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Taylor N, Simpson M, Cox J, Ebbs P, Vanniasinkam T. Infection prevention and control among paramedics: A scoping review. Am J Infect Control 2024:S0196-6553(24)00575-3. [PMID: 38925500 DOI: 10.1016/j.ajic.2024.06.014] [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: 01/22/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Paramedics are exposed to many infectious diseases in their professional activities, leading to a high risk of transmitting infectious diseases to patients in out-of-hospital settings, possibly leading to health care associated infections in hospitals and the community. The COVID-19 pandemic highlighted the importance of infection prevention and control in health care and the role of paramedics in infection control is considered even more critical. Despite this, in many countries such as Australia, research into infection prevention and control research has mainly been focused on in-hospital health care professionals with limited out-of-hospital studies. METHODS This scoping review was based upon Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Literature on knowledge and awareness of infection prevention and control in paramedics in Australia and other countries was evaluated. RESULTS Based upon selection criteria applied, six papers were identified for inclusion in this review. In many studies, infection prevention and control was identified as being important, however compliance with hand hygiene practices was low and most studies highlighted the need for more education and training on infectious disease for paramedics. CONCLUSION Current evidence suggests that paramedics have poor compliance with recommended IPC practices. The profession needs to improve IPC education, training, and culture.
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Affiliation(s)
- Nicholas Taylor
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia; Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.
| | - Maree Simpson
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Jennifer Cox
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Phillip Ebbs
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Thiru Vanniasinkam
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Houben F, Heijer CDD, Dukers-Muijrers NH, Smeets-Peels C, Hoebe CJ. Psychosocial determinants associated with healthcare workers' self-reported compliance with infection prevention and control during the COVID-19 pandemic: a cross-sectional study in Dutch residential care facilities for people with intellectual and developmental disabilities. BMC Public Health 2023; 23:2052. [PMID: 37858182 PMCID: PMC10588203 DOI: 10.1186/s12889-023-16912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Healthcare workers' (HCWs) compliance with infection prevention and control (IPC) is crucial to reduce the infection transmission risk. However, HCWs' compliance with IPC in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is known to be suboptimal. Therefore, this study examined sociodemographic and psychosocial determinants associated with IPC non-compliance in this setting, to inform IPC policy and promotion programmes for adequate IPC behaviour. METHODS An online questionnaire was administered to 285 HCWs from 16 RCFs between March 2021 and March 2022. Determinants associated with IPC non-compliance were assessed using logistic regression analyses. RESULTS Being a woman (OR: 3.57; 1.73-7.37), and being a non-medical professional were associated with increased odds of non-compliance (social workers, OR: 2.83; 1.65-4.85; behavioural specialists, OR: 6.09; 1.98-18.72). Perceived inadequate education/training (aOR: 1.62; 1.15-2.27) and perceived time constraints/competing priorities (aOR: 1.43; 1.03-1.98) were also associated with increased odds of non-compliance, independent of sociodemographic variables. In contrast, the belief that the supervisor complies with IPC (descriptive norm supervisor) was associated with decreased odds of non-compliance (aOR: 0.60; 0.41-0.88). CONCLUSIONS To improve IPC in disability care settings, the implementation of tailored and structural IPC education and training programmes (e.g., on-the-job training) is recommended to increase HCWs' capabilities and bridge the IPC compliance gap between medical and non-medical professionals. In addition, role models, particularly supervisors, are crucial for promoting IPC behaviour. Facilities should create a culture of IPC compliance by norm setting, acting on, and modelling IPC behaviours at all levels of the organisation (management, medical, and non-medical staff).
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Affiliation(s)
- Famke Houben
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands.
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands.
| | - Casper Dj den Heijer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Nicole Htm Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | | | - Christian Jpa Hoebe
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, P.O. Box 33, Heerlen, 6400 AA, The Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands
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Wang X, Liu C, Du Y, Wang D, Zhang X. Do Knowledge, Attitudes, and Barrier Perception Affect the Prevention and Control of Healthcare-Associated Infections? A Structural Equation Modelling Approach. Infect Drug Resist 2023; 16:3051-3063. [PMID: 37220611 PMCID: PMC10200105 DOI: 10.2147/idr.s409398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Healthcare-associated infections (HCAIs) have become a global public health problem, resulting in high mortality, serious morbidity, and heavy healthcare costs. Infection prevention and control (IPC) is a significant priority for healthcare workers (HCWs) to eliminate HCAIs. However, barriers exist in the IPC implementation in daily clinical work. This study aimed to explore the relationship between HCWs' knowledge, attitudes, barrier perception, as well as their effects on IPC practice. Patients and Methods A structured questionnaire survey was conducted among HCWs who were responsible for IPC in a large tertiary hospital in China. Cronbach's alpha, average variance extracted (AVE), composite reliability (CR), as well as confirmatory factor analyses (CFA) were performed for reliability and validity. Structural equation modelling (SEM) was applied to establish the relationship between knowledge, attitudes, barrier perception and IPC practice. A Multiple Indicators Multiple Causes (MIMIC) model was conducted to detect the effects of covariates on factor structure. Results In total, 232 valid questionnaires were eventually collected. The average score of knowledge, attitudes, barrier perception and IPC practice were 2.95±0.75, 4.06±0.70, 3.14±0.86, and 4.38±0.45, respectively. The instrument demonstrated good reliability and validity. The SEM results showed that knowledge was positively associated with attitudes (β=0.151, p=0.039), and attitudes had positive effects on IPC practice (β=0.204, p=0.001), whereas barrier perception was negatively associated with attitudes and IPC practice (β=-0.234, p<0.001; β=-0.288, p<0.001, respectively). Additionally, time proportion spent on IPC was significantly associated with attitudes and practice (β=0.180, p=0.015; β=0.287, p<0.001, respectively), and training on HCAIs was a predicator for barrier perception and practice (β=0.192, p=0.039; β=-0.169, p=0.038, respectively). Conclusion IPC practice was indirectly affected by knowledge through the mediation of attitudes, whereas barrier perception had a negative impact. Designing deficiency-based training programs, developing sustained IPC habits, and strengthening management support are recommended to optimize IPC practice.
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Affiliation(s)
- Xuemei Wang
- Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, People’s Republic of China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Yaling Du
- First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, People’s Republic of China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei Province, People’s Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
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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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Personelle und organisatorische Voraussetzungen zur Prävention nosokomialer Infektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:332-351. [PMID: 36802229 DOI: 10.1007/s00103-022-03647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Dekker M, Jongerden IP, Caris MG, de Bruijne MC, Vandenbroucke-Grauls CMJE, van Mansfeld R. Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework. BMC Health Serv Res 2023; 23:140. [PMID: 36759832 PMCID: PMC9912654 DOI: 10.1186/s12913-023-09111-5] [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: 10/27/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Important elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines. METHODS We used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Between 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance). CONCLUSIONS Our infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.
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Affiliation(s)
- Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Irene P. Jongerden
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martine G. Caris
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Martine C. de Bruijne
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina M. J. E. Vandenbroucke-Grauls
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine – Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Rosa van Mansfeld
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Thandar MM, Rahman MO, Haruyama R, Matsuoka S, Okawa S, Moriyama J, Yokobori Y, Matsubara C, Nagai M, Ota E, Baba T. Effectiveness of Infection Control Teams in Reducing Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17075. [PMID: 36554953 PMCID: PMC9779570 DOI: 10.3390/ijerph192417075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
The infection control team (ICT) ensures the implementation of infection control guidelines in healthcare facilities. This systematic review aims to evaluate the effectiveness of ICT, with or without an infection control link nurse (ICLN) system, in reducing healthcare-associated infections (HCAIs). We searched four databases to identify randomised controlled trials (RCTs) in inpatient, outpatient and long-term care facilities. We judged the quality of the studies, conducted meta-analyses whenever interventions and outcome measures were comparable in at least two studies, and assessed the certainty of evidence. Nine RCTs were included; all were rated as being low quality. Overall, ICT, with or without an ICLN system, did not reduce the incidence rate of HCAIs [risk ratio (RR) = 0.65, 95% confidence interval (CI): 0.45-1.07], death due to HCAIs (RR = 0.32, 95% CI: 0.04-2.69) and length of hospital stay (42 days vs. 45 days, p = 0.52). However, ICT with an ICLN system improved nurses' compliance with infection control practices (RR = 1.17, 95% CI: 1.00-1.38). Due to the high level of bias, inconsistency and imprecision, these findings should be considered with caution. High-quality studies using similar outcome measures are needed to demonstrate the effectiveness and cost-effectiveness of ICT.
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Affiliation(s)
- Moe Moe Thandar
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Md. Obaidur Rahman
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
- Center for Evidence-Based Medicine and Clinical Research, Dhaka 1230, Bangladesh
| | - Rei Haruyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Sadatoshi Matsuoka
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Sumiyo Okawa
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Jun Moriyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuta Yokobori
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Chieko Matsubara
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Mari Nagai
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke’s International University, Tokyo 104-0044, Japan
- Tokyo Foundation for Policy Research, Minato, Tokyo 106-0032, Japan
| | - Toshiaki Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Perera N, Haldane V, Ratnapalan S, Samaraweera S, Karunathilake M, Gunarathna C, Bandara P, Kawirathne P, Wei X. Implementation of a coronavirus disease 2019 infection prevention and control training program in a low-middle income country. INT J EVID-BASED HEA 2022; 20:228-235. [PMID: 35170481 PMCID: PMC9593323 DOI: 10.1097/xeb.0000000000000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS The COVID-19 pandemic poses an ongoing risk to health workers globally. This is particularly true in low- and middle-income countries (LMICs) where resource constraints, ongoing waves of infection, and limited access to vaccines disproportionately burden health systems. Thus, infection prevention and control (IPC) training for COVID-19 remains an important tool to safeguard health workers. We report on the implementation of evidence-based and role-specific COVID-19 IPC training for health workers in a hospital and public health field setting in Sri Lanka. METHODS We describe the development of training materials, which were contextualized to local needs and targeted to different staffing categories including support staff. We describe development of role- and context-specific IPC guidelines and accompanying training materials and videos during the first year of the COVID-19 pandemic. We describe in-person training activities and an overview of session leadership and participation. RESULTS Key to program implementation was the role of champions in facilitating the training, as well as delivery of training sessions featuring multi-media videos and role play to enhance the training experience. A total of 296 health workers participated in the training program sessions. Of these, 198 were hospital staff and 98 were from the public health workforce. Of the 296 health workers who participated in a training session, 277 completed a pre-test questionnaire and 256 completed post-test questionnaires. A significant increase in knowledge score was observed among all categories of staff who participated in training;however, support staff had the lowest pre-test knowledge on IPC practices at 71%, which improved to only 77% after the formal class. CONCLUSION Implementing an IPC training program during a complex health emergency is a challenging, yet necessary task. Leveraging champions, offering training through multiple modalities including the use of videos and role play, as well as inclusion of all staff categories, is crucial to making training accessible.
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Affiliation(s)
- Niranjala Perera
- Ministry of Health, Sri Lanka
- Dalla Lana School of Public Health, University of Toronto
| | | | - Savithiri Ratnapalan
- Dalla Lana School of Public Health, University of Toronto
- Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto
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Dehghan-Nayeri N, Seifi A, Rostamnia L, Varaei S, Ghanbari V, Sari AA, Haghani H. Challenges of and corrective recommendations for healthcare-associated infection's case findings and reporting from local to national level in Iran: a qualitative study. BMC Nurs 2022; 21:193. [PMID: 35854382 PMCID: PMC9297611 DOI: 10.1186/s12912-022-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The accuracy of health care−associated infections (HAIs) statistics in many countries is questionable and the main reasons of this inaccuracy are not well-known. The study aim was to explore inhibitors of and corrective recommendations for HAIs case findings and reporting in some of Iran hospitals. Methods Sixteen face-to-face interviews and an expert panel were performed with expertise of infection prevention and control (IPC) programs in hospitals, and Deputies of Health and Treatment in medical university and Ministry of Health from Feb 2018 to May 2019. Using conventional content analysis, code, subcategories and categories were developed. Result Three categories emerged including improper structure preparation, conflict of interest, and inadequate motivation. Allocating distinct budget and adequate staff to IPC programs, developing a user-friendly surveillance system and engaging physicians and nurses for HAIs reporting are the main corrective recommendations accepted by the expert panel. Conclusion Despite the improvement in growing case-findings and reporting of HAIs in Iran, there are many challenges which inhibit accurate case finding and reporting of HAIs. So it is necessary to update the structure, system and rules to reach accurate HAIs data in Iran.
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Affiliation(s)
- Nahid Dehghan-Nayeri
- Nursing and Midwifery care research center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases, Faculty of medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leili Rostamnia
- Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Esar square, Kermanshah, Iran.
| | - Shokoh Varaei
- Medical-Surgical Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ghanbari
- Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Haghani
- College of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
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Dekker M, Jongerden IP, de Bruijne MC, Jelsma JGM, Vandenbroucke-Grauls CMJE, van Mansfeld R. Strategies to improve the implementation of infection control link nurse programs in acute care hospitals. J Hosp Infect 2022; 128:54-63. [PMID: 35820554 DOI: 10.1016/j.jhin.2022.07.005] [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: 04/04/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection control practitioners face several challenges when implementing infection control link nurse (ICLN) programs. Identification of strategies to address these can improve the impact of current ICLN programs and guide their future implementation. AIM We aimed to identify implementation strategies for ICLN programs in acute care hospitals with the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching tool. METHODS An expert panel matched 19 implementation and sustainment barriers, identified i n our previous studies, to the most fitting CFIR constructs. Subsequently, we applied the CFIR- ERIC Matching Tool and generated a list of implementation strategies to address these barriers. FINDINGS Barriers were predominantly found within the CFIR domains 'inner setting' (characteristics of the implementing organization) and 'process' (stages of implementation). With the ERIC Matching Tool we identified the ten most important strategies to address barriers of implementation of ICLN programs: identify and prepare champions, conduct local consensus discussions, assess for readiness and identify barriers and facilitators, inform local opinion leaders, use facilitation, create a learning collaborative, conduct local needs assessments, develop a formal implementation blueprint, build a coalition, and identify early adopters. CONCLUSION The CFIR domains 'inner setting' and 'process' appeared as most important to impede implementation of ICLN programs in acute care hospitals. Application of the CFIR-ERIC tool highlighted the identification and preparation of champions as the leading strategy for the successful implementation of these programs. With this tool, strategies can be specifically tailored towards local implementation and sustainment barriers.
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Affiliation(s)
- Mireille Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, Boelelaan 1117, 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
| | - Martine C de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith G M Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, Boelelaan 1117, Amsterdam, The Netherlands; Aarhus University, Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus, Denmark
| | - Rosa van Mansfeld
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Microbiology and Infection Prevention, Boelelaan 1117, Amsterdam, The Netherlands
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Dekker M, Mansfeld RV, Vandenbroucke-Grauls CMJE, Lauret TE, Schutijser BCFM, de Bruijne MC, Jongerden IP. Role perception of infection control link nurses; a multi-centre qualitative study. J Infect Prev 2022; 23:93-100. [PMID: 35495104 PMCID: PMC9052847 DOI: 10.1177/17571774211066786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Infection control link nurses (ICLN) disseminate knowledge on infection prevention topics to their peers. Little is known about how they succeed and thereby contribute to infection prevention in daily practise. Aim To explore the experiences of infection control link nurses regarding their role in acute care hospitals and identify perceived facilitators and best practices. Methods We conducted a qualitative study with semi-structured individual and focus group interviews with ICLN. The effect of COVID-19 on the ICLN role was added as a topic in focus group interviews during the pandemic. Results Twenty-six ICLN working in acute care hospitals were interviewed. ICLN perceived their role as to identify, monitor, facilitate and inform their colleagues on infection prevention topics related to their ward. Their experiences vary from feeling challenged and wonder how to get started, to feeling confident and taking initiatives that lead to ward-based improvements. When inspired by each other and supported by infection control practitioners or managers, ICLN feel empowered to initiate more activities to improve practice. During the COVID-19 pandemic, ICLN felt their responsibilities were magnified. When transferred to another ward, the focus on the ICLN role seemed dispersed. Discussion Empowered ICLN adjust and operationalize infection prevention policies to fit the conditions of their specific wards and provide practical instructions and feedback to their peers which enable better compliance to infection prevention policies. Support and inspiration from other ICLN, infection control practitioners and management contribute to this empowerment and consequently to taking impactful initiatives to improve practice.
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Affiliation(s)
- Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Tessa E Lauret
- Department of Medical Microbiology and Infection Prevention, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bernadette CFM Schutijser
- Department of Medical Microbiology and Infection Prevention, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Houben F, van Hensbergen M, Den Heijer CDJ, Dukers-Muijrers NHTM, Hoebe CJPA. Barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: A theory-informed qualitative study. PLoS One 2021; 16:e0258701. [PMID: 34714846 PMCID: PMC8555856 DOI: 10.1371/journal.pone.0258701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Care institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC. METHODS This qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. RESULTS Our findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines' applicability to (work)setting; (2) professionals' cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation. CONCLUSIONS To promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.
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Affiliation(s)
- Famke Houben
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Casper D. J. Den Heijer
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research
Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht
University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Health Promotion, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research
Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht
University Medical Centre (MUMC+), Maastricht, The Netherlands
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13
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Neuwirth MM, Marche B, Kugler C, Bures D, Sauerland D, Herbrandt S, Ligges U, Mattner F, Otchwemah R. Evidence of the medical and economic benefits of implementing hygiene measures by a prevention link physician in trauma surgery: Study protocol for a biphasic multicenter prospective interventional pre-post cohort study using a structured intervention bundle development and tools of behavior change management. Contemp Clin Trials Commun 2021; 23:100815. [PMID: 34286158 PMCID: PMC8274293 DOI: 10.1016/j.conctc.2021.100815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The German Commission for Hospital Hygiene and Infection Prevention recommends nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). It has been roughly described that a PLP serves as a link between the infection prevention team and the respective clinical departments. No detailed evidence about the contribution made by PLPs to the decrease of infection rates is available in Germany. The "HygArzt" project aims to demonstrate the medical and economic benefits of the implementation of hygiene measures by PLP in trauma surgery/orthopedics. METHODS A multicenter interventional pre/post cohort study design was chosen. The study will run for a three-year period, including a pre-, post-, and an intervention phase, in four different hospitals, one of which will serve as pilot. A complex intervention containing evidence-based infection control measures will be developed and implemented by a PLP to proof efficacy. After the successful implementation of the preventive measures in the pilot hospital, the concept will be transposed to the three remaining trauma and orthopedic departments to confirm the transferability and generalizability. To enable the PLPs of the non-pilot departments, a subject-specific training program will be developed based on the study results of the pilot hospital and offered to the PLPs. DISCUSSION Data are intended to provide evidence that and, if so, to which extent the implementation of specific preventive measures by a medical department-specific PLP is possible and results in a reduction of nosocomial infections in orthopedic surgery and traumatology. CONTRIBUTION TO THE LITERATURE The present study describes a novel complex study design to prove the effectiveness of intervention measures for infection prevention. The study design and newly developed methodological approach could serve as a model for similar studies on infection prevention in the future. For the first time, the presented research project "HygArzt" focuses on the implementation of hygiene measures by an infection prevention link physician (PLP) and investigates whether nosocomial infections, especially surgical site infections, can be reduced by the measures implemented. TRIAL REGISTRATION German clinical Trials register DRKS-ID:00013,296. Registered on March 5, 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013296.
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Affiliation(s)
- Meike M. Neuwirth
- Institute of Hygiene, Cologne Merheim Medical Center, University Hospital Witten/Herdecke Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Benedikt Marche
- Division of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke Cologne, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Christiane Kugler
- Institute for Nursing Sciences, Albert-Ludwigs-Universität Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany
| | - Dominik Bures
- Witten/Herdecke University, Faculty of Economics, Chair for Institutional Economics and Health Police, Witten, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Dirk Sauerland
- Witten/Herdecke University, Faculty of Economics, Chair for Institutional Economics and Health Police, Witten, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Swetlana Herbrandt
- TU Dortmund, Center for Statistical Consulting and Analysis, Vogelpothsweg 87, 44227 Dortmund, Vogelpothsweg 87, 44227 Dortmund, Germany
| | - Uwe Ligges
- TU Dortmund, Center for Statistical Consulting and Analysis, Vogelpothsweg 87, 44227 Dortmund, Vogelpothsweg 87, 44227 Dortmund, Germany
| | - Frauke Mattner
- Institute of Hygiene, Cologne Merheim Medical Center, University Hospital Witten/Herdecke Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Robin Otchwemah
- Institute of Hygiene, Cologne Merheim Medical Center, University Hospital Witten/Herdecke Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Witten/Herdecke University, Division of Hygiene and Environmental Medicine, Cologne, Germany, Ostmerheimer Str. 200, 51109 Cologne, Germany
- Division of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, University Hospital Witten/Herdecke Cologne, Ostmerheimer Str. 200, 51109 Cologne, Germany
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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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Thandar MM, Matsuoka S, Rahman O, Ota E, Baba T. Infection control teams for reducing healthcare-associated infections in hospitals and other healthcare settings: a protocol for systematic review. BMJ Open 2021; 11:e044971. [PMID: 33674376 PMCID: PMC7938975 DOI: 10.1136/bmjopen-2020-044971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
INTRODUCTION Healthcare-associated infections (HCAIs) are a worldwide problem. Infection control in hospitals is usually implemented by an infection control team (ICT). Initially, ICTs consisted of doctors, nurses, epidemiologists and microbiologists; then, in the 1980s, the infection control link nurse (ICLN) system was introduced. ICTs (with or without the ICLN system) work to ensure the health and well-being of patients and healthcare professionals in hospitals and other healthcare settings, such as acute care clinics, community health centres and care homes. No previous study has reported the effects of ICTs on HCAIs. This systematic review aims to assess the effectiveness of ICTs with or without the ICLN system in reducing HCAIs in hospitals and other healthcare settings. METHODS AND ANALYSIS We will perform a comprehensive literature search for randomised controlled trials in four databases: PubMed, Embase, CINAHL and the Cochrane Library. The primary outcomes are: patient-based/clinical outcomes (rate of HCAIs, death due to HCAIs and length of hospital stay) and staff-based/behavioural outcomes (compliance with infection control practices). The secondary outcomes include the costs to the healthcare system or patients due to extended lengths of stay. Following data extraction, we will assess the risk of bias by using the Cochrane Effective Practice and Organization of Care risk of bias tool. If data can be pooled across all the studies, we will perform a meta-analysis. ETHICS AND DISSEMINATION We will use publicly available data, and therefore, ethical approval is not required for this systematic review. The findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER CRD42020172173.
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Affiliation(s)
- Moe Moe Thandar
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sadatoshi Matsuoka
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Obaidur Rahman
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Toshiaki Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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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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Implementation methods of infection prevention measures in orthopedics and traumatology - a systematic review. Eur J Trauma Emerg Surg 2020; 47:1003-1013. [PMID: 32914198 PMCID: PMC8321980 DOI: 10.1007/s00068-020-01477-z] [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: 02/17/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology. Electronic supplementary material The online version of this article (10.1007/s00068-020-01477-z) contains supplementary material, which is available to authorized users.
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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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Steul K, Exner M, Heudorf U. [Personal preconditions for the prevention of nosocomial infections-guidelines of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), federal state hygiene regulations in Germany, and compliance by hospitals in Frankfurt am Main]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:329-340. [PMID: 30783685 DOI: 10.1007/s00103-019-02896-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
According to the amendment of the Infection Protection Act (2011), § 23, 8, all federal states in Germany had to pass their own hospital hygiene regulations, in which the need for hygiene specialists in a hospital is defined.This publication explains in its first part the differences between the nationwide Commission for Hospital Hygiene and Infection Prevention (KRINKO) regulations and the hygiene regulations of the different federal states (Hesse, Bavaria, etc.). All federal states - with the exception of Hesse (Hessian Hygiene Regulation, HHygVO) - refer to the relevant expert recommendations of KRINKO.In a second part of this publication, we highlight differences between KRINKO and HHygVO with the example of hospitals in the city of Frankfurt. In 2017, all Frankfurt hospitals had the necessary hygiene specialists (authorized hygiene practitioners, infection control nurses, authorized hygiene care nurses). However, the need for hospital hygienists could not be met, because there is an insufficient number of physician specialists for hospital hygiene available in Germany.The hospitals cannot solve this problem on their own - a political, superordinate decision and regulation must be made, i. e. by regulation and financial support for the advanced training of post-graduate physicians in hygiene. This is important since only experienced hospital hygienists can instruct or supervise hygiene specialists-in-training.
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Affiliation(s)
- Katrin Steul
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland.
| | - Martin Exner
- Institut für Hygiene und öffentliche Gesundheit, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Ursel Heudorf
- Abteilung Infektiologie und Hygiene, Gesundheitsamt der Stadt Frankfurt am Main, Breite Gasse 28, 60313, Frankfurt am Main, Deutschland
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20
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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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