May 2014. A purposive sample of 12 frontline emergency nurses from five accident and emergency departments in Hong Kong were recruited. The audio-recorded interviews were transcribed verbatim and analysed with a qualitative content analysis approach. RESULTS Four key categories associated with guideline-practice gaps emerged, including getting work done, adapting to accelerated infection control measures, compromising care standards and resolving competing clinical judgments across collaborating departments. The results illustrate that the guideline-practice gaps could be associated with inadequate provision of corresponding organisational supports after guidelines are established. CONCLUSIONS The nurses' experiences have uncovered the difficulties in the implementation of guidelines in emergency care settings and the corresponding strategies used to address these problems. The nurses' experiences reflect their endeavour in adjusting accordingly and adapting themselves to their circumstances in the face of unfeasible guidelines. RELEVANCE TO CLINICAL PRACTICE It is important to customise guidelines to the needs of frontline nurses. Maintaining cross-departmental consensus on guideline interpretation and operation is also indicated as an important component for effective guideline implementation.
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Affiliation(s)
- Stanley Kk Lam
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
| | - Enid Wy Kwong
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Maria Sy Hung
- School of Nursing, Tung Wah College, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Samantha Mc Pang
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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13
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Carter EJ, Wyer P, Giglio J, Jia H, Nelson G, Kauari VE, Larson EL. Environmental factors and their association with emergency department hand hygiene compliance: an observational study. BMJ Qual Saf 2016; 25:372-8. [PMID: 26232494 PMCID: PMC4781664 DOI: 10.1136/bmjqs-2015-004081] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/12/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Hand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of non-traditional patient care areas (ie, hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene. METHODS This was a single-site, observational study. From October 2013 to January 2014, trained observers recorded hand hygiene compliance among staff in the ED according to the World Health Organization 'My 5 Moments for Hand Hygiene'. Multivariable logistic regression was used to analyse the relationship between environmental conditions and hand hygiene compliance, while controlling for important covariates (eg, hand hygiene indication, glove use, shift, etc). RESULTS A total of 1673 hand hygiene opportunities were observed. In multivariable analyses, hand hygiene compliance was significantly lower when the ED was at its highest level of crowding than when the ED was not crowded and lower among hallway care areas than semiprivate care areas (OR=0.39, 95% CI 0.28 to 0.55; OR=0.73, 95% CI 0.55 to 0.97). CONCLUSIONS Unique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission.
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Affiliation(s)
- Eileen J. Carter
- Columbia University School of Nursing, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Peter Wyer
- Columbia University Medical Center/ NewYork-Presbyterian Hospital, New York, NY, USA
| | - James Giglio
- Columbia University Medical Center/ NewYork-Presbyterian Hospital, New York, NY, USA
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | - Elaine L. Larson
- Columbia University School of Nursing, New York, NY, USA
- Columbia University Mailman School of Public Health, New York, NY, USA
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Emergency Department Catheter-Associated Urinary Tract Infection Prevention: Multisite Qualitative Study of Perceived Risks and Implemented Strategies. Infect Control Hosp Epidemiol 2015; 37:156-62. [PMID: 26526870 DOI: 10.1017/ice.2015.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs. METHODS In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants. RESULTS All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement. CONCLUSIONS Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.
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Journal Roundup. J Hosp Infect 2014. [PMCID: PMC7134453 DOI: 10.1016/j.jhin.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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