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Shin B, Jeong IS. Indication-based and patient-based hand hygiene performance among nurses working at a university hospital. Nurs Health Sci 2024; 26:e13154. [PMID: 39168832 DOI: 10.1111/nhs.13154] [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: 01/05/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024]
Abstract
The traditional method of monitoring hand hygiene (HH) based on specific indications does not ensure that HH is performed for all required indications during patient care. This study aimed to compare HH performance rates (HHPRs) based on specific indications versus overall patient care among nurses at a university hospital. The study retrospectively analyzed HH monitoring data for 1398 indications from 543 patients and 190 nurses. Observations were conducted continuously, tracking a single healthcare worker from before patient contact until the end of the contact within a 30-min period. The indication-based HHPR was found to be 89.1%, while the patient-based HHPR was 78.1%. In the context of patient-based HHPR, the lowest rates were observed among nurses in the emergency room (48.3%) and those with less than 1 year of work experience (66.7%). Moreover, the largest discrepancy between indication-based and patient-based HHPR was noted among emergency room nurses with less than 1 year of experience. This significant difference underscores the need for patient-based HH monitoring, particularly for nurses in emergency settings and those with limited experience.
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Affiliation(s)
- Bora Shin
- Department of Infection Control, Jeju National University Hospital, College of Nursing, Pusan National University, Yangsan-si, Korea
| | - Ihn Sook Jeong
- Department of Infection Control, Jeju National University Hospital, College of Nursing, Pusan National University, Yangsan-si, Korea
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Alshagrawi S, Alhodaithy N. Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study. BMC Public Health 2024; 24:2333. [PMID: 39198830 PMCID: PMC11351093 DOI: 10.1186/s12889-024-19461-2] [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: 03/23/2024] [Accepted: 07/12/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Practicing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia. METHOD This qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia. RESULTS We interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Several obstacles and possibilities for enhancement have been identified. CONCLUSION The results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.
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Affiliation(s)
- Salah Alshagrawi
- College of Health Sciences, Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia.
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Muršec D, Svenšek A, Gosak L, Šostar Turk S, Rozman U, Štiglic G, Lorber M. Mobile Applications for Learning Hand Hygiene: A Comparative Analysis. Healthcare (Basel) 2024; 12:1554. [PMID: 39201114 PMCID: PMC11353288 DOI: 10.3390/healthcare12161554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/02/2024] Open
Abstract
Infection control is crucial for high-quality patient care. One of the most effective and commonly used infection control procedures is hand hygiene which, it is known, requires repeated refresher training. There are many ways to educate healthcare professionals about hand hygiene, including the use of mobile applications (apps). Our aim is to review such hand hygiene apps, and to identify which have been available since 2021 and to assess their quality. We conducted a review using the PRISMA diagram to document our app selection process in the Google Play Store and Apple store in March 2024. For the evaluation of apps, we used the user version of the Mobile Application Rating Scale questionnaire (uMARS). Of 16 apps only five adhere to WHO hand hygiene guidelines. Timers were included in 12 of the 16 apps and reminders were included in 10 of 16 apps. The highest overall uMARS scoring app was Give Me 5-Hand Hygiene (4.31 ± 0.28), while Wash your hands! (1.17 ± 0.14) had the lowest score. We found that more than half of the apps were unavailable from the 2021 review. We believe that app-based education could effectively sustain hand hygiene knowledge in healthcare settings.
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Affiliation(s)
- Dominika Muršec
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
| | - Adrijana Svenšek
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
| | - Sonja Šostar Turk
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
| | - Urška Rozman
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
| | - Gregor Štiglic
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000 Maribor, Slovenia
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, 2000 Maribor, Slovenia; (A.S.); (L.G.); (S.Š.T.); (U.R.); (G.Š.); (M.L.)
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Svenšek A, Muršec D, Fijačko N. Assessing the incorporation of the 'Five Moments for Hand Hygiene' into nursing procedure textbooks. Nurse Educ Pract 2024; 79:104044. [PMID: 38964083 DOI: 10.1016/j.nepr.2024.104044] [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: 04/28/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
AIM Our aim was to conduct a thorough comparison between the hand hygiene information included in international nursing textbooks and the Slovenian nursing textbook's equivalent content as it relates to nursing procedures. BACKGROUND Hand hygiene practices are crucial in preventing healthcare-associated infections, which affect millions of patients annually. The idea behind "Five Moments for Hand Hygiene" is to encourage assessing success and boosting self-efficacy. DESIGN Comparison of hand hygiene content in international nursing textbooks with the content in a Slovenian nursing textbook. METHODS A study was conducted between March 2023 and March 2024 to compare hand hygiene content in international nursing textbooks. The study included textbooks from the USA and UK, as well as Slovenian (SI) textbooks. The final phase involved comparing hand hygiene performance practices against the WHO Five Moments for Hand Hygiene. RESULTS The study reviewed 470 nursing procedures across three textbooks, identifying four common ones: female indwelling urinary catheterisation, small-bore feeding tube insertion, enema administration and subcutaneous injections. The USA textbook had the highest number of steps, while the UK textbook had the lowest. Clean protective gloves are not recommended for all nursing procedures, only for small-bore feeding tube insertion and enema administration. The US textbook omitted 12 steps for the female indwelling urinary catheter procedure, while the UK textbook included 10 steps. The SI textbook omitted 8 steps. CONCLUSIONS Hand hygiene is crucial for healthcare infections prevention and control. The study found differences in the frequency of hand hygiene in these nursing procedures. WHO's Five Moments for Hand Hygiene guidelines are not universally accepted, with inadequate hygiene often observed before patient contact. Future research should review foreign textbooks and update existing ones.
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Affiliation(s)
- Adrijana Svenšek
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia.
| | - Dominika Muršec
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Nino Fijačko
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia; Maribor University Medical Centre, Maribor, Slovenia
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Méda ZC, Wend-Rabo DZ, Hien H, Ouattara CA, Ilboudo B, Traoré IT, Savadogo GLB, Sombié I. Facteurs influençant le délai de prise en charge aux urgences chirurgicales du CHU Sourô Sanou. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2024; 36:109-118. [PMID: 38834517 DOI: 10.3917/spub.242.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Assessing patient turnaround times is essential for improving the quality of care in emergency service departments. PURPOSE OF THE RESEARCH This study looked at waiting and treatment times, and their associated factors, in the surgical emergency service department at the Souro Sanou National Teaching Hospital (SSNTH) in Bobo-Dioulasso, Burkina Faso. RESULTS This study was carried out on 380 patients with a median age of thirty-eight. The sex ratio was 0.54. In 63.7 percent of cases, the participants lived in urban areas. Most of the patients surveyed were farmers (34.7 percent). The median waiting time for patients was eleven minutes. The nature of the trauma sustained was associated with the waiting time. The median time taken to administer first aid was sixty-three minutes, with the unavailability of medication at the hospital pharmacy cited as a factor contributing to this delay. The median time taken to obtain paraclinical results was 134 minutes and 102 minutes for laboratory tests and scans, respectively. The factor associated with delays in obtaining scan results was the need for surgical intervention. The median waiting time for surgery was 24.3 hours. CONCLUSIONS The turnaround times in the SSNTH surgical emergency department are long. For the improvement of patient turnaround times to be possible, an overhaul of the department is in order. In particular, a rapid consultation team needs to be established, and essential drugs for emergency care need to be made readily available.
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Kamara MN, Lakoh S, Kallon C, Kanu JS, Kamara RZ, Kamara IF, Moiwo MM, Kpagoi SSTK, Adekanmbi O, Manzi M, Fofanah BD, Shewade HD. Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:486. [PMID: 37999605 PMCID: PMC10674222 DOI: 10.3390/tropicalmed8110486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a "before and after" observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the "intermediate" level, while secondary hospitals declined from "intermediate" to "basic" level. The mean score increased for the "system change" and "institutional safety climate" domains, decreased for "training and education" and "reminders in the workplace" domains, and remained the same for the "evaluation and feedback" domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion.
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Affiliation(s)
- Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention, Freetown 00232, Sierra Leone
| | | | - Matilda Mattu Moiwo
- Republic of Sierra Leone Armed Forces, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Satta S T K Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown 00232, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan 200005, Nigeria
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | | | | | - Hemant Deepak Shewade
- Division of Health Systems Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
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Tsao H, Macdonald R, Dwyer D, Harper T, Rutz D, Sutherland J. Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study. Emerg Med Australas 2023; 35:213-217. [PMID: 36184077 DOI: 10.1111/1742-6723.14097] [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: 06/26/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
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Affiliation(s)
- Henry Tsao
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Rachel Macdonald
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Damien Dwyer
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Tracey Harper
- Infection Control, Redland Hospital, Brisbane, Queensland, Australia
| | - Dominik Rutz
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - John Sutherland
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
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Factors influencing emergency nurses' infection control practices related to coronavirus disease 2019 in Korea. Australas Emerg Care 2023; 26:30-35. [PMID: 35872086 PMCID: PMC9271496 DOI: 10.1016/j.auec.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND When an infectious disease breaks out, emergency nurses are the front-line specialists. Infection control by emergency nurses is important to minimize the risk of infectious disease and to improve the infection control practices of emergency nurses. Therefore, it is crucial to identify the factors influencing infection control practice related to COVID-19. METHODS For this cross-sectional study design used survey methods for data collection, a questionnaire survey was conducted with 161 emergency nurses working in five hospitals selected through convenience sampling. Data were collected from November 10 to November 26 in 2020. RESULTS Infection control practice related to COVID-19 was affected by the infection prevention environment (β = 0.24, p = .002), monitoring of wearing Personal Protective Equipment (β = 0.19, p = .006), knowledge about COVID-19 (β = 0.18, p = .009), perceived severity related to COVID-19 (β = 0.18, p = .010), and perceived barrier related to COVID-19 (β = -0.15, p = .033). CONCLUSION Creating safe infection prevention measures and revitalizing personal protective equipment monitoring are necessary to improve infection control practices. A systematic infection control education program is needed to improve knowledge about COVID-19, emphasize its perceived severity, and identify and eliminate perceived barriers.
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Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [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: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
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Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Nzanga M, Panulo M, Morse T, Chidziwisano K. Adherence to Hand Hygiene among Nurses and Clinicians at Chiradzulu District Hospital, Southern Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710981. [PMID: 36078689 PMCID: PMC9518139 DOI: 10.3390/ijerph191710981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 05/31/2023]
Abstract
Healthcare associated infections (HAIs) are a burden in many countries especially low-income countries due to poor hand hygiene practices in the healthcare settings. Proper hand hygiene in the healthcare setting is an effective way of preventing and reducing HAIs, and is an integral component of infection prevention and control. The objective of this study was to determine adherence to hand hygiene guidelines and associated factors among nurses and clinicians. A quantitative cross-sectional study was conducted at Chiradzulu District Hospital (Malawi) where stratified random sampling was used to obtain the sample of 75 nurses and clinicians. Data were collected using self-administered questionnaires (n = 75), observation checklists (n = 7) and structured observations (n = 566). The study findings confirmed low adherence to hand hygiene practice among healthcare workers (HCWs) in Malawi. Overall, higher hand hygiene practices were reported than observed among nurses and clinicians in all the World Health Organization's (WHO) five critical moments of hand hygiene. This calls on the need for a combination of infrastructure, consumables (e.g., soap) and theory driven behavior change interventions to influence adoption of the recommended hand hygiene behaviors. However, such interventions should not include demographic factors (i.e., age, profession and ward) as they have been proven not to influence hand hygiene performance.
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Affiliation(s)
- Monica Nzanga
- Department of Environmental Health, Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Mindy Panulo
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Tracy Morse
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Kondwani Chidziwisano
- Department of Environmental Health, Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Private Bag 303, Chichiri, Blantyre 3, Malawi
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Alsulami A, A'aqoulah A, Almutairi N. Patient safety culture awareness among healthcare providers in a tertiary hospital in Riyadh, Saudi Arabia. Front Public Health 2022; 10:953393. [PMID: 35923974 PMCID: PMC9339949 DOI: 10.3389/fpubh.2022.953393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Patient safety is a serious concern in the health care industry. To enhance patient safety, healthcare providers are expected to minimize accidental harm to patients and enhance the quality of patient-centered care. The main objective of this study is to explore the awareness of the patient safety culture among healthcare providers. It is further intended to assess key fields and factors that hinder patient safety adoption and determine the effects of demographic factors on healthcare providers' awareness of patient safety culture. This study applied a cross-sectional quantitative design. It was conducted in a tertiary hospital in Riyadh, Saudi Arabia. The participants consisted of all healthcare providers working in a specific tertiary hospital in Saudi Arabia. A random sampling technique was applied in this study. The study sample size was 409 participants. A valid and reliable questionnaire was used to collect the required data. The T-tests, ANOVA. And regression was used. The study found that there is a moderate level of patient safety culture awareness among healthcare providers. Moreover, the findings also revealed that the age group “31–40” showed statistically different awareness levels as compared to the “more than 50 years' age group” (p = 0.012). Also, this study has found that gender and education have a significant influence on the awareness level of patient safety culture while position and work area have no influence on the awareness level of patient safety culture among healthcare providers. Managers in healthcare institutions should develop speeder response plans and make them part of the patient safety culture. Institutions offering bachelor's degrees and postgraduate in nursing should pay more attention to the subject of patient safety. The government healthcare sector, together with the private healthcare sector, should continuously train healthcare providers on patient safety procedures to improve the patient safety culture. Healthcare providers should be encouraged to report errors made during diagnosis or treatments to avoid them in the future.
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Affiliation(s)
- Abdulkarim Alsulami
- Department of Health Systems Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ashraf A'aqoulah
- Department of Health Systems Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- *Correspondence: Ashraf A'aqoulah
| | - Nouf Almutairi
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Issa M, Dunne SS, Dunne CP. Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review. Ir J Med Sci 2022; 192:871-899. [PMID: 35435564 PMCID: PMC10066077 DOI: 10.1007/s11845-022-03004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Background
In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered.
Aim
Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs.
Methods
Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED.
Results
One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8–89.7%).
Conclusion
Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.
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Affiliation(s)
- M Issa
- School of Medicine, University of Limerick, Master's in Public Health Programme, Limerick, Ireland
| | - S S Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland.
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Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, Augusto O, Owiso G, Ndegwa L, Luvsansharav UO, Bancroft E, Rabinowitz P, Lynch J, Njoroge A. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control 2022; 11:56. [PMID: 35379327 PMCID: PMC8981833 DOI: 10.1186/s13756-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
Objective To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019. Methods A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts. Results Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time. Conclusion Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
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Affiliation(s)
- Jemima Kibira
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Loyce Kihungi
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Mary Ndinda
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Evelyn Wesangula
- Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya
| | - Catherine Mwangi
- Infection Prevention and Control Department, Thika Level 5 Hospital, Kiambu, Kenya
| | - Faith Muthoni
- Infection Prevention and Control Department, Kitale County Referral Hospital, Trans-Nzoia, Kenya
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, USA
| | - George Owiso
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Linus Ndegwa
- Division of Global Health Protection (DGHP), Center for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Elizabeth Bancroft
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - John Lynch
- Department of Medicine, University of Washington, Seattle, USA
| | - Anne Njoroge
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya. .,Department of Global Health, University of Washington, Seattle, USA.
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The Efficacy of Lavender Aromatherapy in Reducing the Overcrowding-Related Anxiety in Health Care Workers. Adv Emerg Nurs J 2021; 43:225-236. [PMID: 34397501 DOI: 10.1097/tme.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In general, emergency departments (EDs) are stressful workplaces with excessive workloads and time pressures. Crowding, which is an important problem worldwide disrupting ED functions, leads further increases in the stressors which health care workers are exposed to. Long-term exposure to stressors can lead to anxiety in health care workers. The aim of this study was to determine the effect of aromatherapy on crowding-related anxiety in ED health care workers. Crowding was measured simultaneously with the National Emergency Department Overcrowding Scale objectively and the Health Care Workers' Crowding Perception Evaluation Form subjectively. The state-trait anxiety level was measured at each crowding level according to the health care workers' perception. When perceived crowding was at severely overcrowding level, lavender oil aromatherapy was applied. Anxiety level was measured before and after aromatherapy. Aromatherapy was repeated 3 times on different days. A significant positive correlation was found between state anxiety level and perceived crowding (r = 0.415, p < 0.001). Aromatherapy was found to have a significant correlation in reducing the overcrowding-related anxiety in health care workers (p < 0.05). This study showed that there is a significant correlation between anxiety level and perceived crowding, and aromatherapy is related to a decrease in overcrowding-related anxiety. In EDs, lavender oil aromatherapy can be used as a complementary method in reducing the overcrowding-related anxiety. But further researches are needed to verify that aromatherapy has a causative effect on reducing overcrowding-related anxiety.
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Laher AE, Van Rooyen LR, Jawa A, Enyuma COA, Swartzberg KM. Compliance with hygiene practices among healthcare workers at an academic hospital emergency department. Afr J Emerg Med 2021; 11:352-355. [PMID: 34367895 PMCID: PMC8327483 DOI: 10.1016/j.afjem.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/25/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Healthcare-associated infections (HCAIs) are an important contributor to patient morbidity and mortality. Healthcare workers (HCWs) hands are the chief mode of transmission of HCAIs. The emergency centre (EC) is frequently the first point of contact for patients within the health care system. The aim of this study is to determine compliance with hygiene practices among healthcare workers at a tertiary hospital EC. Methods Hygiene practices of staff were observed over a six-week period. Data pertaining to compliance rates with hand cleansing and other hygiene practices was collected. Consent was obtained retrospectively to avoid influencing participant behaviour. Results From a total of 477 potential hygiene opportunities, compliance with hand hygiene was only 34.4% (n = 164). Hand cleansing with an alcohol-based hand rub was observed in 87 (26.7%) of the 326 (68.3%) opportunities where it was indicated, while handwashing with soap and water was observed in 35 (23.2%) of the 151 opportunities where this was indicated. Compliance to each of the six steps of handwashing ranged between 62.2% and 83.5%, with there being a gradual deterioration in compliance from step one through to step six. Compliance with ‘bare below the elbows’ was observed in 242 (50.7%) opportunities while disposable surgical gloves were worn on 85 (44.7%) of the 190 opportunities where this was indicated. Conclusion Compliance with hygiene practices among EC HCWs is suboptimal. Various strategies including ongoing systematic training and regular audits may improve overall hygiene practices among EC staff.
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Affiliation(s)
- Abdullah E. Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Corresponding author at: Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg 2193, South Africa.
| | - Ljuba-Ruth Van Rooyen
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali Jawa
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Callistus OA Enyuma
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
| | - Kylen M. Swartzberg
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Seitz RM, Yaffee AQ, Peacock E, Moran TP, Pendley A, Rupp JD. Self-Reported Use of Personal Protective Equipment among Emergency Department Nurses, Physicians and Advanced Practice Providers during the 2020 COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137076. [PMID: 34281013 PMCID: PMC8297270 DOI: 10.3390/ijerph18137076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
Background: Emergency departments (EDs) have seen dramatic surges in patients infected with COVID-19 and are high-risk transmission environments. Knowledge, attitudes and practice regarding personal protective equipment (PPE) among ED health care workers (HCWs) during the COVID-19 pandemic have not been studied, thus this study examines this knowledge gap. Methods: This was a cross-sectional survey of 308 HCWs in two urban EDs in Atlanta, Georgia in April and May of 2020. Results: We surveyed 308 HCWs; 137 responded (44% response rate). All HCWs reported adequate knowledge and 96% reported compliance with PPE guidelines. Reported sources of PPE information: 56.7% charge nurse, 67.3% the institutional COVID-19 website. Frequency of training was positively associated with understanding how to protect themselves and patients (OR = 1.7, 95% CI: 1.0–2.9). Conclusions: Few HCWs are willing to care for patients without PPE, and therefore we should aim for resiliency in the PPE supply chain. EDs should consider multiple communication strategies, including a website with concise information and enhanced training for key personnel, particularly the charge nurse. Attention to frequency in HCW training may be key to improve confidence in protecting themselves and patients. Findings can be leveraged by EDs to implement effective PPE training.
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Alnasser AA, Aldeeri IA, Aljamal WM, Sharahili KA, Alturki YA. Patients' knowledge, awareness, and attitude regarding patient safety at a teaching hospital, Riyadh, Saudi Arabia. J Family Med Prim Care 2021; 9:5236-5241. [PMID: 33409194 PMCID: PMC7773081 DOI: 10.4103/jfmpc.jfmpc_587_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 01/23/2023] Open
Abstract
Aims: Our primary objective is to investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety. The secondary objective of this research is to determine factors that influence patients' knowledge regarding patient safety. Methods: We performed a cross-sectional study with a targeted sample of 410 patients at King Khalid University Hospital, Riyadh, Saudi Arabia. Self-administered paper-based questionnaires were distributed to outpatient clinics on February 2, 2019 until March 20, 2019. Finally, the data were analyzed by (SPSS). Results: There were 450 questioners distributed, and 410 were completed and returned (91% response rate). Most of the patients were below the age of 50 (77.9%), 54.8%, of them were females, and almost half received higher education (54.1%). Among the respondents who are taking drugs, 21.6% do not have any knowledge about the side effects of their drugs, and 47.8% of patients said that their physicians do not tell them the side effects of their prescribed drugs. Whereas 20.7% of patients claimed that they experienced a medical error, 66.3% did not report the errors, and the reason was not knowing how to report or to whom in 54.4% of the patients. In regards of infection control, 47% of the participants misunderstood means to prevent the spread of the infections and how it could be transmitted. Conclusion: Patients' knowledge about patient safety need to be improved. We suggest educating the patients by providing training programs for patients, and we recommend further studies.
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Affiliation(s)
- Abdullah A Alnasser
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ibraheem A Aldeeri
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Waleed M Aljamal
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid A Sharahili
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yousef A Alturki
- Professor and Consultant Family Medicine, Department of Family and Community Medicine, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
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18
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Salomão MC, Freire MP, Boszczowski I, Raymundo SF, Guedes AR, Levin AS. Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Emerg Infect Dis 2020; 26:1156-1163. [PMID: 32267827 PMCID: PMC7258474 DOI: 10.3201/eid2606.190965] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) colonization is common in hospital patients admitted to intensive care units (ICU) from the emergency department. We evaluated the effect of previous hospitalization in the emergency department on CRE colonization at ICU admission. Our case–control study included 103 cases and 201 controls; cases were patients colonized by CRE at admission to ICU and controls were patients admitted to ICU and not colonized. Risk factors were emergency department stay, use of carbapenem, Simplified Acute Physiology Score, upper digestive endoscopy, and transfer from another hospital. We found that ED stay before ICU admission was associated with CRE colonization at admission to the ICU. Our findings indicate that addressing infection control problems in EDs will help to control carbapenem resistance in ICUs.
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19
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Yehouenou CL, Dohou AM, Fiogbe AD, Esse M, Degbey C, Simon A, Dalleur O. Hand hygiene in surgery in Benin: opportunities and challenges. Antimicrob Resist Infect Control 2020; 9:85. [PMID: 32539867 PMCID: PMC7296752 DOI: 10.1186/s13756-020-00748-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 06/04/2020] [Indexed: 02/03/2023] Open
Abstract
Background Hand Hygiene (HH) has been described as the cornerstone and starting point in all infection control. Compliance to HH is a fundamental quality indicator. The aim of this study was to investigate the HH compliance among Health-care Workers (HCWs) in Benin surgical care units. Methods A multicenter prospective observational study was conducted for two months. The World Health Organization (WHO) Hand Hygiene Observation Tool was used in obstetric and gastrointestinal surgery through six public hospitals in Benin. HH compliance was calculated by dividing the number of times HH was performed by the total number of opportunities. HH technique and duration were also observed. Results A total of 1315 HH opportunities were identified during observation period. Overall, the compliance rate was 33.3% (438/1315), without significant difference between professional categories (nurses =34.2%; auxiliaries =32.7%; and physicians =32.4%; p = 0.705). However, compliance rates differed (p < 0.001) between obstetric (49.4%) and gastrointestinal surgery (24.3%). Generally, HCWs were more compliant after body fluid exposure (54.5%) and after touching patient (37.5%), but less before patient contact (25.9%) and after touching patient surroundings (29.1%). HCWs were more likely to use soap and water (72.1%) compared to the alcohol based hand rub solution (27.9%). For all of the WHO five moments, hand washing was the most preferred action. For instance, hand rub only was observed 3.9% after body fluid exposure and 16.3% before aseptic action compared to hand washing at 50.6 and 16.7% respectively. Duration of HH performance was not correctly adhered to 94% of alcohol hand rub cases (mean duration 9 ± 6 s instead of 20 to 30 s) and 99.5% of hand washing cases (10 ± 7 s instead of the recommended 40 to 60 s). Of the 432 HCWs observed, 77.3% followed HH prerequisites (i.e. no artificial fingernails, no jewellery). We also noted a lack of permanent hand hygiene infrastructures such as sink, soap, towels and clean water. Conclusion Compliance in surgery was found to be low in Benin hospitals. They missed two opportunities out of three to apply HH and when HH was applied, technique and duration were not appropriate. HH practices should be a priority to improve patient safety in Benin.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium. .,Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin. .,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326.
| | - Angèle Modupe Dohou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326
| | - Ariane Dessièdé Fiogbe
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326
| | - Marius Esse
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin
| | - Cyriaque Degbey
- Institut Régional de Santé Publique Comlan Alfred Quenum (IRSP), Ouidah, Benin.,Clinique Universitaire d'Hygiène Hospitalière, Centre National Hospitalo-universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Anne Simon
- Pole de microbiologie, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Microbiologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Pharmacy, Cliniques universitaires Saint-Luc, Université catholique de Louvain, UCLouvain, Brussels, Belgium
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20
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Vaisman A, Bannerman G, Matelski J, Tinckam K, Hota SS. Out of sight, out of mind: a prospective observational study to estimate the duration of the Hawthorne effect on hand hygiene events. BMJ Qual Saf 2020; 29:932-938. [DOI: 10.1136/bmjqs-2019-010310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
BackgroundHuman auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects’ behaviour due to their awareness of being observed. For the first time, we used electronic HH monitoring to characterise the duration of the HE on HH events after human auditors have left the ward.MethodsObservations were prospectively conducted on two transplant wards at a tertiary centre between May 2018 and January 2019. HH events were measured using the electronic GOJO Smartlink Activity Monitoring System located throughout the ward. Non-covert human auditing was conducted in 1-hour intervals at random locations on both wards on varying days of the week. Two adjusted negative binomial regression models were fit in order to estimate an overall auditor effect and a graded auditor effect.ResultsIn total, 365 674 HH dispensing events were observed out of a possible 911 791 opportunities. In the adjusted model, the presence of an auditor increased electronic HH events by approximately 2.5-fold in the room closest to where the auditor was standing (9.86 events per hour/3.98 events per hour; p<0.01), an effect sustained across only the partial hour before and after the auditor was present but not beyond the first hour after the auditor left. This effect persisted but was attenuated in areas distal from the auditor (total ward events of 6.91*6.32–7.55, p<0.01). Additionally, there was significant variability in the magnitude of the HE based on temporal and geographic distribution of audits.ConclusionThe HE on HH events appears to last for a limited time on inpatient wards and is highly dynamic across time and auditor location. These findings further challenge the validity and value of human auditing and support the need for alternative and complementary monitoring methods.
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21
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Lam SKK, Kwong EWY, Hung MSY, Pang SMC, Chien WT. A qualitative descriptive study of the contextual factors influencing the practice of emergency nurses in managing emerging infectious diseases. Int J Qual Stud Health Well-being 2020; 14:1626179. [PMID: 31184291 PMCID: PMC6566498 DOI: 10.1080/17482631.2019.1626179] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: Emergency nurses are engaged in the management of epidemic events that unfold along with the evolution of diseases. The goal of this study was to explore the contextual factors that inhibited the ability of emergency nurses to perform their duties in response to an outbreak. Methods: A qualitative descriptive design was used to explore the experiences and perceptions of emergency nurses. Participants were purposively recruited from 12 emergency departments in Hong Kong. Semi-structured face-to-face individual interviews were conducted with 26 emergency nurses. The audio-recorded interviews were transcribed verbatim and interpreted with a thematic analysis approach. Results: Four intertwined themes emerged from the analysis: resource constraints, threats of infection, ubiquitous changes and lingering uncertainties. These themes portrayed the constraints and challenges surrounding the work environment of emergency nurses. Conclusion: This study described the instabilities and vulnerabilities of the circumstances in which the emergency nurses were situated in during epidemic events. The findings shed light on the importance of hospitals and emergency departments in addressing both the technical problems and adaptive challenges that face emergency nurses during epidemic events.
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Affiliation(s)
- Stanley K K Lam
- a School of Nursing , Tung Wah College , Kowloon , Hong Kong
| | - Enid W Y Kwong
- b School of Nursing , Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Maria S Y Hung
- a School of Nursing , Tung Wah College , Kowloon , Hong Kong
| | - Samantha M C Pang
- b School of Nursing , Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Wai T Chien
- c The Nethersole School of Nursing , The Chinese University of Hong Kong , New Territories , Hong Kong
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22
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Jeanes A, Coen PG, Drey NS, Gould DJ. Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool. Am J Infect Control 2020; 48:68-76. [PMID: 31358420 PMCID: PMC7115327 DOI: 10.1016/j.ajic.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. METHODS The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. RESULTS Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. CONCLUSIONS Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, Maples House, London, United Kingdom
| | - Nicolas S Drey
- School of Health Studies, University of London, London, United Kingdom
| | - Dinah J Gould
- School of healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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23
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Irek EO, Aliyu AA, Dahiru T, Obadare TO, Aboderin AO. Healthcare-associated infections and compliance of hand hygiene among healthcare workers in a tertiary health facility, southwest Nigeria. J Infect Prev 2019; 20:289-296. [PMID: 31762791 DOI: 10.1177/1757177419848141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/06/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Healthcare-associated infections (HAIs) are threats in healthcare settings contributing to increased morbidity, mortality and antimicrobial resistance worldwide. Hand hygiene (HH) is the simplest and most important single intervention to reduce HAIs. Aims/objectives This study sought to determine rates of HAIs as well as compliance of HH among healthcare workers (HCWs) in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Methods A cross-sectional study was conducted among 227 HCWs (59 doctors, 129 nurses and 39 ward attendants) selected by multistage sampling across 10 hospital wards. Electronic interviewer-administered questionnaire, HH compliance checklist and point prevalence of HAI were done using World Health Organization and Centers for Disease Control and Prevention toolkits, respectively. Results Only 20.33% (n = 12) of doctors, 3.88% (n = 5) of nurses and 2.56% (n = 1) of ward attendants had good knowledge of HH (χ2 = 22.22, P value = 0.01). Among doctors, 11.86% (n = 7), 6.98% (n = 9) of nurses and 2.56% (n = 1) of ward attendants had positive perception towards HH (χ2 = 7.87, P value = 0.25). Of the 174 opportunities for HH observed, compliance rates were 42.37%, 55.81% and 68.97% among doctors, nurses and ward attendants, respectively. Point prevalence of HAI was 16.38%. Discussion Good knowledge and positive perception about HH were uncommon among doctors, nurses and ward attendants. However, ward attendants had the highest compliance to HH. There was a high prevalence of HAIs in this institution.
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Affiliation(s)
- Emmanuel O Irek
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Nigeria Field Epidemiology and Laboratory Training, Abuja, Nigeria
| | - Alhaji A Aliyu
- Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Tukur Dahiru
- Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Temitope O Obadare
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Aaron O Aboderin
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Rasouli HR, Aliakbar Esfahani A, Abbasi Farajzadeh M. Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study. BMC Emerg Med 2019; 19:62. [PMID: 31666023 PMCID: PMC6822347 DOI: 10.1186/s12873-019-0275-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Emergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals. Methods Original research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase. Results Out of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized. Conclusion ED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.
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Affiliation(s)
- Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Aliakbar Esfahani
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Seo HJ, Sohng KY, Chang SO, Chaung SK, Won JS, Choi MJ. Interventions to improve hand hygiene compliance in emergency departments: a systematic review. J Hosp Infect 2019; 102:394-406. [PMID: 30935982 DOI: 10.1016/j.jhin.2019.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
The emergency department (ED) is where hand hygiene problems are significant as the procedures in the ED are often high risk and invasive. To date, there have been no comprehensive reviews on hand hygiene in EDs. The aim of this study was to investigate hand hygiene compliance (HHC) rate, factors affecting the HHC rate, and intervention strategies to improve HHC in EDs. Electronic databases were used to search for research published from 1948 to January 2018. The databases included ovidMEDLINE, ovidEMBASE, the Cochrane Library, CINAHL, Koreamed, and Kmbase. All study designs were included. Two reviewers independently extracted the data and assessed the bias risk using reliable and validated tools. A narrative synthesis was performed. Twenty-four studies, including 12 cross-sectional surveys and 12 interventional studies, were included. Of the 12 interventional studies reviewed, only 33% (N = 4) reported HHC rates of more than 50%. Factors that influenced HHC included types of healthcare worker, hand hygiene indication, ED crowding, positive attitudes towards HHC, patient location, auditing hand hygiene, and type of shift. Almost all of the studies (83.3%) applied multimodal or dual interventions to improve HHC. A range of strategies, including education, monitoring and providing feedback, campaigns, and cues, effectively improved HHC. The review findings indicate that there is a room for improvement in HHC in EDs. Future randomized controlled trials are necessary to determine which intervention modalities are most effective and sustainable for HHC improvement.
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Affiliation(s)
- H-J Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - K-Y Sohng
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
| | - S O Chang
- College of Nursing, Korea University, Seoul, South Korea
| | - S K Chaung
- Department of Nursing, Semyung University, Jecheon, South Korea
| | - J S Won
- College of Nursing, Eulji University, Sungnam, South Korea
| | - M-J Choi
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
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West GF, Resendiz M, Lustik MB, Nahid MA. Bacterial Contamination of Military and Civilian Uniforms in an Emergency Department. J Emerg Nurs 2018; 45:169-177.e1. [PMID: 30573161 DOI: 10.1016/j.jen.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/04/2018] [Accepted: 10/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The emergency department is a fast-paced, high-volume environment, serving patients with diverse and evolving acuities. Personnel providing direct care are continually exposed to pathogenic microorganisms from patients and everyday surfaces, to which the organisms may spread. Indeed, hospital items-such as electronic devices, stethoscopes, and staff clothing-have demonstrated high rates of contamination. Despite this, policies governing the use, disinfection, and wear of various environmental surfaces remain relaxed, vague, and/or difficult to enforce. This study aimed to examine the bacterial contamination on 2 hospital uniform types in a large military hospital within the emergency department. METHODS Environmental sampling of military and civilian nursing staff uniforms was performed on 2 separate occasions. Emergency nurses wore hospital-provided freshly laundered scrubs on the first sampling day and home-laundered personally owned uniforms complicit with ED policy on the second sampling day. Samples were collected by impressing of contact blood agar growth medium at arrival (0 hour), 4 hours, and 8 hours of wear. Microbiological methods were used to enumerate and identify bacterial colonies. RESULTS Bacterial contamination of personally owned uniforms was significantly higher than freshly laundered hospital-provided scrubs on 4 different sampling sites and across the span of an 8-hour workday. No significant differences were observed between military and civilian personally owned uniforms. However, several risk factors for nosocomial infection were increased in the military subgroup. DISCUSSION Re-evaluating organizational factors (such as uniform policies) that increase the propensity for pathogenic contamination are critical for mitigating the spread and acquisition of multidrug-resistant organisms in the emergency department.
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Staines A, Vanderavero P, Duvillard B, Deriaz P, Erard P, Kundig F, Juillet C, Clerc O. Sustained improvement in hand hygiene compliance using a multi-modal improvement programme at a Swiss multi-site regional hospital. J Hosp Infect 2018; 100:176-182. [DOI: 10.1016/j.jhin.2018.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
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Liang SY, Riethman M, Fox J. Infection Prevention for the Emergency Department: Out of Reach or Standard of Care? Emerg Med Clin North Am 2018; 36:873-887. [PMID: 30297010 PMCID: PMC6203442 DOI: 10.1016/j.emc.2018.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110, USA.
| | - Madison Riethman
- Communicable Disease, Clark County Public Health, Center for Community Health, 1601 East Fourth Plain Boulevard, Building 17, PO Box 9825, Vancouver, WA 98666, USA
| | - Josephine Fox
- Infection Prevention, Barnes-Jewish Hospital, Mailstop 90-75-593, 4590 Children's Place, St Louis, MO 63108, USA
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Älgå A, Karlow Herzog K, Alrawashdeh M, Wong S, Khankeh H, Stålsby Lundborg C. "Reality rarely looks like the guidelines": a qualitative study of the challenges hospital-based physicians encounter in war wound management. Scand J Trauma Resusc Emerg Med 2018; 26:52. [PMID: 29945644 PMCID: PMC6020423 DOI: 10.1186/s13049-018-0517-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/11/2018] [Indexed: 11/21/2022] Open
Abstract
Background Globally, armed conflict is a major contributor to mortality and morbidity. The treatment of war-associated injuries is largely experience-based. Evidence is weak due to difficulty in conducting medical research in war settings. A qualitative method could provide insight into the specific challenges associated with providing health care to injured civilians. The aim of this study was to explore the challenges hospital-based physicians encounter in war wound management, focusing on surgical intervention and antibiotic use. Methods Semi-structured, face-to-face interviews were conducted with physicians at a Jordanian hospital supported by Médecins Sans Frontières. The interviews were recorded, transcribed verbatim and analysed using content analysis with an inductive and deductive approach. Results We found that challenges in war wound management primarily relate to protocol adherence. Protocols for the management of acute war wounds were adhered to on areas that could be considered commonly agreed principles of war wound surgery, such as the use of wound debridement and the evaluation of the systemic condition of the patient before initiating antibiotic treatment. We identified limitations imposed on the physicians that complicate or even hinder protocol adherence. Additionally, we identified factors associated with conscious deviations from the protocols. Conclusions We conclude that adherence to established protocols around the management of acute war wounds is difficult. We present aspects that may be considered when establishing clinical projects in similar contexts. The knowledge gained by this study could provide insights for the development of protocols or guidelines for wound management and antibiotic use in an unstable setting, such as a hospital in close proximity to armed conflict. We suggest the use of a grounded theory approach to further study the discrepancy between guideline recommendations and actual practice.
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Affiliation(s)
- Andreas Älgå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Karlow Herzog
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Sidney Wong
- Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Hamidreza Khankeh
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Zottele C, Magnago TSBDS, Dullius AIDS, Kolankiewicz ACB, Ongaro JD. Hand hygiene compliance of healthcare professionals in an emergency department. Rev Esc Enferm USP 2017; 51:e03242. [PMID: 28902323 DOI: 10.1590/s1980-220x2016027303242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze compliance with hand hygiene by healthcare professionals in an emergency department unit. METHOD This is a longitudinal quantitative study developed in 2015 with healthcare professionals from a university hospital in the state of Rio Grande do Sul. Each professional was monitored three times by direct non-participant observation at WHO's five recommended moments in hand hygiene, taking the concepts of opportunity, indication and action into account. Descriptive and analytical statistics were used. RESULTS Fifty-nine healthcare professionals participated in the study. The compliance rate was 54.2%. Nurses and physiotherapists showed a compliance rate of 66.6% and resident physicians, 41.3%. When compliance was compared among professional categories, nurses showed greater compliance than resident physicians (OR = 2.83, CI = 95%: 1.09-7.34). CONCLUSION Hand hygiene compliance was low. Multidisciplinary approaches could be important strategies for forming partnerships to develop learning and implementation of hand hygiene practices. OBJETIVO Analisar a adesão à higienização das mãos dos profissionais de saúde em unidade de Pronto-Socorro. MÉTODO Estudo quantitativo longitudinal desenvolvido com profissionais de saúde de um Hospital Universitário do Rio Grande do Sul, em 2015. Para cada profissional, realizaram-se três acompanhamentos com observação direta não participante nos cinco momentos preconizados para higienização das mãos, levando-se em conta os conceitos de Oportunidade, Indicação e Ação. Utilizou-se da estatística descritiva e analítica. RESULTADOS Participaram do estudo 59 profissionais de saúde. A taxa de adesão foi de 54,2%. Os enfermeiros e fisioterapeutas obtiveram a taxa de adesão de 66,6% e os médicos residentes, de 41,3%. Ao ser comparada a adesão entre as categorias profissionais, os enfermeiros tiveram maior aderência do que os médicos residentes (RC=2,83; IC=95%:1,09-7,34). CONCLUSÃO A adesão à higienização das mãos foi baixa. Abordagens multidisciplinares podem ser estratégias importantes para formar parcerias que desenvolvam a aprendizagem e a efetivação de práticas de HM.
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Affiliation(s)
- Caroline Zottele
- Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Juliana Dal Ongaro
- Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil
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Chiu IM, Lin YR, Syue YJ, Kung CT, Wu KH, Li CJ. The influence of crowding on clinical practice in the emergency department. Am J Emerg Med 2017; 36:56-60. [PMID: 28705743 DOI: 10.1016/j.ajem.2017.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED). METHODS This 1-year retrospective cohort study conducted in two EDs in Taiwan included 70,222 adult non-trauma visits during the day shift between July 1, 2011, and June 30, 2012. The ED occupancy status, determined by the number of patients staying during their time of visit, was used to measure crowding, grouped into four quartiles, and analyzed in reference to the clinical practice. The clinical practices included decision-making time, patient length of stay, patient disposition, and use of laboratory examinations and computed tomography (CT). RESULT The four quartiles of occupancy statuses determined by the number of patients staying during their time of visit were <24, 24-39, 39-62, and >62. Comparing >62 and <24 ED occupancy statuses, the physicians' decision-making time and patients' length of stay increased by 0.3h and 1.1h, respectively. The percentage of patients discharged from the ED decreased by 15.5% as the ED observation, general ward, and intensive care unit admissions increased by 10.9%, 4%, and 0.7%, respectively. CT and laboratory examination slightly increased in the fourth quartile of ED occupancy. CONCLUSION Overcrowding in the ED might increase physicians' decision-making time and patients' length of stay, and more patients could be admitted to observation units or an inpatient department. The use of CT and laboratory examinations would also increase. All of these could lead more patients to stay in the ED.
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Affiliation(s)
- I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yuan-Jhen Syue
- Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Jui Li
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Poovelikunnel TT, Duffy F, Finn C, McCormack F, Walsh J, Humphreys H. Is overcrowding a barrier to hand hygiene and how can it be addressed? J Hosp Infect 2017; 97:30-31. [PMID: 28600078 DOI: 10.1016/j.jhin.2017.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T T Poovelikunnel
- Infection Prevention and Control Department, Beaumont Hospital, Dublin 9, Ireland.
| | - F Duffy
- Infection Prevention and Control Department, Beaumont Hospital, Dublin 9, Ireland
| | - C Finn
- Infection Prevention and Control Department, Beaumont Hospital, Dublin 9, Ireland
| | - F McCormack
- Infection Prevention and Control Department, Beaumont Hospital, Dublin 9, Ireland
| | - J Walsh
- Infection Prevention and Control Department, Beaumont Hospital, Dublin 9, Ireland
| | - H Humphreys
- RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
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Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control 2017; 45:528-535. [PMID: 28456322 DOI: 10.1016/j.ajic.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP.
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More Doctor-Patient Contact Is Not the Only Explanation For Lower Hand-Hygiene Compliance in Australian Emergency Departments. Infect Control Hosp Epidemiol 2017; 38:502-504. [PMID: 28179031 DOI: 10.1017/ice.2016.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haac B, Rock C, Harris AD, Pineles L, Stein D, Scalea T, Hu P, Hagegeorge G, Liang SY, Thom KA. Hand Hygiene Compliance in the Setting of Trauma Resuscitation. Injury 2017; 48:165-170. [PMID: 27568844 PMCID: PMC5711429 DOI: 10.1016/j.injury.2016.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Healthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1)before touching a patient; 2)before a clean procedure; 3)after body fluid exposure; and 4)after touching a patient or 5)patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated. MATERIALS AND METHODS Using video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center. RESULTS 342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall. CONCLUSION HH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.
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Affiliation(s)
- Bryce Haac
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Clare Rock
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Halsted 831, 600 N. Wolfe Street, Baltimore, MD 21287, United States
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States
| | - Deborah Stein
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Peter Hu
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - George Hagegeorge
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States
| | - Stephen Y Liang
- Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, MO 63110, United States
| | - Kerri A Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States.
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