Prospective, randomized comparison of castor oil and sodium phosphate preparation for barium enema.

OBJECTIVE: To compare castor oil and sodium phosphate preparation (Swiff) in patients' satisfaction, efficacy for colon cleanness, side effects, and prices. MATERIAL AND METHOD: One hundred patients referred for barium enema were randomized to receive castor oil (n = 50) and sodium phosphate preparation (n = 50). They graded their satisfaction using a 5-point scale (easy, acceptable, slightly difficult, extremely difficult, and unacceptable). The efficacy for colon cleanness was graded by two radiologists using a 5-point scale (excellent, easy for evaluation, acceptable, difficult for evaluation, and unacceptable). Side effects were evaluated by patients' vital signs, total number of bowel frequency, and 10 associated symptoms. RESULTS: Both preparations revealed no difference in patients' satisfaction (p = 0.882) and efficacy of colon cleanness (p = 0.130). Sodium phosphate preparation was more expensive (79 vs. 10 Baht) and caused higher number of bowel frequency (p < 0.001). CONCLUSION: With a cheaper price, castor oil was comparable with sodium phosphate preparation in patients' satisfaction and efficacy of colon cleanness.

Strategies to improve hand hygiene practices in two university hospitals.

OBJECTIVE: To evaluate the strategies to improve hand hygiene practices among participants in two university hospitals. MATERIAL AND METHOD: A quasi-experimental study was performed from January 1, 2001 to December 31, 2004 at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to identify factors associated with non-adherence in hand hygiene practices among participants, 2) intervention phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and performance feedback. RESULTS: Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404 HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant improvement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive procedures (p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001). CONCLUSION: Different strategies worked well in different institutions. The present study suggested the role of multi-faceted approaches to help improve handhygiene practices among HCWs.

Effectiveness of education and quality control work group focusing on nursing practices for prevention of ventilator-associated pneumonia.

OBJECTIVES: To evaluate the effectiveness of education and quality control work group focusing on nursing practices for prevention of ventilator-associated pneumonia (VAP). MATERIAL AND METHOD: A quasi-experimental study was performed to evaluate the effect of education and quality control work group on prevention of VAP by 18 nurses in the womens' medical ward, Surat Thani Hospital, Thailand. Pre-intervention nursing practices were observed in March, 2002, followed by interventions in April 2002 and two post-tests on nursing practices in May 2002 and July 2002. Interventions included education and quality control work group focusing on nursing practices on prevention of VAR Each observation period lasted for one month. Research instruments included a demographic data collection form, a quality control circle teaching plan, an evaluation manual and an observational recording form. RESULTS: After the intervention, significant improvement on nursing practices for prevention of VAP was observed in the first (60% vs. 85%; P<0.001) and the second month (60% vs. 91 %; P<0.001) post-intervention. Compliance to nursing practice guidelines among the participants were also increased in all practice categories (87% vs. 98%; P<0.001). CONCLUSION: The present study suggests the positive roles of education and quality control work group to improve nursing practices for preventions of VAP Additional studies are needed to examine the long-term effects of these interventions.

Evaluation of a training course in infection control for nurses.

OBJECTIVE: To evaluate the effectiveness of a training course in infection control for nurses. MATERIAL AND METHODS: A quasi-experimental study was performed from November 1, 2001 to December 31, 2002. The study was divided into three phases; 1) pre-intervention (November 1-30, 2001) to survey baseline data among participants, 2) intervention (January 1-31, 2002) to establish, develop and conduct the training course, 3) post-intervention (February 1, 2002 to December 31, 2002) to evaluate the effectiveness of the training program, and conduct a workshop for infection control project presentations. The research instruments consisted of questionaires and a focus group discussion guide. RESULTS: Forty-six nurses who had experience of working as infection control nurses (ICN) for more than one year and 46 hospital administrators were enrolled in the pre-interventional phase. Major problems identified among ICNs were inadequate knowledge, multiple simultaneous job descriptions, overwork and lack of collaboration from colleagues. After intervention, significant improvement was observed on their knowledge and confidence among ICNs (rating scale, 4.09 vs. 3.43; p< 0.001). All administrators agreed that the training course was beneficial to ICNs and believed that the problems in practices of IC would be solved. More satisfaction of ICNs among hospital administrators was also observed (97.7% vs. 28.3%; p< 0.001). CONCLUSION: The present study suggested that the training course to provide practical knowledge for ICNs be effective and should be conducted periodically to keep up with the advance in medical technology. An ICN network with other academic institutions should be established.

Effect of an education program on the prevention of ventilator-associated pneumonia: A multicenter study.

OBJECTIVE: To evaluate the effect of an educational program targeted on modifiable risk factors on ventilator-associated pneumonia (VAP) rates. MATERIAL AND METHOD: After a preliminary study on VAP risk factors was conducted at one teaching hospital, a pre- and post-interventional study was then performed on 12 hospitals in Thailand from January 1, 2002 to June 30, 2003. Each hospital randomly selected 20 patients, who were on mechanical ventilation to be enrolled The study was divided into two phases; 1) pre-intervention, 2) post-intervention. Data collected included patients 'demography and risk factors for VAP During pre-interventional phase, data on risk factors for VAP was analyzed and fedback to healthcare providers in the wards by an infection control nurse (ICN) of the individual hospital. An educational programme on the prevention of VAP was introduced by the ICN. Ventilator-associated pneumonia rates and their risk factors were continuously monitored during the post-interventionl phase. RESULTS: Two hundred and forty four patients in the pre-interventional phase and 254 patients in the post-interventional phase were included. There was no significant difference in the demography between these two patient populations. After the intervetion, there was a significant improvement in hand-hygiene practices (p<0.001) among healthcare providers and increased use of sucralfate (p=0.05) for stress ulcer prophylaxis. Ventilation-associated pneumonia rate (40.5% vs. 24%; p<0.001) and crude mortality rate associated with VAP (12.3% vs. 8.7%; p<0.001) were also reduced CONCLUSION: The educational programme targeted on modifiable risk factors for prevention of VAP was effective and should be considered as an intervention to reduce VAP rates in developing countries.

Effectiveness of education and problem solving work group on nursing practices to prevent needlestick and sharp injury.

OBJECTIVES: To examine the effect of an education program and problem solving work group on nursing practices for prevention of needlestick and sharp injury. MATERIAL AND METHOD: A quasi-experimental study design with a control group was conducted at the emergency and labor rooms in Sermngam Hospital, Lampang. All healthcare workers (HCWs) in the emergency and labor room were randomly assigned to the experimental and control group from April 17, 2002 to September 3, 2002. Data collection included demographics, a participatory problem solving plan, and safety nursing practice observation recording form. The present study was divided into a two months observation period, followed by a one month intervention period and a two month post-intervention observation period. Interventions included education and posters to promote safe nursing practices, peer reminders to avoid unsafe nursing practices, providing devices for recapping needles and small-sized trays to facilitate one-handed recapping, and making a hole in the lid of a sharp container Nursing practices on prevention of needlestick and sharp injury were prospectively monitored. RESULTS: Twelve HCWs (12/24; 50%) were randomly assigned to the experimental group and 12 (12/24; 50%) were assigned to the control group. There was no difference with respects to demographic and safety nursing practices on prevention of needlestick and sharp injury during the pre-interventional period among these groups. Compared to the pre-interventional period, significant improvement on safety nursing practices for all nursing practice categories were observed in the experimental group after the intervention (P=0.001). Compared to the control group, all safety nursing practice categories were performed more often in the experimental group (p=0.001). CONCLUSION: The educational and problem solving work group on nursing practices to prevent needlestick and sharp injury were effective and should be considered as an intervention to reduce needlestick and sharp injury in emergency and labor rooms at Sermngarm Hospital.