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Rubano M, Kieffer E, Larson E, Colline N, Portillo C. The development of a long-term care infection prevention compendium during the COVID-19 pandemic. Am J Infect Control 2023; 51:1356-1359. [PMID: 37245601 PMCID: PMC10212793 DOI: 10.1016/j.ajic.2023.05.008] [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: 02/06/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Long-term care (LTC) facilities experienced significant morbidity and mortality rates among both residents and staff during the COVID-19 pandemic, for which they were ill-prepared to practice adequate infection prevention and control (IPC). METHODS Our team developed a process for creating a compendium of curated IPC resources. This process harnessed the experience and expertise of nurses actively working in LTC during the pandemic. RESULTS The publicly available online compendium of IPC resources is relevant to all departments found within LTC settings. The compendium contains a wide array of IPC tools, research, reports, international resources, and customizable educational slide decks. DISCUSSION Online repositories of curated IPC resources can equip direct care workers with accurate, easily accessible resources to support the maintenance of proper IPC practice and protocol in LTC settings. CONCLUSIONS Future research should evaluate the effectiveness and usefulness of this model and explore its utility in additional medical contexts.
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Affiliation(s)
- Mario Rubano
- Center for Healthy Aging, The New York Academy of Medicine, New York, NY
| | - Elana Kieffer
- Center for Healthy Aging, The New York Academy of Medicine, New York, NY
| | - Elaine Larson
- Center for Healthy Aging, The New York Academy of Medicine, New York, NY; School of Nursing, Columbia University, New York, NY
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Hansen S, Remschmidt C, Schröder C, Behnke M, Gastmeier P. Strengthening the role of hospital leadership in infection control (LEAD-IC) - a multimodal educational intervention in German acute care hospitals. BMC MEDICAL EDUCATION 2023; 23:758. [PMID: 37821838 PMCID: PMC10568750 DOI: 10.1186/s12909-023-04709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated. METHODS A controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants' activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed. RESULTS Eight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively). CONCLUSION Multimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.
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Affiliation(s)
- Sonja Hansen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - Cornelius Remschmidt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Christin Schröder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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Fields B, Still C, Medlin A, Strayer A, Arbaje AI, Gilmore-Bykovskyi A, Werner N. Care Partner Inclusion of People Hospitalized With Alzheimer Disease and Related Dementias: Protocol for a Mixed Methods Systems Engineering Approach to Designing a Health Care System Toolkit. JMIR Res Protoc 2023; 12:e45274. [PMID: 37191978 PMCID: PMC10230354 DOI: 10.2196/45274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners' active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. OBJECTIVE This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. METHODS The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. RESULTS The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. CONCLUSIONS We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45274.
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Affiliation(s)
- Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Catherine Still
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Austin Medlin
- Department of Design & Wellness, Indiana University, Bloomington, IN, United States
| | - Andrea Strayer
- College of Nursing, University of Iowa, Iowa City, IA, United States
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole Werner
- Department of Design & Wellness, Indiana University, Bloomington, IN, United States
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von Lengerke T, Tomsic I, Krosta KME, Ebadi E, Keil V, Buchta F, Luz JK, Schaumburg T, Kolbe-Busch S, Chaberny IF. Tailoring implementation interventions of different order in infection prevention and control: A cascadic logic model (IPC-CASCADE). FRONTIERS IN HEALTH SERVICES 2022; 2:960854. [PMID: 36925806 PMCID: PMC10012664 DOI: 10.3389/frhs.2022.960854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
Implementation interventions in infection prevention and control (IPC) differ by recipients. The two target groups are healthcare workers directly involved in patient care ("frontline") and IPC professionals as proxy agents, that is, implementation support practitioners. While both types of implementation interventions aim to promote compliance with clinical interventions to prevent healthcare-associated infections (HAI), their tailoring may be vastly different, for example, due to different behavioural outcomes. Additionally, IPC teams, as recipients of empowering tailored interventions, are under-researched. To overcome this gap and improve conceptual clarity, we proposed a cascadic logic model for tailored IPC interventions (IPC-CASCADE). In the model, we distinguished between interventions by IPC professionals targeting clinicians and those targeting IPC professionals (first- and second-order implementation interventions, respectively). Tailoring implies selecting behaviour change techniques matched to prospectively-assessed determinants of either clinician compliance (in first-order interventions) or interventions by IPC professionals for frontline workers (in second-order interventions). This interventional cascade is embedded in the prevailing healthcare system. IPC-CASCADE is horizontally structured over time and vertically structured by hierarchy or leadership roles. IPC-CASCADE aims to highlight the potential of increasing the impact of tailored interventions by IPC professionals for clinicians (to improve their compliance) via tailored interventions for IPC professionals (to improve their work as proxy agents). It underlines the links that IPC professionals define between macro contexts (healthcare and hospitals) and frontline workers in HAI prevention. It is specific, i.e., "tailored" to IPC, and expected to assist implementation science to better conceptualise tailoring.
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Affiliation(s)
- Thomas von Lengerke
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Karolin M E Krosta
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Center for Laboratory Medicine, Hannover, Germany
| | - Valentine Keil
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany.,Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Frederike Buchta
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - J Katrin Luz
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Tiffany Schaumburg
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
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Rubano MD, Kieffer EF, Larson EL. Infection prevention and control in nursing homes during COVID-19: An environmental scan. Geriatr Nurs 2021; 43:51-57. [PMID: 34808421 PMCID: PMC8810224 DOI: 10.1016/j.gerinurse.2021.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
To examine processes and programmatic elements of infection prevention and control (IPC) efforts and identify themes and promising approaches in nursing homes (NHs), an environmental scan was conducted. Data sources included a literature search, relevant listservs and websites, and expert consensus based on a virtual summit of leaders in IPC in long-term care settings. Three thematic areas emerged which have the potential to improve overall IPC practices in the long-term care setting: staffing and resource availability, training and knowledge of IPC practices, and organizational culture. If improved IPC practices and reduced cross-transmission of infections in NHs are to be sustained, both short-term and long-term changes in these areas are essential to fully engage staff, build trust, and enhance a 'just' organizational culture.
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Affiliation(s)
- Mario D Rubano
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States.
| | - Elana F Kieffer
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States
| | - Elaine L Larson
- New York Academy of Medicine, 1216 5th Avenue - Office #441, New York, NY 10029, United States; Columbia University, New York, NY, United States
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