A Survey of Adherence to Guidelines to Prevent Healthcare-Associated Infections in Iranian Intensive Care Units

Use of nursing care bundles for the prevention of ventilator-associated pneumonia in low-middle income countries: A scoping review

BACKGROUND

Ventilator-associated pneumonia (VAP) is a significant concern in low-middle-income countries (LMICs), where the burden of hospital-acquired infections is high, and resources are low. Evidence-based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs.

AIM

This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines.

STUDY DESIGN

The review was conducted using Arksey and O'Malley's (2005) five-stage framework and the PRISMA-ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies.

RESULTS

After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities.

CONCLUSIONS

This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC.

RELEVANCE TO CLINICAL PRACTICE

IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP.

Exploring Australian emergency department clinicians' knowledge, attitudes and adherence to the national peripheral intravenous catheter clinical care standard: A cross-sectional national survey

OBJECTIVE

This study aimed to (i) capture clinicians' knowledge, attitude and adherence to the first Australian national peripheral intravenous catheter (PIVC) Clinical Care Standard, (ii) examine the instrument performance of the knowledge related questions and (iii) explore the educational needs for, and barriers to, Standard adherence among Australian ED clinicians.

METHODS

A cross-sectional national online survey was conducted from March to June 2022, using a snowball sampling method. The survey used 5-point Likert scales and multiple-choice questions to capture respondents' knowledge, attitude and adherence to the Standard as well as the educational needs for, and barriers to, Standard adherence.

RESULTS

In total, 433 ED nurses and doctors responded. Although nearly half (n = 206, 47.6%; 95% confidence interval [CI] 55.5-65.8) of respondents claimed that they were unfamiliar with the Standard, questions on PIVC knowledge yielded that most respondents had adequate knowledge of most of the key standards. Respondents' attitudes towards multiple intravenous insertion attempts and ongoing PIVC competency monitoring are not in agreement with the Standard. Self-reported practices regarding routine insertion of idle catheters (55%; 95% CI 49.9-59.9), using antecubital fossa as the first insertion site (84%; 95% CI 80-87), insertion without confidence (46%; 95% CI 41.2-51.1) and lack of routine reviewing the ongoing needs of PIVC (40%; 95% CI 35.3-45.1) were not aligned with the Standard. Unawareness of the Standard and non-practical recommendations were rated as the top barriers to Standard adherence.

CONCLUSION

The findings of the survey suggest that the Standard may need modification to align with the needs of ED clinicians. Future studies need to explore the applicability and relevancy of some recommendations in the ED settings as they may cause low adherence to the Standard.

Management Strategies During the COVID-19 Pandemic Crisis: The Experiences of Health Managers from Iran, Ardabil Province

OBJECTIVE

The coronavirus disease 2019 (COVID-19) outbreak is the most threatening public health challenge in the 21th century, and more than 200 countries are affected. Considering that Iran was one of the first countries influenced by the COVID-19 pandemic, this study aimed to explain the crisis management strategies during the COVID-19 pandemic in Ardabil province.

METHODS

This study used a qualitative method using content analysis in which 12 health-care managers or decision-makers involved in the management of the COVID-19 crisis were recruited through purposeful sampling. In-depth, semi-structured interviews were used to collect data, which continued until data saturation.

RESULTS

Data analysis led to nine categories, including prior preparation for the COVID-19 crisis; challenges and management of workforce shortages; benefiting from the participation of volunteer staff; challenges and strategies for physical space, supplies, and personal protective equipment (PPE); designation of referral centers for COVID-19; protocolized patient transport; benefiting from donations and charity support; management of information about COVID-19; and learning from the prior stages of crisis.

CONCLUSION

This study revealed that, in critical situations, managers use multiple and, to some extent, unique strategies for decision-making and crisis control. Therefore, the health system can use the findings of the current study for proper response to similar crises and training of future managers.

Expanding Fiscal Space for Healthcare System through Efficiency: A Qualitative Study from Iran

BACKGROUND

Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran's healthcare system.

METHODS

This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework.

RESULTS

We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources.

CONCLUSION

Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives.

Barriers to and Facilitators of Nurses' Adherence to Clinical Practice Guidelines: A Qualitative Study

BACKGROUND

Guidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm.

AIMS

The present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines.

METHODS

Detailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis.

FINDINGS

Identified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision.

CONCLUSION

Interventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.

Health care-associated infections in Iran: A national update for the year 2015

BACKGROUND

A national surveillance system for health care-associated infections (HAIs) in Iran is relatively new, and an update on incidence and mortality rates can aid clinicians and stakeholders in development of new guidelines and imperative modifications to be made.

METHODS

Data were extracted from the national HAIs surveillance software for more than 7 million hospitalizations during 2015. Data regarding age, gender, deaths, ward of admission, and microbiologic findings were collected and analyzed.

RESULTS

From 491 hospitals, 7,018,393 hospitalizations were reported during 2015; 82,950 patients had been diagnosed with at least 1 HAI, 6,355 of whom died (crude fatality rate, 7.7). Men comprised 51.4% of the patients. The incidence rate was calculated to be 1.18. Urinary tract infections and pneumonia were the most commonly reported infections (27.9% and 23.8%) and 33% of patients were older than age 65 years. Intensive care units had the highest incidence rates, followed by burn units with incidence rates close to 9. Highest percentages of deaths were reported among patients with an HAI in the intensive care unit (20.6%) and those with pneumonia (39.6%).

CONCLUSION

Although the underreporting of HAIs hinders accurate calculation of incidence, the present study provides a general update. The results can help in modification of national guidelines and appropriate choice of antimicrobial agents in the management of HAIs.