Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study

State of infection prevention knowledge among healthcare professionals in Japan: a questionnaire survey analysis using text mining

BACKGROUND

Healthcare-associated infections (HAIs) are an important issue that needs to be continuously addressed in healthcare institutions, and healthcare professionals (HCPs) are expected to strengthen educational programmes on infection prevention. Although the incidence of HAIs in Japan has been decreasing, the actual state of knowledge on infection prevention among HCPs remains unclear.

AIM

To clarify the actual infection prevention knowledge of HCPs in Japan.

METHODS

The study participants were 1158 HCPs working in healthcare institutions with frequent contact with patients (283 doctors, 591 nurses, 115 physical therapists, 97 radiologists, and 72 medical technologists). HCPs described the infection prevention behaviours they consciously adhered to via an online self-administered questionnaire. Data were analysed by text mining. Categories were extracted from the responses to reveal HCPs' infection prevention knowledge.

FINDINGS

More than half of the participants (64.9%) were aged > 40 years, and 48.1% had over 20 years of clinical experience. The majority of the participants were nurses (51.0%), 43.9% had a bachelor's degree, and 56.6% were female. Seven categories regarding infection prevention knowledge were extracted: "performing hand hygiene and gargling," "wearing personal protective equipment," "strengthening one's immunity," "protecting oneself and patients from infection," "distinguishing clean and unclean zones," "actions to prevent transmission to others in daily life activities," and "maintaining distance from others."

CONCLUSION

These results suggest that most HCPs working in healthcare settings in Japan prioritize and adhere to standard precautionary measures, and that the low incidence of HAIs may be influenced by perceptions of the knowledge of "handwashing and gargling" among HCPs.

Development and Validation of the Infection Prevention Appraisal Scale

It has been emphasized that future studies aimed at improving adherence to infection prevention guidelines should focus on beliefs in, e.g., self-efficacy. Reliable situation specific measures are needed to measure the phenomenon of self-efficacy, but there seems to be few valid scales available that are suitable for measuring one's belief in self-efficacy regarding infection prevention measures. The purpose of the study was to develop a unidimensional appraisal scale to capture nurses' beliefs in their abilities to practice medical asepsis in care situations. When creating the items, evidence-based guidelines for preventing healthcare-associated infections were used together with Bandura's guide for constructing self-efficacy scales. Face validity, content validity, and concurrent validity were tested in various samples of the target population. Furthermore, dimensionality was evaluated on data collected from 525 registered nurses and licensed practical nurses recruited from the medical, surgical, and orthopaedic wards of 22 Swedish hospitals. The Infection Prevention Appraisal Scale (IPAS) consists of 14 items. Face and content validity were endorsed by target population representatives. The exploratory factor analysis suggested unidimensionality, and the internal consistency was good (Cronbach's alpha 0.83). The total scale score correlated with the General Self-Efficacy Scale, as expected, and supported concurrent validity. The Infection Prevention Appraisal Scale demonstrates sound psychometric properties supporting a unidimensional measure of self-efficacy to medical asepsis in care situations.

Healthcare personnel's working conditions in relation to risk behaviours for organism transmission: A mixed-methods study

AIMS AND OBJECTIVES

To investigate healthcare personnel's working conditions in relation to risk behaviours for organism transmission.

BACKGROUND

Healthcare personnel's behaviour is often influenced by working conditions that in turn can impact the development of healthcare-associated infections. Observational studies are scarce, and further understanding of working conditions in relation to behaviour is essential for the benefit of the healthcare personnel and the safety of the patients.

DESIGN

A mixed-methods convergent design.

METHODS

Data were collected during 104 h of observation at eight hospital units. All 79 observed healthcare personnel were interviewed. Structured interviews covering aspects of working conditions were performed with the respective first-line manager. The qualitative and quantitative data were collected concurrently and given equal priority. Data were analysed separately and then merged. The study follows the GRAMMS guidelines for reporting mixed-methods research.

RESULTS

Regardless of measurable and perceived working conditions, risk behaviours frequently occurred especially missed hand disinfection. Healthcare personnel described staffing levels, patient-level workload, physical factors and interruptions as important conditions that influence infection prevention behaviours. The statistical analyses confirmed that interruptions increase the frequency of risk behaviours. Significantly higher frequencies of risk behaviours also occurred in activities where healthcare personnel worked together, which in the interviews was described as a consequence of caring for high-need patients.

CONCLUSIONS

These mixed-methods findings illustrate that healthcare personnel's perceptions do not always correspond to the observed results since risk behaviours frequently occurred regardless of the observed and perceived working conditions. Facilitating the possibility for healthcare personnel to work undisturbed when needed is essential for their benefit and for patient safety.

RELEVANCE FOR CLINICAL PRACTICE

The results can be used to enlighten healthcare personnel and managers and when designing future infection prevention work.

Continued wearing of gloves: a risk behaviour in patient care

Background

The wearing of gloves is included in the standard principles for preventing healthcare associated infections. A continued wearing of gloves may, however, result in the transmission of organisms instead of preventing infections. Few studies have explored how common it is for surfaces to be touched by potentially contaminated gloves.

Methods

Secondary analysis of field notes from 48 hours of unstructured observations of healthcare personnel's actions during patient care. The new focus was on to what extent healthcare personnel wore gloves that should have been removed or changed, what surfaces were touched by contaminated gloves and what patient-related activities were involved.

Results

A continued wearing of gloves occurred in about half of the observed episodes of patient care. On average, 3.3 surfaces were touched by contaminated gloves. The surfaces most frequently touched were ‘unused single-use items’, ‘equipment controls/switches/regulators/flush buttons’ and ‘bed linen’. This occurred mostly while helping patients with ‘personal hygiene’, when performing ‘test taking’ or during procedures involving the operation of medical or other ‘equipment’.

Conclusion

The continued wearing of gloves during patient-related activities carries the risk of organism transmission, as the gloves touch many surfaces. The most critical moments seem to be when the use of gloves is considered essential. A better understanding of the motivators of improper glove-use behaviour is needed to develop interventions that rectify the improper use of gloves.

Perceptions of Infection Control Practices and the use of Vignettes to Alter Infection Control Behavior: A Feasibility Study

Aim

To explore the perceptions of infection control practices among healthcare personnel and evaluate the use of authentic vignettes as a means to alter infection control behavior.

Method

Four authentic vignettes were used as a part of reflective dialogues with healthcare personnel. An evaluation of the dialogues was performed with six healthcare personnel using the focus group technique. Qualitative content analysis was used to analyze the data.

Results

The mind-set to help one another and do one's best in every situation was described as a core aspect in preventing the transmission of microorganisms. Having support, taking personal responsibility, being knowledgeable about infection control practices, and having a reasonable workload were seen to play decisive roles in controlling the spread of infection. Discussing authentic comprehensible vignettes with colleagues during the allotted time was considered a valuable method for improving infection control practices.

Conclusion

Meaningful insights on how best to use vignettes as a means to improve infection control practice were gained. These findings should be considered when designing theory-driven interventions in different contexts, which are aimed at improving infection control practices in health care.