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de la Rosa-Zamboni D, Villa-Guillén M, Bustos-Hamdan A, Rosas-Mateos MI, Medina-Pelcastre M, Torres-García M, Franco-Hernández MI, Del Carmen Castellanos-Cruz M, Parra-Ortega I, Fest-Parra E, Casillas-Casillas MC, Guerrero-Díaz AC. Effect of UV-C disinfection and copper plating on healthcare-associated infections in a NICU with high ESBL infections. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00117-5. [PMID: 38705751 DOI: 10.1016/j.eimce.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Healthcare-associated infections (HCAIs) in neonates are frequent and highly lethal, in particular those caused by extended spectrum beta-lactamase (ESBL) producing bacteria. We evaluated the beneficial effects of ultraviolet C (UV-C) disinfection and copper adhesive plating on HCAIs in the Neonatal Intensive Care Unit (NICU) of a third level paediatric hospital in Mexico City, both in combination of hand-hygiene (HH) and prevention bundles. METHODS All NICU patients were included. There were 4 periods (P): P1: HH monitoring and prevention bundles; P2: P1+UV-C disinfection; P3: P2+Copper adhesive plating on frequent-contact surfaces and P4: Monitoring of P3 actions. RESULTS 552 neonates were monitored during 15,467 patient days (PD). HCAI rates decreased from 11.03/1000 PD in P1 to 5.35/1000 PD in P4 (p=0.006). HCAIs with bacterial isolates dropped from 5.39/1000 PD in PI to 1.79/1000 PD in P4 (p=0.011). UV-C and copper were associated with significant HCAI prevention (RR 0.49, CI95% 0.30-0.81, p=0.005) and with lesser HCAIs with bacterial isolates (RR 0.33, CI95% 0.14-0.77, p=0.011). CONCLUSIONS Copper adhesive plating combined with UV-C disinfection were associated with a drop in HCAI rates and with the elimination of ESBL-caused HCAIs. Hence, we propose that these strategies be considered in MDRO proliferation preventions.
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Affiliation(s)
| | - Mónica Villa-Guillén
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Anaíd Bustos-Hamdan
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | - Marisol Medina-Pelcastre
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Margarita Torres-García
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | | | - Israel Parra-Ortega
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | - Edmedt Fest-Parra
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
| | | | - Ana Carmen Guerrero-Díaz
- Hospital Infantil de México Federico Gómez, Doctor Márquez 162 Doctores, Ciudad de México, Mexico
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Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [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: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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Rowley S, Clare S. ANTT ® standardisation facilitates new efficiencies with a novel partially-sterile Standard-ANTT PIVC Pack. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S10. [PMID: 37027407 DOI: 10.12968/bjon.2023.32.7.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Introduction: The widespread adoption of the ANTT®Clinical Practice Framework as a single standard for aseptic technique, has highlighted that many clinical procedures do not require a sterile procedure pack to be performed safely and aseptically. This study explores the utilisation of a partially-sterile procedure pack that is specifically tailored to Standard-ANTT. Methods: A prospective project improvement evaluation, using a non-paired sample (pre: n=41; post: n =33) of emergency department staff in an NHS hospital. Staff were evaluated performing peripheral intravenous cannulations (PIVC) using Standard-ANTT and the B. Braun Standard-ANTT peripheral cannulation pack. Findings: Significant improvements were observed in practice following the implementation of the pack and training in Standard-ANTT, including: Key-Part protection significantly improved (pre: n=28, 68.2%; post: n=33, 100%), and reduction in the Key-Site being touched after disinfection (pre: n=17; 41.4%; post n=5; 15.1%). Conclusions: In conjunction with appropriate education and training, this study provides proof of concept that due to the widespread use of the ANTT Clinical Practice Framework as a single standard aseptic technique, procedure packs that are specifically tailored to Standard-ANTT, can help to promote best practice and improve efficiencies. DEFINITIONS Partially-sterile procedure pack - all items required to be sterile remain in their individual blister wrapper. The final assembled pack itself is not then subjected to a further round of sterilisation as it is not needed. Sterile procedure pack - often contains a mixture of non-sterile and sterile items that have been stripped from their individual blister wrapper requiring the sterilisation of the final assembled pack.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice (ASAP)
| | - Simon Clare
- Research and Development Director, The Association for Safe Aseptic Practice (ASAP)
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Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses. J Hosp Infect 2023; 133:55-61. [PMID: 36565934 DOI: 10.1016/j.jhin.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs), but report challenges and unwarranted variations in practice. OBJECTIVE To explore nurses' experiences, perceived gaps in information and support needed to conduct PRAs. METHODS Qualitative interviews were undertaken with 20 nurses in the UK National Health Service between September 2021 and January 2022 employing approaches to sampling and data collection adopted in grounded theory. RESULTS Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised, but that much could still be done to contain the risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported, and informants were unclear whether asepsis was needed to perform routine procedures (e.g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development, and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. CONCLUSION There is a need for detailed guidelines to inform PRAs, better access to clinical updating, and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognized methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.
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Peacock WF, Chemaly RF, Torriani F, Shahid Z, Dawal S. A new normal for the clinician's third hand: Stethoscope hygiene and infection prevention. Am J Infect Control 2023; 51:114-118. [PMID: 36351475 DOI: 10.1016/j.ajic.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Affiliation(s)
- W Frank Peacock
- Research Henry JN Taub Department of Emergency Medicine Baylor College of Medicine, Houston, TX.
| | - Roy F Chemaly
- Clinical Virology Research Department of ID/IC/EH UT MD, Anderson Cancer Center, Houston, TX; Division of Epidemiology, Human Genetics, and Environmental Sciences, UT School of Public Health, Houston, TX; Medicine Baylor College of Medicine, Houston, TX
| | - Francesca Torriani
- Infection Prevention and Clinical Epidemiology and Tuberculosis Control UC San Diego Health, Clinical Division of ID And Global Health at UC San Diego San Diego, CA
| | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, Manhattan, NY
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Barton A, Bitmead J, Clare S, Daniels R, Gregory B, Lee P, Leitch A, McDonald C. How to improve aseptic technique to reduce bloodstream infection during vascular access procedures. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:880-885. [PMID: 36149420 DOI: 10.12968/bjon.2022.31.17.880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Bloodstream infections associated with vascular access procedures pose a serious risk to patients that can be reduced by better standards of aseptic technique. The objectives of this roundtable of experts were to achieve a consensus on how to improve skin antisepsis in hospital, improve training, competency, compliance and consistency in skin antisepsis, review the role of devices in improving skin antisepsis, identify methods to improve skin antisepsis integrated with the Aseptic Non Touch Technique (ANTT®) approach, and identify challenges to the implementation of the panel's recommendations. Recommendations include using MHRA-licensed 2% chlorhexidine gluconate in 70% isopropyl alcohol solution with bidirectional strokes for up to 30 seconds, then leaving the skin to air dry for 30 seconds; using the ANTT Clinical Practice Framework and terminology as the standard for skin antisepsis training and practice; standardised ANTT and skin antisepsis education with 3-yearly competency assessments for all UK health professionals; and more research to address the evidence gap on transmission of infection after skin antisepsis.
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Affiliation(s)
- Andrew Barton
- Nurse Consultant, Intravenous Therapy and Vascular Access, Frimley Health NHS Foundation Trust
| | - James Bitmead
- Senior Infection Prevention Control Nurse, University College London Hospitals NHS Foundation Trust
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
| | - Ron Daniels
- Consultant in Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, and Founder and Joint CEO, UK Sepsis Trust
| | - Beverley Gregory
- Consultant Nurse HCAI Healthcare-Acquired Infections, HARP Healthcare Associated Infection and Antimicrobial Resistance and Prescribing Programme, Public Health Wales
| | - Paul Lee
- Medical Devices Training Manager and Deputy Head of MEMS (Medical Equipment Management Services), Swansea Bay University Health Board
| | - Anne Leitch
- Value Based Heath and Care Lead, Scottish Government (secondment)
| | - Carl McDonald
- Former Bacteriology Consultant Clinical Scientist for NHS Blood and Transplant
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Abstract
TOPIC This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter-related bloodstream infections is likely as high as and may surpass the number of central venous catheter-related bloodstream infections, with significant associated morbidity and mortality. PURPOSE OF PAPER Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. CONTENT COVERED This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.
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Affiliation(s)
- Barb Nickel
- Barb Nickel is the critical care clinical nurse specialist for CHI Health St. Francis, Grand Island, Nebraska. She is a member of the Infusion Nurses Society Standards of Practice Committee
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Shettigar S, Somasekhara Aradhya A, Ramappa S, Reddy V, Venkatagiri P. Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach. BMJ Open Qual 2021; 10:bmjoq-2021-001394. [PMID: 34344750 PMCID: PMC8336114 DOI: 10.1136/bmjoq-2021-001394] [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: 02/08/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Lack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months. Methods All nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded. Results Significant improvement was seen in compliance to various components—use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate’s sickness level. Conclusions Using a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.
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Heydenrych I, De Boulle K, Kapoor KM, Bertossi D. The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments. Clin Cosmet Investig Dermatol 2021; 14:779-814. [PMID: 34276222 PMCID: PMC8279269 DOI: 10.2147/ccid.s315711] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.
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Affiliation(s)
- Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Century City, Cape Town, South Africa
| | | | | | - Dario Bertossi
- Maxillofacial Department, University of Verona, Verona, Italy
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Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021; 25:557-565. [PMID: 34177176 PMCID: PMC8196366 DOI: 10.5005/jp-journals-10071-23818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim and objective To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. Materials and methods The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as “IV line insertion and maintenance bundle” included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the “incidence of phlebitis and infiltration” was outcome measures while “scores on checklist of IV line insertion and IV line maintenance and administration of drugs” were process measures. Result The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles. Conclusion Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success. How to cite this article Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557–565.
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Affiliation(s)
- Neelima Singh
- Department of Nursing, Vardhman Mahavir, Medical College and Safdarjung Hospital, New Delhi, India
| | - Geetanjli Kalyan
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sukhwinder Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Rowley S, Clare S. How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland? ACTA ACUST UNITED AC 2020; 29:924-932. [DOI: 10.12968/bjon.2020.29.16.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
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Sethi N, Singh S, Kaur J, Raghukumar S, Ramchandani C, Dharmana S, Balani K, Jain H, Khoja M, Singhal S. Consensus Guidelines on Opening Up of Aesthetic Practices in India During the COVID-19 Era. Clin Cosmet Investig Dermatol 2020; 13:661-669. [PMID: 32982359 PMCID: PMC7490074 DOI: 10.2147/ccid.s267528] [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: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The COVID-19 is a pandemic which has affected most people directly or indirectly. It being a communicable disease, the best way to control the disease is to prevent its spread. Lockdown in India has resulted in aesthetic practices all over the country being shut down indefinitely. As things return to normal, most aesthetic practitioners are looking forward to opening practices. Hence, there was a definite need for a consensus on how to safely open up practices in India and at the same time reassure patients coming into these clinics that their safety is paramount. METHODS This consensus guidelines use the PICO model in its structure. Five critical areas for opening up clinical establishments were identified and approached independently. A questionnaire was prepared using the modified Likert scale, and all the stakeholders were asked to answer the same. Any differences were then resolved with discussion among the stakeholders. The entire study was divided into five subgroups which were then analyzed in detail. RESULTS Key recommendations and consensus guidelines were made after detailed analysis. Handy flow diagram reviews of these key areas have been provided. A thorough review of literature was also done on each of the critical areas and recommendations incorporated wherever feasible. CONCLUSION These recommendations have considered the difficulties and cultural issues faced by aesthetic practices in India. They are user friendly, easy to understand and implement. These guidelines would help in reassuring practices to open up safely and continue serving patients with utmost care. LEVEL OF EVIDENCE Level V, Consensus guidelines.
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Affiliation(s)
- Nitin Sethi
- Plastic & Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab141001, India
| | - Sukhbir Singh
- Resplendent the Cosmetic Studio, New Delhi110048, India
| | - Jasleen Kaur
- Department of Dermatology, SGRDIMS & R, Amritsar, India
| | | | | | | | | | - Hema Jain
- Health and Harmony Clinic, Pune, India
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Balachander B, Rajesh D, Pinto BV, Stevens S, Rao Pn S. Simulation training to improve aseptic non-touch technique and success during intravenous cannulation-effect on hospital-acquired blood stream infection and knowledge retention after 6 months: The snowball effect theory. J Vasc Access 2020; 22:353-358. [PMID: 32667233 DOI: 10.1177/1129729820938202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intravenous cannulation is a common procedure and a valuable skill in the neonatal intensive care unit. Standardized procedure and personnel training are needed in the unit to prevent hospital-acquired blood stream infections. Hence, we evaluated the effect of training using a low-fidelity simulation on the improvement of the aseptic non-touch technique during intravenous cannulation and knowledge retention after 6 months. METHODS The study was conducted in a tertiary care neonatal unit from June 2017 to July 2018. All the staff nurses and junior resident doctors posted in the neonatal intensive care were included in the study. A protocol and checklist score sheet was developed. The score sheet consisted of 23 items with a total score of 46. Participants were expected to obtain a minimum of 80%. A pre-test was conducted initially, followed by a formal training and then a post-test. The NITA newborn venous access mannequin was used to facilitate the training. A re-training for new nurses was conducted after 6 months. Data were analyzed using paired t-test. RESULTS A total of 29 doctors and nurses were enrolled in the training. The mean pre-test score was 29.93 compared to 42.66 in the post-test scores (mean difference 12.24(95% confidence interval: 9.39-16.05), p < 0.01. The mean scores were higher when the simulation was conducted after 6 months. There was a significant decline in blood stream infection rates from 5.5 to 1.65 per 1000 patient days (p = 0.05). CONCLUSION Simulation-based training of health care personnel is a good modality to improve aseptic non-touch technique during intravenous cannulation in the neonatal intensive care unit. Simulation-based training also helps in knowledge retention and standardization of training procedures.
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Affiliation(s)
- Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Deepa Rajesh
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Bonita Viona Pinto
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Sofia Stevens
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Suman Rao Pn
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
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Sørensen UBS, Klaas IC, Boes J, Farre M. The distribution of clones of Streptococcus agalactiae (group B streptococci) among herdspersons and dairy cows demonstrates lack of host specificity for some lineages. Vet Microbiol 2019; 235:71-79. [DOI: 10.1016/j.vetmic.2019.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/28/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
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Hegarty J, Howson V, Wills T, Creedon SA, Mc Cluskey P, Lane A, Connolly A, Walshe N, Noonan B, Guidera F, Gallagher AG, Murphy S. Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric. Int Wound J 2019; 16:641-648. [PMID: 30932342 PMCID: PMC6850176 DOI: 10.1111/iwj.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.
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Affiliation(s)
- Josephine Hegarty
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Victoria Howson
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Teresa Wills
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Sile A. Creedon
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | | | - Aoife Lane
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Aine Connolly
- Nursing Division, Cork University Hospital GroupIreland
| | - Nuala Walshe
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Fiona Guidera
- Nursing Division, Mercy University HospitalCorkIreland
| | - Anthony G Gallagher
- Application of Science to Simulation based Education and Research on Training Centre, College of Medicine and Health, University College Cork, Cork, Ireland & Faculty of Life and Health SciencesUlster University, Magee Campus, Northland Rd, Londonderry BT48 7JLUnited Kingdom
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
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