Keeping hospitals clean and safe without breaking the bank; summary of the Healthcare Cleaning Forum 2018

Human factors engineering simulated analysis in administrative, operational and maintenance loops of nuclear reactor control unit using artificial intelligence and machine learning techniques

The nuclear reactor control unit employs human factor engineering to ensure efficient operations and prevent any catastrophic incidents. This sector is of utmost importance for public safety. This study focuses on simulated analysis of specific areas of nuclear reactor control, specifically administration, operation, and maintenance, using artificial intelligence software. The investigation yields effective artificial intelligence algorithms that capture the essential and non-essential components of numerous parameters to be monitored in nuclear reactor control. The investigation further examines the interdependencies between various parameters and validates the statistical outputs of the model through attribution analysis. Furthermore, a Multivariant ANOVA analysis is conducted to identify the interactive plots and mean plots of crucial parameters interactions. The artificial intelligence algorithms demonstrate the correlation between the number of vacant staff jobs and both the frequency of license event reports each year and the ratio of contract employees to regular employees in the administrative domain. An AI method uncovers the relationships between the operator failing rate (OFR), operator processed errors (OEE), and operations at limited time frames (OLC). The AI algorithm reveals the interdependence between equipment in the out of service (EOS), progressive maintenance schedule (PRMR), and preventive maintenance schedules (PMRC). Effective machine learning neural network models are derived from generative adversarial network (GAN) algorithms and proposed for administrative, operational and maintenance loops of nuclear reactor control unit.

Using a human-factors engineering approach to evaluate environmental cleaning in Veterans' Affairs acute and long-term care facilities: A qualitative analysis

BACKGROUND

Environmental cleaning is important in the interruption of pathogen transmission. Although prevention initiatives have targeted environmental cleaning, practice variations exist and compliance is low. Evaluation of human factors influencing variations in cleaning practices can be valuable in developing interventions to standardized practices. We conducted a work-system analysis using a human-factors engineering (HFE) framework to identify barriers and facilitators to environmental cleaning practices in acute and long-term care settings within the Veterans' Affairs health system.

METHODS

We conducted a qualitative study with key stakeholders at 3 VA facilities. We analyzed transcripts for thematic content and mapped themes to the HFE framework.

RESULTS

Staffing consistency was felt to improve cleaning practices and teamwork. We found that many environmental management service (EMS) staff were veterans who were motivated to serve fellow veterans, especially to prevent infections. However, hiring veterans comes with regulatory hurdles that affect staffing. Sites reported some form of monitoring their cleaning process, but there was variation in method and frequency. The EMS workload was affected by whether rooms were occupied by patients or were semiprivate rooms; both were reportedly more difficult to clean. Room design and surface finishes were identified as important to cleaning efficiency.

CONCLUSION

HFE work analysis identified barriers and facilitators to environmental cleaning. These findings highlight intervention entry points that may facilitate standardized work practices. There is a need to develop task-specific procedures such as cleaning occupied beds and semiprivate rooms. Future research should evaluate interventions that address these determinants of environmental cleaning.

Expectations of clients, insurers, and providers: a qualitative responsiveness assessment among private health insurance sector in Kampala-Uganda

BACKGROUND

There is less attention to assessing how health services meet the expectations of private health insurance (PHI) actors, clients, insurers, and providers in developing countries. Interdependently, the expectations of each actor are stipulated during contract negotiations (duties, obligations, and privileges) in a PHI arrangement. Complementary service roles performed by each actor significantly contribute to achieving their expectations. This study assessed the role of PHI in meeting the expectations of clients, insurers, and providers in Kampala. Lessons from this study may inform possible reviews and improvements in Uganda's proposed National Health Insurance Scheme (NHIS) to ensure NHIS service responsiveness.

METHODS

This study employed a qualitative case-study design. Eight (8) focus group discussions (FGDs) with insured clients and nine (9) key informant interviews (KIIs) with insurer and provider liaison officers between October 2020 and February 2021 were conducted. Participants were purposively selected from eligible institutions. Thematic analysis was employed, and findings were presented using themes with corresponding anonymized narratives and quotes.

RESULTS

Client-Provider, Client-Insurer, and Provider-Insurer expectations were generally not met. Client-provider expectations: Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting times. Both clients and providers received inadequate feedback about services they received and delivered respectively, in addition to prompt care being received by a few clients. For client-insurer expectations, under unclear service packages, clients received low-quality medicines. Lastly, for provider-insurer expectations, delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were most reported. Weak coordination between the client-provider and insurer did not support delivery processes for responsive service.

CONCLUSION

Health care service responsiveness was generally low. There is a need to commit resources to support the setting up of clearer service package orientation programs, and efficient monitoring and feedback platforms. Uganda's proposed National Health Insurance Act may use these findings to: Inform its design initiatives focusing on operating under realistic expectations, investment in quality improvement systems and coordination, and efficient and accountable client care relationships.

Healthcare workers' experiences of caring for patients colonized with carbapenemase-producing Enterobacterales (CPE) in an acute hospital setting - a scoping review

Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.

Innovation for infection prevention and control-revisiting Pasteur's vision

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

The Development of Technology to Prevent, Diagnose, and Manage Antimicrobial Resistance in Healthcare-Associated Infections

There is a growing risk of antimicrobial resistance (AMR) having an adverse effect on the healthcare system, which results in higher healthcare costs, failed treatments and a higher death rate. A quick diagnostic test that can spot infections resistant to antibiotics is essential for antimicrobial stewardship so physicians and other healthcare professionals can begin treatment as soon as possible. Since the development of antibiotics in the last two decades, traditional, standard antimicrobial treatments have failed to treat healthcare-associated infections (HAIs). These results have led to the development of a variety of cutting-edge alternative methods to combat multidrug-resistant pathogens in healthcare settings. Here, we provide an overview of AMR as well as the technologies being developed to prevent, diagnose, and control healthcare-associated infections (HAIs). As a result of better cleaning and hygiene practices, resistance to bacteria can be reduced, and new, quick, and accurate instruments for diagnosing HAIs must be developed. In addition, we need to explore new therapeutic approaches to combat diseases caused by resistant bacteria. In conclusion, current infection control technologies will be crucial to managing multidrug-resistant infections effectively. As a result of vaccination, antibiotic usage will decrease and new resistance mechanisms will not develop.

Results of an international pilot survey on health care environmental hygiene at the facility level

BACKGROUND

Health care-associated infections (HAIs) are a major threat to patient safety worldwide. The importance of the health care environment in patient care is not always adequately addressed. Currently, no overview exists of how health care environmental hygiene (HEH) is performed around the world.

METHODS

Our pilot survey tested a preliminary version of a framework for HEH self-assessment. It aimed to gather data to improve the framework as well as evaluate the strengths and challenges in HEH programs around the world, and across resource levels. The survey was developed by a group of experts, and based on the hand hygiene multimodal improvement strategy. The online survey was sent to 743 health care facilities (HCFs) from all of the World Bank income levels, aiming for at least 4 participants from each level. Overall responses were analyzed as a group as well as stratified per income level using OpenEpi.

RESULTS

Overall, 51 HCFs from 35 countries participated. Almost all HCFs surveyed (50/51, 98%) were found lacking in some or all of the 5 components of the WHO multimodal strategy independent of income level. The results demonstrate the widespread challenges in HEH institutions are facing around the world.

CONCLUSION

The feedback from survey participants allowed for the improvement of the self-assessment tool. There is a clear need for more focus on and investment in HEH programs in HCFs worldwide.

"Our job is to break that chain of infection": Challenges environmental management services (EMS) staff face in accomplishing their critical role in infection prevention

OBJECTIVES

Contaminated surfaces in healthcare settings contribute to the transmission of nosocomial pathogens. Adequate environmental cleaning is important for preventing the transmission of important pathogens and reducing healthcare-associated infections. However, effective cleaning practices vary considerably. We examined environmental management services (EMS) staff experiences and perceptions surrounding environmental cleaning to describe perceived challenges and ideas to promote an effective environmental services program.

DESIGN

Qualitative study.

PARTICIPANTS

Frontline EMS staff.

METHODS

From January to June 2019, we conducted individual semistructured interviews with key stakeholders (ie, EMS staff) at 3 facilities within the Veterans' Affairs Healthcare System. We used the Systems Engineering Initiative for Patient Safety (SEIPS) framework (ie, people, environment, organization, tasks, tools) to guide this study. Interviews were audio-recorded, transcribed, and analyzed for thematic content.

RESULTS

In total, 13 EMS staff and supervisors were interviewed. A predominant theme that emerged were the challenges EMS staff saw as hindering their ability to be effective at their jobs. EMS staff interviewed felt they understand their job requirements and are dedicated to their work; however, they described challenges related to feeling undervalued and staffing issues.

CONCLUSIONS

EMS staff play a critical role in infection prevention in healthcare settings. However, some do not believe their role is recognized or valued by the larger healthcare team and leadership. EMS staff provided ideas for improving feelings of value and job satisfaction, including higher pay, opportunities for certifications and advancement, as well as collaboration or integration with the larger healthcare team. Healthcare organizations should focus on utilizing these suggestions to improve the EMS work climate.

Effectiveness Of The Bicinchoninic Acid Method In Patient Unit Cleaning In Intensive Care

Objective: This study was conducted to identify the effectiveness of the Bicinchoninic Acid/(BCA) method applied for evaluate the cleaning the beds of the patients with infections or colonization requiring strict contact isolation after discharge. Methods: This is an experimental study and it was used the ORION checklist. In this study, 480 BCA and 480 microbiological samples were taken from 40 patient units before and after cleaning and the results were compared. The cleaning procedure was evaluated by examining whether there was post-cleaning gel residue in the areas stained with fluorescent gel before the cleaning. Results: When post-cleaning BCA and post-cleaning microbiological sampling data were compared, no statistical difference was found. When the data of the areas stained with fluorescent gel before and after the cleaning were compared, it was observed that there was a statistical difference. It was revealed that the bedside and the bed controller were mostly contaminated in both methods. Conclusions: It was concluded that BCA was an effective method that could be used to evaluate the cleaning applied to the infected patient unit. It is thought that cleaning only areas that are considered to be contaminated after evaluating the cleaning with an effective method will prevent contamination due to cleaning and will provide more positive results in terms of time, labor, and cost. The control of cleanliness using objective methods can help maintain a safe environment. This study is registered to ClinicalTrials.gov with the number ID:NCT04212130.

A Qualitative Study of Factors Influencing Unsafe Work Behaviors Among Environmental Service Workers: Perspectives of Workers, and Safety Managers: The Case of Government Hospitals in Addis Ababa, Ethiopia

BACKGROUND

Environmental Service (EVS) is a term that refers to cleaning in healthcare facilities. EVS personnel are exposed to a variety of hazards, including physical, chemical, ergonomic, cognitive, and biological hazards that contribute to the development of diseases and disabilities. Recognizing the conditions that promote unsafe behavior is the first step in reducing such hazards. The purpose of this study was to (a) investigate the attitudes and perceptions of safety among employees and safety managers in Addis Ababa hospitals, and (b) figure out what factors inhibit healthy work behaviors.

METHODS

The data for this study was gathered using 2 qualitative data gathering methods: key informant interviews and individual in-depth interviews. About 25 personnel from 3 Coronavirus treatment hospitals were interviewed to understand more about the factors that make safe behavior challenging. The interviews were recorded, transcribed, and then translated into English. Open Code 4.02 was used for thematic analysis.

RESULTS

Poor safety management and supervision, a hazardous working environment, and employee perceptions, skills, and training levels were all identified as key factors in the preponderance of unsafe work behaviors among environmental service workers.

CONCLUSIONS

Different types of personal and environmental factors were reported to affect safe work behavior among environmental service personnel. Individual responsibility is vital in reducing or eliminating these risk factors for unsafe behaviors, but management's involvement in providing resources for safe work behavior is critical.

Environmental cleaning and infection prevention and control: The role of Patient Service Assistants

BACKGROUND

In Australia, Patient Service Assistants are an integral part of all health care settings, yet there is a paucity of studies considering their understandings and perceptions of their role about infection prevention and control. The aim in this study was to explore haematology Personal Service Assistants' experience, understanding and perceptions of their role in improving patient safety through environmental cleaning.

METHODS

A qualitative exploratory descriptive design was utilised to collect data from cleaning staff via focus groups. Three semi-structured focus groups were conducted.

RESULTS

Seven Patient Service Assistants participated in the study out of 11 employed. Two key themes emerged from the thematic analysis: (1) Playing a major role in Infection Prevention and Control, and (2) prioritising good interpersonal relationships over promoting infection prevention and control. Patient Service Assistants emphasised the importance of their involvement in keeping the ward clean, including patients' rooms and surroundings, to prevent cross infection. Most participants underlined the dilemmas they faced when visitors and/or informal cleaning employees or casual ward staff did not adhere to ward infection prevention and control norms.

CONCLUSION

Patient Service Assistants were employing key infection prevention and control principles in their ward cleaning routine, with the aim of achieving a safer patient environment although they were reluctant to challenge observed practice deviations. The role of Patient Service Assistants highlights the widely held misconception that patient safety is solely dependent on healthcare workers.

Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: a systematic review

BACKGROUND

Healthcare-associated infections (HAI) are one of the gravest threats to patient safety worldwide. The importance of the hospital environment has recently been revalued in infection prevention and control. Though the literature is evolving rapidly, many institutions still do not consider healthcare environmental hygiene (HEH) very important for patient safety. The evidence for interventions in the healthcare environment on patient colonization and HAI with multidrug-resistant microorganisms (MDROs) or other epidemiologically relevant pathogens was reviewed.

METHODS

We performed a systematic review according to the PRISMA guidelines using the PubMed and Web of Science databases. All original studies were eligible if published before December 31, 2019, and if the effect of an HEH intervention on HAI or patient colonization was measured. Studies were not eligible if they were conducted in vitro, did not include patient colonization or HAI as an outcome, were bundled with hand hygiene interventions, included a complete structural rebuild of the healthcare facility or were implemented during an outbreak. The primary outcome was the comparison of the intervention on patient colonization or HAI compared to baseline or control. Interventions were categorized by mechanical, chemical, human factors, or bundles. Study quality was assessed using a specifically-designed tool that considered study design, sample size, control, confounders, and issues with reporting. The effect of HEH interventions on environmental bioburden was studied as a secondary outcome.

FINDINGS

After deduplication, 952 records were scrutinized, of which 44 were included for full text assessment. A total of 26 articles were included in the review and analyzed. Most studies demonstrated a reduction of patient colonization or HAI, and all that analyzed bioburden demonstrated a reduction following the HEH intervention. Studies tested mechanical interventions (n = 8), chemical interventions (n = 7), human factors interventions (n = 3), and bundled interventions (n = 8). The majority of studies (21/26, 81%) analyzed either S. aureus, C. difficile, and/or vancomycin-resistant enterococci. Most studies (23/26, 88%) reported a decrease of MDRO-colonization or HAI for at least one of the tested organisms, while 58% reported a significant decrease of MDRO-colonization or HAI for all tested microorganisms. Forty-two percent were of good quality according to the scoring system. The majority (21/26, 81%) of study interventions were recommended for application by the authors. Studies were often not powered adequately to measure statistically significant reductions.

INTERPRETATION

Improving HEH helps keep patients safe. Most studies demonstrated that interventions in the hospital environment were related with lower HAI and/or patient colonization. Most of the studies were not of high quality; additional adequately-powered, high-quality studies are needed. Systematic registration number: CRD42020204909.

Rapid disinfection of radiology treatment rooms using an autonomous ultraviolet germicidal irradiation robot

BACKGROUND

Ultraviolet germicidal irradiation (UVGI) technologies have emerged as a promising adjunct to manual cleaning, however, their potential to shorten cleaning times remains unexplored.

METHODS

A <10-minute disinfection procedure was developed using a robotic UVGI platform. The efficacy and time to perform the UVGI procedure in a CT scan treatment room was compared with current protocols involving manual disinfection using biocides. For each intervention, environmental samples were taken at 12 locations in the room before and after disinfection on seven distinct occasions.

RESULTS

The mean UVC dose at each sample location was found to be 13.01 ± 4.36 mJ/cm², which exceeded published UVC thresholds for achieving log reductions of many common pathogens. Significant reductions in microbial burden were measured after both UVGI (P≤.001) and manual cleaning (P≤.05) conditions, with the UVGI procedure revealing the largest effect size (r = 0.603).

DISCUSSION

These results support the hypothesis that automated deployments of UVGI technology can lead to germicidal performance that is comparable with, and potentially better than, current manual cleaning practices.

CONCLUSIONS

Our findings provide early evidence that the incorporation of automated UVGI procedures into cleaning workflow could reduce turnaround times in radiology, and potentially other hospital settings.

Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

INTRODUCTION

The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient's experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening's implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal.

METHODS

In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization's six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines.

RESULTS

Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients' thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system.

CONCLUSION

This study approached a unique way to strengthen the health system by exploring patients' feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government's role to continue its efforts to strengthen the health system.

The dialysis facility levels and sizes are associated with outcomes of incident hemodialysis patients

The outcomes of patients with incident kidney failure who start hemodialysis are influenced by several factors. Whether hemodialysis facility characteristics are associated with patient outcomes is unclear. We included adults diagnosed as having kidney failure requiring hemodialysis during January 1, 2001 to December 31, 2013 from the Taiwan National Health Insurance Research Database to perform this retrospective cohort study. The exposures included different sizes and levels of hemodialysis facilities. The outcomes were all-cause mortality, cardiovascular death, infection-related death, hospitalization, and kidney transplantation. During 2001-2013, we identified 74,406 patients and divided them in to three groups according to the facilities where they receive hemodialysis: medical center (n = 8263), non-center hospital (n = 40,008), and clinic (n = 26,135). The multivariable Cox model demonstrated that a larger facility size was associated with a low mortality risk (hazard ratio [HR] 0.991, 95% confidence interval [95% CI] 0.984-0.998; every 20 beds per facility). Compared with medical centers, patients in non-center hospitals and clinics had higher mortality risks (HR 1.13, 95% CI 1.09-1.17 and HR 1.11, 95% CI 1.06-1.15, respectively). Patients in medical centers and non-center hospitals had higher risk of hospitalization (subdistribution HR [SHR] 1.11, 95% CI 1.10-1.12 and SHR 1.22, 95% CI 1.21-1.23, respectively). Patients in medical centers had the highest rate of kidney transplantation among the three groups. In patients with incident kidney failure, a larger hemodialysis facility size was associated with lower mortality. Overall, medical center patients had a lower mortality rate and higher transplantation rate, whereas clinic patients had a lower hospitalization risk.

National guidelines for sanitation services: Addressing the unmet need of standardizing cleaning practices in tertiary care public health facilities of a developing country

BACKGROUND

Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities.

OBJECTIVE

To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India.

METHODS

The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping.

RESULTS

Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc.

CONCLUSION

Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.

Fighting Antibiotic Resistance in Hospital-Acquired Infections: Current State and Emerging Technologies in Disease Prevention, Diagnostics and Therapy

Rising antibiotic resistance is a global threat that is projected to cause more deaths than all cancers combined by 2050. In this review, we set to summarize the current state of antibiotic resistance, and to give an overview of the emerging technologies aimed to escape the pre-antibiotic era recurrence. We conducted a comprehensive literature survey of >150 original research and review articles indexed in the Web of Science using "antimicrobial resistance," "diagnostics," "therapeutics," "disinfection," "nosocomial infections," "ESKAPE pathogens" as key words. We discuss the impact of nosocomial infections on the spread of multi-drug resistant bacteria, give an overview over existing and developing strategies for faster diagnostics of infectious diseases, review current and novel approaches in therapy of infectious diseases, and finally discuss strategies for hospital disinfection to prevent MDR bacteria spread.

Factors associated with environmental service worker cleaning practices in health care settings: A systematic review of the literature

INTRODUCTION

Health care-associated infections can be reduced through better environmental disinfection practices. Central to effective disinfection is the environmental service worker (ESW). The aim of this systematic literature review was to identify factors associated with the disinfection practices of ESWs in health care settings.

METHODS

A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Ten online databases and search engines were selected for the review of English-language studies published between 2000 and 2019.

RESULTS

Thirty-one (31) eligible studies were identified. Environmental disinfection was associated with many factors (eg, knowledge, perceptions) as well as ESW exposure to education/training sessions. When education/training was combined with performance evaluation/feedback, significant improvement in ESW disinfection practices was reported.

CONCLUSIONS

To sustain improvements in disinfection practices, education/training sessions need to be continuous. The long-term commitment of an organization is also essential for continuous improvement in disinfection outcomes. While knowledge transfer is critical for behavior change, education/training also needs to focus on the skills and perceptions of ESWs. Future studies need to use a randomized controlled design with larger sample sizes to determine a true effect.

Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review

BACKGROUND

Knowledge of infection prevention and control (IPC) procedures among healthcare workers (HCWs) is crucial for effective IPC. Compliance with IPC measures has critical implications for HCWs safety, patient protection and the care environment.

AIMS

To discuss the body of available literature regarding HCWs' knowledge of IPC and highlight potential factors that may influence compliance to IPC precautions.

DESIGN

A systematic review. A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis [PRISMA] statement.

DATA SOURCES

Electronic databases (PubMed, CINAHL, Embase, Proquest, Wiley online library, Medline, and Nature) were searched from 1 January 2006 to 31 January 2021 in the English language using the following keywords alone or in combination: knowledge, awareness, healthcare workers, infection, compliance, comply, control, prevention, factors. 3417 papers were identified and 30 papers were included in the review.

RESULTS

Overall, the level of HCW knowledge of IPC appears to be adequate, good, and/or high concerning standard precautions, hand hygiene, and care pertaining to urinary catheters. Acceptable levels of knowledge were also detected in regards to IPC measures for specific diseases including TB, MRSA, MERS-CoV, COVID-19 and Ebola. However, gaps were identified in several HCWs' knowledge concerning occupational vaccinations, the modes of transmission of infectious diseases, and the risk of infection from needle stick and sharps injuries. Several factors for noncompliance surrounding IPC guidelines are discussed, as are recommendations for improving adherence to those guidelines.

CONCLUSION

Embracing a multifaceted approach towards improving IPC-intervention strategies is highly suggested. The goal being to improve compliance among HCWs with IPC measures is necessary.

Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review

Healthcare-associated infections (HAIs) are the most common adverse outcomes due to delivery of medical care. HAIs increase morbidity and mortality, prolong hospital stay, and are associated with additional healthcare costs. Contaminated surfaces, particularly those that are touched frequently, act as reservoirs for pathogens and contribute towards pathogen transmission. Therefore, healthcare hygiene requires a comprehensive approach whereby different strategies may be implemented together, next to targeted, risk-based approaches, in order to reduce the risk of HAIs for patients. This approach includes hand hygiene in conjunction with environmental cleaning and disinfection of surfaces and clinical equipment. This review focuses on routine environmental cleaning and disinfection including areas with a moderate risk of contamination, such as general wards. As scientific evidence has not yet resulted in universally accepted guidelines nor led to universally accepted practical recommendations pertaining to surface cleaning and disinfection, this review provides expert guidance for healthcare workers in their daily practice. It also covers outbreak situations and suggests practical guidance for clinically relevant pathogens. Key elements of environmental cleaning and disinfection, including a fundamental clinical risk assessment, choice of appropriate disinfectants and cleaning equipment, definitions for standardized cleaning processes and the relevance of structured training, are reviewed in detail with a focus on practical topics and implementation.

The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

BACKGROUND

Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania.

METHODS

This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context.

RESULTS

Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11-1.60), and by 1.08 (CI = 1.03-1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies.

CONCLUSIONS

The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review

Background

Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries.

The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions.

Method

This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs.

Results

From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding.

Conclusion

Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.

Implementation of human factors engineering approach to improve environmental cleaning and disinfection in a medical center

Background

Inadequate hospital cleaning may contribute to cross-transmission of pathogens. It is important to implement effective cleaning for the safe hospital environment. We conducted a three-phase study using human factors engineering (HFE) approach to enhance environmental cleanliness.

Methods

This study was conducted using a prospective interventional trial, and 28 (33.3%) of 84 wards in a medical center were sampled. The three-phases included pre-intervention analysis (Phase 1), implementing interventions by HFE principles (Phase 2), and programmatic analysis (Phase 3). The evaluations of terminal cleaning and disinfection were performed using the fluorescent marker, the adenosine triphosphate bioluminescence assay, and the aerobic colony count method simultaneously in all phases. Effective terminal cleaning and disinfection was qualified with the aggregate outcome of the same 10 high-touch surfaces per room. A score for each high-touch surface was recorded, with 0 denoting a fail and 10 denoting a pass by the benchmark of the evaluation method, and the total terminal cleaning and disinfection score (TCD score) was a score out of 100.

Results

In each phase, 840 high-touch surfaces were collected from 84 rooms after terminal cleaning and disinfection. After the interventions, the TCD score by the three evaluation methods all showed significant improved. The carriage incidence of multidrug-resistant organism (MDRO) decreased significantly from 4.1 per 1000 patient-days to 3.6 per 1000 patient-days (P = .03).

Conclusion

The HFE approach can improve the thoroughness and the effectiveness of terminal cleaning and disinfection, and resulted in a reduction of patient carriage of MDRO at hospitals. Larger studies are necessary to establish whether such efforts of cleanliness can reduce the incidence of healthcare-associated infection.

Hospital environment hygiene nurse: a key player to reduce healthcare associated infections by multi-resistant organisms

Background

Multi-Resistant Organisms (MRO) healthcare-associated infections (HAI) are closely associated with contamination of surfaces. Outsourced companies are usually in charge of both hospital hygiene and environmental hygiene personnel (EHP) supervision, which can result in bias.

Methods

A quasi-experimental study. The intervention was to add the "Hospital Environment Hygiene Nurse" (HEHN). MRO acquired infection rate and MRO acquired colonized rate were calculated, pre and post intervention. Confounding variables: MRO carriage rate upon admission and hospitalisation days median (HDM) were calculated.

Results

Median length of stay: 5 days (p=0.85, interquartile range=6 days). Carriage rate upon admission: 4.3% for pre-intervention vs 5.3% post-intervention, dif. (CI 95%): 1% (-1% to 2.9%) p=0.33. MRO acquired infection rate: 4.3% for pre-intervention vs. 2% post-intervention, Standardized Infection Ratio (SIR) (CI 95%): 0.47 (0.25 to 0.87). MRO acquired colonization rate:10.4% for pre-intervention vs. 7.9% post-intervention, SIR (CI 95%): 0.75 (0.53 to 1.07).

Conclusions

As a reinforcement to standard infection control (IC) measures in place, the incorporation of an exclusive, full-time HEHN was significantly useful to reduce MRO HAI.

Efficacy of pulsed-xenon ultraviolet light for disinfection of high-touch surfaces in an Ecuadorian hospital

Background

Hospital environment in patient care has been linked on healthcare-associated infections (HAI). No touch disinfection technologies that utilize pulsed xenon ultraviolet light has been recognized to prevent infection in contaminated environments. The purpose of this study was: 1) to evaluate the effectiveness of pulsed-xenon ultraviolet light (PX-UV) disinfection for the reduction of bacteria on environmental surfaces of Hospital General Enrique Garcés, and 2) to evaluate the in-vitro efficacy against multi-drug resistance microorganisms.

Methods

This was a quality-improvement study looking at cleaning and disinfection of patient areas. During the study, a total of 146 surfaces from 17 rooms were sampled in a secondary 329-bed public medical center. Microbiological samples of high-touch surfaces were taken after terminal manual cleaning and after pulsed xenon ultraviolet disinfection. Cleaning staff were blinded to the study purpose and told clean following their usual protocols. For positive cultures PCR identification for carbapenemase-resistance genes (blaKPC, blaIMP, blaVIM, and blaNDM) were analyzed and confirmed by sequencing. The total number of colony forming units (CFU) were obtained and statistical analyses were conducted using Wilcoxon Rank Sum tests to evaluate the difference in CFU between terminal manual cleaning and after pulsed xenon ultraviolet disinfection.

Results

After manual disinfection of 124 surfaces showed a total of 3569 CFU which dropped to 889 CFU in 80 surfaces after pulsed xenon disinfection (p < 0.001). Overall, the surface and environmental contamination was reduced by 75% after PX-UV compared to manual cleaning and disinfection. There were statistically significant decreases in CFU counts of high touch surfaces in OR 87% (p < 0.001) and patient rooms 76% (p < 0.001). Four rooms presented serine carbapenemases blaKPC, and metallo beta-lactamases blaNDM, blaVIM, blaIMP. confirmed by PCR and sequencing. The in-vitro testing with endemic strains found that after five minutes of pulsed xenon ultraviolet exposure an 8-log reduction was achieved in all cases.

Conclusion

This study is one of the first of its kind in an Ecuador Hospital. We found that pulsed-xenon ultraviolet disinfection technology is an efficacious complement to the established manual cleaning protocols and guidelines in the significant reduction of MDRO.

The effectiveness of a novel colorant additive in the daily cleaning of patient rooms

The quality of daily cleaning was assessed comparing a standard bleach product with the bleach product containing a novel colorant additive in an inpatient setting. Effectiveness was assessed using fluorescent markings and microbiological analysis of environmental and experimental specimens. Our findings showed no significant difference in cleaning between these groups.