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Kelly S, Kaehny M, Powell MC. Learning from Nursing Home Infection Prevention and Control Citations During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:36-42. [PMID: 36719658 DOI: 10.3928/00989134-20230106-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The devastating effects of coronavirus disease 2019 (COVID-19) highlight the critical need for effective infection prevention and control (IPC) practices in nursing homes. Nursing management and infection preventionists should be cognizant of the most common reasons underlying federal IPC citations during the pandemic. Analysis of IPC citation data from the first 7 months of the public health emergency identified that adherence to personal protective equipment (PPE) and mask use, appropriate transmission-based precautions, and hand hygiene were the most common reasons for COVID-19-related F880 citations, including those that placed a person at immediate risk for serious injury or death. More specific staff practices and other factors leading to a citation are also highlighted. Although nursing homes may have limited control over factors such as PPE supply and staffing resources, nursing management and infection preventionists can use these results to help ensure that operational mechanisms, staff training, and adherence monitoring efforts effectively address the areas most associated with COVID-19 IPC noncompliance. [Journal of Gerontological Nursing, 49(2), 36-42.].
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Cai H, Garcia A, Polivka B, Spreckelmeyer K, Yang FM. Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:24-37. [PMID: 36691318 DOI: 10.1177/19375867221149126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic. BACKGROUND LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue. METHODS The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses. RESULTS The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. CONCLUSIONS This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.
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Affiliation(s)
- Hui Cai
- Department of Architecture, University of Kansas, Lawrence, KS, USA
| | - Amy Garcia
- University of Kansas School of Nursing, Kansas City, KS, USA
| | - Barbara Polivka
- University of Kansas School of Nursing, Kansas City, KS, USA
| | | | - Frances M Yang
- University of Kansas School of Nursing, Kansas City, KS, USA
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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Sandbekken IH, Hermansen Å, Utne I, Grov EK, Løyland B. Students' observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic. BMC Infect Dis 2022; 22:156. [PMID: 35164685 PMCID: PMC8845230 DOI: 10.1186/s12879-022-07143-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/10/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. METHODS This observational study used the World Health Organization's observation tool for studying hand hygiene indication and adherence: "My five moments for hand hygiene." For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. RESULTS The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. CONCLUSIONS Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers' knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.
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Affiliation(s)
- Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. La COVID-19 dans les foyers de soins de longue durée en Ontario et en Colombie-Britannique. CMAJ 2021; 193:E263-E269. [PMID: 33593958 PMCID: PMC8034325 DOI: 10.1503/cmaj.201860-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Liu
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Colleen J Maxwell
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Pat Armstrong
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Michael Schwandt
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Andrea Moser
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Margaret J McGregor
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Susan E Bronskill
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
| | - Irfan A Dhalla
- Faculté de médecine de Harvard (Liu), Boston, Mass.; Département de politiques et d'interventions sociales (Liu), Université d'Oxford, Oxford, R.-U.; Écoles de pharmacie, de santé publique et de système de santé (Maxwell), Université de Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Département de sociologie (Armstrong), Université York; Département de médecine familiale et communautaire (Moser); Institut de politiques, de gestion et d'évaluation de la santé (Bronskill, Dhalla), École de santé publique Dalla Lana, et Département de médecine (Dhalla), Université de Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculté de médecine (Schwandt), École de la santé publique et des populations, et Département de pratique familiale (McGregor), Université de la Colombie-Britannique; Vancouver Coastal Health (Schwandt); Vancouver, C.-B
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Dellefield ME, Madrigal CB, Verkaaik C, Close J. Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019. Nurs Outlook 2021; 69:182-192. [PMID: 33541725 DOI: 10.1016/j.outlook.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. PURPOSE To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. METHODS Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events. They were described using descriptive statistics and discourse content analysis. FINDINGS We identified clinical events, their duration, work shift, and nursing skill mix for each SOD. Most to least common themes about failures in nursing surveillance were acquisition/transfer of information; decision-making; and early recognition of problems. DISCUSSION Our analysis of nursing surveillance failures in CLC immediate jeopardy SODs provides insight into opportunities for registered nurses and the nursing skill mix to reduce avoidable harms.
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Affiliation(s)
- Mary Ellen Dellefield
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA.
| | - Caroline B Madrigal
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center, Providence, RI
| | - Catherine Verkaaik
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
| | - Jackie Close
- Department of Nursing and Patient Care Services, VA San Diego Healthcare System, San Diego, CA
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Liu M, Maxwell CJ, Armstrong P, Schwandt M, Moser A, McGregor MJ, Bronskill SE, Dhalla IA. COVID-19 in long-term care homes in Ontario and British Columbia. CMAJ 2020; 192:E1540-E1546. [PMID: 32998943 DOI: 10.1503/cmaj.201860] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michael Liu
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Colleen J Maxwell
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Pat Armstrong
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Michael Schwandt
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Andrea Moser
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Margaret J McGregor
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Susan E Bronskill
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
| | - Irfan A Dhalla
- Harvard Medical School (Liu), Boston, Mass.; Department of Social Policy and Intervention (Liu), University of Oxford, Oxford, UK; Schools of Pharmacy and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; ICES Central (Maxwell, Bronskill); Department of Sociology (Armstrong), York University; Department of Family and Community Medicine (Moser); Institute of Health Policy, Management and Evaluation (Bronskill, Dhalla), Dalla Lana School of Public Health, and Department of Medicine (Dhalla), University of Toronto; Baycrest Health Sciences (Moser); Unity Health Toronto (Dhalla), Toronto, Ont.; Faculty of Medicine (Schwandt), School of Population and Public Health, and Department of Family Practice (McGregor), University of British Columbia; Vancouver Coastal Health (Schwandt); Vancouver, BC
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Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. CMAJ 2020; 192:E946-E955. [PMID: 32699006 PMCID: PMC7828970 DOI: 10.1503/cmaj.201197] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. RESULTS The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.
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Affiliation(s)
- Nathan M Stall
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
| | - Aaron Jones
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Kevin A Brown
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Paula A Rochon
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Andrew P Costa
- Division of General Internal Medicine and Geriatrics (Stall), Sinai Health System and the University Health Network; Women's College Research Institute (Stall, Rochon), Women's College Hospital; Department of Medicine (Stall, Rochon) and Institute of Health Policy, Management and Evaluation (Stall, Rochon), University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Jones, Costa), McMaster University, Hamilton, Ont.; Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Schlegel Chair in Clinical Epidemiology and Aging (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
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9
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Løyland B, Peveri AM, Hessevaagbakke E, Taasen I, Lindeflaten K. Students' observations of hand hygiene in nursing homes using the five moments of hand hygiene. J Clin Nurs 2019; 29:821-830. [PMID: 31820503 DOI: 10.1111/jocn.15136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To use nursing students to observe hand hygiene adherence in nursing homes and to explore whether the students' reflections after observing hand hygiene practices gives them a deeper understanding of the subject matter. BACKGROUND Residents in nursing homes worldwide have low tolerance for healthcare-associated infections that require antibiotics, and hand hygiene is the single most effective action to reduce infections. DESIGN Observational study using (a) World Health Organization's (WHO) "Five moments for hand hygiene" validated tool to record indications and adherence and (b) an exploratory study of individual reflection notes from students conducted during and after observations. METHODS From February 12-15, 2018, 26 nursing students in their second semester of a 3-year bachelor programme participated as observers in five wards in four nursing homes in the Oslo metropolitan area. This study was performed according to the STROBE statement. RESULTS Hand hygiene was performed for 57.2% of the 2,393 indications observed and recorded. Adherence differed significantly by type of personnel and by location. Four thematic categories emerged from the reflection notes: (a) practical awareness and introspection; (b) visualisation and enhancement of understanding of practice learning; (c) incorrect hand hygiene practices; and (d) stimulation to increase essential knowledge. CONCLUSION Hand hygiene adherence was too low to prevent healthcare-associated infections and to reduce the use of antibiotics. The students' reflection notes indicated more "insight and understanding of the complexity of hand hygiene." We suggest using nursing students in clinical placement as a means of incorporating different interventions as part of their learning skills and become "living reminders" of the importance of hygiene and infection prevention. RELEVANCE FOR CLINICAL PRACTICE Improving the student's activity about hygiene and infection prevention in clinical placement may help to raise awareness by healthcare workers in nursing homes.
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Affiliation(s)
- Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Anne Marthe Peveri
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Elisabeth Hessevaagbakke
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Inger Taasen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Katrin Lindeflaten
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Larson EL, Murray MT, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon RG, Mosiello L, Neu N, Saiman L. Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 2018; 44. [PMID: 28632004 PMCID: PMC5732083 DOI: 10.1080/08964289.2017.1288607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.
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11
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Cohen CC, Dick A, Stone PW. Isolation Precautions Use for Multidrug-Resistant Organism Infection in Nursing Homes. J Am Geriatr Soc 2017; 65:483-489. [PMID: 28211567 DOI: 10.1111/jgs.14740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine factors associated with isolation precaution use in nursing home (NH) residents with multidrug-resistant organism (MDRO) infection. DESIGN Retrospective, cross-sectional analysis. SETTING Nursing homes with Centers for Medicare and Medicaid Services' certification from October 2010 to December 2013. PARTICIPANTS Elderly, long-stay NH residents with positive MDRO infection assessments. MEASUREMENTS Data were obtained from the Minimum Data Set (MDS) 3.0, Certification and Survey Provider Enhanced Reporting, and Area Health Resource File. Multivariable regression with facility fixed effects was conducted. RESULTS The sample included 191,816 assessments of residents with MDRO infection, of which isolation use was recorded in 12.8%. Of the NHs reporting MDRO infection in the past year, 31% used isolation at least once among residents with MDRO infection. Resident characteristics positively associated with isolation use included locomotion (23.6%, P < .001) and eating (17.9%, P < .001) support. Isolation use was 14.3% lower in those with MDRO history (P < .001). Residents in NHs that had received an infection control-related citation in the past year had a greater probability of isolation use (3.4%, P = .02); those in NHs that had received a quality-of-care citation had lower probability of isolation use (-3.3%, P = .03). CONCLUSION This is the first study to examine the new MDS 3.0 isolation and MDRO items. Isolation was infrequently used, and the proportion of isolated MDRO infections varied between facilities. Inspection citations were related to isolation use in the following year. Further research is needed to determine whether and when isolation should be used to best decrease risk of MDRO transmission and improve quality of care.
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Affiliation(s)
- Catherine C Cohen
- Center for Health Policy, Columbia University School of Nursing, New York City, New York
| | | | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York City, New York
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12
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McDanel JS, Carnahan RM. Antimicrobial Stewardship Strategies in Nursing Homes: Urinary Tract Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Nursing Homes in States with Infection Control Training or Infection Reporting Have Reduced Infection Control Deficiency Citations. Infect Control Hosp Epidemiol 2015; 36:1475-6. [PMID: 26350287 DOI: 10.1017/ice.2015.214] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Cohen CC, Herzig CTA, Carter EJ, Pogorzelska-Maziarz M, Larson EL, Stone PW. State focus on health care-associated infection prevention in nursing homes. Am J Infect Control 2014; 42:360-5. [PMID: 24679560 PMCID: PMC4030678 DOI: 10.1016/j.ajic.2013.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/21/2013] [Accepted: 11/27/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite increased focus on health care-associated infections (HAI), between 1.6 and 3.8 million HAI occur annually among the vulnerable population residing in US nursing homes (NH). This study characterized state department of health (DOH) activities and policies intended to improve quality and reduce HAI in NH. METHODS We created a 17-item standardized data collection tool informed by 20 state DOH Web sites, reviewed by experts in the field and piloted by 2 independent reviewers (Cohen's κ .45-.73). The tool and corresponding protocol were used to systematically evaluate state DOH Web sites and related links. RESULTS Three categories of data were abstracted: (1) consumer-directed information intended to increase accountability of and competition between NH, including mandatory HAI reporting and NH inspection reports; (2) surveyor training for federally-mandated NH inspections; and (3) guidance for NH providers to prevent HAI and monitor incidence. Only 5 states included HAI reporting in NH with differing HAI types and reporting requirements. CONCLUSION State DOH information and activities focused on NH quality and reducing HAI were inconsistent. Systematically characterizing state DOH efforts to reduce HAI in NH is important to interpret the effects of these activities.
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Affiliation(s)
| | - Carolyn T. A. Herzig
- , Columbia University School of Nursing, Mailman School of Public Health, New York, NY
| | | | | | - Elaine L. Larson
- , Columbia University School of Nursing, Mailman School of Public Health, New York, NY
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Castle N, Handler S, Wagner L. Hand Hygiene Practices Reported by Nurse Aides in Nursing Homes. J Appl Gerontol 2013; 35:267-85. [PMID: 24652917 DOI: 10.1177/0733464813514133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 10/28/2013] [Indexed: 11/16/2022] Open
Abstract
Information from nurse aides describing their opinions of hand hygiene practices in nursing homes including perceived barriers to hand hygiene is presented. The information comes from a questionnaire developed for this investigation, with items addressing compliance, facility guidelines and protocols, training, hand washing facilities and materials, and hand washing barriers. Information from 4,211 nurse aides (response rate of 56%) working in a nationally representative sample of 767 nursing homes (participation rate = 51%) is used. We find that 57.4% of nurse aides comply with hand washing when caring for residents most of the time, while 21.7% always comply. With facilities, 43.3% sometimes check that hand washing is performed. In summary, self-reported compliance was poor, and facilities and materials were often lacking. These findings are useful in identifying issues and interventions, including the need for further initiatives to address hand hygiene practices.
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