The efficacy of cotton cover gowns in reducing infection in nursing neutropenic patients: an evidence-based study

Healthcare-associated infections in a Tunisian university hospital: from analysis to action

INTRODUCTION

Our study was conducted, in university hospital center (UHC) Farhat Hached of Sousse (city in Tunisian center-east), within healthcare-associated infections (HAI) epidemiological surveillance (ES) program, based, among others, on HAI regular prevalence surveys. Our objectives are to resituate HAI prevalence rate and to identify their risk factors (RF) in order to adjust, in our hospital, prevention programs.

METHODS

It is a transversal descriptive study, including all patients who had been hospitalized for at least 48 hours, measuring prevalence of HAI a "given day", with only one passage by service. Risk factors were determined using Epiinfo 6.0, by uni-varied analysis, then, logistic regression stepwise descending for the variables whose p.

RESULTS

The study focused on 312 patients. Infected patients prevalence was 12.5% and that of HAI was 14.5%. Infections on peripheral venous catheter (PVC) dominated (42.2%) among all HAI identified. HAI significant RF were neutropenia (p < 10(-4)) for intrinsic factors, and PVC for extrinsic factors (p = 0,003).

CONCLUSION

Predominance of infections on PVC should be subject of specific prevention actions, including retro-information strategy, prospective ES, professional practices evaluation and finally training and increasing awareness of health personnel with hygiene measures. Finally, development of a patient safety culture with personnel ensures best adherence to hygiene measures and HAI prevention.

Impact of Universal Gowning and Gloving on Health Care Worker Clothing Contamination

OBJECTIVE

To determine whether gowning and gloving for all patient care reduces contamination of healthcare worker (HCW) clothing, compared to usual practice.

DESIGN

Cross-sectional surveys.

SETTING

Five study sites were recruited from intensive care units (ICUs) randomized to the intervention arm of the Benefits of Universal Gown and Glove (BUGG) study.

PARTICIPANTS

All HCWs performing direct patient care in the study ICUs were eligible to participate.

METHODS

Surveys were performed first during the BUGG intervention study period (July–September 2012) with universal gowning/gloving and again after BUGG study conclusion (October–December 2012), with resumption of usual care. During each phase, HCW clothing was sampled at the beginning and near the end of each shift. Cultures were performed using broth enrichment followed by selective media. Acquisition was defined as having a negative clothing culture for samples taken at the beginning of a shift and positive clothing culture at for samples taken at the end of the shift.

RESULTS

A total of 348 HCWs participated (21–92 per site), including 179 (51%) during the universal gowning/gloving phase. Overall, 51 (15%) HCWs acquired commonly pathogenic bacteria on their clothing: 13 (7.1%) HCWs acquired bacteria during universal gowning/gloving, and 38 (23%) HCWs acquired bacteria during usual care (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2–0.6). Pathogens identified includedS. aureus(25 species, including 7 methicillin-resistantS. aureus[MRSA]),Enterococcusspp. (25, including 1 vancomycin-resistantEnterococcus[VRE]),Pseudomonasspp. (4),Acinetobacterspp. (4), andKlebsiella(2).

CONCLUSION

Nearly 25% of HCWs practicing usual care (gowning and gloving only for patients with known resistant bacteria) contaminate their clothing during their shift. This contamination was reduced by 70% by gowning and gloving for all patient interactions.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Footwear Exchange Has No Influence on the Incidence of Febrile Neutropenia in Patients Undergoing Chemotherapy for Hematologic Malignancies

Objective:

To determine whether footwear exchange affects the incidence of febrile neutropenia among patients undergoing chemotherapy for hematologic malignancies.

Design:

Open trial with historical comparison.

Setting:

The 12-bed high-efficiency particulate air-fil-tered hematology unit at Osaka University Hospital, Suita, Japan.

Patients:

Those with hematologic malignancies who underwent chemotherapy from January 1997 through January 2003. Footwear exchange was discontinued in January 2000.

Methods:

The surveillance system was based on the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Rates of febrile neutropenia were calculated for neutropenic patient-days (ie, days with neutropenia < 500/μL).

Results:

From January 1997 through December 1999 and from February 2000 through January 2003, 58 and 54 patients endured 237 and 184 neutropenic periods following chemotherapy, and their total neutropenic days were 3,123 and 2,503, respectively. They showed episodes of febrile neutropenia 89 and 68 times, respectively. Infection rates were 28.5 and 27.2 per 1,000 neutropenic patient-days (P = .83), respectively.

Conclusion:

The incidence of febrile neutropenia was not affected by footwear exchange. In hematology units, changing shoes does not appear to affect the rate of infections during neutropenic periods.

Evidence-Based Nursing Practice to Prevent Infection in Hospitalized Neutropenic Patients With Cancer

PURPOSE/OBJECTIVES

To review studies that have assessed the effectiveness of selected nursing interventions used in hospitals to prevent healthcare-associated infections in neutropenic patients with cancer.

DATA SOURCES

Literature review of low microbial diets, protective clothing and environments, personal hygiene, and oral care in English-language articles from PubMed; the Cumulative Index of Nursing and Allied Health Literature; the National Guideline Clearinghouse, 1980-June 2003; and Cochrane Database of Systematic Reviews.

DATA SYNTHESIS

Few studies have demonstrated the effectiveness of low microbial food and water and protective environments and clothing in reducing infections in neutropenic patients with cancer, and hospitals vary in these practices. Skin antisepsis reduces microbial counts, but data regarding the effect on infections are lacking. Many studies were characterized by insufficient sample sizes or use of multiple interventions.

CONCLUSIONS

Major gaps exist in empirical evidence regarding which nursing interventions might be helpful in preventing or controlling healthcare-associated infections in neutropenic patients.

IMPLICATIONS FOR NURSING

Although the evidence base for clinical practices such as a low microbial diet, protective environments and clothing, and special skin antisepsis regimens is weak, some of these practices seem prudent and reasonable. Until further evidence is available, clinicians can use consensus guidelines and should assist in identifying clinical practices that require additional research. Ultimately, interventions with little or no demonstrated efficacy should be examined systematically or abandoned. Additional studies of sufficient sample size regarding nursing practices such as the role of protective environments, room placement, antiseptic bathing, and prevention and treatment of oral complications are indicated. Because of difficulties in randomization and risk stratification, rigorous observational studies often may be an acceptable alternative to clinical trials.