1
|
Carayon P, Thuemling T, Parmasad V, Bao S, O'Horo J, Bennett NT, Safdar N. Implementation of An Antibiotic Stewardship Intervention to Reduce Prescription of Fluoroquinolones: A Human Factors Analysis in Two Intensive Care Units. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022; 26:161-171. [PMID: 35146329 DOI: 10.1177/25160435211025417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as Clostridioides difficile (CDI); this is particularly important for fluoroquinolones (FQ), which are frequently used in critical care settings. In this study, using a multiple case study research approach, we conduct an in-depth analysis of an intervention aimed at limiting ICU prescriber access to FQ in two ICUs of two hospitals. The data collection and analysis were guided by a human factors engineering approach based on the SEIPS (Systems Engineering Initiative for Patient Safety) model and evidence-based implementation principles. Our results show some differences in the implementation of the FQ intervention between the two ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped to quickly identify problems with the intervention and ensure that changes were made in a just-in-time manner (e.g. just-in-time training, removal of FQ in order set for pneumonia). Despite their organizational differences, both sites developed strategies to successfully implement the FQ intervention.
Collapse
Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | - Teresa Thuemling
- Wisconsin Institute for Healthcare Systems Engineering; University of Wisconsin-Madison
| | | | - Songtao Bao
- School of Journalism and Mass Communication; University of Wisconsin-Madison
| | | | | | - Nasia Safdar
- Department of Medicine; University of Wisconsin-Madison
| |
Collapse
|
2
|
Devi A, Ravindra K, Kaur M, Kumar R. Evaluation of biomedical waste management practices in public and private sector of health care facilities in India. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:26082-26089. [PMID: 31278642 DOI: 10.1007/s11356-019-05785-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/17/2019] [Indexed: 04/15/2023]
Abstract
Proper management of biomedical waste (BMW) is required to avoid environmental and human health risks. The current study evaluated the BWM practices in public and private health care facilities of Fatehgarh Sahib District in Punjab, India. The study was conducted, using a modified World Health Organization (WHO) tool in 120 health care facilities randomly selected from rural and urban areas. At primary health care level, BMW management guidelines were followed in 67.2% of the public sector and 40.4% of the private sector facilities, whereas in secondary health care sectors both private and public sector follows 100% compliance. Health facilities were graded into different categories according to median score, i.e., scores less than < 2.5 was categorized as red (no credible BMW management system in place), scores between 2.5 to 7.5 as yellow (system present but needs major improvement) and scores > 7.5 as green (good system in place for BMW). It was observed that among primary health care facilities, 85% of the public sector and 64% of private sector facilities falls in the red category, whereas for secondary health care facilities only 8% fall in the red category. Logistic regression helped to identify the major factors that affect the performance of the health care facility, and it shows that regular training on BMW and improved infrastructure can improve the BMW management practices. Further, proper management of BMW requires multi-sectoral coordination, which can be better addressed through policies and by providing periodical training to all stakeholders.
Collapse
Affiliation(s)
- Aruna Devi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| |
Collapse
|
3
|
Cavallari JM, Burch KA, Hanrahan J, Garza JL, Dugan AG. Safety climate, hearing climate and hearing protection device use among transportation road maintainers. Am J Ind Med 2019; 62:590-599. [PMID: 31104314 DOI: 10.1002/ajim.22970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND It is important to understand workplace factors including safety climate that influence hearing protection device (HPD) use. We sought to investigate the association between HPD use, safety climate, and hearing climate, a new measure specific to hearing. METHODS A survey was developed and distributed among transportation "maintainers" who perform road maintenance and repair. A new hearing climate measure was designed by adapting a safety climate measure. HPD use was assessed by asking workers how often they wear HPD while in noise. The differences in safety climate and hearing climate were compared by the frequency of HPD use using analysis of variance. RESULTS Among 166 maintainers, 54% reported always or almost always wearing HPD while noise exposed. High-frequency HPD users reported a statistically significant higher safety climate (P = 0.004) and hearing climate (P = 0.003). CONCLUSIONS Hearing climate predicts the frequency of HPD use and may be a useful measure when assessing and improving hearing conservation programs.
Collapse
Affiliation(s)
- Jennifer M. Cavallari
- Division of Occupational and Environmental MedicineUConn School of MedicineFarmington Connecticut
| | - Katrina A. Burch
- Division of Industrial and Organizational PsychologyUniversity of ConnecticutMansfield Connecticut
- Department of Psychological SciencesWestern Kentucky UniversityBowling Green Kentucky
| | - Jeffrey Hanrahan
- Division of Industrial and Organizational PsychologyUniversity of ConnecticutMansfield Connecticut
| | - Jennifer L. Garza
- Division of Occupational and Environmental MedicineUConn School of MedicineFarmington Connecticut
| | - Alicia G. Dugan
- Division of Occupational and Environmental MedicineUConn School of MedicineFarmington Connecticut
| |
Collapse
|
4
|
Green-McKenzie J, McCarthy RB, Shofer FS. Characterisation of occupational blood and body fluid exposures beyond the Needlestick Safety and Prevention Act. J Infect Prev 2016; 17:226-232. [PMID: 28989483 PMCID: PMC5102074 DOI: 10.1177/1757177416645339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/27/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act. METHODS Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used. RESULTS Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32 %), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported 'other' and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P <0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P <0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear. CONCLUSIONS Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs.
Collapse
Affiliation(s)
- Judith Green-McKenzie
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Frances S Shofer
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
5
|
Abstract
The purpose of this literature review is to consider key themes from empirical research relating to the knowledge and compliance of universal precautions amongst healthcare practitioners. Utilising international studies, strategies to improve universal precautions are analysed. The review identifies areas of limited knowledge, synthesises existing research and suggests aspects of universal precautions that need to be studied further. A literature search of studies listed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was conducted from 1990–2003, using a number of key words. Review, analysis and synthesis of selected studies were performed. The findings of this review showed that universal precautions are considered an effective means of protecting patients and staff and controlling infection. The consensus from this body of evidence is that, globally, knowledge of universal precautions is inadequate and compliance low. Studies from many countries have shown that specific intervention strategies, such as education, are influential in improving knowledge and compliance. This review concludes that it is imperative that future research examines how the attitudes and beliefs of practitioners can be influenced and changed to reenforce adherence to universal precautions within the clinical practice setting. There remains a lack of evidence on the long-term benefits of practice interventions to improve compliance, and what specific barriers are influential in affecting how healthcare practitioners adopt universal precautions more effectively in their practice.
Collapse
Affiliation(s)
- John Gammon
- Health Science Swansea Institute of Higher Education
| | | |
Collapse
|
6
|
Schröder I, Huang DYQ, Ellis O, Gibson JH, Wayne NL. Laboratory safety attitudes and practices: A comparison of academic, government, and industry researchers. ACS CHEMICAL HEALTH & SAFETY 2016. [DOI: 10.1016/j.jchas.2015.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Green-McKenzie J, Shofer FS. Duration of Time on Shift Before Accidental Blood or Body Fluid Exposure for Housestaff, Nurses, and Technicians. Infect Control Hosp Epidemiol 2015; 28:5-9. [PMID: 17230381 DOI: 10.1086/510568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 04/14/2006] [Indexed: 11/04/2022]
Abstract
Background.Shift work has been found to be associated with an increased rate of errors and accidents among healthcare workers (HCWs), but the effect of shift work on accidental blood and body fluid exposure sustained by HCWs has not been well characterized.Objectives.To determine the duration of time on shift before accidental blood and body fluid exposure in housestaff, nurses, and technicians and the proportion of housestaff who sustain a blood and body fluid exposure after 12 hours on duty.Methods.This retrospective, descriptive study was conducted during a 24-month period at a large urban teaching hospital. Participants were HCWs who sustained an accidental blood and body fluid exposure.Results.Housestaff were on duty significantly longer than both nursing staff (P = .02) and technicians (P < .0001) before accidental blood and body fluid exposure. Half of the blood and body fluid exposures sustained by housestaff occurred after being on duty 8 hours or more, and 24% were sustained after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4% among housestaff, and 3% among phlebotomists.Conclusions.Housestaff were significantly more likely to have longer duration of time on shift before blood and body fluid exposure than were the other groups. Almost one-quarter of accidental blood and body fluid exposures to housestaff were incurred after they had been on duty for 12 hours or more. Housestaff sustained a higher rate of accidental blood and body fluid exposures than did nursing staff and technicians.
Collapse
|
8
|
Leiss JK. Safety climate and use of personal protective equipment and safety medical devices among home care and hospice nurses. INDUSTRIAL HEALTH 2014; 52:492-497. [PMID: 25055845 PMCID: PMC4273017 DOI: 10.2486/indhealth.2014-0074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/25/2014] [Indexed: 06/03/2023]
Abstract
Use of personal protective equipment (PPE) and safety medical devices is mandated for healthcare workers to reduce the risk of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) from exposure to patients' blood. Research has shown that a strong safety climate may promote increased use of PPE. Therefore, the objective of this study was to examine the association between safety climate and use of PPE among homecare/hospice nurses in North Carolina. To this end, a mail survey was conducted in 2006. The response rate, adjusted on the assumption that the proportion of eligible nurses from among those who did not return the questionnaire or could not be contacted was similar to the proportion among those who did return the questionnaire, was 69% (n=833 eligibles). The percentage of nurses who used the specified PPE was two to three times greater among nurses who had a strong safety climate. Safety climate was only weakly associated with using safety devices. These results suggest that improving safety climate may be a powerful tool for increasing use of PPE.
Collapse
Affiliation(s)
- Jack K Leiss
- Cedar Grove Institute for Sustainable Communities, USA
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
- Kathryn Nichol
- Occupational Health Services Program, St Michael's Hospital, Toronto, ON, Canada.
| | | | | | | | | | | |
Collapse
|
10
|
Martel J, Bui-Xuan EF, Carreau AM, Carrier JD, Larkin É, Vlachos-Mayer H, Dumas ME. Respiratory hygiene in emergency departments: compliance, beliefs, and perceptions. Am J Infect Control 2013; 41:14-8. [PMID: 22503134 PMCID: PMC7115267 DOI: 10.1016/j.ajic.2011.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 12/22/2011] [Accepted: 12/23/2011] [Indexed: 11/21/2022]
Abstract
Background Low respiratory hygiene compliance among health care workers of emergency departments has become a major concern in the spread of respiratory infections. Our objective was to determine the compliance with respiratory hygiene of triage nurses at 2 university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency health care workers. Methods A 2-part, cross-sectional, descriptive study was conducted at 2 training centers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed. A self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the health care workers at the emergency department of the 2 hospital sites. Results Median objective compliance with respiratory hygiene measures of triage nurses was 22% (interquartile range [IQR], 11%-33%). Median perceived compliance of the health care workers was 68% (IQR, 61%-79%). Median actual knowledge score was 75% (IQR, 75%-100%). Overall, 91.9% of respondents believed that the mask was an effective preventive measure. The main obstacles toward mask wearing by the health care worker were “tendency to forget” (37.8%) and “discomfort” (35.1%). Conclusion The compliance rate at our institution is very low. We identified a few factors affecting adherence to respiratory hygiene measures that are of potential use in targeting groups and formulating recommendations.
Collapse
|
11
|
Eliseo LJ, Murray KA, White LF, Dyer S, Mitchell PA, Fernandez WG. EMS providers' perceptions of safety climate and adherence to safe work practices. PREHOSP EMERG CARE 2012; 16:53-8. [PMID: 22128907 DOI: 10.3109/10903127.2011.621043] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. OBJECTIVE To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. METHODS EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. RESULTS One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). CONCLUSION EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.
Collapse
Affiliation(s)
- Laura J Eliseo
- Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
AIM A study was undertaken involving nursing students and nurse mentors to investigate the experiences and learning needs of nursing students in relation to infection prevention. One of the objectives was to consider the views of both nursing students and mentors towards the Infection Prevention and Control Nurse (IPCN) as an important staff member in infection prevention and control. BACKGROUND Infection prevention and control is a national and international priority but compliance with precautions can be low. One reason for this is staff attitudes. Infection Prevention and Control Nurses have an important role to play in the management of patient care through clinical staff and it is therefore important that they are seen as approachable and effective in their role. METHODS Using a qualitative approach, data were obtained through semistructured interviews with 31 nursing students and 32 nurse mentors. Interviews were recorded, transcribed and analysed using framework analysis. FINDINGS Three themes emerged: attitudes towards the IPCN, effects of the presence of the IPCN and preferred qualities in IPCNs. CONCLUSIONS Areas for future research are identified and recommendations made to address areas where attitudes may affect both clinical practice and the education of nursing students in clinical placements. IMPLICATIONS FOR NURSING MANAGEMENT Nurse specialists or practitioners, who are often seen within a management role, need to consider how they work with clinical staff in order to foster more collaborative relationships.
Collapse
Affiliation(s)
- Deborah J Ward
- Lecturer in Infection Control, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| |
Collapse
|
13
|
Lehman EJ, Huy JM, Viet SM, Gomaa A. Compliance With Bloodborne Pathogen Standards at Eight Correctional Facilities. JOURNAL OF CORRECTIONAL HEALTH CARE 2012; 18:29-44. [DOI: 10.1177/1078345811421466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Everett J. Lehman
- Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Janice M. Huy
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | | | - Ahmed Gomaa
- Surveillance Branch, Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| |
Collapse
|
14
|
Feng X, Acord L, Cheng Y, Zeng J, Song J. The relationship between management safety commitment and patient safety culture. Int Nurs Rev 2011; 58:249-54. [DOI: 10.1111/j.1466-7657.2011.00891.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Provision and use of personal protective equipment among home care and hospice nurses in North Carolina. Am J Infect Control 2011; 39:123-8. [PMID: 20864219 DOI: 10.1016/j.ajic.2010.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 05/21/2010] [Accepted: 05/21/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND We investigated the frequency with which home care/hospice nurses are provided with and use personal protective equipment (PPE) and factors associated with use. METHODS We conducted a mail survey among home care/hospice nurses in North Carolina in 2006. RESULTS The adjusted response rate was 69% (n = 833). Between 68% and 86% of nurses were always provided with the relevant types of PPE; these nurses were 2.5-3 times more likely to use the PPE in scenarios involving a potential for blood exposure compared with nurses who were not always provided with PPE. Nurses who always had sufficient time during home visits were 50% more likely to use PPE. Nurses who visited more homes with adverse working conditions were less likely to use PPE. CONCLUSION The public health policy of providing PPE to health care workers and ensuring that they use that equipment to prevent occupational blood exposure is not being fully implemented for home care and hospice nurses. Greater provision of PPE could reduce blood exposure in this population. Conditions of the home care/hospice work environment may be impeding nurses' ability to use PPE.
Collapse
|
16
|
Levy MH, Mogg D. Infection control standards for Australian prisons: forgotten, but not forgiving. ACTA ACUST UNITED AC 2009. [DOI: 10.1071/hi09004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Hinkin J, Gammon J, Cutter J. Review of personal protection equipment used in practice. Br J Community Nurs 2008; 13:14-9. [PMID: 18399366 DOI: 10.12968/bjcn.2008.13.1.27978] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the U.K., and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.
Collapse
Affiliation(s)
- Jon Hinkin
- School of Health Sciences, Swansea University, Wales.
| | | | | |
Collapse
|
18
|
Adjei AA, Armah HB, Gbagbo F, Ampofo WK, Boamah I, Adu-Gyamfi C, Asare I, Hesse IFA, Mensah G. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: A national multicenter study. BMC Infect Dis 2008; 8:33. [PMID: 18328097 PMCID: PMC2311310 DOI: 10.1186/1471-2334-8-33] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 03/07/2008] [Indexed: 12/13/2022] Open
Abstract
Background Prisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in prison officers in Ghana. Methods A national multicenter cross-sectional study was undertaken on correlates of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infections in sample of prison inmates and officers from eight of ten regional central prisons in Ghana. A total of 1366 inmates and 445 officers were enrolled between May 2004 and December 2005. Subjects completed personal risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for presence of antibodies to HIV, HCV and Treponema pallidum; and surface antigen of HBV (HBsAg). These data were analyzed using both univariate and multivariate techniques. Results Almost 18% (1336) of 7652 eligible inmates and 21% (445) of 2139 eligible officers in eight study prisons took part. Median ages of inmates and officers were 36.5 years (range 16–84) and 38.1 years (range 25–59), respectively. Among inmates, HIV seroprevalence was 5.9%, syphilis seroprevalence was 16.5%, and 25.5% had HBsAg. Among officers tested, HIV seroprevalence was 4.9%, HCV seroprevalence was 18.7%, syphilis seroprevalence was 7.9%, and 11.7% had HBsAg. Independent determinants for HIV, HBV and syphilis infections among inmates were age between 17–46, being unmarried, being illiterate, female gender, being incarcerated for longer than median time served of 36 months, history of homosexuality, history of intravenous drug use, history of sharing syringes and drug paraphernalia, history of participation in paid sexual activity, and history of sexually transmitted diseases. Independent determinants for HIV, HBV, HCV and syphilis infections among officers were age between 25–46, fale gender, being unmarried, being employed in prison service for longer than median duration of employment of 10 years, and history of sexually transmitted diseases. Conclusion The comparably higher prevalence of HIV, HBV, HCV and syphilis in prison inmates and officers in Ghana suggests probable occupational related transmission. The implementation of infection control practices and risk reduction programs targeted at prison inmates and officers in Ghana is urgently required to address this substantial exposure risk.
Collapse
Affiliation(s)
- Andrew A Adjei
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Markkanen P, Quinn M, Galligan C, Chalupka S, Davis L, Laramie A. There's no place like home: a qualitative study of the working conditions of home health care providers. J Occup Environ Med 2007; 49:327-37. [PMID: 17351519 DOI: 10.1097/jom.0b013e3180326552] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. METHODS The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. RESULTS HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. CONCLUSIONS The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.
Collapse
Affiliation(s)
- Pia Markkanen
- Department of Work Environment, School of Health and Environment, University of Massachusetts Lowell, Lowell, MA 01854, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Azar-Cavanagh M, Burdt P, Green-McKenzie J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol 2007; 28:165-70. [PMID: 17265397 DOI: 10.1086/511699] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 07/11/2005] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.
Collapse
|
21
|
Gershon RRM, Sherman M, Mitchell C, Vlahov D, Erwin MJ, Lears MK, Felknor S, Lubelczyk RA, Alter MJ. Prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers. Infect Control Hosp Epidemiol 2006; 28:24-30. [PMID: 17230384 DOI: 10.1086/510813] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 09/22/2005] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. SETTING Correctional systems in 3 states. RESULTS Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. CONCLUSION Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.
Collapse
Affiliation(s)
- Robyn R M Gershon
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Gershon RRM, Mitchell C, Sherman MF, Vlahov D, Lears MK, Felknor S, Lubelczyk RA. Hepatitis B vaccination in correctional health care workers. Am J Infect Control 2005; 33:510-8. [PMID: 16260326 DOI: 10.1016/j.ajic.2005.04.245] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 04/22/2005] [Accepted: 04/23/2005] [Indexed: 01/05/2023]
Abstract
BACKGROUND Data on bloodborne pathogen risk among health care workers (HCWs) employed in the correctional setting are sparse, even though the prevalence of bloodborne infections, including hepatitis B virus (HBV), among inmates is high. To address this, we determined prevalence and correlates of hepatitis B virus vaccination status in correctional health care workers (CHCWs) employed in 3 state correctional health care facilities. METHODS A confidential, self-administered cross-sectional survey was performed. RESULTS Four hundred eleven (69.8%) of 588 eligible participants completed the survey. Of these, 264 (64.2%) reported receiving a primary hepatitis B (HB) vaccine series. Vaccination rates varied by state and by job category. Parenteral exposures were not uncommon; 8.6% (n = 24) of clinical CHCWs and 2.0% (n = 7) of nonclinical CHCWs reported one or more needlesticks in the 6-month period prior to the study. Among clinical staff, vaccination correlated with licensure (RN or MD) and race (white) and in nonclinical staff with history of close contact with HBV infected inmates and with needlestick injury. CONCLUSION Although the HB vaccination rate among CHCWs was generally high, given their potential risk of exposure to HBV, universal vaccination should be encouraged and should include those nonclinicians with job duties that may involve potential exposure to blood/body fluids.
Collapse
Affiliation(s)
- Robyn R M Gershon
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Mitchell CS, Gershon RRM, Lears MK, Vlahov D, Felknor S, Lubelczyk RA, Sherman MF, Comstock GW. Risk of Tuberculosis in Correctional Healthcare Workers. J Occup Environ Med 2005; 47:580-6. [PMID: 15951718 DOI: 10.1097/01.jom.0000161738.88347.e4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence, incidence, and risk factors for occupational infection with tuberculosis among healthcare workers employed in correctional facilities. METHODS The authors conducted a self-administered survey, clinical interview, and tuberculin skin testing. RESULTS The overall tuberculin skin test point prevalence rate was 17.7%, the reactivity rate was 2.2%, and the annual incidence was 1.3%. At the multivariate level, after controlling for bacille Calmette-Guérin vaccination, only origin of birth remained significantly associated with prevalence of tuberculosis infection. CONCLUSIONS Although the prevalence of tuberculin reactivity was high in this population, the risk factors were predominantly demographic rather than occupational. Nevertheless, continued vigilance to control occupational exposure to this and other respiratory pathogens is warranted, given the potential for future outbreaks of tuberculosis, as well as other known and emerging airborne pathogens.
Collapse
|
24
|
|