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Orangi S, Orangi T, Kabubei KM, Honda A. Understanding factors influencing the use of clinical guidelines in low-income and middle-income settings: a scoping review. BMJ Open 2023; 13:e070399. [PMID: 37344115 DOI: 10.1136/bmjopen-2022-070399] [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: 06/23/2023] Open
Abstract
OBJECTIVE A scoping review was undertaken to determine the extent to which existing studies have examined factors influencing healthcare providers' use of clinical guidelines in low and middle-income country (LMIC) settings and determine which factors constrain or facilitate the use of clinical guidelines by healthcare providers. DESIGN Scoping review. DATA SOURCES The literature search was conducted using PubMed in January 2021. ELIGIBILITY CRITERIA We identified empirical studies, published between 2011-2021 in English, which included clinicians and/or nurses as healthcare providers, used a health facility as the study site, and were located in an LMIC. DATA EXTRACTION AND SYNTHESIS Information extracted from the literature review was organised using themes and the findings synthesised using thematic analysis. RESULTS The review identified five types of interacting factors that influence healthcare providers' use of and compliance with clinical guidelines. The factors identified are organisational factors, factors relating to individual healthcare providers, attributes of the clinical guidelines, patient-related factors and institutional factors. Organisational factors can be further divided into the physical work environment, organisational culture and working conditions. The effective use of clinical guidelines in LMIC settings is greatly impacted by the contextualisation of clinical guidelines, end-user engagement and alignment of the implementation of clinical guidelines with the institutional arrangements in the broader health system. CONCLUSION The development and evaluation of concrete interventions is vital to facilitate the implementation of clinical guidelines and improve healthcare service quality. Further studies are necessary to examine the relative importance of the five identified factors on the effective use of clinical guidelines in different contexts.
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Affiliation(s)
- Stacey Orangi
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Tiffany Orangi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
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Lv Y, Huang X, Xiang Q, Yang Q, Chen J, Cai M, Wang P, Jia P, Wang H, Xie C, Li L, Zhang D, Wei D, Wu J. Effectiveness of enhanced check during acute phase to reduce central venous catheters-associated bloodstream infections: a before-after, real-world study. Antimicrob Resist Infect Control 2022; 11:151. [PMID: 36474305 PMCID: PMC9724293 DOI: 10.1186/s13756-022-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of enhanced check to the duration of the central venous catheters associated bloodstream infections (CABSIs), and the impact on infection rates. METHODS A before-after, real-world study in six adult intensive care units was conducted. All adult patients who had only one central venous catheter were included during two consecutive periods. The intervention period, added cross-check that all patients with central venous catheter (CVC) need to be performed, and included nurses' checks for insertion practices and doctors' checks for maintenance practices. Propensity scores matching were used to account for potential confounding, and restricted cubic spline was served as visualizing the CABSI risk. RESULTS A total of 2906 patients with 26,157 CVC-days were analyzed. After intervention, the density incidence of CABSI decreased from 10.24 to 6.33/1,000 CVC-days (P < 0.001), and the acute period of rapid increase in CABSI risk was shortened, 6.5 to 5 days for femoral-vein catheterization and 7 to 5.5 days for subclavian-vein catheterization. For jugular-vein catheterization, the acute onset period disappeared. CONCLUSION Enhanced check during the first 7 calendar days after CVC insertion shortens the duration of the CABSI acute phase and tends to decrease CABSI rate.
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Affiliation(s)
- Yu Lv
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Xiaobo Huang
- grid.54549.390000 0004 0369 4060Intensive Care Unit, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Qian Xiang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Qin Yang
- grid.54549.390000 0004 0369 4060Department of Nursing, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Jin Chen
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Minhong Cai
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Pingping Wang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Ping Jia
- grid.54549.390000 0004 0369 4060Intensive Care Unit, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Hui Wang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Caixia Xie
- grid.54549.390000 0004 0369 4060Department of Nursing, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Luting Li
- Development Department, Chengdu Yiou Technology Co. LTD, Chengdu, 610000 Sichuan People’s Republic of China
| | - Dingding Zhang
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Daoqiong Wei
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Jiayu Wu
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
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Devrim I, Erdem H, El-Kholy A, Almohaizeie A, Logar M, Rahimi BA, Amer F, Alkan-Ceviker S, Sonmezer MC, Belitova M, Al-Ramahi JW, Pshenichnaya N, Gad MA, Santos L, Khedr R, Hassan AN, Boncuoglu E, Cortegiani A, Marino A, Liskova A, Hakamifard A, Popescu CP, Khan MA, Marinova R, Petrov N, Nsutebu E, Shehata G, Tehrani HA, Alay H, Mareković I, Zajkowska J, Konkayev A, Ramadan ME, Pagani M, Agin H, Tattevin P, El-Sokkary R, Ripon RK, Fernandez R, Vecchio RFD, Popescu SD, Kanj S. Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey. Am J Infect Control 2022; 50:1327-1332. [PMID: 35263612 DOI: 10.1016/j.ajic.2022.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. METHODS The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. RESULTS Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). CONCLUSIONS Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.
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Affiliation(s)
- Ilker Devrim
- Pediatric Infectious Diseases Department, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye.
| | - Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Abdullah Almohaizeie
- Pharmaceutical Care Division, King Faisal Specialist Hospital Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mateja Logar
- Department of Infectious Diseases, UMC Ljubljana, Ljubljana, Slovenia
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sevil Alkan-Ceviker
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University, Medical Faculty Hospital, Canakkale, Türkiye
| | - Meliha Cagla Sonmezer
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, School of Medicine, Ankara, Türkiye
| | - Maya Belitova
- Department of Anesthesiology and Intensive Care, University Hospital "Queen Giovanna"-ISUL, EAD, Sofia, Bulgaria
| | - Jamal Wadi Al-Ramahi
- Department of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Maha Ali Gad
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt
| | - Lurdes Santos
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University/Children Cancer Hospital Egypt, Cairo, Egypt
| | - Abdullahi Nur Hassan
- Department of Infectious Diseases and Clinical Microbiology, Algomed Hospital, Adana, Türkiye
| | - Elif Boncuoglu
- Pediatric Infectious Diseases Department, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo and Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Marino
- Department of Infectious Diseases, Garibaldi Nesima Hospital, Catania, Italy
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Corneliu Petru Popescu
- Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | | | | | | | - Emmanuel Nsutebu
- Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Handan Alay
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Faculty of Medicine, Erzurum, Türkiye
| | - Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Croatia
| | | | - Aidos Konkayev
- Institution of Trauma and Orthopedics, Astana Medical University, Nur-Sultan, Kazakhstan
| | | | - Michele Pagani
- UOC Anestesia e Rianimazione 1, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hasan Agin
- Pediatric Intensive Care Unit, Dr. Behçet Uz Children's Hospital, Izmir, Türkiye
| | - Pierre Tattevin
- Department of Infectious and Tropical Diseases, University Hospital of Pontchaillou, Rennes, France
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Bangladesh
| | | | | | | | - Souha Kanj
- American University of Beirut Medical Center, Beirut, Lebanon
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Impact of an Educational Program on Nurses' Performance in Providing Peripherally Inserted Central Catheter Care for Neonates. JOURNAL OF INFUSION NURSING 2020; 43:275-282. [PMID: 32881814 DOI: 10.1097/nan.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
All nurses who care for neonates with peripherally inserted central catheters require enhanced awareness of the current practice guidelines and standards. This study evaluated the impact of an educational program on nurses' performance from May 2016 to July 2017 at 4 hospitals in Tehran, Iran. The performance of 80 nurses was observed and scored 3 times before the intervention. Four weeks after the last training session, their performance was observed with the same researcher, and the checklist was completed 3 times in different working shifts. Four 35- to 45-minute training sessions were completed with a 4-week follow-up. Results of the study indicated that training courses should be held every 6 months, including permanent or periodic feedback.
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Lutwick L, Al-Maani AS, Mehtar S, Memish Z, Rosenthal VD, Dramowski A, Lui G, Osman T, Bulabula A, Bearman G. Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases. Int J Infect Dis 2019; 84:22-29. [PMID: 31005622 DOI: 10.1016/j.ijid.2019.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.
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Affiliation(s)
- Larry Lutwick
- Mayo Clinic Health Care System, Eau Claire, WI, USA.
| | | | | | - Ziad Memish
- Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | | | - Grace Lui
- The Chinese University of Hong Kong, Hong Kong, China
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Ferrara P, Albano L. The adherence to guidelines for preventing CVC-related infections: a survey among Italian health-care workers. BMC Infect Dis 2018; 18:606. [PMID: 30509200 PMCID: PMC6276178 DOI: 10.1186/s12879-018-3514-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Since correct maintenance of intravascular catheters is an effective strategy for preventing central-line infections, the aim of this study was to assess the level of adherence to guidelines for CVC maintenance amongst Italian HCWs. Methods From July 2016 thru January 2017, a cross sectional survey was carried out in a random sample of 549 HCWs working in different hospitals of Campania region (Italy). Results The 68.9% of interviewees returned the questionnaire. Overall, respondents’ level of knowledge about CDC guidelines was low, with only the 20.7% of HCWs acknowledging guidelines main recommendations: the nurse stuff, the availability of hospital internal protocols, the use of guidelines themselves as source of information, and higher number of years of practice were significantly associated with a higher level of knowledge. An extremely positive attitude towards the utility of guidelines for preventing CVC-related infections was shown, with a linear regression model indicating a stronger attitude in physicians, in who knew the CDC main recommendations and correct use of antibiotic ointments, as well as in HCWs needing additional information on the prevention of CVC-related infections. Regarding the behaviors, physicians were more likely to be adherent about recommended evidence-based practices. Two more multivariate logistic and ordinal logistic regression models were built to investigate characteristics associated with correct behavior regarding the removal of catheter dressing if patients have tenderness at insertion site or fever without an obvious source, respectively. Conclusions This study reflected an important lack of evidence-based knowledge and practices regarding the CVC management, highlighting the baseline role of education and training programs, as well as pointing out the role of organizational interventions to address the adherence to best practices for the reduction of CLABSIs. Electronic supplementary material The online version of this article (10.1186/s12879-018-3514-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pietro Ferrara
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 5, Via Luciano Armanni, 80138, Naples, Italy
| | - Luciana Albano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 5, Via Luciano Armanni, 80138, Naples, Italy.
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Esposito MR, Guillari A, Angelillo IF. Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS One 2017; 12:e0180473. [PMID: 28665993 PMCID: PMC5493401 DOI: 10.1371/journal.pone.0180473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/15/2017] [Indexed: 01/17/2023] Open
Abstract
The objectives of the cross-sectional study were to delineate the knowledge, attitudes, and behavior among nurses regarding the prevention of central line-associated bloodstream infections (CLABSIs) and to identify their predisposing factors. A questionnaire was self-administered from September to November 2011 to nurses in oncology and outpatient chemotherapy units in 16 teaching and non-teaching public and private hospitals in the Campania region (Italy). The questionnaire gathered information on demographic and occupational characteristics; knowledge about evidence-based practices for the prevention of CLABSIs; attitudes towards guidelines, the risk of transmitting infections, and hand-washing when using central venous catheter (CVC); practices about catheter site care; and sources of information. The vast majority of the 335 nurses answered questions correctly about the main recommendations to prevent CLABSIs (use sterile gauze or sterile transparent semipermeable dressing to cover the catheter site, disinfect the needleless connectors before administer medication or fluid, disinfect with hydrogen peroxide the catheter insertion site, and use routinely anticoagulants solutions). Nurses aged 36 to 50 years were less likely to know these main recommendations to prevent CLABSIs, whereas this knowledge was higher in those who have received information about the prevention of these infections from courses. Nurses with lower education and those who do not know two of the main recommendations on the site’s care to prevent the CLABSIs, were more likely to perceive the risk of transmitting an infection. Higher education, attitude toward the utility allow to dry antiseptic, and the need of washing hands before wearing gloves for access to port infusion were predictors of performing skin antiseptic and aseptic technique for dressing the catheter insertion site. Educational interventions should be implemented to address the gaps regarding knowledge and practice regarding the prevention of CLABSIs and to ensure that nurses use evidence-based prevention interventions.
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Affiliation(s)
| | - Assunta Guillari
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Italo Francesco Angelillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- * E-mail:
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Oliveira FTD, Ferreira MMF, Araújo STCD, Bessa ATTD, Moraes ACB, Stipp MAC. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care. Rev Esc Enferm USP 2017; 51:e03212. [PMID: 28380162 DOI: 10.1590/s1980-220x2016182303212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/30/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care. OBJETIVO Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. MÉTODO Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. RESULTADOS Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão. CONCLUSÃO O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.
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Affiliation(s)
- Francimar Tinoco de Oliveira
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | - Maria Manuela Frederico Ferreira
- Escola Superior de Enfermagem de Coimbra, Conselho para a Qualidade e Avaliação da Unidade Científico Pedagógica de Enfermagem Fundamental, Coimbra, Portugal
| | - Silvia Teresa Carvalho de Araújo
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | | | - Advi Catarina Barbachan Moraes
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Médico-Cirúrgica, Rio de Janeiro, RJ, Brazil
| | - Marluci Andrade Conceição Stipp
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Metodologia da Enfermagem, Rio de Janeiro, RJ, Brazil
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9
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Shamshiri M, Fuh Suh B, Mohammadi N, Nabi Amjad R. A Survey of Adherence to Guidelines to Prevent Healthcare-Associated Infections in Iranian Intensive Care Units. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27435. [PMID: 27621932 PMCID: PMC5004621 DOI: 10.5812/ircmj.27435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 01/13/2016] [Accepted: 03/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are acquired by patients while receiving care. The highest incidence of HAIs has been documented in admissions to intensive care units. Adherence to evidence-based practices is the most important step for preventing HAIs. OBJECTIVES To determine the rate of adherence to evidence-based post-insertion recommended care practices after admission into the intensive care unit for the following devices: central line catheter, indwelling urinary catheter, and mechanical ventilator. PATIENTS AND METHODS A structured observational cross-sectional research design was used. Data were collected using a checklist and a self-report questionnaire. The minimum sample size required for this study was 276 post-insertion care episodes, and 332 episodes were observed. The ANOVA test was used to identify any significant differences among the mean scores of the three devices. RESULTS Overall observed adherence rates were 18.3%, 59.1%, and 43.1% for central line catheters, indwelling urinary catheter, and mechanical ventilator, respectively. Of the observed episodes of device care, only in 9.4% of the episodes was regular oral care performed for patients on mechanical ventilators and only in 19.3% of the episodes were indwelling urinary catheters properly secure after insertion. More so, in none (0.0%) of the episodes was the central line catheter hub disinfected before being accessed. CONCLUSIONS Evidence-based post-insertion recommended care practices were not consistently and uniformly implemented in the intensive care units. Establishment of a program for the surveillance of adherence to recommended guidelines is required for improving compliance by health professionals and the quality of preventive care.
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Affiliation(s)
- Mahmood Shamshiri
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, IR Iran
| | - Boudouin Fuh Suh
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences-International Campus, Tehran, IR Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran
| | - Reza Nabi Amjad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
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Alkubati SA, Ahmed NT, Mohamed ONE, Fayed AM, Asfour HI. Health care workers' knowledge and practices regarding the prevention of central venous catheter-related infection. Am J Infect Control 2015; 43:26-30. [PMID: 25448304 DOI: 10.1016/j.ajic.2014.09.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). The objective in this descriptive study was to assess the knowledge of health care workers in ICUs about guidelines for the prevention of CVC-RI and their adherence to these guidelines in practices. METHODS Health care workers were assessed for their actual practices during central venous catheter (CVC) insertion and care. Then a questionnaire was distributed to the health care workers to assess their knowledge regarding the prevention of CVC-RI. RESULTS All the health care workers (N = 100; 40 physicians, 60 nurses) in the ICUs (levels I and III and triage) of Alexandria Main University Hospital participated in the present study. The response rate was 100%. The total percentage of correct answers of the health care workers about the guidelines for the prevention of CVC-RI was low. There was no significant difference between physicians' and nurses' knowledge regarding the total score on the questionnaire (P = .134). However, physicians had a significantly higher knowledge about the pathophysiology of CVC-RI and skin antisepsis items than nurses. There were no significant differences between the knowledge of physicians and nurses in other items except for CVC care, where nurses showed significantly higher knowledge than physicians (P = .001). CONCLUSION The results of the present study revealed health care worker's low knowledge regarding the prevention of CVC-RI and low compliance with the standard guidelines of CVC care. Therefore, health care workers should be periodically evaluated for their knowledge and practices regarding guidelines for the prevention of CVC-RI.
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Affiliation(s)
- Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen.
| | - Nadia T Ahmed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Osama N E Mohamed
- Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Akram M Fayed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hayam I Asfour
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Sadeghi-Bazargani H, Tabrizi JS, Azami-Aghdash S. Barriers to evidence-based medicine: a systematic review. J Eval Clin Pract 2014; 20:793-802. [PMID: 25130323 DOI: 10.1111/jep.12222] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. METHODS Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. RESULTS Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. CONCLUSION The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled.
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Aveling EL, McCulloch P, Dixon-Woods M. A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries. BMJ Open 2013; 3:e003039. [PMID: 23950205 PMCID: PMC3752057 DOI: 10.1136/bmjopen-2013-003039] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/05/2013] [Accepted: 07/15/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Bold claims have been made for the ability of the WHO surgical checklist to reduce surgical morbidity and mortality and improve patient safety regardless of the setting. Little is known about how far the challenges faced by low-income countries are the same as those in high-income countries or different. We aimed to identify and compare the influences on checklist implementation and compliance in the UK and Africa. DESIGN Ethnographic study involving observations, interviews and collection of documents. Thematic analysis of the data. SETTING Operating theatres in one African university hospital and two UK university hospitals. PARTICIPANTS 112 h of observations were undertaken. Interviews with 39 theatre and administrative staff were conducted. RESULTS Many staff saw value in the checklist in the UK and African hospitals. Some resentment was present in all settings, linked to conflicts between the philosophy behind the checklist and the realities of local cultural, social and economic contexts. Compliance-involving use, completeness and fidelity-was considerably higher, though not perfect, in the UK settings. In these hospitals, compliance was supported by established structures and systems, and was not significantly undermined by major resource constraints; the same was not true of the low-income context. Hierarchical relationships were a major barrier to implementation in all settings, but were more marked in the low-income setting. Introducing a checklist in a professional environment characterised by a lack of accountability and transparency could make the staff feel jeopardised legally, professionally, and personally, and it encouraged them to make misleading records of what had actually been done. CONCLUSIONS Surgical checklist implementation is likely to be optimised, regardless of the setting, when used as a tool in multifaceted cultural and organisational programmes to strengthen patient safety. It cannot be assumed that the introduction of a checklist will automatically lead to improved communication and clinical processes.
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Affiliation(s)
| | - Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
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