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Nettelrodt KME, Tomsic I, Stolz M, Krauth C, Chaberny IF, von Lengerke T. Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study. Psychol Res Behav Manag 2024; 17:2757-2767. [PMID: 39070067 PMCID: PMC11283262 DOI: 10.2147/prbm.s464335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. Participants and Methods N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. Results The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only. Conclusion The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.
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Affiliation(s)
- Karolin M E Nettelrodt
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Maike Stolz
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
- Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
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Bushuven S, Bentele M, Bentele S, Trifunovic-Koenig M, Lederle S, Gerber B, Bansbach J, Friebel J, Ganter J, Nachtigall I, Scheithauer S. Hand hygiene in emergencies: Multiprofessional perceptions from a mixed methods based online survey in Germany. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100207. [PMID: 38783870 PMCID: PMC11111829 DOI: 10.1016/j.ijnsa.2024.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Despite high vulnerability to infection, hand disinfection compliance in emergencies is low. This is regularly justified as the disinfection procedure delays life support, and instead, wearing disposable gloves is preferred. Simulation studies showed higher achievable compliance than detected in real-life situations. This study aimed to explore healthcare providers' attitudes toward hand disinfection and using gloves in emergencies. Methods We conducted an anonymous online survey in Germany on the attitude and subjective behavior in the five moments of hand hygiene in a closed environment and an open convenience sampling survey. Statistics included paired student's t-tests corrected for multiple testing. For qualitative analysis, we employed a single-coder approach. Results In 400 participants, we detected low priority of WHO-1 (before touching a patient) and WHO-2 (before clean/aseptic procedure) hand hygiene moments, despite knowing the risks of omission of hand disinfection. For all moments, self-assessment exceeded the assessment of colleagues (p < 0.001). For WHO-3, we detected a lower disinfection priority for wearing gloves compared to contaminated bare hands. Qualitative analyses revealed five themes: basic conditions, didactic implementations, cognitive load, and uncertainty about feasibility and efficacy. Discussion Considering bias, the study's subjective nature, the unknown role of emergency-related infections contributing to hospital-acquired infections, and different experiences of healthcare providers, we conclude that hand disinfection before emergencies is de-prioritized and justified by the emergency situation regardless of the objective feasibility. Conclusion This study reveals subjective and objective barriers to implementation of WHO-1 and WHO-2 moments of hand disinfection to be further evaluated and addressed in educational programs.
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Affiliation(s)
- Stefan Bushuven
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Hegau Bodensee Hospital Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Department for Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | | | - Sven Lederle
- St Johns Ambulance, Local Association Singen am Hohentwiel, Singen, Germany
| | - Bianka Gerber
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Julian Friebel
- Emergency Medical Services Department, Berlin Fire and Rescue Service, Berlin, Germany
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC),Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Ganter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Irit Nachtigall
- Helios, Region East Infectious Diseases and Antibiotic Stewardship and Medical School Berlin, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Germany
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Bushuven S, Bentele M, Trifunovic-Koenig M, Gerber B, Bentele S, Hagen F, Schoeffski O, Marung H, Strametz R. Learning motivation and self-assessment in health economics: a survey on overconfidence in healthcare providers. BMJ Open 2024; 14:e079319. [PMID: 38684267 PMCID: PMC11057277 DOI: 10.1136/bmjopen-2023-079319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Lifelong learning is the foundation for professionals to maintain competence and proficiency in several aspects of economy and medicine. Until now, there is no evidence of overconfidence (the belief to be better than others or tested) and clinical tribalism (the belief that one's own group outperforms others) in the specialty of health economics. We investigated the hypothesis of overconfidence effects and their relation to learning motivation and motivational patterns in healthcare providers regarding healthcare economics. METHODS We conducted a national convenience online survey of 116 healthcare workers recruited from social and personal networks to detect overconfidence effects and clinical tribalism and to assess learning motivation. Instruments included self-assessments for five learning dimensions (factual knowledge, skills, attitude, problem-solving and behaviour) and a four-item situational motivation scale. The analysis comprised paired t-tests, correlation analyses and two-step cluster analyses. RESULTS We detected overplacement, overestimation and signs of clinical tribalism. Responders in the physician subgroup rated themselves superior to colleagues and that their professional group was superior to other professions. Participants being educators in other competencies showed high overconfidence in health economics. We detected two groups of learners: overconfident but motivated persons and overconfident and unmotivated learners. Learning motivation did not correlate with overconfidence effects. DISCUSSION We could show the presence of overconfidence in health economics, which is consistent with studies in healthcare and the economy. The subjective perception of some medical educators, being role models to students and having a superior 'attitude' (eg, morality) concerning the economy may foster prejudice against economists as students might believe them. It also may aggravate moral distress and disrupts interactions between healthcare providers managers and leaders. Considering the study's limitations, lifelong interprofessional and reflective training and train-the-trainer programmes may be mandatory to address the effects.
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Affiliation(s)
- Stefan Bushuven
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Freiburg, Germany
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), Engen, Germany
- Institute for Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Singen, Germany
| | - Milena Trifunovic-Koenig
- Training Center for Emergency Medicine (NOTIS e.V.), Engen, Germany
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Bianka Gerber
- Training Center for Emergency Medicine (NOTIS e.V.), Engen, Germany
- Institute for Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V.), Engen, Germany
- Department for Emergency Medicine, University of Augsburg, Augsburg, Germany
| | - Fritz Hagen
- Department of Emergency Medicine, Paramedic and Fire Academy, Munich, Germany
| | - Oliver Schoeffski
- Chair of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Hartwig Marung
- Department Health Sciences, MSH Medical School Hamburg, Hamburg, Germany
| | - Reinhard Strametz
- Wiesbaden Institute for Healthcare Economics and Patient Safety, Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany
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Tingelhoff PD, Hufert F, Kiessling C, Otto B. Infection prevention in medical education - results of a descriptive cross-sectional study in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc4. [PMID: 38504860 PMCID: PMC10946213 DOI: 10.3205/zma001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/02/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Objective The aim of the study was to assess the current curricular status of content on infection prevention in hospitals during medical education prior to the development of a serious game on infection prevention in hospitals. In addition, the data collected was to be contrasted with the training for a specialist nurse in hygiene and infection prevention (FKHI). Methodology In an online survey, persons in charge of medical degree programs and continuing education centers for FKHI, SkillsLabs and professional associations in Germany were asked to answer 28 questions on framework conditions, teaching, examinations, and gamification. Results Data was collected for 22 medical degree programs and 5 FKHI continuing education centers. Due to the low response rate, the data for the FKHI was only analyzed in summary form. On average, 13.5 teaching units (median) are available in medical studies. Six degree programs have a longitudinal curriculum. In 7 of the 22 degree programs, teaching is based on the National Competency-Based Learning Objectives Catalogue (NKLM). Almost all locations teach this content in lectures (n=18) and/or in internships (n=13). Teaching and examinations are most common in the third year of study (n=12). In addition to practical OSCE examinations (n=5), written (n=12) and computer-based (n=8) examinations are used in particular. Gamification is known as a didactic approach to some extent but is not used for teaching infection prevention. Conclusions Infection prevention in hospitals is given relatively low priority in medical education. Teaching and examinations are based on traditional knowledge-oriented formats, although practical teaching and practical examinations are established at some locations. In contrast to the FKHI, learning objectives currently appear to be less standardized. Further interprofessional development of teaching would be desirable in the future.
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Affiliation(s)
- Paul-Dierk Tingelhoff
- Witten/Herdecke University, Faculty of Medicine, Education of Personal and Interpersonal Competencies in Health Care, Witten, Germany
| | - Frank Hufert
- Brandenburg Medical School Theodor Fontane Senftenberg, Institute of Microbiology and Virology, Senftenberg, Germany
| | - Claudia Kiessling
- Witten/Herdecke University, Faculty of Medicine, Education of Personal and Interpersonal Competencies in Health Care, Witten, Germany
| | - Bertram Otto
- Witten/Herdecke University, Faculty of Medicine, Education of Personal and Interpersonal Competencies in Health Care, Witten, Germany
- Klinikum Ernst von Bergmann, Clinic for Gastroenterology, Hepatology, Infectiology and Rheumatology, Klinikum Potsdam, Germany
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Keil V, Schaumburg T, Buchta F, Luz JK, Kolbe-Busch S, Chaberny IF, von Lengerke T. Improving leadership skills of infection prevention and control teams by psychological empowerment: study protocol for a cluster randomised controlled trial (IP-POWER). BMJ Open 2024; 14:e083806. [PMID: 38346888 PMCID: PMC10862334 DOI: 10.1136/bmjopen-2023-083806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) teams are routinely confronted with intense emotions in their daily work, as they are involved in many change processes with front-line medical staff, for example, when promoting compliance with basic IPC measures. In addition, they are confronted with challenges due to their role as intermediaries. Based on former research, this study aims to empower IPC teams to promote clinicians' compliance through interventions focusing on the IPC teams' leadership skills. METHODS AND ANALYSIS The IP-POWER study (Infection Prevention with head and heart: Psychological empowerment of IPC teams), a multicentre, two-arm, non-blinded, cluster-randomised controlled trial with a parallel waiting control group, is planned to be conducted in Germany as of February to November 2024. A group of 10 voluntary hospitals is going to participate in a multistage intervention programme, including 2 days of intense psychological training; 5 hospitals will be randomly assigned to the waiting control group. After the workshops, there will be a 12-week follow-up period during which the contents learnt within the workshops can be applied and internalised into IPC practice. The proposed outcomes (both self-assessed and other-assessed leadership competencies of IPC team members and their task profiles, perceived workload, motivation to act in order to implement IP measures and goal attainment) are going to be collected with an online questionnaire, followed by an analysis with IBM SPSS (Statistics 29 (or later)) using descriptive analyses and multiple linear regressions. Additionally, as external data sources, hand hygiene compliance rates from the study hospitals' monitoring systems will be analysed using χ² tests. ETHICS AND DISSEMINATION This study was reviewed and approved by the ethics committee of the University of Leipzig (184/23-ek; vote from 4 July 2023). Findings will be disseminated via peer-review publications, and national and international conference presentations. TRIAL REGISTRATION NUMBER DRKS00031879.
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Affiliation(s)
- Valentine Keil
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Tiffany Schaumburg
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Frederike Buchta
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - J Katrin Luz
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Susanne Kolbe-Busch
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Iris Freya Chaberny
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
- Christian-Albrecht University of Kiel, University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
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Bushuven S, Bansbach J, Bentele M, Bentele S, Gerber B, Reinoso-Schiller N, Scheithauer S. Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study. Front Med (Lausanne) 2023; 9:1025449. [PMID: 36687411 PMCID: PMC9853186 DOI: 10.3389/fmed.2022.1025449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background and aim There are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations. Materials and methods In 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated. Results A total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time. Conclusion To the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.
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Affiliation(s)
- Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany,Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany,Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany,*Correspondence: Stefan Bushuven ✉
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Bentele
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany,Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
| | - Stefanie Bentele
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany,Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany,Department of Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Bianka Gerber
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany
| | - Nicolas Reinoso-Schiller
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany
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