A patient's journey through the operating department from an infection control perspective

Reporting and conducting patient journey mapping research in healthcare: A scoping review

AIM

To identify how patient journey mapping is being undertaken and reported.

DESIGN

A scoping review of the literature was undertaken using JBI guidance.

DATA SOURCES

Databases were searched in July 2021 (16th-21st), including Ovid's Medline, Embase, Emcare and PsycINFO; Scopus; Web of Science Core Collection, the Directory of Open Access Journals; Informit and; ProQuest Dissertations and Theses Global.

REVIEW METHODS

Eligible articles included peer-reviewed literature documenting journey mapping methodologies and studies conducted in healthcare services. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. A table was used to extract data and synthesize results.

RESULTS

Eighty-one articles were included. An acceleration of patient journey mapping research was observed, with 76.5% (n = 62) of articles published since 2015. Diverse mapping approaches were identified. Reporting of studies was inconsistent and largely non-adherent with relevant, established reporting guidelines.

CONCLUSION

Patient journey mapping is a relatively novel approach for understanding patient experiences and is increasingly being adopted. There is variation in process details reported. Considerations for improving reporting standards are provided.

IMPACT

Patient journey mapping is a rapidly growing approach for better understanding how people enter, experience and exit health services. This type of methodology has significant potential to inform new, patient centred models of care and facilitate clinicians, patients and health professionals to better understand gaps and strategies in health services. The synthesised results of this review alert researchers to options available for journey mapping research and provide preliminary guidance for elevating reporting quality.

An exploration on the relationship between traffic flow and the rate of surgical site infections: A literature review

Surgical site infections are the second most frequent type of health-care associated infections in Europe and America. Public Health England's data on 139,691 operations at 209 hospitals reported 1,635 surgical site infections between April 2012 and March 2017. Patients with a surgical site infection are twice as likely to die, five times more likely to be readmitted after discharge and are likely to have a prolonged hospitalization. Therefore, it is still a significant issue that professionals need to help reduce. This literature review looks at ventilation within theatres and how traffic flow can affect the air flow and if it can increase the incidence rates of surgical site infections. Recommendations of strategies are made to help reduce traffic flow within operating theatres.

Microbiological Assessment of Indoor Air of Teaching Hospital Wards: A case of Jimma University Specialized Hospital

BACKGROUND

Hospital environment represents a congenial situation where microorganisms and susceptible patients are indoors together. Thus, the objective of this study is to provide fundamental data related to the microbial quality of indoor air of Jimma University Specialized Hospital wards, to estimate the health hazard and to create standards for indoor air quality control.

METHODS

The microbial quality of indoor air of seven wards of Jimma University Specialized Hospital was determined. Passive air sampling technique, using open Petri-dishes containing different culture media, was employed to collect sample twice daily.

RESULTS

The concentrations of bacteria and fungi aerosols in the indoor environment of the wards ranged between 2123 - 9733 CFU/m(3). The statistical analysis showed that the concentrations of bacteria that were measured in all studied wards were significantly different from each other (p-value=0.017), whereas the concentrations of fungi that were measured in all sampled wards were not significantly different from each other (p-value=0.850). Moreover, the concentrations of bacteria that were measured at different sampling time (morning and afternoon) were significantly different (p-value =0.001).

CONCLUSION

All wards that were included in the study were heavily contaminated with bacteria and fungi. Thus, immediate interventions are needed to control those environmental factors which favor the growth and multiplication of microbes, and it is vital to control visitors and students in and out the wards. Moreover, it is advisable that strict measures be put in place to check the increasing microbial load in the hospital environment.

Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres

BACKGROUND

Since air can play a central role as a reservoir for microorganisms, in controlled environments such as operating theatres regular microbial monitoring is useful to measure air quality and identify critical situations. The aim of this study is to assess microbial contamination levels in operating theatres using both an active and a passive sampling method and then to assess if there is a correlation between the results of the two different sampling methods.

METHODS

The study was performed in 32 turbulent air flow operating theatres of a University Hospital in Southern Italy. Active sampling was carried out using the Surface Air System and passive sampling with settle plates, in accordance with ISO 14698. The Total Viable Count (TVC) was evaluated at rest (in the morning before the beginning of surgical activity) and in operational (during surgery).

RESULTS

The mean TVC at rest was 12.4 CFU/m3 and 722.5 CFU/m2/h for active and passive samplings respectively. The mean in operational TVC was 93.8 CFU/m3 (SD = 52.69; range = 22-256) and 10496.5 CFU/m2/h (SD = 7460.5; range = 1415.5-25479.7) for active and passive samplings respectively. Statistical analysis confirmed that the two methods correlate in a comparable way with the quality of air.

CONCLUSION

It is possible to conclude that both methods can be used for general monitoring of air contamination, such as routine surveillance programs. However, the choice must be made between one or the other to obtain specific information.

Minimising the spread of infection in the operating department

We live in a world of continuing advances in technology, surgical techniques and rapidly improving medicine. Despite these advances, diseases are continuing to thrive and cause infection both in the community and, more disturbingly, in hospitals. Damani (2003) states that medical care is more complex than ever before, and this has resulted in hospital acquired infections (HAls) increasing due to organisms which are resistant to antibiotics such as: methicillin resistant staphylococcus aureus (MRSA) and vancomyan resistant enterococci (VRE). Wilson (2006) explains that hospitals provide a particularly fertile breeding ground for resistant micro-organisms, due to the widespread exposure to antibiotics and the many opportunities that hospitals provide to transfer MRSA between vulnerable patients and into sites which are susceptible to infection, such as wounds and invasive devices. Damani (2003) emphasises again that the key to successful control of antimicrobial resistant pathogens in hospitals is good isolation techniques, and especially rigorous attention to hand hygiene by all members of staff who are in contact with patients affected or colonised with resistant pathogens. The aim should be to eliminate the infection as quickly as possible and to ensure that the patient's period of isolation is kept to a minimum. Advice and knowledge about the control of infection is therefore imperative.