Can patient-reported room cleanliness measures predict hospital-acquired C. difficile infection? A study of acute care facilities in New York state

Room of Hazards: A Comparison of Differences in Safety Hazard Recognition Among Various Hospital-Based Healthcare Professionals and Trainees in a Simulated Patient Room

OBJECTIVES

Adverse events in hospitals are common. While studies have used simulated patient rooms to assess healthcare trainees' skills in detecting safety hazards, few have explored the characteristics of safety hazards that make them more or less identifiable to healthcare workers. We sought to determine differences in hospital-based safety hazard identification among physicians, nurses, and other staff members.

METHODS

Healthcare workers were invited to identify safety hazards in a simulated patient room with intentionally placed hazards. Responses were transcribed and compared between physicians (MD), nurses (RN), and other hospital-based healthcare professionals and trainees (other). Data were analyzed using nonparametric statistical analysis.

RESULTS

Twelve physicians, 29 nurses, and 26 other staff members participated in this study. Different professions identified different numbers of total hazards with nurses identifying more hazards than other professions (RN: 9.59, MD: 9.17, other: 6.35; P = 0.001). All professions had difficulty identifying hazards associated with omission (e.g., no precaution sign: MD: 8.3%, RN: 3.4%, other: 0%) or hazards requiring 2-step logical thinking (e.g., intravenous heparin for patient with head laceration: MD: 0%, RN: 6.9%, other: 0%).

CONCLUSIONS

Physicians, nurses, and others identified different numbers of total hazards, and few participants identified hazards associated with omission or 2-step logical thinking. While previous studies have found differences in types of hazards identified among different healthcare members, we identified hazards that were collectively challenging for all participants to identify. Future studies should target identification of these types of hazards, using human factor engineering to decrease risk of patient harm.

Investigating the association of room features with healthcare-facility-onset Clostridioides difficile: An exploratory study

OBJECTIVE

To investigate hospital room and patient-level risk factors associated with increased risk of healthcare-facility-onset Clostridioides difficile infection (HO-CDI).

DESIGN

The study used a retrospective cohort design that included patient data from the institution's electronic health record, existing surveillance data on HO-CDI, and a walk-through survey of hospital rooms to identify potential room-level risk factors. The primary outcome was HO-CDI diagnosis.

SETTING

A large academic medical center.

PATIENTS AND PARTICIPANTS

All adult patients admitted between January 1, 2015, and December 31, 2016 were eligible for inclusion. Prisoners were excluded. Patients who only stayed in rooms that were not surveyed were excluded.

RESULTS

The hospital room survey collected room-level data on 806 rooms. Included in the study were 17,034 patients without HO-CDI and 251 with HO-CDI nested within 535 unique rooms. In this exploratory study, room-level risk factors associated with the outcome in the multivariate model included wear on furniture and flooring and antibiotic use by the prior room occupant. Hand hygiene devices and fixed in-room computers were associated with reduced odds of a HO-CDI. Differences between hospital buildings were also detected. The only individual patient factors that were associated with increased odds of HO-CDI were antibiotic use and comorbidity score.

CONCLUSION

Combining a hospital-room walk-through data collection survey, EHR data, and CDI surveillance data, we were able to develop a model to investigate room and patient-level risks for HO-CDI.