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Sax H, Marschall J. Infection prevention and control in 2030: a first qualitative survey by the Crystal Ball Initiative. Antimicrob Resist Infect Control 2024; 13:88. [PMID: 39135082 PMCID: PMC11320869 DOI: 10.1186/s13756-024-01431-3] [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: 10/17/2023] [Accepted: 06/28/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Healthcare delivery is undergoing radical changes that influence effective infection prevention and control (IPC). Futures research (short: Futures), the science of deliberating on multiple potential future states, is increasingly employed in many core societal fields. Futures might also be helpful in IPC to facilitate current education and organisational decisions. Hence, we conducted an initial survey as part of the IPC Crystal Ball Initiative. METHODS In 2019, international IPC experts were invited to answer a 10-item online questionnaire, including demographics, housekeeping, and open-ended core questions (Q) on the "status of IPC in 2030" (Q1), "people in charge of IPC" (Q2), "necessary skills in IPC" (Q3), and "burning research questions" (Q4). The four core questions were submitted to a three-step inductive and deductive qualitative content analysis. A subsequent cross-case matrix produced overarching leitmotifs. Q1 statements were additionally coded for sentiment analysis (positive, neutral, or negative). RESULTS Overall, 18 of 44 (41%) invited experts responded (from 11 countries; 12 physicians, four nurses, one manager, one microbiologist; all of them in senior positions). The emerging leitmotifs were "System integration", "Beyond the hospital", "Behaviour change and implementation", "Automation and digitalisation", and "Anticipated scientific progress and innovation". The statements reflected an optimistic outlook in 66% of all codes of Q1. CONCLUSIONS The first exercise of the IPC Crystal Ball Initiative reflected an optimistic outlook on IPC in 2030, and participants envisioned leveraging technological and medical progress to increase IPC effectiveness, freeing IPC personnel from administrative tasks to be more present at the point of care and increasing IPC integration and expansion through the application of a broad range of skills. Enhancing participant immersion in future Crystal Ball Initiative exercises through simulation would likely further increase the authenticity and comprehensiveness of the envisioned futures.
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Affiliation(s)
- Hugo Sax
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Friedbuehlstrasse 53, CH-3010, Bern, Switzerland.
| | - Jonas Marschall
- Division of Infectious Diseases, John T Milliken Department of Internal Medicine, Washington University School of Medicine, 4523 Clayton Ave, St. Louis, MO, 63110, USA.
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Stewart S, Totka JP, Hanrahan K. Ted Lasso and Team Science for Evidence-Based Practice Teamwork. J Perianesth Nurs 2024; 39:155-159. [PMID: 38099886 DOI: 10.1016/j.jopan.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 02/04/2024]
Affiliation(s)
- Stephanie Stewart
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Joan P Totka
- College of Nursing, Marquette University, Milwaukee, WI; Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI
| | - Kirsten Hanrahan
- Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA.
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Keating JA, Parmasad V, McKinley L, Safdar N. Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection. Am J Infect Control 2023; 51:1444-1448. [PMID: 37329984 PMCID: PMC10773464 DOI: 10.1016/j.ajic.2023.06.008] [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: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.
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Affiliation(s)
- Julie A Keating
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Vishala Parmasad
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Linda McKinley
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI; Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
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van Dijk MD, van Beeck EF, Huis A, van der Gun BT, Polinder S, van Eijsden RA, Burdorf A, Vos MC, Erasmus V. Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before-after study in operating theatres in the Netherlands. BMJ Open 2023; 13:e073137. [PMID: 37085301 PMCID: PMC10124304 DOI: 10.1136/bmjopen-2023-073137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT). DESIGN Multicentre before-after study. SETTING This study was performed in four Dutch hospitals. INTERVENTION The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. Poisson and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures). RESULTS Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration. CONCLUSION This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anita Huis
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bernardina Tf van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rianne Am van Eijsden
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Zheng F, Wang K, Wang Q, Yu T, Zhang X. The pre-analytical process management status and influencing factors of laboratory test before prescribing antimicrobial in developing country. BMC Health Serv Res 2023; 23:283. [PMID: 36966281 PMCID: PMC10039769 DOI: 10.1186/s12913-023-09243-8] [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: 04/13/2022] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION The results of laboratory testing are crucial basis for clinicians to prescribe antimicrobial. Laboratory testing is a highly complex process, and increasing evidence suggests that errors and obstacles in the pre-analytical process (PP) will affect reasonable antimicrobial use. However, PP was an easily neglected link in hospital infection management and the current situation of it and the influencing factors of management are not clear. METHODS A cross-sectional survey was conducted in the department of clinical, specimen collection, transportation, and inspection in 109 secondary and tertiary hospitals in Central China. The rate of antimicrobial susceptibility test request (AST) and related indexes of above departments were calculated to describe the situation. Management characteristics (frequency of training etc.) were described as proportions and fractional probit regression analysis was used to determine the influencing factors. RESULTS The average rate of non restricted-use antimicrobial was 63%, the restricted-use was 86%, the special-use was 95%. The zero obstacle rate of specimen collection was 27.3%, of specimen transportation was 19.4% and of inspection feedback was 61.7%. There was a difference between the secondary and tertiary hospitals on non restricted-use (X2 = 22.968, P < 0.001); restricted-use (X2 = 29.466, P < 0.001); special-use (X2 = 27.317, P < 0.001). Taking non restricted-use as an example, training (OR = 0.312, 95%CI: 0.148,0.429), low-frequency appraisal (OR = 0.153, 95%CI: 0.082,0.224), guidance (OR = 0.32, 95%CI: 0.237,0.403) and information technology (OR = 0.104, 95%CI: 0.009,0.199) were positive factors. CONCLUSIONS There were substantial differences in the rate of AST request in clinical department between secondary and tertiary hospitals. The zero obstacle rate in collection, transportation and inspection department were still low. In most departments, training and performance appraisal were positive factors, guidance and information technology were positive supporting factors.
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Affiliation(s)
- Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Kang Wang
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tiantian Yu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Leveraging antimicrobial stewardship programs in response to the coronavirus disease 2019 (COVID-19) public health emergency. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e41. [PMID: 36310788 PMCID: PMC9615001 DOI: 10.1017/ash.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has strained antimicrobial stewardship programs (ASPs) but offered new opportunities. This review summarizes the impact of the COVID-19 pandemic on ASPs, review the contributions ASPs have made in the pandemic response, and highlight the potential role of ASPs in future pandemics.
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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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Assi M, Abbas S, Nori P, Doll M, Godbout E, Bearman G, Stevens MP. Infection Prevention and Antimicrobial Stewardship Program Collaboration During the COVID-19 Pandemic: a Window of Opportunity. Curr Infect Dis Rep 2021; 23:15. [PMID: 34426728 PMCID: PMC8374122 DOI: 10.1007/s11908-021-00759-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We describe the similarities between antimicrobial stewardship programs (ASPs) and infection prevention programs (IPPs), and we discuss how these similarities lend themselves to synergy between programs. We also discuss how the COVID-19 pandemic has generated further opportunities for future collaborations that could benefit both programs. RECENT FINDINGS The COVID-19 pandemic has created new needs, such as real-time data and access to personnel important to both programs, such as information technologists and infectious diseases specialists. It has also increased concerns about rising rates of antimicrobial resistance and healthcare-associated infections, both of which overlap significantly and are key focus areas for both ASPs and IPPs. These emergent issues have highlighted the need for enhanced program infrastructure and new team models. The shift towards telecommunication and telework has facilitated the creation of enhanced infrastructures for collaboration on activities ranging from data access and reporting to providing telehealth services to remote hospitals. These enhanced infrastructures can be leveraged in future collaborative efforts between ASPs and IPPs. SUMMARY Collaboration between IPPs and ASPs can mitigate setbacks experienced by health systems during the current pandemic, enhance the performance of both programs in the post-pandemic era and increase their preparedness for future pandemic threats. As health systems plan for the post-pandemic era, they should invest in opportunities for synergy between ASPs and IPPs highlighted during the pandemic.
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Affiliation(s)
- Mariam Assi
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Salma Abbas
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Peshawar, Pakistan
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue 4H, Bronx, NY 10467 USA
| | - Michelle Doll
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Emily Godbout
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Gonzalo Bearman
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Michael P. Stevens
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
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