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Chen Y, Cao X, Liu C, Sheng W, Wang J, Zhao L. Examining the knowledge level of nurses regarding aseptic non touch technique in nurses: a cross-sectional study. BMC Nurs 2024; 23:525. [PMID: 39085915 PMCID: PMC11293212 DOI: 10.1186/s12912-024-02154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice. METHODS The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses. RESULTS A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master's degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest. CONCLUSIONS ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use.
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Affiliation(s)
- Yilin Chen
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiuzhu Cao
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Chang Liu
- Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wanting Sheng
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jie Wang
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Linfang Zhao
- Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Giustivi D, Baroni M, Di Capua M, Paglia S. On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management. J Vasc Access 2023; 24:1495-1499. [PMID: 35343297 DOI: 10.1177/11297298221086112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND COVID-19 patients require frequent arterial blood gas analysis for the assessment of oxygenation status. OBJECTIVE The main objective of this research is to describe a dedicated protocol developed to standardize the insertion and management of peripheral Arterial Catheters (AC) for on-demand use, in the Emergency Department of "Maggiore" Hospital (Lodi, Italy).This strategy represents a valid alternative to repeated arterial punctures outside the intensive care unit. METHODS The crucial points of the protocol were defined: vessel selection criteria, device used, technique of insertion, choice of securement and dressing device, and procedures had been created for correct management. RESULTS During April and December 2020, 50 AC were inserted, two dislocations and one malfunction were observed. No major complications (Catheter Related Bloodstream Infection, thrombosis, bleeding, pseudoaneurysms, hematoma, artery occlusion - even temporary - and skin irritation) were observed. CONCLUSIONS To the authors knowledge, this is the first article describing the insertion and management of ACs for on-demand utilization outside the intensive care unit. The safe and effective use of this technique could be clinically relevant in patients requiring multiple ABG without need of invasive monitoring; it also allows the reduction of both artery sticks and workload of health care providers. However, clinical studies are needed to confirm the validity of the proposed treatment, especially the use of the most appropriate securement system and the most effective solution for locking catheters.
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Purssell E, Hawker C, Gallagher R, Gould DJ. What techniques are recommended to undertake procedures that require asepsis? Content and cluster analysis of information supplied in international guidance. J Hosp Infect 2023; 139:201-206. [PMID: 37478914 DOI: 10.1016/j.jhin.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Health professionals frequently conduct procedures requiring asepsis but there is no definitive evidence-based guidance on how aseptic technique should be undertaken. OBJECTIVE To undertake content and cluster analysis to compare and contrast information relating to the conduct of aseptic technique in national and international guidance. METHODS Content and hierarchical cluster analysis. RESULTS We identified 16 sources of information from: organizations that generate infection prevention guidelines, provide advice about infection prevention in addition to other topics, generate guidance for procedures (e.g., wound care); practice manuals; MeSH and Wikipedia. Content related to: theory underpinning aseptic technique; terminology used; how and when it should be undertaken; and equipment. The nature and amount of information varied widely. Most frequently stated information related to: environment or equipment (N = 13), followed by the absolute nature of asepsis and the importance of hand hygiene (N = 10); general personal protective equipment, the significance of pathogens, and no-touch techniques (N = 8); that it is risk-based (N = 7); the existence of key parts or sites, and that there are different types of aseptic technique (N = 6). The most comprehensive sources were a wound care organization in the USA, and a British internationally used textbook. Least information was provided in some general infection prevention guidelines. CONCLUSION Progress with research and practice in relation to aseptic technique suffers through lack of common goals and understanding. This study is one step towards establishing what constitutes aseptic technique, how and when it should be conducted, and the equipment necessary. This is required to support practice, policy and education, and may improve sustainability of healthcare resources.
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Affiliation(s)
- E Purssell
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK.
| | - C Hawker
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - R Gallagher
- Nursing Department, Royal College of Nursing, London, UK
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Hagger MS, Hamilton K. Optimizing behavior change through integration of individual- and system-level intervention approaches. Behav Brain Sci 2023; 46:e157. [PMID: 37646242 DOI: 10.1017/s0140525x23001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
We contend that individual-level ("i-frame") intervention strategies can be appropriately integrated with system-level ("s-frame") strategies to optimize population-level behavior change. We outline instances of effective "i-frame" interventions, and how coordinated, integrated, well-resourced interventions that encompass components at both levels, and has organizational and user-group support, may optimize sustained behavior change intervention efforts, and allay practices that undermine "s-frame" components.
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Affiliation(s)
- Martin S Hagger
- Department of Psychological Sciences, University of California, Merced, CA, USA ; www.martinhagger.com
- Health Sciences Research Institute, University of California, Merced, CA, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Kyra Hamilton
- Department of Psychological Sciences, University of California, Merced, CA, USA ; www.martinhagger.com
- Health Sciences Research Institute, University of California, Merced, CA, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia ; www.hapiresearchlab.com
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Rowley S, Clare S. ANTT ® standardisation facilitates new efficiencies with a novel partially-sterile Standard-ANTT PIVC Pack. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S10. [PMID: 37027407 DOI: 10.12968/bjon.2023.32.7.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Introduction: The widespread adoption of the ANTT®Clinical Practice Framework as a single standard for aseptic technique, has highlighted that many clinical procedures do not require a sterile procedure pack to be performed safely and aseptically. This study explores the utilisation of a partially-sterile procedure pack that is specifically tailored to Standard-ANTT. Methods: A prospective project improvement evaluation, using a non-paired sample (pre: n=41; post: n =33) of emergency department staff in an NHS hospital. Staff were evaluated performing peripheral intravenous cannulations (PIVC) using Standard-ANTT and the B. Braun Standard-ANTT peripheral cannulation pack. Findings: Significant improvements were observed in practice following the implementation of the pack and training in Standard-ANTT, including: Key-Part protection significantly improved (pre: n=28, 68.2%; post: n=33, 100%), and reduction in the Key-Site being touched after disinfection (pre: n=17; 41.4%; post n=5; 15.1%). Conclusions: In conjunction with appropriate education and training, this study provides proof of concept that due to the widespread use of the ANTT Clinical Practice Framework as a single standard aseptic technique, procedure packs that are specifically tailored to Standard-ANTT, can help to promote best practice and improve efficiencies. DEFINITIONS Partially-sterile procedure pack - all items required to be sterile remain in their individual blister wrapper. The final assembled pack itself is not then subjected to a further round of sterilisation as it is not needed. Sterile procedure pack - often contains a mixture of non-sterile and sterile items that have been stripped from their individual blister wrapper requiring the sterilisation of the final assembled pack.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice (ASAP)
| | - Simon Clare
- Research and Development Director, The Association for Safe Aseptic Practice (ASAP)
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Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses. J Hosp Infect 2023; 133:55-61. [PMID: 36565934 DOI: 10.1016/j.jhin.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs), but report challenges and unwarranted variations in practice. OBJECTIVE To explore nurses' experiences, perceived gaps in information and support needed to conduct PRAs. METHODS Qualitative interviews were undertaken with 20 nurses in the UK National Health Service between September 2021 and January 2022 employing approaches to sampling and data collection adopted in grounded theory. RESULTS Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised, but that much could still be done to contain the risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported, and informants were unclear whether asepsis was needed to perform routine procedures (e.g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development, and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. CONCLUSION There is a need for detailed guidelines to inform PRAs, better access to clinical updating, and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognized methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.
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Abstract
At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes "clean," "aseptic," or so-called "sterile" technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.
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Li J, Ding Y, Lu Q, Jin S, Zhang P, Jiang Z, Zhang F, Lyu Y, Lin F. Routine replacement versus replacement as clinical indicated of peripheral intravenous catheters: A multisite randomised controlled trial. J Clin Nurs 2021; 31:2959-2970. [PMID: 34779070 DOI: 10.1111/jocn.16129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To compare the safety of replacing peripheral intravenous catheter as clinically indicated versus routine replacement on patient outcomes in the Chinese context. BACKGROUND Some evidence from developed countries recommend replacing peripheral intravenous catheter as clinically indicated; however, there is limited evidence from developing countries. DESIGN A multisite randomised controlled trial. METHODS The 3050 participants from three hospitals in China were randomly assigned to clinically indicated or routine replacement groups. Patients in the clinically indicated group had the catheters kept in situ until any of the following clinical signs appeared: phlebitis, infiltration, occlusion, displacement, local infection and diagnosed catheter-related bloodstream infection. Patients in the routine replacement group had their peripheral intravenous catheters replaced every 96 hours. The outcomes of phlebitis, infiltration, occlusion, displacement; catheter-related bloodstream infection, all-cause bloodstream infection, and local infection were compared. CONSORT checklist was used to guide the reporting of this RCT. RESULTS The risk of phlebitis, phlebitis per 1000 catheter days, occlusion, dislodgement, all bloodstream infections, local infection and mortality between the two groups were not significantly different. The risk of infiltration was increased in the clinically indicated group (HR 1.29). There was no catheter-related bloodstream infection reported in either group. Patients' first peripheral intravenous catheter dwelling time and cumulative indwelling time of all peripheral intravenous catheters in the clinically indicated group were significantly longer than the routine replacement group. There was no statistical significant difference in survival times from phlebitis between the two groups. CONCLUSIONS In the Chinese context, removing peripheral catheters as clinical indicated did not increase the risk of phlebitis, occlusion, catheter displacement and catheter infection; however, there was an increased infiltration incidence. RELEVANCE TO CLINICAL PRACTICE In developing countries, removing peripheral catheters as clinical indicated is feasible, but more frequent observations of infiltration are highly recommended.
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Affiliation(s)
- Jing Li
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Beijing, China
| | - Sanli Jin
- Peking University School of Nursing, Beijing, China
| | - Peiying Zhang
- Nursing Department, Peking University First Hospital, Xicheng District, Beijing, China
| | - Zhixia Jiang
- Guizhou Nursing Vocational College, Guiyang, China.,Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | | | - Yang Lyu
- Beijing Chao-Yang Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,Sunshine Coast Health Institute, Queensland, Australia.,School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
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Clare S, Rowley S. Best practice skin antisepsis for insertion of peripheral catheters. ACTA ACUST UNITED AC 2021; 30:8-14. [PMID: 33433273 DOI: 10.12968/bjon.2021.30.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.
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Affiliation(s)
- Simon Clare
- Research and Practice Development Director ANTT, The Association for Safe Aseptic Practice
| | - Stephen Rowley
- Clinical Director ANTT, The Association for Safe Aseptic Practice
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Carr PJ, O'Connor L, Gethin G, Ivory JD, O'Hara P, O'Toole O, Healy P. In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? Protocol for a systematic review. HRB Open Res 2021; 3:19. [PMID: 34124573 PMCID: PMC8167500 DOI: 10.12688/hrbopenres.13028.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration: This study has been submitted to PROSPERO and we are awaiting confirmation of registration.
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Affiliation(s)
- Peter J. Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Laura O'Connor
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - John D. Ivory
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Orla O'Toole
- Clinical Trials Unit, HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Gould D, Hawker C, Chudleigh J, Drey N, Gallagher R, Purssell E. Survey with content analysis to explore nurses' satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique. NURSE EDUCATION TODAY 2021; 98:104749. [PMID: 33545557 DOI: 10.1016/j.nedt.2021.104749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 07/26/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Aseptic technique is a key skill undertaken every day by large numbers of nurses. However, there is relatively little empirical evidence to underpin practice. Furthermore, it is not clear to what extent it should be considered a single task or a set of principles to be applied differentially depending upon the situation and how individual nurses make this decision. OBJECTIVE This study explored nurses' experiences of continuing professional education (CPE) in relation to aseptic technique. DESIGN A national survey was undertaken throughout the United Kingdom. Responses were subjected to inductive quantitative content analysis. PARTICIPANTS Participants were recruited via an electronic link placed on the website of a major nursing organisation. RESULTS 941 nurses responded. 253 (26.9%) were satisfied with arrangements for continuing professional education. Satisfaction was associated with a perception of good support from employers, sound preparation before qualifying and practising aseptic technique regularly. 311 (33%) were dissatisfied. Reasons included witnessing unwarranted variations in practice (n = 55, 5.8%), witnessing suboptimal practice requiring correction (65, 6.9%), a perception that standards had fallen through a decline in pre-registration preparation (n = 109, 11.6%) and opportunities for updating (n = 124, 13.2%). Some employers had introduced training in conjunction with organisation-wide change in practice. In other cases participants reported receiving updates when required to perform a new procedure, when moving between clinical specialities or changing employer. Train-the-trainer (cascade) teaching was used in formal and informal arrangements for updating. CONCLUSION This study provides a springboard for exploring arrangements for updating and assessing nurses' competence to undertake aseptic technique. Health providers need to evaluate what is currently provided and address gaps in provision. There is clear evidence that the current system does not meet the needs of many nurses.
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Carr PJ, O'Connor L, Gethin G, Ivory JD, O'Hara P, O'Toole O, Healy P. In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? Protocol for a systematic review. HRB Open Res 2020; 3:19. [PMID: 34124573 PMCID: PMC8167500 DOI: 10.12688/hrbopenres.13028.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 09/21/2023] Open
Abstract
Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration: This study has been submitted to PROSPERO and we are awaiting confirmation of registration.
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Affiliation(s)
- Peter J. Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Laura O'Connor
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - John D. Ivory
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Orla O'Toole
- Clinical Trials Unit, HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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13
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Rowley S, Clare S. How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland? ACTA ACUST UNITED AC 2020; 29:924-932. [DOI: 10.12968/bjon.2020.29.16.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
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14
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Carr PJ, O'Connor L, Gethin G, Ivory JD, O'Hara P, O'Toole O, Healy P. Study protocol: In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? HRB Open Res 2020; 3:19. [PMID: 34124573 PMCID: PMC8167500 DOI: 10.12688/hrbopenres.13028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 09/21/2023] Open
Abstract
Introduction: Intravenous therapy and medicines (IVTM) are the most common invasive interventions in use in healthcare. Prescribed IVTM play an essential role in the treatment of illness, management of chronic conditions and in maintaining health and wellbeing. The intravenous (IV) route is the administration of concentrated medications (diluted or undiluted) directly into peripherally or centrally inserted vascular access devices. Medication safety is a key priority and best practice standards are required to guide the safe preparation and administration of IVTM. Methods: We will conduct a systematic review of the literature pertaining to the preparation and administration of intravenous therapy and medicines. Our search will include studies concerned with the preparation and/or administration of IVTM via peripheral or central vascular access devices. We will be guided by the preferred reporting items for systematic review and meta-analysis (PRISMA) in this review. Literature will include all trial designs, national/international guidelines, and expert consensus opinion made available in English from 2009 to present day. Conclusions: We will synthesise the evidence concerning safe and effective preparation and administration of intravenous therapy and medicines to inform the development of a national guideline for healthcare professionals in Ireland. The availability of up-to-date, contemporaneous evidence-based practice standards will ensure quality and safety for service-users. Registration: This study has been submitted to PROSPERO and we are awaiting confirmation of registration.
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Affiliation(s)
- Peter J. Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Laura O'Connor
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - John D. Ivory
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Orla O'Toole
- Clinical Trials Unit, HRB Clinical Research Facility, University Hospital Galway, Galway, Ireland
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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15
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Welyczko N. Peripheral intravenous cannulation: reducing pain and local complications. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S12-S19. [PMID: 32324463 DOI: 10.12968/bjon.2020.29.8.s12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.
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Lin F, Marshall AP, Gillespie B, Li Y, O'Callaghan F, Morrissey S, Whitelock K, Morley N, Chaboyer W. Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:193-201. [PMID: 32282120 DOI: 10.1111/wvn.12436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal. AIMS The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections. METHODS This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data. RESULTS The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation. LINKING EVIDENCE TO ACTION The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.
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Affiliation(s)
- Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Brigid Gillespie
- Menzies Health Institute Queensland, Gold Coast Health and Griffith University, Gold Coast, Queensland, Australia
| | - Yu Li
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Frances O'Callaghan
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Shirley Morrissey
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Whitelock
- Surgical Specialties Unit, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nicola Morley
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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17
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Towell-Barnard A, Slatyer S, Cadwallader H, Harvey M, Davis S. The influence of adaptive challenge on engagement of multidisciplinary staff in standardising aseptic technique in an emergency department: A qualitative study. J Clin Nurs 2019; 29:459-467. [PMID: 31793117 DOI: 10.1111/jocn.15109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/02/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the challenge of engaging multidisciplinary staff in standardising aseptic technique (AT) in an emergency department (ED) in an Australian tertiary hospital, and to better understand the enablers and barriers to implementing practice change within this setting. BACKGROUND Healthcare-associated infections are the most common complication for patients in acute care. A clinical practice framework developed in the United Kingdom (UK) standardised AT practice to reduce potential infection risk. One Australian tertiary hospital drew upon this framework to similarly improve clinical practice. It was understood that standardising practice would require some practitioners only to revisit and demonstrate AT principles already embedded in their practice, while others would be challenged to adopt a new approach. DESIGN Qualitative, descriptive research design. METHODS Data were collected through focus groups held before and after implementation of the AT programme. Data were analysed using the framework method. The (COREQ) checklist was followed. RESULTS Four emergent themes described the influence of motivation on individuals' beliefs and attitudes towards practice change, relationships within the ED context, delivery of education and management directives. CONCLUSION Implementing practice change is more than just providing technical knowledge and includes changing individuals' beliefs and attitudes. An understanding of adaptive challenge can assist in implementing practice change that involves the multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE Results provide evidence as to how the adaptive challenge framework could be a suitable approach to manage potential enablers and barriers to implementing change within a multidisciplinary team in an acute hospital.
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Affiliation(s)
- Amanda Towell-Barnard
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Miwifery, Edith Cowan University, Perth, WA, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Susan Slatyer
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia
| | - Helen Cadwallader
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michelle Harvey
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Susan Davis
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Miwifery, Edith Cowan University, Perth, WA, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Abstract
Community nurses often face challenges when going into a patient's home to change a dressing, particularly if the surroundings are likely to be contaminated by multiple strains of bacteria or viruses. For housebound patients, cleaning the house can be an extremely difficult task due to physical or mental illness. They may also experience a large amount of exudate as a result of possibly debilitating painful wounds, for example, leg ulcers, and may be prone to infection as a result of the difficulties posed in keeping a dressing covering a heavily exuding wound in a possibly unclean environment. Therefore, it is of the utmost importance that a community nurse or healthcare worker be able to change the wound dressing in the cleanest and most supportive manner. This article covers the most recent guidance and research relevant to the practice of aseptic or clean technique when changing dressings in the community.
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Affiliation(s)
- Sarah Jane Palmer
- Registered nurse and freelance writer, based at the Department for Work and Pensions as a disability analyst
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Caguioa J. Reflections on leading an IV team: strategies and impact. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S4-S9. [PMID: 31647727 DOI: 10.12968/bjon.2019.28.19.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jennifer Caguioa
- Lead IV Practitioner, King's College Hospital NHS Foundation Trust
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20
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Affiliation(s)
- Karen Harrold
- IV Access Nurse Consultant, East and North Hertfordshire NHS Trust
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21
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Hegarty J, Howson V, Wills T, Creedon SA, Mc Cluskey P, Lane A, Connolly A, Walshe N, Noonan B, Guidera F, Gallagher AG, Murphy S. Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric. Int Wound J 2019; 16:641-648. [PMID: 30932342 PMCID: PMC6850176 DOI: 10.1111/iwj.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.
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Affiliation(s)
- Josephine Hegarty
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Victoria Howson
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Teresa Wills
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Sile A. Creedon
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | | | - Aoife Lane
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Aine Connolly
- Nursing Division, Cork University Hospital GroupIreland
| | - Nuala Walshe
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
| | - Fiona Guidera
- Nursing Division, Mercy University HospitalCorkIreland
| | - Anthony G Gallagher
- Application of Science to Simulation based Education and Research on Training Centre, College of Medicine and Health, University College Cork, Cork, Ireland & Faculty of Life and Health SciencesUlster University, Magee Campus, Northland Rd, Londonderry BT48 7JLUnited Kingdom
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and MidwiferyUniversity College CorkIreland
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22
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Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. Eur J Oncol Nurs 2018; 33:78-84. [DOI: 10.1016/j.ejon.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 01/10/2023]
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23
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Bitmead J, Oliver G. A safe procedure: best practice for intravenous peripheral cannulation. ACTA ACUST UNITED AC 2018; 27:S1-S8. [DOI: 10.12968/bjon.2018.27.sup2.s1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- James Bitmead
- Infection Control Nurse for Intravenous Access, University College London Hospitals NHS Foundation Trust
| | - Gemma Oliver
- Nurse Consultant Intravenous Care, East Kent Hospitals University NHS Foundation Trust
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Clare S, Rowley S. Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals. J Infect Prev 2018; 19:6-15. [PMID: 29317909 PMCID: PMC5753945 DOI: 10.1177/1757177417720996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Aseptic technique is an important infection prevention competency for protecting patients from healthcare-associated infection (HAI). Healthcare providers using the Aseptic Non Touch Technique (ANTT®) aseptic technique have demonstrated reduced variability and improved compliance with aseptic technique. OBJECTIVES The primary aim of this study is to determine whether standardizing aseptic technique for invasive IV procedures, using the ANTT® - Clinical Practice Framework (CPF), increases staff compliance with the infection prevention actions designed to achieve a safe and effective aseptic technique, and whether this is sustainable over time. METHODS A pragmatic evaluation using a mixed-methods approach consisting of an observational audit of practice, a self-report survey and structured interviews with key stakeholders. Compliance with aseptic technique before and after the implementation of ANTT® was measured by observation of 49 registered healthcare professionals. RESULTS Mean compliance with competencies was 94%; each component of practice was improved over baseline: hand hygiene = 63% (P ≤ 0.001); glove use = 14% (P ≤ 0.037); Key-Part protection = 54% (P ≤ 0.001); a non-touch technique = 45% (P ≤ 0.001); Key-Part cleaning = 82% (P ≤ 0.001); and aseptic field management = 80% (P ≤ 0.001). CONCLUSIONS Results show implementation of ANTT® improved compliance with the prerequisite steps for safe and effective aseptic technique as defined by the ANTT®-CPF. Improvements in compliance were sustained over four years.
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Affiliation(s)
- Simon Clare
- The Association for Safe Aseptic Practice, Surrey, UK
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25
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Simpson P. Long-term urethral catheterisation: guidelines for community nurses. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S22-S26. [PMID: 28493765 DOI: 10.12968/bjon.2017.26.9.s22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An estimated 3% of people living in the community and 12% of those living in residential care use long-term urethral catheterisation for the management of urine drainage. This article provides an overview of safe practice for catheterisation in the community setting, highlighting the need for competent and safe patient assessments. It also aims to provide a rationale for product choices.
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Affiliation(s)
- Paula Simpson
- Continence Specialist Nurse/Adviser, Kent Continence Service
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26
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27
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Conley SB. Central Line-Associated Bloodstream Infection Prevention: Standardizing Practice Focused on Evidence-Based Guidelines. Clin J Oncol Nurs 2017; 20:23-6. [PMID: 26800401 DOI: 10.1188/16.cjon.23-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central venous access devices (CVADs) are integral to the treatment and provision of supportive care for many patients with cancer. Central venous catheters are the most frequent cause of healthcare-associated bloodstream infections. Healthcare-associated bloodstream infections can be prevented when evidence-based practices are followed consistently over time. Establishing nursing best practice with CVADs in the ambulatory setting presents additional challenges because of multiple providers, caregivers, and policies. This article identifies evidence-based practice strategies implemented at a comprehensive ambulatory cancer center to standardize best nursing practice for central lines.
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28
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Ding S, Lin F, Marshall A, Gillespie B. Nurses' practice in preventing postoperative wound infections: an observational study. J Wound Care 2017; 26:28-37. [DOI: 10.12968/jowc.2017.26.1.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Ding
- Clinical Nurse, School of Nursing and Midwifery, Griffith University, Australia; and Gold Coast Hospital and Health Service
| | - F. Lin
- Senior Lecturer, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia
| | - A.P. Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia
| | - B.M. Gillespie
- Professor of Patient Safety, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; Menzies Health Institute Queensland, Griffith University, Australia; and National Centre for Research Excellence in Nursing, Griffith University, Australia
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29
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Branton F, Cathcart E, Bellamy E. A whole health economy approach to reducing MRSA bacteraemia incidence in diabetic foot ulcer patients. J Infect Prev 2016; 17:108-113. [PMID: 28989465 DOI: 10.1177/1757177416633514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/02/2016] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Ulceration of the foot is a common problem among diabetic patients. Infection is a major risk in diabetic foot ulcers (DFU) and many of these are caused by Staphylococcus aureus, in particular meticillin-resistant strains (MRSA). The control and management of MRSA remains a significant challenge and all healthcare organisations in England are required to meet Zero Tolerance Objectives for cases of MRSA bacteraemia (MRSAB). This paper describes a collaborative approach across the health economy to investigate factors contributing to the acquisition of MRSA and MRSAB among DFU patients and make improvements to care to reduce the risk of healthcare-associated infections. METHODS A collaborative approach between acute and community healthcare providers and commissioners was used to conduct Root Cause Analysis and drive improvement to prevent MRSA transmission in DFU patients. RESULTS Screening of all DFU patients was initiated after 6 MRSAB were found to be associated with in DFU. In total 15 patients with the same MRSA antibiogram were identified. Following the implementation of actions focused on isolation, wound management, screening and cleaning no further cases were identified. CONCLUSION This outbreak has demonstrated the value of cross-sector collaboration in investigating HCAI in patients with DFU, improving patient care and reducing the risk of MRSA transmission in these vulnerable patents.
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Affiliation(s)
| | | | - Elaine Bellamy
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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30
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Mutalib M, Evans V, Hughes A, Hill S. Aseptic non-touch technique and catheter-related bloodstream infection in children receiving parenteral nutrition at home. United European Gastroenterol J 2015; 3:393-8. [PMID: 26279849 DOI: 10.1177/2050640615576444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/11/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers. METHODS We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013. RESULTS Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days. CONCLUSION In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.
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Affiliation(s)
- Mohamed Mutalib
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Victoria Evans
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Anna Hughes
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Susan Hill
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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31
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Affiliation(s)
- Nancy L Moureau
- Chief Executive Officer of PICC Excellence; Vascular Access Specialist at Greenville Memorial University Medical Center; Adjunct Associate Professor at Griffith University Health Institute Centre for Health Practice Innovation; Member of the Alliance for Vascular Access Teaching and Research Group (AVATAR), Queensland at Griffith University
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32
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Laws A. Implementing a new urinary catheter insertion and removal pack. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:1032-1035. [PMID: 25345452 DOI: 10.12968/bjon.2014.23.19.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article describes the implementation of a community urinary catheter insertion and removal pack that provides equipment to maintain safe and effective practice at a cost-effective price within Newcastle upon Tyne Hospitals NHS Foundation Trust. This development was achieved through service integration as a result of two large trusts amalgamating, offering the opportunity for practice development resulting in the development of a joint catheter product formulary, the implementation of a patient catheter record booklet and the design of a community urinary catheterisation pack. The impact of service integration has provided scope for proactive working between acute and community continence services, resulting in innovative approaches generating better quality outcomes for patients who require urinary catheterisation.
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Affiliation(s)
- Alyson Laws
- Nurse Specialist, Continence Care; Jackie Rees, Nurse Consultant, Continence Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
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Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86 Suppl 1:S1-70. [PMID: 24330862 PMCID: PMC7114876 DOI: 10.1016/s0195-6701(13)60012-2] [Citation(s) in RCA: 676] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London).
| | - J A Wilson
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - R J Pratt
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - M Golsorkhi
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Tingle
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Bak
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Browne
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Prieto
- Faculty of Health Sciences, University of Southampton (Southampton)
| | - M Wilcox
- Microbiology and Infection Control, Leeds Teaching Hospitals and University of Leeds (Leeds)
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Abstract
Our "Matching Michigan" program has 3 focuses for identifying and reducing nosocomial infection. First, practical training to optimize infection control; second, root cause analysis of blood-culture positives; and third, feedback and use of results to develop new guidelines. Our infection rates are comparable with adult units. Interventions have reduced coagulase-negative staphylococcal infections whereas other infection rates have reduced relative to increased activity.
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Abstract
This article aims to provide guidance for practitioners on intravenous therapy devices, their management and care. It explains the indications for their use and considerations when selecting devices for intravenous therapy and treatment. Both PVADs and CVADs are discussed in detail to provide the practitioner with a clear understanding for each. Infection control and how to reduce infection risks are also addressed with recommendations for best practice guidance on flushing devices, minimising complications and documentation. This article addresses the importance of safe practice and aims to help practitioners to improve their knowledge and clinical decision-making for patients undergoing intravenous therapy.
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Affiliation(s)
- Sherri Ogston-Tuck
- Florence Nightingale School of Nursing and Midwifery, King's College London
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Aziz AM. Reducing needlestick injuries: a review of a community service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:S4, S6, S8 passim. [PMID: 22629591 DOI: 10.12968/bjon.2012.21.sup8.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Community nurses provide care to patients in a variety of settings; for example, health centres, community hospitals, patients' homes, and residential and nursing homes. Administering intramuscular (IM)injections to patients in the community is an everyday activity for many nurses in clinical practice. A great deal of problems related to being 'sharps safe' are common to both community nurses and hospital staff. There had been a reported six needlestick injuries (NSIs) from community clinics administering depot IM injections, which required a review. An audit of practice was undertaken in clinics administering depot injections. The audit was undertaken to monitor compliance in sharps management and investigated how community nurses were administering IM injections. The review highlighted a lack of resources, gaps in knowledge and training deficits. The infection prevention and control nurses worked hard to improve practices and procedures. After a year, there had been a significant reduction in NSIs.
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Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet. J Wound Ostomy Continence Nurs 2012; 39:S30-4. [PMID: 22415169 DOI: 10.1097/won.0b013e3182478e06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rowley S, Clare S. ANTT: an essential tool for effective blood culture collection. ACTA ACUST UNITED AC 2011; 20:S9-10, S12-4. [DOI: 10.12968/bjon.2011.20.sup7.s9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen Rowley
- The Association for Safe Aseptic Practice
- The Association for Safe Aseptic Practice
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Carr PJ, Glynn RW, Dineen B, Devitt D, Flaherty G, Kropmans TJB, Kerin M. Interns' attitudes to IV cannulation: a KAP study. ACTA ACUST UNITED AC 2011; 20:S15-20. [DOI: 10.12968/bjon.2011.20.4.s15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter J Carr
- Emergency Department RGN, National University of Ireland, Galway
| | - Ronan W Glynn
- University Hospital Galway and Surgical Researcher National University of Ireland Galway
| | | | | | | | - Thomas JB Kropmans
- Medical Informatics and Medical Education, National University of Ireland, Galway
| | - Michael Kerin
- National University of Ireland, Galway and Consultant Breast/Endocrine and General Surgeon University Hospital Galway, Ireland
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Carr PJ, Glynn RW, Dineen B, Devitt D, Flaherty G, Kropmans TJB, Kerin M. Interns' attitudes to IV cannulation: a KAP study. ACTA ACUST UNITED AC 2011. [DOI: 10.12968/bjon.2011.20.sup1.s15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter J Carr
- Emergency Department RGN, National University of Ireland, Galway
| | - Ronan W Glynn
- University Hospital Galway and Surgical Researcher National University of Ireland Galway
| | | | | | | | - Thomas JB Kropmans
- Medical Informatics and Medical Education, National University of Ireland, Galway
| | - Michael Kerin
- National University of Ireland, Galway and Consultant Breast/Endocrine and General Surgeon University Hospital Galway, Ireland
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