Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate.

AIM

To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach.

METHODS

A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews.

FINDINGS

Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence.

CONCLUSION

The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.

Implementation of the American Society of Anesthesiologists 2022 paediatric guidelines in a child with mandibular metastasis

The 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway differ significantly from prior guidelines, particularly regarding paediatric patients. These guidelines place new emphasis on establishing a multidisciplinary team led by an anaesthetist trained in paediatric anaesthesia. Here, we demonstrate the clinical application of the new guidelines by presenting the case of a 16-month-old girl with a rapidly growing mandibular mass. The new guidelines stipulated the need for multidisciplinary team assembly; planning with indirect laryngoscopy; the availability of surgical tracheostomy and extracorporeal membrane oxygenation; and multiple 'time out' stops to confirm team members and plans. The patient tolerated induction of general anaesthesia and mask-ventilation and tracheal intubation was achieved uneventfully on the first attempt. Her trachea was extubated uneventfully 5 days later. We emphasise the importance of paediatric anaesthesia training and videolaryngoscopy and discuss components of the 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway with reference to a successful outcome in a paediatric difficult airway scenario.

Psychosocial interventions and strategies to support young people at mass gathering events: a scoping review

OBJECTIVES

To improve health and safety outcomes at mass gathering events (MGEs) for young attendees, it is essential to understand the psychosocial factors that may influence behaviour so that the implementation of support strategies before, during and after MGEs can be developed to enhance outcomes. This review identifies the psychosocial outcomes that may occur at MGEs, including social connection, substance use, risky behaviours and psychological distress and examines what interventions have been implemented to target these outcomes.

STUDY DESIGN

Scoping review.

METHODS

This study examined MGE psychosocial interventions with predominantly youth attendees was conducted using the Preferred Reporting Items of Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Papers were collected from the databases CINAHL, MEDLINE, Embase and PsycINFO. Titles and abstracts were scanned for relevance, followed by a full-text screening. Information relevant to the research question was extracted from papers meeting the inclusion criteria.

RESULTS

Twenty-six papers met the inclusion criteria. The psychosocial factors that were most studied included social influence, social interactions and psychological stressors, which lead to behaviours such as excessive alcohol consumption, drug taking, risky casual sex and risk taking amongst psychological factors of young attendees. Effective interventions implemented before or during MGEs, such as alcohol-free zones, antidrinking campaigns, psychoeducation and disapproval from parents with regard to drinking alcohol, showed promise in reducing harms.

CONCLUSION

Psychosocial interventions have the potential to reduce harms and enhance well-being for young people attending MGEs. This review has identified gaps and opportunities in the current literature with regard to psychosocial interventions and strategies to support young people at MGEs and makes recommendations to support the development and refinement of evidence-based interventions aimed at young MGE attendees.

People, places and the climate emergency – the Scottish Place Standard Tool with a climate lens

Since the launch of the Place Standard tool (PST) in Scotland in 2015 awareness has increased of the critical impact of the climate emergency on health and equity. A 2019 review of the PST, informed by emerging evidence and community and stakeholder feedback, confirmed the need to strengthen its contribution towards place-based climate action. This was partly achieved by integrating enhanced prompts within the PST itself, however with the increased focus of policy and action around climate adaptation and mitigation a knowledge and resource gap remained. So in 2020 PST partners* began work with experts from environmental organisations (Sniffer, Sustainable Scotland Network) and other partners to develop a “Place Standard with a climate lens” (PST CL). The PST CL toolkit was created through an iterative process integrating feedback from 10 pilot projects chosen to represent the varied communities, scales, landscapes and placemaking projects being undertaken across Scotland. It provides a suite of materials to use alongside existing PST resources to help placemaking conversations consider how climate change might play out in a local area. This ensures that local responses to climate change are designed holistically, delivered collaboratively, and helps achieve on other local priorities such as health, wellbeing and equity. This presentation will provide a brief overview of the project background, describe the Scottish PST with a climate lens, share case study examples from the piloting phases, and enable exploration of the learning from Scotland around the value of integrating health and climate in place-based approaches. While the Place Standard tool was not originally designed as a climate change tool, it is an effective method to support the design of local responses to the climate emergency. A “climate lens” can help us to plan the future of our places to maximise the health benefits and minimise the negative consequences of a changing climate.

Abstract P6-15-03: MBC Connect™, an open-access, patient-reported registry of de-identified data from patients living with metastatic breast cancer

Metastatic breast cancer (MBC) remains an incurable disease and is the cause of nearly all deaths from breast cancer. Several barriers prevent efficient research into various questions about living with MBC. A key unmet need is a national database for MBC patient-reported outcomes, which does not exist anywhere in the world. Furthermore, compartmentalized data prevents broad collaborative efforts. Treatment patterns and responses, survival times, and metastatic patterns are not documented systematically and remain unavailable. Large-scale data extraction is challenging, and expensive, and electronic medical records do not provide information regarding patient experiences. Methods: MBC Connect™ was created to help overcome these barriers. MBC Connect, which is sponsored by the Metastatic Breast Cancer Alliance, is a multi-national registry of participant reported information about their experience of MBC. MBC Connect allows MBC patients to voluntarily provide information about their disease, treatment outcomes, and experience of living with their disease so that researchers can gain insight into unmet needs in MBC. MBC Connect has three main goals: 1. Establish an interactive registry of patient-entered, de-identified data for MBC. 2. Create an open-access portal for researchers to study these data. 3. Create a connection between investigators of clinical trials and clinical research studies and registered users who may be interested in clinical trials. Results: MBC Connect collects, via the use of a mobile app (on a smartphone or tablet, iOS and Android compatible) or via a website for desktop users, participant consent, general patient characteristics and demographics, disease characteristics, genetics and tumor mutations, treatment history, quality of life data, and clinical trial experience. This information can be provided by patients living with MBC or their caregiver. The data are collected from responses to surveys and via creation of a treatment profile. The data are de-identified and made available on an open-access Researcher portal, allowing them to be used to advance multiple areas of research into MBC, including both medical treatment aspects and quality of life issues. An interactive feature of MBC Connect is that researchers may submit a request for participants to answer additional surveys. Participants may also be notified about clinical trials for which they may be eligible. In addition, participants will regularly receive “Insights,” which are engaging bytes of information related to MBC. Insights can offer general information about the disease, upcoming events, and other facts, or they can be personalized for the participant based on the information he or she has entered the registry. Conclusions: MBC Connect is a novel platform that aims to accelerate MBC research by providing open access to patient-reported, de-identified data about patients living with MBC. The overarching objective of this technologic initiative is to increase patient engagement with the research community.

Citation Format: Campbell L, De La Torre K, Williams CE, Mertz SA, Pollastro T, Hutton A, Newby J, Ellis MJ, Iyengar NM, Hurlbert MS. MBC Connect™, an open-access, patient-reported registry of de-identified data from patients living with metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-15-03.

The association between prepregnancy obesity and screening positive for postpartum depression

OBJECTIVE

To describe the association between reported prepregnancy body mass index (BMI) and screening positive for depression.

DESIGN

Cohort study.

SETTING

Four urban hospitals in Utah, USA.

POPULATION

Women delivering a term, singleton, live-born infant at one of four urban hospitals in Utah in the period 2005-2007.

METHODS

Women were enrolled immediately postpartum. Demographic, anthropometric, stressors, psychiatric, and medical/obstetric and family-history data were obtained. Prepregnancy height, weight, and pregnancy weight gain were self-reported. The primary exposure variable, prepregnancy BMI, was calculated. Women were stratified into the six World Health Organization BMI categories (underweight, normal weight, pre-obese, or obese class 1-3).

MAIN OUTCOME MEASURE

At 6-8 weeks postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of > or =12.

RESULTS

Among the 1053 women studied, 14.4% of normal weight women screened positive for postpartum depression. This proportion was greater in women classed as underweight (18.0%, n = 11), pre-obese (18.5%, n = 38), obese class 1 (18.8%, n = 16), obese class 2 (32.4%, n = 11), and obese class 3 (40.0%, n = 8) (P < 0.01). Controlling for demographic, psychological, and medical/obstetric factors, prepregnancy class-2 (aOR 2.87, 95% CI 1.21-6.81) and class-3 (aOR 3.94, 95% CI 1.38-11.23) obesity remained strongly associated with screening positive for postpartum depression, compared with women of normal weight.

CONCLUSIONS

Self-reported prepregnancy obesity may be associated with screening positive for depression when measured postpartum.

The enculturation of our nursing graduates

The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates' perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates' needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.

Four rules for taking your message to Wall Street

Managers fail to communicate effectively with Wall Street for all sorts of reasons. But neglecting the investment community--particularly the analysts whose opinions shape the market and whose recommendations often make or break a company's share price--can knock the most carefully conceived and brilliantly executed strategy off course. The companies that struggle the most with providing good information to analysts are those in rapidly evolving industries, where the gap between traditional performance metrics and economic realities is at its widest. In these industries, a company's strategy and the variables that govern its performance can change radically in a short time. What's more, the metrics used to report performance often fail to capture the drivers of value in today's information economy. Few accounting measures are helpful when it comes to assessing the intangible assets--knowledge, skilled employees, and so forth--on which many of today's fastest-growing companies build their strategies. According to Amy Hutton, an associate professor at Harvard Business School, there are four basic rules for clear communications with Wall Street. First, make sure that your company's financial reporting reflects your strategy as closely as possible. Second, popularize the nonfinancial metrics that best predict--and flatter--the performance of your businesses. Third, appoint managers with recognized credibility to your strategic operations. Finally, cultivate the market experts who cover the industries in which you seek to compete. Hutton shows how AOL successfully followed these rules as it significantly changed its strategic direction and competitive arena.

Rats with low levels of brain docosahexaenoic acid show impaired performance in olfactory-based and spatial learning tasks

Studies were carried out to determine if decreased levels of central nervous system docosahexaenoic acid (DHA), a result of consuming an n-3-deficient diet, had an effect on learning- and memory-related behaviors in adult male rats. Females were reared on an n-3-deficient or n-3-adequate diet beginning at 21 d of life. Their male pups, the F2 generation, were weaned to the diet of the dam and tested at 9-12 wk of age. An olfactory-based discrimination and Morris water maze task were used to assess performance. Whole brain was collected after the behavioral experiments and central nervous system fatty acid content was analyzed in olfactory bulb total lipid extracts. F2 generation male rats consuming the n-3-deficient diet had an 82% decrease in DHA compared to rats consuming the n-3-adequate diet. The n-3-deficient animals made significantly more total errors in a 7-problem, 2-odor discrimination task compared to the n-3-adequate group. Furthermore, the escape latency in the Morris water maze task was significantly longer for the n-3-deficient rats compared to the n-3-adequate rats. These results indicate that rats with decreased DHA levels in the central nervous system perform poorer in these tasks compared to rats with higher DHA levels and suggest the presence of learning deficits in these animals.

Olfactory discrimination deficits in n-3 fatty acid-deficient rats

Docosahexaenoic acid (DHA), a long chain n-3 fatty acid, is present in high concentrations in the central nervous system. Although the role that DHA may play in neural function is not well understood, infants fed formulas containing low levels of n-3 fatty acids have decreased visual acuity and neurodevelopmental test scores. The present experiment assessed whether dietary manipulations that decrease the concentration of DHA in the brain interfered with olfactory-based learning. We fed rats a diet that provided adequate n-3 fatty acids or a diet that was deficient in n-3 fatty acids for two generations. The second generation n-3-deficient group had 81% less brain DHA (82% less in olfactory bulb) compared to the n-3-adequate group and made significantly more errors in a series of olfactory-cued, 2-odor discrimination tasks compared to the adequate group. These results suggest that lower levels of central nervous system DHA lead to poorer performance in a series of simple odor discrimination tasks.

Intensive care nurses' experiences with end-of-life care

BACKGROUND

With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved.

OBJECTIVES

To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients.

METHODS

A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined.

RESULTS

"Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward.

CONCLUSIONS

Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

Intensive care nurses' experiences with end-of-life care

BACKGROUND: With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. OBJECTIVES: To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients. METHODS: A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined. RESULTS: "Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward. CONCLUSIONS: Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

What the patient wants from patient participation

In a general practice with an existing patient participation group, a survey of patients was undertaken to ascertain knowledge of and interest in the group. It was hoped that this might avoid the failure that had befallen other groups of this type. Analysis of the questionnaire provided useful information: there was interest in the group, with a potential attendance of almost three-quarters of the respondents. There was a clear lack of knowledge about the functions of the group, but the evidence was that if the desired activities were to be arranged and publicized they would be well attended.