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Aguiar Cabrera EM, Barroso Rosa S, Ojeda Vargas MDM, Hernández Flores CN, Hernández Costa EM. A single plain ring is not associated with increased bacterial load on hands: An experimental study among healthcare worker students undertaking mock surgery. Infect Dis Health 2024; 29:51-60. [PMID: 37993309 DOI: 10.1016/j.idh.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Adequate hand hygiene is considered as one of the most effective strategies in healthcare-related infection prevention. The potential negative effect of rings in hand disinfection and thus, in increased nosocomial infections rates is still controversial. Therefore, the present study was designed with the purpose of examining if rings frequently exposed to surgical scrubbing were associated or not with increased bacterial counts. METHODS 32 volunteers were randomized into 4 groups: A (no rings), B (participants wore a ring), C (no rings and performed surgical scrubbing with chlorhexidine every 48 h) and D (participants wore a ring and performed surgical scrubbing every 48 h). Glove juice samples were obtained at day 0 (T0) and after a 90-min mock-surgery on day 14 (T1). Quantitative (number of UFC/mL) and qualitative data (microorganism type) were collected as study variables. RESULTS All groups were comparable at T0. All ring carriers obtained negative cultures at T1. Ring presence was not associated with higher bacterial counts; comparisons between A vs B groups and C vs D groups showed no statistically significant differences (p = 0.076 and 1.000). T1 negative cultures were more frequent in participants performing surgical scrubbing every second day (93.8 % vs 75 %), although this difference did not reach statistical significance (p = 0.332). CONCLUSIONS The presence of single plain ring does not seem to be associated with an increased hand bacterial load. Regular surgical scrubbing with chlorhexidine impregnated sponges reduces bacterial contamination of hands, even in the presence of plain rings.
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Affiliation(s)
- Eva María Aguiar Cabrera
- Universidad de Las Palmas de Gran Canaria, Medical and Surgical Sciences Department, Las Palmas de Gran Canaria, Spain.
| | - Sergio Barroso Rosa
- Universidad de Las Palmas de Gran Canaria, Medical and Surgical Sciences Department, Las Palmas de Gran Canaria, Spain; Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Orthopaedic Surgery Department, Las Palmas de Gran Canaria, Spain; The Orthopaedic Research Institute of Queensland, Pimlico, Australia.
| | - María Del Mar Ojeda Vargas
- Universidad de Las Palmas de Gran Canaria, Clinical Sciences Department, Las Palmas de Gran Canaria, Spain; Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Microbiology Department, Las Palmas de Gran Canaria, Spain.
| | | | - Elena María Hernández Costa
- Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Surgical Area, Las Palmas de Gran Canaria, Spain.
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Discordance among Belief, Practice, and the Literature in Infection Prevention in the NICU. CHILDREN 2022; 9:children9040492. [PMID: 35455536 PMCID: PMC9027430 DOI: 10.3390/children9040492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
This study evaluates practices of infection control in the NICU as compared with the available literature. We aimed to assess providers’ awareness of their institutional policies, how strongly they believed in those policies, the correlation between institution size and policies adopted, years of experience and belief in a policy’s efficacy, and methods employed in the existing literature. An IRB-approved survey was distributed to members of the AAP Neonatal Section. A systematic review of the literature provided the domains of the survey questions. Data was analyzed as appropriate. A total of 364 providers responded. While larger NICUs were more likely to have policies, their providers are less likely to know them. When a policy is in place and it is known, providers believe in the effectiveness of that policy suggesting consensus or, at its worst, groupthink. Ultimately, practice across the US is non-uniform and policies are not always consistent with best available literature. The strength of available literature is adequate enough to provide grade B recommendations in many aspects of infection prevention. A more standardized approach to infection prevention in the NICU would be beneficial and is needed.
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Abstract
Positive tactile experiences in the newborn period are critical to normal sensory development. Universal gloving in the neonatal intensive care unit has become a controversial issue in neonatal nursing practice. Intended to prevent infection among neonatal patients, universal gloving also hinders the provision of human touch. The purpose of this survey study was to (1) describe gloving policies in neonatal intensive care units, and (2) describe the gloving and touch practices of neonatal nurses and identify associations between these practices and demographic characteristics. The investigators developed a 19-question, anonymous survey. The survey link was distributed through the National Association of Neonatal Nurses' social media and newsletter. Of the 137 responses, only 22.1% of nurses reported unit policy requiring universal gloving. While nurses reported some ambiguity about gloving policies, surveyed nurses commonly used gloves when performing general care activities. Institutional gloving policies varied in this geographically diverse sample, but routine, bare-handed touch was an uncommon practice among neonatal nurses. Research evidence is needed to guide nursing practice and inform policy decisions regarding glove use in the neonatal intensive care unit.
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Pachori P, Gothalwal R, Gandhi P. Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review. Genes Dis 2019; 6:109-119. [PMID: 31194018 PMCID: PMC6545445 DOI: 10.1016/j.gendis.2019.04.001] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/09/2019] [Indexed: 12/29/2022] Open
Abstract
The emergence of antibiotic resistant bacteria in the healthcare is a serious concern. In the Healthcare premises precisely intensive care unit are major sources of microbial diversity. Recent findings have demonstrated not only microbial diversity but also drug resistant microbes largely habitat in ICU. Pseudomonas aeruginosa found as a part of normal intestinal flora and a significant pathogen responsible for wide range of ICU acquired infection in critically ill patients. Nosocomial infection associated with this organism including gastrointestinal infection, urinary tract infections and blood stream infection. Infection caused by this organism are difficult to treat because of the presence of its innate resistance to many antibiotics (β-lactam and penem group of antibiotics), and its ability to acquire further resistance mechanism to multiple class of antibiotics, including Beta-lactams, aminoglycosides and fluoroquinolones. In the molecular evolution microbes adopted several mechanism to maintain genomic plasticity. The tool microbe use for its survival is mainly biofilm formation, quorum sensing, and horizontal gene transfer and enzyme promiscuity. Such genomic plasticity provide an ideal habitat to grow and survive in hearse environment mainly antibiotics pressure. This review focus on infection caused by Pseudomonas aeruginosa, its mechanisms of resistance and available treatment options. The present study provides a systemic review on major source of Pseudomonas aeruginosa in ICU. Further, study also emphasizes virulence gene/s associated with Pseudomonas aeruginosa genome for extended drug resistance. Study gives detailed overview of antibiotic drug resistance mechanism.
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Affiliation(s)
- Preeti Pachori
- Department of Biotechnology, Barkatullah University, Bhopal 462026, Madhya Pradesh, India
| | - Ragini Gothalwal
- Department of Biotechnology, Barkatullah University, Bhopal 462026, Madhya Pradesh, India
| | - Puneet Gandhi
- Department of Research, Bhopal Memorial Hospital and Research Centre (BMHRC), Bhopal 462037, Madhya Pradesh, India
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Adegboye MB, Zakari S, Ahmed BA, Olufemi GH. Knowledge, awareness and practice of infection control by health care workers in the intensive care units of a tertiary hospital in Nigeria. Afr Health Sci 2018; 18:72-78. [PMID: 29977260 PMCID: PMC6016975 DOI: 10.4314/ahs.v18i1.11] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hospital-acquired infections (HAIs), one of the leading causes of, morbidity and mortality, are common in developing countries. Methicillin-resistant staphylococcus aureus (MRSA), commonest cause of HAIs, has been isolated from the hands of more than half of health care workers. Practice of hand hygiene may help in the control of nosocomial infections. We evaluated the practice of infection control among health care workers in the intensive care unit (ICU) of our hospital. Materials and methods This is a descriptive cross-sectional study. Information on knowledge, awareness and practice of infection control in the ICU were obtained from health care workers with the aid of a structured questionnaire. Results Sixty nine out of the 80 (86%) respondents had good knowledge that a hand is the most common vehicle of transmission of infection. However, 53.8% and 32.5% of the respondents had knowledge of movement of hand hygiene and practiced six steps of the hand washing technique respectively. Though, physicians accounted for 68 (85%) of the respondents, only 28% of them practiced the six steps of the hand washing technique with resident doctors constituting a large proportion of hand washing technique defaulters. Only 13.9% of non-physician and 7.5% of physician respondents had ever attended a training program on infection control respectively Conclusion Knowledge and awareness of infection control among the health care workers in our ICU is good but the practice is poor. Training workshop on infection control should be organized for all ICU health care workers to reduce noso-comial infections.
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Affiliation(s)
| | - Suleiman Zakari
- Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Kwara State
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Chen S, Yao J, Chen J, Liu L, Miu A, Jiang Y, Zhu J, Tang S, Chen Y. Knowledge of “Guidelines for the prevention of intravascular catheter-related infections (2011)”: A survey of intensive care unit nursing staffs in China. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Evaluation of the efficacy of antibacterial medical gloves in the ICU setting. J Hosp Infect 2015; 90:248-52. [DOI: 10.1016/j.jhin.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/10/2015] [Indexed: 11/19/2022]
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Bizzarro MJ, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K. A Quality Improvement Initiative to Reduce Central Line–Associated Bloodstream Infections in a Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 31:241-8. [DOI: 10.1086/650448] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To reduce the rate of late-onset sepsis in a neonatal intensive care unit (NICU) by decreasing the rate of central line–associated bloodstream infection (CLABSI).Methods.We conducted a quasi-experimental study of an educational intervention designed to improve the quality of clinical practice in an NICU. Participants included all NICU patients with a central venous catheter (CVC). Data were collected during the period from July 1, 2005, to June 30, 2007, to document existing CLABSI rates and CVC-related practices. A multidisciplinary quality improvement committee was established to review these and published data and to create guidelines for CVC placement and management. Educational efforts were conducted to implement these practices. Postintervention CLABSI rates were collected during the period from January 1, 2008, through March 31, 2009, and compared with preintervention data and with benchmark data from the National Healthcare Safety Network (NHSN).Results.The rate of CLABSI in the NICU decreased from 8.40 to 1.28 cases per 1,000 central line–days (adjusted rate ratio, 0.19 [95% confidence interval, 0.08–0.45]). This rate was lower than the NHSN benchmark rate for level III NICUs. The overall rate of late-onset sepsis was reduced from 5.84 to 1.42 cases per 1,000 patient-days (rate difference, −4.42 cases per 1,000 patient-days [95% confidence interval, −5.55 to −3.30 cases per 1,000 patient-days]).Conclusions.It is possible to reduce the rate of CLABSI, and therefore the rate of late-onset sepsis, by establishing and adhering to evidence-based guidelines. Sustainability depends on continued data surveillance, knowledge of medical and nursing literature, and timely feedback to the staff. The techniques established are applicable to other populations and areas of inpatient care.
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Van Rostenberghe H, Short J, Ramli N, Geok TB, Subramaniam S, Che Yaakob CA, Othman A, Ibrahim NR, Ho J, Mohamed Z, Hasan H. A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections. Front Pediatr 2014; 2:115. [PMID: 25478550 PMCID: PMC4237142 DOI: 10.3389/fped.2014.00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/06/2014] [Indexed: 11/18/2022] Open
Abstract
UNLABELLED Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU). MATERIALS AND METHODS In 2007, six senior neonatal nurses underwent a training course focusing on the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice. The course was led by a psychologist. The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteremia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for 3 years. RESULTS The immediate output of the course included three teaching modules: hand washing, sterile procedures, and general measures to control infection. These modules were subsequently administered to the NICU nurses in regular structured continuous nursing education sessions. The psychological techniques taught in the course were applied. Bacteremia in the NICU significantly decreased in the year of the course and the subsequent years when compared to previous years (from more than 17 in 2005 and 2006 to less than 10 per 100 admissions to the NICU in 2008 and 2009). CONCLUSION This study suggests that a psychologist-led course, followed by a structured CNE can lead to a sustainable reduction in infection rates in a NICU.
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Affiliation(s)
| | - Jacki Short
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Noraida Ramli
- Department of Paediatrics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Tan Beng Geok
- Department of Paediatrics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Che Anuar Che Yaakob
- Department of Obstetrics and Gynaecology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Azizah Othman
- Department of Paediatrics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nor Rosidah Ibrahim
- Department of Paediatrics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Jacqueline Ho
- Department of Paediatrics, Penang Medical College, Georgetown, Malaysia
| | - Zeehaida Mohamed
- Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Habsah Hasan
- Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Zhang M, Lee M, Knott S. Is clinical performance adversely affected by wearing gloves during paediatric peripheral intravenous cannulation? Emerg Med Australas 2014; 26:455-60. [DOI: 10.1111/1742-6723.12277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Zhang
- Department of Emergency Medicine; John Hunter Hospital; Newcastle New South Wales Australia
| | - Mark Lee
- Department of Emergency Medicine; John Hunter Hospital; Newcastle New South Wales Australia
| | - Susan Knott
- Department of Emergency Medicine; John Hunter Hospital; Newcastle New South Wales Australia
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Al-Rawajfah OM. Infection control practices among intensive care unit registered nurses: a Jordanian national study. Nurs Crit Care 2014; 21:e20-7. [PMID: 24450751 DOI: 10.1111/nicc.12078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/24/2013] [Accepted: 11/26/2013] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to evaluate infection control (IC) practices among Jordanian registered nurses (RNs) working in intensive care unit (ICU) settings. BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends periodic assessment of IC practices for health care workers as an effective strategy to control infections. DESIGN Cross-sectional descriptive design. METHODS A stratified, cluster random sampling technique was used. The sample consisted of ICU RNs from all major health care service providers and from all geographical areas in Jordan. The IC-Practices Tool (Cronbach α = 0·88) a self-report instrument was used. RESULTS A total of 21 hospitals participated in the study, of which, 8 were governmental, 7 military, 4 private and 2 university-affiliated. The final sample consisted of 247 RNs from 56 critical care units. Of the total sample, 36% of RNs were from governmental hospitals. Of the total sample, 51% were female with a mean age of 28·5 years (SD = 5·2), and 54·7% worked in general ICUs. The mean overall IC practice score was 122·6 (SD = 13·2). Nurses who reported that they had been trained about IC procedures in their hospital scored higher on the IC practice scale (M = 124·3, SD = 12·3) than nurses who never received any IC training in the hospital (M = 117·3, SD = 14·6, p < 0·001). CONCLUSION This study demonstrated the importance of conducting IC educational programmes as an effective strategy to increase staff compliance with standard IC practices. RELEVANCE TO CLINICAL PRACTICE Educational role of IC nurse is important to enhance RNs compliance with standard IC practices.
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Taylor JE, McDonald SJ, Tan K. A survey of central venous catheter practices in Australian and New Zealand tertiary neonatal units. Aust Crit Care 2013; 27:36-42. [PMID: 24315154 DOI: 10.1016/j.aucc.2013.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Infection is the most common problem with central venous catheters (CVCs) in neonates. There are two published guidelines, including the Centers for Disease Control and Prevention (CDC), for the prevention of intravascular catheter-related infection that describes evidence-based practice to reduce nosocomial infection. OBJECTIVE Our aims were to survey current medical and nursing management of central venous catheters in tertiary neonatal intensive care units in Australia and New Zealand and to compare with the CDC evidence-based practice guideline. METHODS A cross sectional survey was performed across 27 Australian and New Zealand neonatal units in September 2012. Two web-based questionnaires were distributed, one to medical directors related to the insertion of CVCs while CVC "maintenance" surveys were sent to nurse unit managers. RESULTS Seventy percent (19/27) medical management and 59% (16/27) on nursing management surveys were completed. In all neonatal intensive care units (NICUs) there were guidelines for CVC maintenance and for 18 out of 19 there were guidelines for insertion. In the seven units using femoral lines, three had a guideline on insertion and four for maintenance. CVC insertion was restricted to credentialed staff in 57.9% of neonatal units. Only 26.5% used full maximal sterile barriers for insertion. Skin disinfection practices widely varied. Dressing use and dressing change regimens were standardised; all using a semi-permeable dressing. Duration of cleaning time of the access point varied significantly; however, the majority used a chlorhexidine with alcohol solution (68.8%). Line and fluid changes varied from daily to 96 h. The majority used sterile gloves and a sterile dressing pack to access the CVC (68.8%). In the majority of NICUs stopcocks were used (62.5%) with a needle-less access point attached (87.5%). In less than 50% of NICUs education was provided on insertion and maintenance. CONCLUSION There is diversity of current practices and some aspects vary from the CDC guideline. There is a need to review NICU current practices to align with evidence based guidelines. The introduction of a common guideline may reduce variations in practice.
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Affiliation(s)
- Jacqueline E Taylor
- La Trobe University, Bundoora, Australia; Monash Newborn, Monash Medical Centre, Clayton, Australia.
| | - Susan J McDonald
- La Trobe University, Bundoora, Australia; Midwifery Professorial Unit, Mercy Hospital for Women, Melbourne, Australia
| | - Kenneth Tan
- Monash Newborn, Monash Medical Centre, Clayton, Australia; Monash Institute of Medical Research, Monash University, Clayton, Australia
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Leitgeb J, Schuster R, Eng AH, Yee BN, Teh YP, Dosch V, Assadian O. In-vitro experimental evaluation of skin-to-surface recovery of four bacterial species by antibacterial and non-antibacterial medical examination gloves. Antimicrob Resist Infect Control 2013; 2:27. [PMID: 24119412 PMCID: PMC3852982 DOI: 10.1186/2047-2994-2-27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 10/04/2013] [Indexed: 11/25/2022] Open
Abstract
Background The number of bacteria recovered from a stainless steel coupon after touching a pigskin substrate with an examination glove coated on its outside with polyhexanide (PHMB), as compared to the number of bacteria recovered in the same manner with non-coated control gloves was evaluated. Methods Suspensions containing 1 × 109 colony-forming units of 4 clinically relevant bacterial species (Enterococcus faecium ATCC #51559; Escherichia coli ATCC #25922; Klebsiella pneumoniae ATCC #4352; and Staphylococcus aureus ATCC #33591) were used to contaminate Gamma-irradiated pigskin substrates. Bacterial recoveries from the pigskin substrate, stainless steel coupons, and each glove swatch were performed. A difference in the bacterial recovery from the stainless steel coupons after touching with coated and uncoated control gloves was measured. Results For E. faecium, the coated glove showed a reduction of 4.63 log10 cfu recovery, when compared to control gloves. For E. coli, the coated glove showed 5.48 log10 cfu, for K. pneumoniae 5.03 log10 cfu, and for S. aureus 5.72 log10 cfu recovery, when compared to the non-coated control glove. Conclusion An in-vitro experiment designed to mimic cross-contamination of clinically relevant bacteria in a simulated healthcare setting following glove contact with a contaminated biological surface and cross-transfer to a stainless steel surface has demonstrated that an examination glove coated on its outside surface with PHMB was able to reduce bacterial recovery from a contaminated surface by > 4 log10 cfu, compared to a control non-coated examination glove. These elaborated results may encourage further clinical investigation on the clinical impact of an antibacterial examination glove.
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Affiliation(s)
- Johannes Leitgeb
- Department for Hospital Hygiene, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Jackson C, Lowton K, Griffiths P. Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours. Int J Nurs Stud 2013; 51:400-8. [PMID: 23915562 DOI: 10.1016/j.ijnurstu.2013.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/28/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. DESIGN This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. PARTICIPANTS Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. METHODS Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. RESULTS The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. CONCLUSIONS This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.
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Affiliation(s)
- Carole Jackson
- Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, Room 1.21a, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Karen Lowton
- Institute of Gerontology, Department of Social Science, Health & Medicine, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Peter Griffiths
- Chair of Health Services Research, Faculty of Health Sciences, University of Southampton, Room E4015, Building 67, Highfield Campus, SO17 1BJ, United Kingdom
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Bianco A, Coscarelli P, Nobile CGA, Pileggi C, Pavia M. The reduction of risk in central line-associated bloodstream infections: knowledge, attitudes, and evidence-based practices in health care workers. Am J Infect Control 2013; 41:107-12. [PMID: 22980513 DOI: 10.1016/j.ajic.2012.02.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 11/13/2022]
Abstract
BACKGROUND We set out to acquire information about the knowledge, attitudes, and evidence-based practices associated with the insertion and maintenance of central vascular catheters (CVC) for the prevention of central line-associated bloodstream infections (CLABSI). METHODS We selected all health care workers (HCW) in all units using CVCs in the Calabria region of Italy. RESULTS Correct answers about the knowledge of physicians and nurses ranged from 43% to 72.9% and were significantly higher in respondents who worked in intensive care unit (ICU) wards in hospitals that had a written policy about CVC maintenance and had active formal training. Respondents' attitudes toward general aspects of CLABSI prevention were very positive and were significantly higher for HCWs working in regional general hospitals, practicing in ICU wards, and having appropriate knowledge. Concerning HCWs, 83.9% reported that, if patients had any manifestations suggesting local or bloodstream infection, the dressing was removed for assessment purposes; this practice was significantly more likely to occur in HCWs having appropriate knowledge and positive attitudes and who worked in hospitals with a written policy about CVC maintenance. CONCLUSION The study demonstrated that written policies, formal training, and years of experience contributed to an increase in knowledge, practice, and positive attitudes toward CLABSI prevention. In addition the paper demonstrates how great this need is, having reported many non-evidence-based practices still continuing despite new evidence.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, Medical School, University of Catanzaro Magna Græcia, Catanzaro, Italy
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Guembe M, Bustinza A, Sánchez Luna M, Carrillo-Álvarez A, Pérez Sheriff V, Bouza E. Guidelines for preventing catheter infection: assessment of knowledge and practice among paediatric and neonatal intensive care healthcare workers. J Hosp Infect 2012; 81:123-7. [PMID: 22516169 DOI: 10.1016/j.jhin.2012.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 02/26/2012] [Indexed: 10/28/2022]
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An investigation of nurses' knowledge, attitudes, and practices regarding disinfection procedures in Italy. BMC Infect Dis 2011; 11:148. [PMID: 21612613 PMCID: PMC3123570 DOI: 10.1186/1471-2334-11-148] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 05/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the level of knowledge, attitudes, and practice regarding disinfection procedures among nurses in Italian hospitals. METHODS A face-to-face interview gathered the following information: demographic and practice characteristics; knowledge about the healthcare-associated infections (HAIs) and the disinfection practices; attitudes towards the utility of guidelines/protocols and perception of the risks of acquiring/transmitting HAIs; compliance with antisepsis/disinfection procedures; and sources of information. RESULTS Only 29% acknowledged that urinary and respiratory tract infections were the two most common HAIs and this knowledge was significantly higher in those with a higher level of education. Attitudes towards the utility of guidelines/protocols for disinfection procedures showed a mean score of 9.1. The results of the linear regression model indicated a more positive attitude in female nurses, in those with a lower number of years of activity, and in those needing additional information about disinfection procedures. Nurses with higher educational level and with a higher perception of risk of transmitting an infectious disease while working were more likely to perform appropriate antisepsis of the surgical wound and handwashing before and after medication. CONCLUSIONS Plan of successful prevention activities about HAIs and provide pointers to help optimize disinfection procedures and infection prophylaxis and management are needed.
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Efstathiou G, Papastavrou E, Raftopoulos V, Merkouris A. Compliance of Cypriot nurses with Standard Precautions to avoid exposure to pathogens. Nurs Health Sci 2011; 13:53-9. [DOI: 10.1111/j.1442-2018.2011.00576.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mayer J, Mooney B, Gundlapalli A, Harbarth S, Stoddard GJ, Rubin MA, Eutropius L, Brinton B, Samore MH. Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing positive reinforcement. Infect Control Hosp Epidemiol 2010; 32:59-66. [PMID: 21128786 DOI: 10.1086/657666] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors. DESIGN Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006). SETTING A 450-bed teaching tertiary-care hospital. INTERVENTIONS An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives. RESULTS A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P <.001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%-84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%-81% of 4,990 opportunities during year 6 of the program. CONCLUSION This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.
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Affiliation(s)
- Jeanmarie Mayer
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Ashraf MS, Hussain SW, Agarwal N, Ashraf S, El-Kass G, Hussain R, Nemat H, Haller N, Pekmezaris R, Sison C, Walia R, Eichorn A, Cal C, Dlugacz Y, Edwards BT, Louis B, Alano G, Wolf-Klein G. Hand hygiene in long-term care facilities: a multicenter study of knowledge, attitudes, practices, and barriers. Infect Control Hosp Epidemiol 2010; 31:758-62. [PMID: 20500037 DOI: 10.1086/653821] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An anonymous survey of 1143 employees in 17 nursing facilities assessed knowledge of, attitudes about, self-perceived compliance with, and barriers to implementing the 2002 Centers for Disease Control and Prevention hand hygiene guidelines. Overall, employees reported positive attitudes toward the guidelines but differed with regard to knowledge, compliance, and perceived barriers. These findings provide guidance for practice improvement programs in long-term care settings.
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Affiliation(s)
- Muhammad Salman Ashraf
- Department of Internal Medicine, Division of Geriatrics, North Shore-Long Island Jewish (LIJ) Health System, New Hyde Park, New York 11040, USA.
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Hatler C, Buckwald L, Salas-Allison Z, Murphy-Taylor C. Evaluating central venous catheter care in a pediatric intensive care unit. Am J Crit Care 2009; 18:514-20; quiz 521. [PMID: 19880953 DOI: 10.4037/ajcc2009168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection. OBJECTIVES Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs. METHODS A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a central venous catheter with a transparent dressing alone and with a transparent dressing plus a chlorhexidine-impregnated dressing. Nurses also participated in a survey of knowledge about infection control practices related to central catheters. RESULTS Few differences were found between the transparent dressing alone and a chlorhexidine-impregnated dressing plus the transparent dressing. A serendipitous finding was the number of times that central catheters were accessed daily. CONCLUSIONS The results of this project suggest that infection control efforts may be most appropriately focused on processes rather than on products.
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Affiliation(s)
- Carol Hatler
- Carol Hatler is director of nursing research, Linda Buckwald is a mentor, Zoraida Salas-Allison is a manager, and Cathleen Murphy-Taylor is a staff nurse at St Joseph’s Hospital and Medical Center in Phoenix, Arizona
| | - Linda Buckwald
- Carol Hatler is director of nursing research, Linda Buckwald is a mentor, Zoraida Salas-Allison is a manager, and Cathleen Murphy-Taylor is a staff nurse at St Joseph’s Hospital and Medical Center in Phoenix, Arizona
| | - Zoraida Salas-Allison
- Carol Hatler is director of nursing research, Linda Buckwald is a mentor, Zoraida Salas-Allison is a manager, and Cathleen Murphy-Taylor is a staff nurse at St Joseph’s Hospital and Medical Center in Phoenix, Arizona
| | - Cathleen Murphy-Taylor
- Carol Hatler is director of nursing research, Linda Buckwald is a mentor, Zoraida Salas-Allison is a manager, and Cathleen Murphy-Taylor is a staff nurse at St Joseph’s Hospital and Medical Center in Phoenix, Arizona
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A broad-spectrum look at catheter-related bloodstream infections: many aspects, many populations. JOURNAL OF INFUSION NURSING 2009; 32:80-6. [PMID: 19289921 DOI: 10.1097/nan.0b013e318198d30c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The issue of central vascular catheter-related bloodstream infections is prominent in medical literature and practice today, both in the United States and throughout the international healthcare community. In its 2002 report on Guidelines for the Prevention of Intravascular Catheter-Related Infections, the Centers for Disease Control and Prevention estimated that 250,000 cases of central vascular catheter-related infections occur annually. This article is a review of current literature pertaining to catheter-related bloodstream infections. Included are resources from 2004 onward, as well as resources such as the Centers for Disease Control and Prevention, the Institute for Healthcare Improvement, and the National Guideline Clearinghouse.
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Aiello AE, Malinis M, Knapp JK, Mody L. The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes. Am J Infect Control 2009; 37:164-7. [PMID: 18945512 DOI: 10.1016/j.ajic.2008.04.258] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/10/2008] [Accepted: 04/14/2008] [Indexed: 11/17/2022]
Abstract
There are few studies that have assessed factors influencing infection control practices among health care workers (HCW) in nursing homes. We conducted a cross-sectional survey of HCWs (N = 392) in 4 nursing homes to assess whether knowledge, beliefs, and perceptions influence reported hand hygiene habits. Positive perceptions and beliefs regarding effectiveness of infection control in nursing homes were associated with reported appropriate glove use and fingernail characteristics, respectively, among HCWs. Further research on hand hygiene interventions, including targeted educational in-services should be conducted in the nursing home setting.
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Affiliation(s)
- Allison E Aiello
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan-School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007; 20:409-25, table of contents. [PMID: 17630332 PMCID: PMC1932752 DOI: 10.1128/cmr.00041-06] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.
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Affiliation(s)
- Elizabeth Foglia
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, Box 8116, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA
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Naylor MD. Advancing the science in the measurement of health care quality influenced by nurses. Med Care Res Rev 2007; 64:144S-69S. [PMID: 17406016 DOI: 10.1177/1077558707299257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributions to the quality of care for hospitalized patients is intended to push the boundaries in the measurement of nursing performance. Specific recommendations for future research and measure development are presented.
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Affiliation(s)
- Mary D Naylor
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
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Krein SL, Hofer TP, Kowalski CP, Olmsted RN, Kauffman CA, Forman JH, Banaszak-Holl J, Saint S. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. Mayo Clin Proc 2007; 82:672-8. [PMID: 17550746 DOI: 10.4065/82.6.672] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs). PARTICIPANTS AND METHODS Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs. RESULTS The overall survey response rate was 72% (n=516). A higher percentage of VA compared to non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%; P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%; P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Those hospitals having a higher safety culture score, having a certified infection control professional, and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practices. CONCLUSION Most US hospitals are using maximal sterile barrier precautions and chlorhexidine gluconate, 2 of the most strongly recommended practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Wider use of CR-BSI prevention practices by hospitals could be encouraged by fostering a culture of safety, participating in infection prevention collaboratives, and promoting infection control professional certification.
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Affiliation(s)
- Sarah L Krein
- Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
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Gilad J, Borer A. Prevention of catheter-related bloodstream infections in the neonatal intensive care setting. Expert Rev Anti Infect Ther 2007; 4:861-73. [PMID: 17140361 DOI: 10.1586/14787210.4.5.861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nosocomial infection causes substantial morbidity and mortality among neonates treated in the neonatal intensive care setting. Colonization and subsequent infection of central venous catheters leading to catheter-related bloodstream infection is among the most common causes of nosocomial sepsis in this patient population. Prevention of catheter-related bloodstream infection is a major challenge and numerous strategies have been attempted in this context with varying success. Given the dynamic epidemiology of nosocomial infection among neonates and the emergence of antimicrobial resistance, novel prevention strategies are urgently required.
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Affiliation(s)
- Jacob Gilad
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 64239, Israel.
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Translating infection prevention evidence into practice using quantitative and qualitative research. Am J Infect Control 2006; 34:507-12. [PMID: 17015156 DOI: 10.1016/j.ajic.2005.05.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Accepted: 05/16/2005] [Indexed: 11/18/2022]
Abstract
Infection control professionals and hospital epidemiologists, using the valid methods of applied epidemiology-surveillance, benchmarking, intervention, evaluation--have largely been responsible for dramatically reducing the incidence of health care-associated infections over the past several decades. However, we believe that the field of infection control can--and should--also be a leader in understanding how research findings can be efficiently and effectively translated into clinical practice. Unfortunately, there is no current reliable information about which preventive practices are being used in US hospitals to prevent common device-related infections. If we are to understand how best to translate research into practice, the reasons hospitals are using some preventive practices-or are not-must be explored more fully. This article provides a framework for one proposed research endeavor to promote the successful translation of proven infection prevention practices and a subsequent decrease in health care-associated infections. In addition, we hope that this article will stimulate increased interest and research in identifying strategies that will successfully move evidence from the peer-reviewed literature to the patient's bedside.
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