Infection control link nurses in acute care hospitals: a scoping review

Nurses' preferences for interventions to improve infection prevention and control behaviors based on systems engineering initiative to patient safety model: a discrete choice experiment

BACKGROUND

The evidence of preferences for infection prevention and control (IPC) intervention from system perspective was lacked. This study aimed to elicit nurses' preferences for the intervention designed to improve IPC behaviors based on the Systems Engineering Initiative to Patient Safety (SEIPS) model using Discrete Choice Experiment (DCE).

METHODS

A DCE was conducted among nurses who were on active duty and willing to participate from July 5th to 10th, 2021 in a tertiary hospital in Ganzhou City, Jiangxi Province, using convenience sampling. A self-administered questionnaire included scenarios formed by six attributes with varying levels based on SEIPS model: person, organization, tools and technology, tasks, internal environment and external environment. A conditional logit and latent class logit model were performed to analyze the data.

RESULTS

A total of 257 valid questionnaires were analyzed among nurses. The results from the latent class logit model show that nurses' preferences can be divided into three classes. For nurses in multifaceted-aspect-preferred class (41.9%), positive coefficients were obtained in those six attributes. For person-preferred class (19.7%), only person was positively significant. For environment-preferred class (36.4%), the most important attribute were tasks, tools and technology, internal environment and external environment.

CONCLUSIONS

This finding suggest that nurses have three latent-class preferences for interventions. Multifaceted interventions to improve IPC behaviors based on the SEIPS model are preferred by most nurses. Moreover, relevant measured should be performed targeted the latent class of person-preferred and external-environment-preferred nurses.

Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study

BACKGROUND

Standard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses.

METHODS

A quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size.

RESULTS

After developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (β = 5.18; 95% CI= -0.3-10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (β = 20.82; 95% CI 16.40-25.25, p < 0.001).

CONCLUSIONS

Given the continuing level of interest that exists in improving health care workers' hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.

Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales

Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU.

Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework

BACKGROUND

Important elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines.

METHODS

We used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance.

RESULTS

Between 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance).

CONCLUSIONS

Our infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.

Infection prevention and control in Indonesian hospitals: identification of strengths, gaps, and challenges

BACKGROUND

Infection prevention and control (IPC) in hospitals is key to safe patient care. There is currently no data regarding the implementation of IPC in hospitals in Indonesia. The aim of this study was to assess the existing IPC level in a nationwide survey, using the World Health Organization (WHO) IPC assessment framework tool (IPCAF), and to identify strengths, gaps, and challenges.

METHODS

A cross-sectional study was conducted from July to November 2021. Of all general hospitals in Indonesia, 20% (N = 475) were selected using stratified random sampling based on class (A, B, C and D; class D with a maximum of 50 beds and class A with ≥ 250 beds) and region. The IPCAF was translated into Indonesian and tested in four hospitals. Questions were added regarding challenges in the implementation of IPC. Quantitative IPCAF scores are reported as median (minimum-maximum). IPC levels were calculated according to WHO tools.

RESULTS

In total, 355 hospitals (74.7%) participated in this study. The overall median IPCAF score was 620.0 (535.0-687.5). The level of IPC was mostly assessed as advanced (56.9% of hospitals), followed by intermediate (35.8%), basic (7.0%) and inadequate (0.3%). In the eastern region of the country, the majority of hospitals scored intermediate level. Of the eight core components, the one with the highest score was IPC guidelines. Almost all hospitals had guidelines on the most important topics, including hand hygiene. Core components with the lowest score were surveillance of healthcare-associated infections (HAIs), education and training, and multimodal strategies. Although > 90% of hospitals indicated that surveillance of HAIs was performed, 57.2% reported no availability of adequate microbiology laboratory capacity to support HAIs surveillance. The most frequently reported challenges in the implementation of IPC were communication with the management of the hospitals, followed by the unavailability of antimicrobial susceptibility testing results and insufficient staffing of full-time IPC nurses.

CONCLUSION

The IPC level in the majority of Indonesian hospitals was assessed as advanced, but there was no even distribution over the country. The IPCAF in combination with interviews identified several priority areas for interventions to improve IPC in Indonesian hospitals.

Effectiveness of Infection Control Teams in Reducing Healthcare-Associated Infections: A Systematic Review and Meta-Analysis

The infection control team (ICT) ensures the implementation of infection control guidelines in healthcare facilities. This systematic review aims to evaluate the effectiveness of ICT, with or without an infection control link nurse (ICLN) system, in reducing healthcare-associated infections (HCAIs). We searched four databases to identify randomised controlled trials (RCTs) in inpatient, outpatient and long-term care facilities. We judged the quality of the studies, conducted meta-analyses whenever interventions and outcome measures were comparable in at least two studies, and assessed the certainty of evidence. Nine RCTs were included; all were rated as being low quality. Overall, ICT, with or without an ICLN system, did not reduce the incidence rate of HCAIs [risk ratio (RR) = 0.65, 95% confidence interval (CI): 0.45-1.07], death due to HCAIs (RR = 0.32, 95% CI: 0.04-2.69) and length of hospital stay (42 days vs. 45 days, p = 0.52). However, ICT with an ICLN system improved nurses' compliance with infection control practices (RR = 1.17, 95% CI: 1.00-1.38). Due to the high level of bias, inconsistency and imprecision, these findings should be considered with caution. High-quality studies using similar outcome measures are needed to demonstrate the effectiveness and cost-effectiveness of ICT.

Strategies to improve the implementation of infection control link nurse programs in acute care hospitals

BACKGROUND

Infection control practitioners face several challenges when implementing infection control link nurse (ICLN) programs. Identification of strategies to address these can improve the impact of current ICLN programs and guide their future implementation.

AIM

We aimed to identify implementation strategies for ICLN programs in acute care hospitals with the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching tool.

METHODS

An expert panel matched 19 implementation and sustainment barriers, identified i n our previous studies, to the most fitting CFIR constructs. Subsequently, we applied the CFIR- ERIC Matching Tool and generated a list of implementation strategies to address these barriers.

FINDINGS

Barriers were predominantly found within the CFIR domains 'inner setting' (characteristics of the implementing organization) and 'process' (stages of implementation). With the ERIC Matching Tool we identified the ten most important strategies to address barriers of implementation of ICLN programs: identify and prepare champions, conduct local consensus discussions, assess for readiness and identify barriers and facilitators, inform local opinion leaders, use facilitation, create a learning collaborative, conduct local needs assessments, develop a formal implementation blueprint, build a coalition, and identify early adopters.

CONCLUSION

The CFIR domains 'inner setting' and 'process' appeared as most important to impede implementation of ICLN programs in acute care hospitals. Application of the CFIR-ERIC tool highlighted the identification and preparation of champions as the leading strategy for the successful implementation of these programs. With this tool, strategies can be specifically tailored towards local implementation and sustainment barriers.

Role perception of infection control link nurses; a multi-centre qualitative study

Background

Infection control link nurses (ICLN) disseminate knowledge on infection prevention topics to their peers. Little is known about how they succeed and thereby contribute to infection prevention in daily practise.

Aim

To explore the experiences of infection control link nurses regarding their role in acute care hospitals and identify perceived facilitators and best practices.

Methods

We conducted a qualitative study with semi-structured individual and focus group interviews with ICLN. The effect of COVID-19 on the ICLN role was added as a topic in focus group interviews during the pandemic.

Results

Twenty-six ICLN working in acute care hospitals were interviewed. ICLN perceived their role as to identify, monitor, facilitate and inform their colleagues on infection prevention topics related to their ward. Their experiences vary from feeling challenged and wonder how to get started, to feeling confident and taking initiatives that lead to ward-based improvements. When inspired by each other and supported by infection control practitioners or managers, ICLN feel empowered to initiate more activities to improve practice. During the COVID-19 pandemic, ICLN felt their responsibilities were magnified. When transferred to another ward, the focus on the ICLN role seemed dispersed.

Discussion

Empowered ICLN adjust and operationalize infection prevention policies to fit the conditions of their specific wards and provide practical instructions and feedback to their peers which enable better compliance to infection prevention policies. Support and inspiration from other ICLN, infection control practitioners and management contribute to this empowerment and consequently to taking impactful initiatives to improve practice.

Development and evaluation of an intravascular link nurse network to sustain improvements in practice

Link nurses have been used to support many areas of specialist nursing practice since the 1980s. They add value as they provide a practical and timely way of sharing information and knowledge and raising awareness with the wider multidisciplinary team. One strategy to improve standards and sustain improvements in the care of vascular access devices was to develop an intravascular link nurse network: 'Finding the missing link'. The link nurses are supported to attend quarterly masterclasses underpinned by the current evidence base. The masterclasses provide forums and workshops for learning, sharing initiatives, processes, progress and feedback. Results from the 2018/2019 sessions evaluation showed that 80% of the link nurses scored the workshops as excellent, 14% good, less than 1% fair and poor, and 4% did not provide an answer. Overall, 87% of link nurses were extremely likely to recommend the programme, 13% were likely to recommend it, and 93% found it helpful in their personal and professional growth. The network with supporting masterclasses has proven to be an effective strategy within the Trust.

Infection control teams for reducing healthcare-associated infections in hospitals and other healthcare settings: a protocol for systematic review

INTRODUCTION

Healthcare-associated infections (HCAIs) are a worldwide problem. Infection control in hospitals is usually implemented by an infection control team (ICT). Initially, ICTs consisted of doctors, nurses, epidemiologists and microbiologists; then, in the 1980s, the infection control link nurse (ICLN) system was introduced. ICTs (with or without the ICLN system) work to ensure the health and well-being of patients and healthcare professionals in hospitals and other healthcare settings, such as acute care clinics, community health centres and care homes. No previous study has reported the effects of ICTs on HCAIs. This systematic review aims to assess the effectiveness of ICTs with or without the ICLN system in reducing HCAIs in hospitals and other healthcare settings.

METHODS AND ANALYSIS

We will perform a comprehensive literature search for randomised controlled trials in four databases: PubMed, Embase, CINAHL and the Cochrane Library. The primary outcomes are: patient-based/clinical outcomes (rate of HCAIs, death due to HCAIs and length of hospital stay) and staff-based/behavioural outcomes (compliance with infection control practices). The secondary outcomes include the costs to the healthcare system or patients due to extended lengths of stay. Following data extraction, we will assess the risk of bias by using the Cochrane Effective Practice and Organization of Care risk of bias tool. If data can be pooled across all the studies, we will perform a meta-analysis.

ETHICS AND DISSEMINATION

We will use publicly available data, and therefore, ethical approval is not required for this systematic review. The findings will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

CRD42020172173.

Effectiveness of implementing link nurses and audits and feedback to improve nurses' compliance with standard precautions: A cluster randomized controlled trial

BACKGROUND

To prevent health care-associated infections, health organizations recommend that health care workers stringently observe standard precautions (SPs). Nevertheless, compliance with SPs is still suboptimal, emphasizing the need for improvement interventions.

METHODS

A cluster randomized controlled trial with a pretest-post-test design was conducted with 121 clinical nurses who worked in different wards of a university hospital. The intervention group (n = 61) had 3 infection control link nurses nominated and attended systematic audits and feedback. The control group (n = 60) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of SPs compliance was performed via the World Health Organization observational hand hygiene form and Compliance with Standard Precaution Scale Italian version.

RESULTS

At the post-test, nurses in the intervention group reported significantly increased compliance with hand hygiene, whereas no significant improvement was found in the control group. Nurses in both groups reported significantly increased Compliance with Standard Precaution Scale Italian version scores; however, a higher increase and practical significance was observed in the intervention group. Participants who improved their scores were also compared between groups, showing a significantly greater increase of individual scores in intervention group compared to the control group.

CONCLUSIONS

The findings of this study provide significant practical implications for hospitals seeking to improve compliance with SPs among nurses, showing the effectiveness of using infection control link nurses combined with systematic audits and feedback.

Hospital preparedness and management of pediatric population during COVID-19 outbreak

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

Infection control link nurse programs in Dutch acute care hospitals; a mixed-methods study

Background

Infection control link nurse programs show considerable variation. We report how Dutch link nurse programs are organized, how they progress, and how contextual factors may play a role in the execution of these programs.

Methods

This mixed-methods study combined a survey and semi-structured interviews with infection control practitioners, based on items of the Template for Intervention Description and Replication (TIDieR) checklist.

Results

The Netherlands has 74 hospitals; 72 infection control practitioners from 72 different hospitals participated in the survey. Four of these infection control practitioners participated in interviews. A link nurse program was present in 67% of the hospitals; responsibility for 76% of these programs lied solely with the infection prevention and control team. The core component of most programs (90%) was education. Programs that included education on infection prevention topics and training in implementation skills were perceived as more effective than programs without such education or programs where education included only infection prevention topics.

The interviews illustrated that these programs were initiated by the infection prevention team with the intention to collaborate with other departments to improve practice. Content for these programs was created at the time of their implementation. Infection control practitioners varied in their ability to express program goals and to engage experts and key stakeholders.

Conclusions

Infection control link nurse programs vary in content and in set up. Programs with a clear educational content are viewed as more successful by the infection control practitioners that implement these programs.