1
|
Hidad S, de Greeff SC, Haenen A, de Haan F, Leusink GL, Timen A. Mind the gap: knowledge, attitudes and perceptions on antimicrobial resistance, antimicrobial stewardship and infection prevention and control in long-term care facilities for people with disabilities in the Netherlands. Antimicrob Resist Infect Control 2024; 13:56. [PMID: 38835090 DOI: 10.1186/s13756-024-01415-3] [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: 03/19/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs). METHODS A web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC. RESULTS In total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR. CONCLUSION Although the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.
Collapse
Affiliation(s)
- S Hidad
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S C de Greeff
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A Haenen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - F de Haan
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - G L Leusink
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Timen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
2
|
SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Collapse
|
3
|
Tsang CC, Holroyd-Leduc JM, Ewa V, Conly JM, Leslie MM, Leal JR. Barriers and Facilitators to the Use of Personal Protective Equipment in Long-Term Care: A Scoping Review. J Am Med Dir Assoc 2023; 24:82-89.e2. [PMID: 36473522 DOI: 10.1016/j.jamda.2022.11.012] [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: 07/14/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review existing literature evaluating barriers and facilitators to the use of personal protective equipment (PPE) by health care workers in long-term care (LTC). DESIGN Scoping review. SETTING AND PARTICIPANTS Health care workers in LTC settings. METHODS Several online databases were searched and a gray literature search was conducted. Study inclusion criteria were (1) conducted in nursing homes or LTC settings, (2) focused on LTC health care workers as the study population, and (3) identified barriers and/or facilitators to PPE use. The Theoretical Domains Framework (TDF), which assesses barriers to implementation across 14 behavioral change domains, was used to extract and organize data about barriers and facilitators to appropriate use of PPE from the included studies. RESULTS A total of 5216 references were screened for eligibility and 10 studies were included in this review. Eight of the 10 studies were conducted during the COVID-19 pandemic. Several barriers and facilitators to PPE use were identified. The most common TDF domain identified was environmental context and resources, which was observed in 9 of the 10 studies. Common barriers to PPE use included supply issues (n = 7 studies), the cost of acquisition (n = 3 studies), unclear guidelines on appropriate use of PPE (n = 2 studies), difficulty providing care (n = 2 studies), and anxiety about frightening patients (n = 2 studies). Having PPE readily available facilitated the use of PPE (n = 2 studies). CONCLUSIONS AND IMPLICATIONS Further research is necessary to identify barriers and facilitators more extensively across behavior change domains to develop effective strategies to improve PPE use and prevent infection transmission within LTC.
Collapse
Affiliation(s)
- Christian C Tsang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Jayna M Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Vivian Ewa
- Department of Family Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John M Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - Myles M Leslie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jenine R Leal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Peters A, Carry J, Cave C, Sauser J, Pittet D. Acceptability of an alcohol-based handrub gel with superfatting agents among healthcare workers: a randomized crossover controlled study. Antimicrob Resist Infect Control 2022; 11:97. [PMID: 35841075 PMCID: PMC9283849 DOI: 10.1186/s13756-022-01129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Healthcare workers often experience skin dryness and irritation from performing hand hygiene frequently. Low acceptability and tolerability of a formulation are barriers to hand hygiene compliance, though little research has been conducted on what specific types of formulation have higher acceptability than others. Objective To compare the acceptability and tolerability of an ethanol-based handrub gel with superfatting agents to the isopropanol-based formulations (a rub and a gel formulation) currently used by healthcare workers at the University of Geneva Hospitals, Geneva, Switzerland. Methods Forty-two participants were randomized to two sequences, testing the isopropanol-based formulation that they are using currently (Hopirub® or Hopigel®), and the ethanol-based formulation containing superfatting agents (Saniswiss Sanitizer Hands H1). Participants tested each of the formulations over 7–10 day work shifts, after which skin condition was assessed and feedback was collected. Results H1 scored significantly better than the control formulations for skin dryness (P = 0.0209), and participants felt less discomfort in their hands when using that formulation (P = 0.0448). H1 caused less skin dryness than Hopirub®/Hopigel® (P = 0.0210). Though overall preference was quite polarized, 21 participants preferred H1 intervention formulation and 17 preferred the Hopirub®/Hopigel® formulation that they normally used in their care activities. Conclusion We observed a difference in acceptability and strongly polarized preferences among the participants' reactions to the formulations tested. These results indicate that giving healthcare workers a choice between different high-quality products is important to ensure maximum acceptability. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01129-4.
Collapse
|
5
|
Rio CD, Roseira CE, Perinoti LCSDC, Figueiredo RMD. The use of gloves by the nursing team in a hospital environment. Rev Bras Enferm 2021; 74:e20200972. [PMID: 34037152 DOI: 10.1590/0034-7167-2020-0972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to verify the compliance rate of the use of gloves by the nursing team in a hospital environment. METHODS a descriptive study, carried out in a hospital in the state of Sao Paulo, Brazil, between August and October 2019, through the observation of the nursing team in carrying out a total of 396 procedures. All ethical aspects were considered. RESULTS 32 different types of procedures were observed. The compliance rate with the use of gloves occurred only in one observation (0.25%). Excluding hand hygiene, it was 60.1% (238). In other 158 (39.9%) opportunities, incorrect use varied between reuse (18.43%), unnecessary use (8.33%) and non-use when necessary (13.13%). Hands were cleaned before using gloves in 1.76% of the observations and in 4.54% immediately after their removal. CONCLUSIONS non-conformities were identified in the use of gloves when observing the performance of procedures by the nursing team.
Collapse
Affiliation(s)
- Caroline do Rio
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
| | | | | | | |
Collapse
|
6
|
Flores A, Wrigley M, Askew P, Craig R, Egan B, Towey L, Shawe J. Use of non-sterile gloves in the ward environment: an evaluation of healthcare workers' perception of risk and decision making. J Infect Prev 2020; 21:108-114. [PMID: 32494294 DOI: 10.1177/1757177420907687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Studies have found that inappropriate use of non-sterile gloves (NSG) can affect hand hygiene compliance; the main risks are missing opportunities for hand hygiene and gloves being a vector for microbial transmission. Aim The aims of this study were to explore the accuracy of healthcare worker (HCW) risk assessment and decision making regarding the use of NSG. Methods The study was conducted in two acute NHS Trusts and a community social enterprise. A cross-sectional survey was carried out, followed by qualitative semi-structured interviews. Findings There were highly significant differences at the 95% probability level between staff groups, unqualified staff being significantly more likely than qualified staff to report NSG use when not indicated (P < 0.0001). The primary motivating factor for staff to wear NSG was for personal protection; the secondary factor being the protection of patients. Staff were also motivated by a desire to create an image of professionalism. Respondents were more likely to follow the lead of seniors in their own profession. Discussion The results suggest a necessity for change interventions aimed at unqualified staff such as healthcare assistants (HCAs). It would be beneficial to review the indications for glove use and amend organisational policies accordingly. Leaders in each professional staff group would be required to influence practice across organisations, taking into account motivating factors, and in association with multi-modal interventions to improve practice.
Collapse
Affiliation(s)
- Ashley Flores
- Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | | | - Peter Askew
- IMSL, Pale Lane, Hartley Wintney, Hampshire, Hartley Wintney, UK
| | - Rachel Craig
- Ashford & St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | | |
Collapse
|
7
|
The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities. Infect Control Hosp Epidemiol 2019; 40:1394-1399. [PMID: 31647042 DOI: 10.1017/ice.2019.292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antibiotic-resistant organism (ARO) colonization rates in skilled nursing facilities (NFs) are high; hand hygiene is crucial to interrupt transmission. We aimed to determine factors associated with hand hygiene adherence in NFs and to assess rates of ARO acquisition among healthcare personnel (HCP). METHODS HCP were observed during routine care at 6 NFs. We recorded hand hygiene adherence, glove use, activities, and time in room. HCP hands were cultured before and after patient care; patients and high-touch surfaces were cultured. HCP activities were categorized as high-versus low-risk for self-contamination. Multivariable regression was performed to identify predictors of hand hygiene adherence. RESULTS We recorded 385 HCP observations and paired them with cultures performed before and after patient care. Hand hygiene adherence occurred in 96 of 352 observations (27.3%) before patient care and 165 of 358 observations (46.1%) after patient care. Gloves were worn in 169 of 376 observations (44.9%). Higher adherence was associated with glove use before patient care (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.44-4.54) and after patient care (OR, 3.11; 95% CI, 1.77-5.48). Compared with nurses, certified nurse assistants had lower hand hygiene adherence (OR, 0.31; 95% CI, 0.15-0.67) before patient care and physical/occupational therapists (OR, 0.22; 95% CI, 0.11-0.44) after patient care. Hand hygiene varied by activity performed and time in the room. HCP hands were contaminated with AROs in 35 of 385 cultures of hands before patient care (0.9%) and 22 of 350 cultures of hands after patient care (6.3%). CONCLUSIONS Hand hygiene adherence in NFs remain low; it is influenced by job title, type of care activity, and glove use. Hand hygiene programs should incorporate these unique care and staffing factors to reduce ARO transmission.
Collapse
|
8
|
Jain S, Clezy K, McLaws ML. Modified glove use for contact precautions: Health care workers' perceptions and acceptance. Am J Infect Control 2019; 47:938-944. [PMID: 30850247 DOI: 10.1016/j.ajic.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone. METHODS We have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76). RESULTS Pretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts. Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts. Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts. The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering. CONCLUSIONS The trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.
Collapse
Affiliation(s)
- Susan Jain
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia; Infection Prevention and Control, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kate Clezy
- Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Human factors engineering (HFE) approaches are increasingly being used in healthcare, but have been applied in relatively limited ways to infection prevention and control (IPC). Previous studies have focused on using selected HFE tools, but newer literature supports a system-based HFE approach to IPC. RECENT FINDINGS Cross-contamination and the existence of workarounds suggest that healthcare workers need better support to reduce and simplify steps in delivering care. Simplifying workflow can lead to better understanding of why a process fails and allow for improvements to reduce errors and increase efficiency. Hand hygiene can be improved using visual cues and nudges based on room layout. Using personal protective equipment appropriately appears simple, but exists in a complex interaction with workload, behavior, emotion, and environmental variables including product placement. HFE can help prevent the pathogen transmission through improving environmental cleaning and appropriate use of medical devices. SUMMARY Emerging evidence suggests that HFE can be applied in IPC to reduce healthcare-associated infections. HFE and IPC collaboration can help improve many of the basic best practices including use of hand hygiene and personal protective equipment by healthcare workers during patient care.
Collapse
|
10
|
Kelcikova S, Mazuchova L, Bielena L, Filova L. Flawed self-assessment in hand hygiene: A major contributor to infections in clinical practice? J Clin Nurs 2019; 28:2265-2275. [PMID: 30786083 DOI: 10.1111/jocn.14823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/04/2019] [Accepted: 02/09/2019] [Indexed: 12/27/2022]
Abstract
AIM To assess the quality of self-assessment and the attitude of healthcare workers (HCWs) to hand hygiene (HH) as possible factors of unsatisfactory HH compliance in clinical practice. BACKGROUND Noncompliance of HH causes healthcare-acquired infections (HAI) in patients. It is assumed that HH-related infections make up approximately 80% of all infections in clinical practice. Our observations suggest that self-assessment and attitude might be surprisingly important factors. DESIGN AND METHOD The cross-sectional approach using questionnaire and direct observation was applied. We followed STROBE guidelines. In total, questionnaires of 639 HCWs of surgical departments were included in the study, and 127 HCWs had been also directly observed. RESULTS High self-assessment regarding HH compliance and its knowledge was reported by 74% and 83% of HCWs, respectively. At the same time, only 51% of HCWs positively evaluated their colleagues with respect to HH. Similar to previous studies, we have found significant differences between physicians and nurses regarding the level of self-assessment, attitude and perception of HH. Physicians were more critical in self-assessment and considered HH less important compared to nurses. The observations revealed drawbacks in HH practices. The high level of self-overassessment might be a contributing factor to noncompliance with HH. CONCLUSIONS It is necessary to establish systematic professional training and education of HCWs in relation to their HH, and to continuously monitor and evaluate the level of self-assessment in clinical practice, mainly in surgery. RELEVANCE TO CLINICAL PRACTICE A reasonable objective level of self-assessment and attitude to HH are the most important conditions for preventing of HAI in patients.
Collapse
Affiliation(s)
- Simona Kelcikova
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak
| | - Lucia Mazuchova
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak
| | - Lubica Bielena
- Martin University Hospital, Department of Hospital Hygiene, Martin, Slovak
| | - Lenka Filova
- Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovak
| |
Collapse
|
11
|
Abstract
BACKGROUND Routine hand hygiene effectively removes methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin resistant Enterococcus (VRE) from the ungloved hands of healthcare workers (HCWs) who are caring for patients under contact precautions, when exposure to bodily fluids is not expected. METHODS HCWs' ungloved hands were cultured after hand hygiene with alcohol-based hand rub (ABHR) or soap-and-water wash after routine clinical care of patients known to be colonized or infected with MRSA or VRE. RESULTS Two hundred forty samples from 40 HCWs were tested and found to be culture negative for either MRSA or VRE after contact with patients when 3 pumps of ABHR (0/80) or plain soap-and-water wash (0/80) were used. No VRE was observed in any of the 120 samples collected. Two plates (2/40) grew 1 colony-forming unit of MRSA after 2 pumps of ABHR. Two HCWs with positive plates were cultured negative on retesting. CONCLUSION We showed that appropriate hand hygiene was effective in removing MRSA and VRE even when gloves were not used for routine clinical care, despite contact with patients known to be colonized with MRSA or VRE. A modified approach to glove use for dry contact with patients on contact precautions might improve patient safety within healthcare settings.
Collapse
|
12
|
Bora MM, Zarghami A. The association between hand hygiene compliance and glove use: Still unknown? Am J Infect Control 2018; 46:118. [PMID: 29153642 DOI: 10.1016/j.ajic.2017.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/27/2022]
|