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Teymourzadeh E, Bahadori M, Fattahi H, Rahdar HA, Mirzaei Moghadam S, Shokri A. Prevalence and Predictive Factors for Nosocomial Infection in the Military Hospitals: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:58-68. [PMID: 34178764 PMCID: PMC8213630 DOI: 10.18502/ijph.v50i1.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: To assess prevalence and predictive factors for Nosocomial Infection (NI) in the military hospitals. Methods: PubMed, Scopus, Cochrane and PreQuest databases were systematically searched for studies published between Jan 1991 and Oct 2017 that reported the prevalence of NI and predictive factors among military hospitals. We performed the meta-analysis using a random effects model. Subgroup analysis was done for heterogeneity and the Egger test to funnel plots was used to assess publication bias. Results: Twenty-eight studies with 250,374 patients were evaluated in meta-analysis. The overall pooled estimate of the prevalence of NI was 8% (95% 6.0–9.0). The pooled prevalence was 2% (95% CI: 2.0–3.0) when we did sensitivity analysis and excluding a study. The prevalence was highest in burn unit (32%) and ICU (15%). Reported risk factors for NI included gender (male vs female, OR: 1.45), age (Age≥65, OR: 2.4), diabetes mellitus (OR: 2.32), inappropriate use of antibiotics (OR: 2.35), received mechanical support (OR: 2.81), co-morbidities (OR: 2.97), admitted into the ICU (OR: 2.26), smoking (OR: 1.36) and BMI (OR: 1.09). Conclusion: The review revealed a difference of prevalence in military hospitals with other hospitals and shows a high prevalence of NI in burn units. Therefore careful disinfection and strict procedures of infection control are necessary in places that serve immunosuppressed individuals such as burn patient. Moreover, a vision for the improvement of reports and studies in military hospitals to report the rate of these infections are necessary.
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Affiliation(s)
- Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohamadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamed Fattahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
| | - Hossein Ali Rahdar
- Department of Microbiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Sima Mirzaei Moghadam
- Department of Midwifery, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Jeanes A, Coen PG, Drey NS, Gould DJ. Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool. Am J Infect Control 2020; 48:68-76. [PMID: 31358420 PMCID: PMC7115327 DOI: 10.1016/j.ajic.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. METHODS The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. RESULTS Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. CONCLUSIONS Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, Maples House, London, United Kingdom
| | - Nicolas S Drey
- School of Health Studies, University of London, London, United Kingdom
| | - Dinah J Gould
- School of healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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3
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Makic MBF, Martin SA, Burns S, Philbrick D, Rauen C. Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Crit Care Nurse 2013; 33:28-42. [DOI: 10.4037/ccn2013787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is a research nurse scientist at the University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing in Aurora
| | - Sarah A. Martin
- Sarah A. Martin is a pediatric nurse practitioner and cares for inpatients on the pediatric surgery service at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois. She is the associate editor for the Journal of Pediatric Health Care
| | - Suzanne Burns
- Suzanne Burns is an advanced practice nurse in critical care and a professor of nursing in the acute and specialty care program at the University of Virginia Health System in Charlottesville
| | - Dinah Philbrick
- Dinah Philbrick is a staff nurse on the intravenous team and a member of the Evidence Based Practice Council at Northern Westchester Hospital, Mt Kisco, New York
| | - Carol Rauen
- Carol Rauen is an independent clinical nurse specialist and education consultant in Kill Devil Hills, North Carolina
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Nichol K, McGeer A, Bigelow P, O'Brien-Pallas L, Scott J, Holness DL. Behind the mask: Determinants of nurse's adherence to facial protective equipment. Am J Infect Control 2013; 41:8-13. [PMID: 22475568 PMCID: PMC7132700 DOI: 10.1016/j.ajic.2011.12.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 11/14/2022]
Abstract
BACKGROUND As the predominant occupation in the health sector and as the health worker with the most patient interaction, nurses are at high risk for occupational transmission of communicable respiratory illness. The use of facial protective equipment (FPE) is an important strategy to prevent occupational transmission. METHODS A 2-phased study was conducted to examine nurse's adherence to recommended use of FPE. Phase 1 was a cross-sectional survey of nurses in selected units of 6 acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. RESULTS Of the 1,074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of FPE. Multivariable analysis revealed 6 predictors of adherence: unit type, frequency of equipment use, equipment availability, training, organizational support, and communication. Following the survey, 100 observations in 14 intensive care units were conducted that revealed a 44% competence rate with proper use of N95 respirators and knowledge as a significant predictor of competence. CONCLUSION Whereas increasing knowledge should enhance competence, strategies to improve adherence to recommended use of FPE in a busy and complex health care setting should focus on ready availability of equipment, training and fit testing, organizational support for worker health and safety, and good communication practices.
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Affiliation(s)
- Kathryn Nichol
- Occupational Health Services Program, St Michael's Hospital, Toronto, ON, Canada.
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Xia Y, Lu C, Zhao J, Han G, Chen Y, Wang F, Yi B, Jiang G, Hu X, Du X, Wang Z, Lei H, Han X, Han L. A bronchofiberoscopy-associated outbreak of multidrug-resistant Acinetobacter baumannii in an intensive care unit in Beijing, China. BMC Infect Dis 2012. [PMID: 23198973 PMCID: PMC3562511 DOI: 10.1186/1471-2334-12-335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Bronchofiberscopy, a widely used procedure for the diagnosis of various pulmonary diseases within intensive care units, has a history of association with nosocomial infections. Between September and November 2009, an outbreak caused by multidrug-resistant Acinetobacter baumannii (MDR-Ab) was observed in the intensive care unit of a tertiary care hospital in Beijing, China. This study is aimed to describe the course and control of this outbreak and investigate the related risk factors. Methods Clinical and environmental sampling, genotyping with repetitive extragenic palindromic polymerase chain reaction (REP-PCR), and case–control risk factor analysis were performed in the current study. Results During the epidemic period, 12 patients were infected or colonized with MDR-Ab. Sixteen (72.7%) of twenty-two MDR-Ab isolates from the 12 patients and 22 (84.6%) of 26 MDR-Ab isolates from the bronchofiberscope and the healthcare-associated environment were clustered significantly into a major clone (outbreak MDR-Ab strain) by REP-PCR typing. Seven patients carrying the outbreak MDR-Ab strain were defined as the cases. Six of the seven cases (83%) received bronchofiberscopy versus four of the 19 controls (21%) (odds ratio, 22.5; 95% confidence interval, 2.07–244.84; P = 0.005). Several potential administrative and technical problems existed in bronchofiberscope reprocessing. Conclusions Bronchofiberscopy was associated with this MDR-Ab outbreak. Infection control precautions including appropriate bronchofiberscope reprocessing and environmental decontamination should be strengthened.
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Affiliation(s)
- Yukun Xia
- Department for Hospital Infection Control & Research, Institute of Disease Control & Prevention of People's Liberation Army, Academy of Military Medical Sciences, Fengtai Dong Street 20, Beijing, China
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Low compliance to handwashing program and high nosocomial infection in a brazilian hospital. Interdiscip Perspect Infect Dis 2012; 2012:579681. [PMID: 22719756 PMCID: PMC3375026 DOI: 10.1155/2012/579681] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 12/14/2022] Open
Abstract
Background. It is a fact that hand hygiene prevents nosocomial infection, but compliance with recommended instructions is commonly poor. The purpose of this study was to implement a hand hygiene program for increase compliance with hand hygiene and its relationship with nosocomial infection (NI) and MRSA infection/colonization rates. Methods. Compliance to hand hygiene was evaluated in a hospital by direct observation and measured of health care-associated infections, including methicillin resistant Staphylococcus aureus, before and after an educational intervention, using visual poster, colorful stamps, and feedback of the results. Results. Overall compliance did not increase during intervention, only handwashing before and after patient contact has improved from 40% to 76% (P = 0.01) for HCWs, but NI and MRSA rates remained high and stable. Conclusion. In a combination of high prevalence of NI and low compliance to hand hygiene, the programme of measure does not motivate the HCW hand hygiene. Future interventions should employ incremental evaluation to develop effective hand hygiene initiatives.
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Kennedy M, Burnett E. Hand hygiene knowledge and attitudes: comparisons between student nurses. J Infect Prev 2011. [DOI: 10.1177/1757177411411124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is recognised that early intervention in healthcare workers’ education is important in terms of embedding effective infection prevention and control knowledge into practice. One of the most important aspects of this education is hand hygiene compliance and technique expectations. This small study was undertaken in collaboration with the University of Dundee, School of Nursing and Midwifery and NHS Tayside. It explored the differences in knowledge, attitudes and practice towards hand hygiene among second and third year student nurses with the aim of reviewing and informing the development of future educational material at undergraduate level in order to continually enhance knowledge and skills and bridge the theory–practice gap. This study concluded that third year student nurses did have a slightly better knowledge base than the second years and that although knowledge, attitudes and practice were reported to be of a good standard overall, there were still some important issues that must be addressed.
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Affiliation(s)
- M Kennedy
- NHS Tayside, Room C2016, Nurses Residences, Ninewells Hospital, Dundee, UK
| | - E Burnett
- University of Dundee, School of Nursing and Midwifery, Dundee, UK
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Stackelroth J, Shaban RZ. The challenges of implementing a national hand hygiene initiative in rural and remote areas: Is it time for a new approach to auditing? ACTA ACUST UNITED AC 2011. [DOI: 10.1071/hi11001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gantt LT, Webb-Corbett R. Using Simulation to Teach Patient Safety Behaviors in Undergraduate Nursing Education. J Nurs Educ 2010; 49:48-51. [DOI: 10.3928/01484834-20090918-10] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 11/24/2008] [Indexed: 11/20/2022]
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Yuan CT, Dembry LM, Higa B, Fu M, Wang H, Bradley EH. Perceptions of hand hygiene practices in China. J Hosp Infect 2008; 71:157-62. [PMID: 19013685 PMCID: PMC7132447 DOI: 10.1016/j.jhin.2008.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 09/26/2008] [Indexed: 11/29/2022]
Abstract
Hand hygiene is considered one of the most important infection control measures for preventing healthcare-associated infections. However, compliance rates with recommended hand hygiene practices in hospitals remain low. Previous literature on ways to improve hand hygiene practices has focused on the USA and Europe, whereas studies from developing countries are less common. In this study, we sought to identify common issues and potential strategies for improving hand hygiene practices in hospitals in China. We used a qualitative survey design based on in-depth interviews with 25 key hospital and public health staff in eight hospitals selected by the Chinese Ministry of Health. We found that hospital workers viewed hand hygiene as paramount to effective infection control and had adequate knowledge about proper hand hygiene practices. Despite these positive attitudes and adequate knowledge, critical challenges to improving rates of proper hand hygiene practices were identified. These included lack of needed resources, limited organisational authority of hospital infection control departments, and ineffective use of data monitoring and feedback to motivate improvements. Our study suggests that a pivotal issue for improving hand hygiene practice in China is providing infection control departments adequate attention, priority, and influence within the hospital, with a clear line of authority to senior management. Elevating the place of infection control on the hospital organisational chart and changing the paradigm of surveillance to continuous monitoring and effective data feedback are central to achieving improved hand hygiene practices and quality of care.
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Affiliation(s)
- C T Yuan
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut 06520-8034, USA
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