Assessing a safety climate tool adapted to address respiratory illnesses in Canadian hospitals

Background

Studies have shown an association between workplace safety climate scores and patient outcomes. This study aimed to investigate (1) performance of the hospital safety climate scale that was adapted to assess acute respiratory illness safety climate, (2) factors associated with safety climate scores, and (3) whether the safety scores were associated with following recommended droplet and contact precautions.

Methods

A survey of Canadian healthcare personnel participating in a cohort study of influenza during the 2010/2011-2013/2014 winter seasons. Factor analysis and structural equation modeling were used for analyses.

Results

Of the 1359 participants eligible for inclusion, 88% were female and 52% were nurses. The adapted items loaded to the same factors as the original scale. Personnel working on higher risk wards, nurses, and younger staff rated their hospital's safety climate lower than other staff. Following guidelines for droplet and contact precautions was positively associated with ratings of management support and absence of job hindrances.

Conclusion

The adapted tool can be used to assess hospital safety climates regarding respiratory pathogens. Management support and the absence of job hindrances are associated with hospital staff's propensity and ability to follow precautions against the transmission of respiratory illnesses.

Respiratory infection prevention: perceptions, barriers and facilitators after SARS-CoV-2

BACKGROUND

Respiratory hygiene, especially in context of COVID-19, is of upmost importance. Healthcare professionals (HCPs) play an important role in the prevention of infections. Their perceptions of the subject are needed to tailor effective communication and training on prevention.

METHODS

20 French HCPs were questioned about their perceptions on respiratory hygiene and infections, by the means of recorded semi-structured interviews and a focus group. The interviews and focus group were transcribed then analysed through lexicometric and thematic content analyses.

RESULTS

HCP discourse revolved around the use of face masks, the prevention and the characteristics of respiratory infections and the means to prevent them.COVID-19 excepted, HCPs considered respiratory infections as benign. They associated respiratory hygiene to the observance of cough etiquette, the preservation of lung health, the act of protecting oneself and others, and the adherence to safety protocols. Main barriers to good practices were organizational ones, such as the lack of consultation and mobilization of HCPs in the development of preventive measures, suboptimal information sharing and the physical and relational constraints of face masks. They advised means of improving communication and information promotion.

CONCLUSION

Since the pandemic crisis, HCPs have developed a better awareness about the prevention of respiratory infections. Except for COVID-19, respiratory infections are mostly considered as benign. Barriers and facilitators evoked by HCPs will help to build national communication and tools.

A nationwide survey on the implementation of infection prevention and control components in 1442 hospitals in the Republic of Korea: comparison to the WHO Infection Prevention and Control Assessment Framework (IPCAF)

Background

The current SARS-CoV-2 pandemic continues to underscore the inadequacy of infection prevention and control (IPC) and the importance of its sound establishment in healthcare facilities. The Infection Prevention and Control Assessment Framework (IPCAF) by the World Health Organization allows systematic assessment of IPC capacity in healthcare facilities and has been applied in many national-level surveys. This study aims to assess the IPC capacity of Korean hospitals as well as their strengths and pitfalls by analyzing the results of the first government-led nationwide IPC survey in comparison to the IPCAF frame.

Methods

The Korean National Infection Prevention and Control Survey (KNIPCS) was conducted from February to March 2018. The survey questionnaire for KNIPCS was developed through a series of expert consultations and a round of pre-testing in two randomly selected hospitals. The survey questionnaire was distributed to a total of 2108 hospitals. Although the survey preceded the release of IPCAF, its contents complied with IPCAF to a large extent, allowing exploration of its results with regards to IPCAF.

Results

All tertiary hospitals and 96.5% of general hospitals had implemented IPC teams, whereas the percentage was lower for long-term care hospitals (6.3%). A similar trend was observed for IPC surveillance and monitoring activities across hospital types. The percentage of interactive IPC training was lower than 30% in all hospital groups. Disinfection was frequently monitored in all hospital types (e.g. 97.3% in general hospitals and 85.3% in long-term care hospitals). However, activities regarding antimicrobial resistance, such as multi-drug resistant pathogen screening, were weak in hospitals (25%) and long-term care hospitals (25%), compared to tertiary hospitals (83.3%) and general hospitals (57.7%).

Conclusions

In general, essential IPC structures, such as IPC teams and programs, were well in place in most tertiary and general hospitals in Korea. These hospital groups also actively conducted various IPC activities. As most previous legislative and multimodal policy measures have targeted these hospital groups, we speculate that future policy efforts should encompass long-term care hospitals and smaller-sized hospitals to strengthen the IPC capacity of these hospital groups. Efforts should also be put forth to promote IPC training and antimicrobial activities.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

Barriers to the Use of PPE to Prevent Pertussis Exposures in a Pediatric Primary Care Network

BACKGROUND

The resurgence of pertussis is contributing to mounting healthcare worker (HCW) exposures, especially within pediatric outpatient settings. Infection prevention and control (IPC) guidelines for ambulatory sites exist, but are not uniformly implemented. Our aim was to identify facilitators and barriers to the use of IPC practices to prevent pertussis transmission in ambulatory pediatric settings.

METHODS

HCWs at 18 of 25 (72%) clinics in a pediatric ambulatory network completed a theory-based questionnaire about pertussis and personal protective equipment (PPE). The questionnaire contained randomly distributed versions of two vignettes to create an experimental design assessing barriers to PPE use.

RESULTS

Three hundred forty-three of 467 (73%) HCWs completed the survey: 234 (68%) clinical and 109 (32%) nonclinical. Seventy-one percent of clinical HCWs reported wearing PPE when caring for a patient with suspected pertussis; only 27% used PPE for patients with any respiratory symptoms. Among clinical HCWs, reported PPE use when caring for patients with suspected pertussis was independently associated with attitudes toward PPE (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.8, 16.6), knowledge and skills (OR 4.6, 95% CI 1.4, 15.2), and lack of perceived barriers (OR 3.2, 95% CI 1.3, 7.9). HCWs who did not perceive PPE use as a norm were less likely to report using PPE (OR 0.2, 95% CI 0.1, 0.6) or distributing masks to patients with cough (OR 0.02, 95% CI 0.00, 0.2). Reported PPE use was not influenced by perceived infection risk or mask accessibility.

CONCLUSION

Our results identified barriers to PPE use and targets for education to prevent pertussis transmission in ambulatory pediatric settings.

Health care worker exposures to pertussis: missed opportunities for prevention

OBJECTIVE

Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines.

METHODS

We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.

RESULTS

A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites.

CONCLUSIONS

Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.

Mass screening for fever in children: a comparison of 3 infrared thermal detection systems

OBJECTIVES

Infrared thermal detection systems (ITDSs) have been used with limited success outside the United States to screen for fever during recent outbreaks of novel infectious diseases. Although ITDSs are fairly accurate in detecting fever in adults, there is little information about their utility in children.

METHODS

In a pediatric emergency department, we compared temperatures of children (<18 years old) measured using 3 ITDSs (OptoTherm Thermoscreen, FLIR ThermoVision 360, and Thermofocus 0800H3) to standard, age-appropriate temperature measurements (confirmed fever defined as ≥38.0°C [oral or rectal], ≥37.0°C [axillary]). Measured temperatures were compared with parental reports of fever using descriptive, multivariate, and receiver operating characteristic analyses.

RESULTS

Of 855 patients, 400 (46.8%) had parent-reported fever, and 306 (35.8%) had confirmed fever. At optimal fever thresholds, OptoTherm and FLIR had sensitivity (83.0% and 83.7%, respectively) approximately equal to parental report (83.9%) and greater than Thermofocus (76.8%), and specificity (86.3% and 85.7%) greater than parental report (70.8%) and Thermofocus (79.4%). Correlation coefficients between traditional thermometry and ITDSs were 0.78 (OptoTherm), 0.75 (FLIR), and 0.66 (Thermofocus).

CONCLUSIONS

Compared with traditional thermometry, FLIR and OptoTherm were reasonably accurate in detecting fever in children and better predictors of fever than parental report. These findings suggest that ITDSs could be a useful noninvasive screening tool for fever in the pediatric age group.

Respiratory hygiene in emergency departments: compliance, beliefs, and perceptions

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.

Transmission of 2009 pandemic influenza A (H1N1) virus among healthcare personnel-Southern California, 2009

OBJECTIVE

In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak.

DESIGN

Cohort study.

SETTING

Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009.

PARTICIPANTS

Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States.

METHODS

Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use.

RESULTS

Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings.

CONCLUSIONS

pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.

Evaluation of patients' mask use after the implementation of cough etiquette in the emergency department

We developed a patient-based survey to evaluate the impact of a respiratory hygiene and cough etiquette implementation strategy on infection control practices in the emergency department. The frequency of self-reported mask use by coughing patients was low (27%) and often inconsistent. The frequency of use was highest among patients who presented with myalgia (odds ratio, 14.7; P = .02) and among patients who visited the emergency department during January (odds ratio, 4.1; P = .04).