Patients' Hand Washing and Reducing Hospital-Acquired Infection

Using patients' observations to evaluate healthcare workers' alcohol-based hand rub with Pulpe'friction audits: a promising approach?

Background

Hand hygiene plays an important role in the transmission of nosocomial infections from healthcare workers (HCW) to patients. Patients could play a key role in improving hand hygiene by sharing their experience of the HCW's practices. Already in 2019, the French national mission of transversal support for actions to prevent healthcare-associated infections proposed the national "Pulpe'friction" audit, to assess HCW's reported practices, social representations, and barriers to using alcohol-based hand rubs (ABHR). This audit consisted of a positive discussion between an auditor and the HCW as well as patients, which led the HCW to declare their real practices and the barriers they faced in the field and the patients to report about the HCW's ABHR practices and the information they received about when they should perform hand hygiene.

Objective

To assess whether an association existed between HCW's reported ABHR compliance and patients' declarations about HCW's compliance in the Pulpe'friction audit data.

Methods

Data from Pulpe'friction were collected from 1st January to 31st December 2019, before the COVID-19 pandemic. Mixed linear models were performed to analyze the association between self-reporting by HCW and patients, regarding hand rubs performed by HCW prior to patient care.

Results

There was a positive association between patients' observations and HCW's declared practices regarding the frequency of with which professionals performed hand rubs before patient contact. This indicates that professional and patient statements show the same tendency. The positive association was found in hospitals for patients under 45 and over 64 years old and for paramedics, but not for physicians and not in nursing homes or long-term care facilities. Patients felt more motivated to observe and evaluate HCWs' practices if they had received information about how to correctly wash their hands.

Conclusion

Patients agreed to be involved in the evaluation or professional practices. The patients' observations were positively associated with HCWs reports. New indicators taking patients' observations into account could be interesting.

Hand Hygiene and Antimicrobial Resistance in the COVID-19 Era: An Observational Study

Hand hygiene (HH) is one of the most important infection prevention and control strategies at the hospital level. The aim of this study was to evaluate the potential COVID-19 pandemic impact on HH practices and rate of healthcare-associated infections. Data on alcohol-based handrub consumption (AHC) and antimicrobial resistance across 27 Italian hospitals over the period 2017–2021 were considered. Data on Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteria (CRE) were extracted from the antimicrobial resistance regional surveillance system. A significant increase was highlighted, with a peak in 2020 and a partial fall in 2021 for AHC (p < 0.001). The decrease in MRSA rates in 2021 compared to 2017–2019 was significant (p = 0.013). A significant Spearman’s correlation between AHC and CRE rates was found (Spearman’s ρ −0.646, p = 0.032). This study supports the importance of AHC monitoring and showed that improving AHC was an attainable goal in the COVID-19 era. However, other strategies are needed to maintain the high levels of AHC attained during the pandemic, in order to avoid a progressive drop that has already begun in 2021. Furthermore, our results support the inverse relationship between AHC and infection rates and antimicrobial-resistant bacteria.

Impact of coronavirus disease 2019 on infectious disease treatment and infection control at a tertiary hospital in Japan

Introduction

Coronavirus disease 2019 (COVID-19) has greatly impacted medical care practices. Although the effects on infectious disease treatment and infection control, such as antimicrobial resistance, have been specified, very few reports exist on the specific effects of COVID-19.

Methods

We investigated the effects of COVID-19 on daily medical practices at a tertiary hospital in Japan by comparing the use of hand sanitizers, the detection of bacteria from blood cultures, and the amount dose of antibacterial drugs used for one year before (April 2019 to March 2020, fiscal year 2019.) and after COVID-19 admissions began (April 2020 to March 2021, fiscal year 2020).

Results

The use of hand sanitizers increased by 1.4–3 times during the year after COVID-19 admissions began; the incidence of methicillin-susceptible Staphylococcus aureus and all S. aureus detected in blood cultures reduced in all departments. No decrease was observed in the usage of all antibacterial drugs; rather, the usage of all antibacterial drugs tended to increase in all departments. Therefore, no significant change was observed in the detection of drug-resistant bacteria and the trends of antibacterial drug use based on the acceptance of COVID-19 patients.

Conclusions

The prevalence of drug-resistant bacteria and trends of antibacterial drug use remained unchanged despite the increased use of hand sanitizers due to the admission of patients with COVID-19.

Hand hygiene determinants of informal caregivers in hospitals under Pender's perspective

OBJECTIVES

to analyze hand hygiene determinants of informal caregivers in a hospital environment.

METHODS

qualitative study conducted with 55 caregivers at a university hospital in the Northeast of Brazil. A semi-structured instrument was used, adapted from Nola Pender's Health Promotion Model, from which the deductive categories were derived.

RESULTS

the general behavior included hand hygiene before meals and after using the bathroom. Sensitivity to the requirements for hand hygiene was observed, but the barriers and self-efficacy consisted of the availability of soap or alcohol-based hand sanitizers, the lack of knowledge on the importance of and forgetfulness of the practice. The reinforcement on the importance of the practice and being in a contaminated environment were influencers, and commitment, warnings, and training were indispensable.

CONCLUSIONS

benefits related to protection from infections were seen as positive determinants for hand hygiene adherence. For non-adherence, factors such as lack of sanitizing supplies, ignorance towards the importance of the activity, and forgetfulness stood out.

Effect of topical antimicrobial therapy and household cleaning on meticillin-resistant Staphylococcus pseudintermedius carriage in dogs

BACKGROUND

Meticillin-resistant Staphylococcus pseudintermedius (MRSP) is a multidrug-resistant canine pathogen with a low zoonotic potential. This study investigated MRSP carriage and clearance through topical antimicrobial therapy and household cleaning in dogs recovered from MRSP infection.

METHODS

Dogs were swabbed for MRSP carriage; household contamination was assessed using contact plates. Carrier dogs were allocated randomly to receive topical fusidic acid and chlorhexidine/miconazole treatment combined with owners implementing a household hygiene protocol (H&T) or implementation of hygiene alone (H) over three weeks. Carriage-negative dogs were monitored monthly. The relatedness of isolates over time was investigated by pulsed-field gel electrophoresis (PFGE).

RESULTS

At inclusion, MRSP carriage was confirmed in 31/46 (67.4%) index dogs and 16/24 (66.7%) contact dogs, and contamination was found in 18/40 (45%) environments. In dogs completing all cycles, interventions cleared carriage in 5/9 (55.6%) dogs in group H&T and 2/6 (33.3%) in group H. Environmental contamination was infrequent but associated with carrier dogs (p = 0.047). Monthly monitoring of initially negative dogs showed intermittent carriage in 9/14 dogs. PFGE-concordance was found among all 34 MRSP isolated from eight index dogs over time.

CONCLUSION

MRSP carriage was common in dogs after recovery from infection. Topical antimicrobial therapy temporarily eliminated carriage but recurrence was frequent. Management efforts must include the prevention of recurrent infections and hygiene.

A comparison of knowledge and practices of universal precautions among public sector health care workers in Ugu north sub-district, KwaZulu-Natal, South Africa (2010-2014)

Background

Annually, there are a high number of needlestick injuries (NSIs) among health care workers (HCWs) globally. The knowledge and practice of HCWs of universal precautions (UPs) play an important role in determining the risk of an NSI. The objective of this study was to compare the knowledge and practices of UPs among HCWs with NSIs with HCWs without NSIs, in Ugu north sub-district in KwaZulu-Natal (KZN), South Africa, between 2010 and 2014.

Methods

A study among HCWs having an NSI (n = 100) between 2010 and 2014 compared with controls (n = 200) was conducted in 2016–2017 at a district hospital and 11 primary health care facilities in Ugu north sub-district, KZN, South Africa. Health care workers’ knowledge and practices of UPs were assessed by using a standardised questionnaire. Knowledge and practice responses were scored, and means and standard deviations (SDs) were calculated. Total scores of knowledge and practices were categorised into acceptable and unacceptable, and a binary logistic model was used to identify independent factors associated with being a case. The accepted level of significance was 0.05.

Results

The majority of the participants were nurses (n = 233; 77.7%) and female (n = 227; 75.7%). Control HCWs had better practice scores for UPs (86.13%; SD: 16.57) compared with cases (82.43%; SD: 19.98). The logistic regression analysis showed that the HCWs with acceptable knowledge and unacceptable practice were more likely to have had an NSI (odds ratio [OR]: 5.8; 95% confidence interval [CI]: 1.4–24.0).

Conclusion

There were significant differences between cases and controls with respect to knowledge and practice of UPs that are important findings for workplace health and safety and HCW training.

Increasing patient participation in hand hygiene practices in adult surgical wards in a tertiary institution: a best practice implementation project

INTRODUCTION

The WHO states that hospital-acquired infections may be transmitted through contaminated hands. Practicing hand hygiene using alcohol-based handrub or soap and water reduces harmful organisms. The Joanna Briggs Institute (JBI) best practice recommends empowering patients with hand hygiene knowledge and engaging their involvement to strengthen hand hygiene practices.

AIMS

The aim of this project was to improve hand hygiene among surgical inpatients.

METHODS

This evidence-based quality improvement project was conducted in three phases: the baseline audit, implementing best practice, and the postimplementation audit. Participants were patients hospitalized in three surgical wards of a 1200-bed acute care tertiary hospital. This project utilized the online JBI Practical Application of Clinical Evidence System and The Getting Research into Practice program to identify barriers and strategies. Nurses provided patients with an education pamphlet and regularly reminded them to improve their hand hygiene practices.

RESULTS

Ninety-four patients were audited between April and June 2018. Patients' hand hygiene practices improved from 19.1% at baseline audit to 61.7% (P < 0.01) at first follow-up audit. Patients' hand hygiene improved from 48.9 to 72.3% (P = 0.03) before meals, and from 92.6 to 98.9% (P = 0.65) after toileting. The proportion of patients who received a hand hygiene information leaflet in an appropriate language increased from 64.9 to 89.4% (P < 0.01).

CONCLUSION

Patients' involvement in the hand hygiene program has significantly improved their hand hygiene practices. Patient education and patient information leaflet continue to be an effective strategy to improve knowledge and practices.

Microbial Air Quality in Healthcare Facilities

There is increasing evidence that indoor air quality and contaminated surfaces provide an important potential source for transmission of pathogens in hospitals. Airborne hospital microorganisms are apparently harmless to healthy people. Nevertheless, healthcare settings are characterized by different environmental critical conditions and high infective risk, mainly due to the compromised immunologic conditions of the patients that make them more vulnerable to infections. Thus, spread, survival and persistence of microbial communities are important factors in hospital environments affecting health of inpatients as well as of medical and nursing staff. In this paper, airborne and aerosolized microorganisms and their presence in hospital environments are taken into consideration, and the factors that collectively contribute to defining the infection risk in these facilities are illustrated.

Patient education on infection control: A systematic review

BACKGROUND

Lately, suggestions have been emphasizing the importance of engaging patients and family members in infection control (IC) through participation and education after showing that patients and family members can aid in preventing the transmission of health care-associated infections. However, assessing patient education on IC measures in hospitals is poorly investigated.

PURPOSE

To identify all available studies in the literature that assessed hospitalized patients' education on IC measures.

METHODS

PubMed, Embase, and CINAHL were searched from inception till May 6, 2020 without restrictions. We used Strengthening the Reporting of Observational Studies in Epidemiology tool for assessing the reporting quality of each eligible study.

MAIN FINDINGS

Of the 6,740 identified papers, 25 were eligible for inclusion. Education on health care-associated infections was investigated in 8 studies, education on central line-associated bloodstream infections in 1, education on surgical site infections in 2, education on hand hygiene in 12, education on isolation rationale, precautions, usage of personal protective equipment in 3, and education on respiratory hygiene in 1. In general, a low percentage of patient education on IC was found in most of the included papers.

CONCLUSIONS

The low percentage of patient education on IC in hospitals highlights the need for additional emphasis on patient involvement in IC. Further studies are needed to assess patient education on several IC measures and to explore the education of family members as well.

Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study

Objective

Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior.

Methods

The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum.

Results

Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients.

Conclusion

HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.

A Comparison of Nosocomial Infection Density in Intensive Care Units on Relocating to a New Hospital

Background

The study aimed to investigate the changes in nosocomial infection density after patients were transferred to the intensive care unit (ICU) of a new-build hospital.

Methods

The types and rates of nosocomial infections were obtained for a one-year period retrospectively before leaving the old hospital premises and for a one-year periods after moving into the new hospital. The intensive care unit in the “old” premises was comprised of a 17-bedded hall, and thirty-three nurses shifted to work forty-eight hours a week, with each nurse assigned to provide care for two patients. The intensive care unit in the “new” premises consisted of single rooms, each with twenty-eight beds.

Results

The median nosocomial infection density decreased from 23 to 15 per 1000 in-patient days. The catheter-related urinary tract infection rate decreased from 7.5 to 2.6 per100 catheter days.

Conclusions

Treatment of patients in the new hospital resulted in a decrease in nosocomial infection density.

Addressing the Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hematopoietic Cell Transplantation: Learning Networks as a Means for Sharing Best Practices

The full impact of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on the field of hematopoietic cell transplantation (HCT) is unknown. This perspective paper reviews the following: current COVID-19 epidemiology, diagnosis, and potential therapies; care considerations unique to HCT recipients; and the concept of a learning network to assimilate emerging guidelines and best practices and to optimize patient outcomes through facilitating shared learning and experience across transplantation centers.

A Proposed Process for Risk Mitigation During the COVID-19 Pandemic

Recent executive orders have led some applied behavior analysis (ABA) providers to interpret themselves as "essential personnel" during the COVID-19 pandemic. In this article, we argue against a blanket interpretation that being labeled "essential personnel" means that all in-person ABA services for all clients should continue during the COVID-19 pandemic. We believe this argument holds even if ABA providers are not in a jurisdiction currently under an active shelter-at-home or related order. First, we provide a brief description of risks associated with continued in-person ABA service delivery, as well as risks associated with the temporary suspension of services or the transition to remote ABA service delivery. For many clients, continued in-person service delivery carries a significant risk of severe harm to the client, family and caregivers, staff, and a currently overburdened health care system. In these situations, ABA providers should temporarily suspend services or transition to telehealth or other forms of remote service delivery until information from federal, state, and local health care experts deems in-person contact safe. In rare cases, temporary suspension of services or a transition to remote service delivery may place the client or others at risk of significant harm. In these situations, in-person services should likely continue, and ongoing assessment and risk mitigation are essential.

Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study

Background

The prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel.

In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The goal is a prevention strategy based upon three dimensions: “adherence”, “empowerment” and “acceptance”. “AHOI” stands for the “Activation of patients, persons in need of care and care givers for a Hygiene-conscious participatiOn in Infection control”. Results from the AHOI pilot study on the implementation of a multimodal intervention bundle are reported.

Methods

In 2017, a two-stage patient survey was conducted on two surgical wards for 14 weeks. In addition to the intervention bundle, acceptance, adherence and empowerment regarding individual hygiene behaviour and perception were evaluated. The bundle included an AHOI-welcome-box with an informational and entertaining brochure and supportive incentives. Furthermore, multiple visual materials like video presentations for patients’ bedside TV, posters and visual reminders in the patients’ bedrooms and sanitary facilities were installed.

Results

179 respondents were surveyed at admission, 139 at discharge and 133 at both time points. Almost all respondents wanted to contribute to infection control. The AHOI project was well accepted by patients. Two-thirds wanted to be more involved. More than a third expected a negative response from staff after pointing out hygiene deficiencies. Four respondents observed a deficiency in hygiene with healthcare personnel and reported a very positive reaction once this was communicated to the personnel. More than four-fifths of the respondents felt well integrated and adequately informed post intervention. The feeling of active involvement correlated significantly with subjective participation and adherence to hygienic measures, especially self-reported hand disinfection.

Conclusion

The results demonstrated that the required inclusion of patients in infection control is possible with AHOI. Active involvement of patients and relatives is associated with improvements in adherence to infection prevention measures.

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

BACKGROUND

The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further.

METHODS

Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients' hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing.

RESULTS

A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces.

CONCLUSIONS

Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.

Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care: a crossover study

Background

Hand hygiene is a critical component of infection control. Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Alcohol-based hand rub (ABHR) can lead to improved compliance. We aimed to determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol.

Methods

Thirty six elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to determine product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During the 3-day testing period, participants were provided with their own portable bottle of ABHR. A research nurse objectively assessed the skin integrity of the hands at baseline and throughout the study. Skin moisture content was determined using a Scalar Moisture Checker Probe (Science Technology Resources, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period.

Results

Both products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content had improved by the end of the study. Residents preferred either of the test products to the liquid formulation currently in use by the LTCF.

Conclusions

Overall, the elderly were willing to use ABHR for hand hygiene. Both products were well tolerated and preferred over the usual product provided by the LTCF. However, forgetfulness and difficulty rubbing the product over the hands due to finger stiffness posed a challenge for some residents. This could be overcome by using healthcare worker-assisted hand hygiene at specified times each day and prompts to serve as reminders to perform hand hygiene.

Hand hygiene of nursing and midwifery students in Cambodia

AIM

To determine the relationship between knowledge, attitude and the practice of hand hygiene by nursing and midwifery students in Cambodia.

BACKGROUND

Hand hygiene is the most cost-effective means to prevent hospital-acquired infections. Techniques of hand hygiene are simple; however, many researchers have found hand hygiene knowledge, attitude and practice to be poor in many healthcare settings worldwide, especially in developing countries. Cambodia is a developing country in Southeast Asia and data regarding hand hygiene are limited.

METHODS

A cross-sectional descriptive study was conducted to assess the level of knowledge, attitude and practice of hand hygiene. Students in nursing and midwifery programmes were the target population (n = 300). Survey data were collected from January to May 2017. Descriptive statistics, t-tests and correlation coefficients were calculated to assess relationships between student knowledge, attitude and hand hygiene practice.

RESULT

The level of knowledge, attitude and practice of hand hygiene in nursing and midwifery students was moderate. A majority of students had received hand hygiene training. There was no significant difference between nursing and midwifery students in knowledge, attitude and practice of hand hygiene. However, a Pearson correlation of attitude and practice had a weak positive relationship.

CONCLUSION

Both nursing and midwifery students demonstrated moderate levels of knowledge, attitudes and practice of hand hygiene.

IMPLICATION FOR NURSING AND HEALTH POLICY

This study identified a need for hand hygiene training. Developing training programmes to improve attitudes about hand hygiene is strongly recommended. Effective training may contribute to change behaviours of hand hygiene (attitude), improve practice and ultimately reduce hospital-acquired infections.

European survey of management of patients with multidrug-resistant organisms in rehabilitation facilities

BACKGROUND

Rehabilitation facilities have among the highest prevalence of multidrug-resistant organism (MDRO) colonization of any inpatient population. There is no formal consensus on how patients with MDROs should be managed in the rehabilitation setting.

AIM

The aim of this study was to assess how rehabilitation hospitals throughout Europe manage patients with MDROs, and the impact of MDRO carriage on outcomes.

DESIGN

Cross-sectional study.

SETTING

Online questionnaire distributed to European rehabilitation facilities.

POPULATION

European rehabilitation facilities.

METHODS

A Survey Monkey® questionnaire was designed and circulated to rehabilitation hospitals via the European Union of Medical Specialists, Physical and Rehabilitation Medicine Section.

RESULTS

Fifty-four responses were received of which 45 were suitable for analysis. Six out of 26 (23%) countries included in the study reported at least one rehabilitation facility with an estimated MDRO prevalence rate of 31% or higher. Screening of all patients on admission was always carried out in 33% (15 of 45) of facilities. Twenty-five of the 45 facilities (69%), aim to isolate, or cohort patients who have MDROs. Patients with MDROs wait longer for admission (36%, 16 of 45) and in the case of five hospitals admission is refused. Fifty-one percent (23 of 45) of facilities reported that colonization with an MDRO severely or moderately limits rehabilitation outcome.

CONCLUSIONS

Our research shows that many of the challenges posed by MDROs are common to facilities throughout Europe. We strongly recommend that all patients are screened for MDROs on admission. We stress that any negative impact of a patients MDRO status on their rehabilitation outcome must be minimized.

CLINICAL REHABILITATION IMPACT

Specific guidance on the management of rehabilitation patients with MDROs, would allow them to partake in a full rehabilitation program, while limiting the spread of MDROs.

Infection preventionists' challenges in psychiatric clinical settings

BACKGROUND

Infection preventionists (IPs) play an important role in preventing health care-associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings.

METHODS

A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis.

RESULTS

This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators.

CONCLUSIONS

The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

Patient as a Partner in Healthcare-Associated Infection Prevention

Objectives: The objective of the study was getting to know the knowledge and attitudes towards hand hygiene (HH) among Polish patients and healthcare workers (HCWs). Methods: 459 respondents replied to the survey: 173 (37.6%) patients and 286 (62.3%) HCWs; 57 HCWs were additionally interviewed. Results: Few HCWs knew and used the “5 moments for HH” in the required situations. Both patients and HCWs rated HH of other HCWs poorly: only 75% of patients and 54% of HCWs noticed the application of HH before blood sample collection, but 1/2 of interviewed HCWs did not encounter a request for HH from a patient. According to interviews, 23 (40%) HCWs did not admonish others when they did not use HH. Seventy-five percent of patients and HCWs claimed that, in the past, in schools the toilets were poorly stocked, but the situation improved with the passage of time. Conclusions: There are barriers with resspect to treating patients as partners in HH in Polish hospitals and HCWs’ lack of compliance with the “5 moments for HH” significantly reduces patients’ safety. Practice implications: Education regarding HH should be conducted for the whole society from an early age: lack of proper supplies in school bathrooms impedes the development of positive HH habits.