Antimicrobial efficacy and durability of copper formulations over one year of hospital use.

OBJECTIVE: To evaluate 3 formulations of copper (Cu)-based self-sanitizing surfaces for antimicrobial efficacy and durability over 1 year in inpatient clinical areas and laboratories. DESIGN: Randomized control trial. SETTING: We assessed 3 copper formulations: (1) solid alloy 80% Cu-20% Ni (integral copper), (2) spray-on 80% Cu-20% Ni (spray-on) and (3) 16% composite copper-impregnated surface (CIS). In total, 480 coupons (1 cm2) of the 3 products and control surgical grade (AISI 316) stainless steel were inserted into gaskets and affixed to clinical carts used in patient care areas (including emergency and maternity units) and on microbiology laboratory bench work spaces (n = 240). The microbial burden and assessment of resistance to wear, corrosion, and material compatibility were determined every 3 months. Participants included 3 tertiary-care Canadian adult hospital and 1 pediatric-maternity hospital. RESULTS: Copper formulations used on inpatient units statistically significantly reduced bacterial bioburden compared to stainless steel at months 3 and 6. Only the integral copper product had significantly less bacteria than stainless steel at month 12. No statistically significant differences were detected in microbial burden between copper formulations and stainless-steel coupons on microbiology laboratory benches where bacterial counts were low overall. All mass changes and corrosion rates of the formulations were acceptable by engineering standards. CONCLUSIONS: Copper surfaces vary in their antimicrobial efficacy after 1 year of hospital use. Frequency of cleaning and disinfection influence the impact of copper; the greatest reduction in microbial bioburden occurred in clinical areas compared to the microbiology laboratory where cleaning and disinfection were performed multiple times daily.

Considerations for preparing a randomized population health intervention trial: lessons from a South African-Canadian partnership to improve the health of health workers.

BACKGROUND: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. OBJECTIVE: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North-South partnerships. DESIGN: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. RESULTS: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. CONCLUSION: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North-South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge.

Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use?

We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demonstrated improvement in PPE sequence scores (P = .001); moreover, hand hygiene also was more frequent during both donning and doffing of PPE (P < .001).

The infection control audit: the standardized audit as a tool for change.

BACKGROUND: Health care workers' compliance with infection control practices and principles is vital in preventing the spread of disease. One tool to assess infection control practice in clinical areas is the infection control audit; however, many institutions do not approach this in a systematic fashion. METHODS: Key features of the infection control audit were identified by the infection control team and developed into a standardized format for review of clinical areas. The audit incorporates a review of the physical layout, protocols and policies, knowledge of basic infection control principles, and workplace practice review. RESULTS: Over the last 13 years, the infection control unit has completed 17 audits involving 1525 employees. Four-hundred-one staff members have filled out questionnaires that assessed their understanding of standard precautions. A total of 257 recommendations have been made, and 95% of these have been implemented. The majority of recommendations address separation of clean and dirty supplies, hand hygiene compliance, hand hygiene signage, proper use of barriers, and environmental cleaning. CONCLUSION: The infection control audit is an opportunity to implement changes and to introduce remedial measures in collaboration with various departments and services. A standardized approach to the audit allows benchmarking of practices across the institution and enhances standards of care.

Infection control - delivering the message in the 21 century.

The experiences gleaned from new and suddenly emergent infectious diseases (e.g. SARS, avian influenza or diarrhea caused by Clostridium difficile) have highlighted how important it is, also for infection prophylaxis, to be able to find instruments for rapid and effective communication. Since 1990 online (E) learning has been used to train nursing staff and offers the advantage of being able to study at an individual pace as well as cut down on the time and financial resources needed. It serves to overcome geographic distances in respect of the teaching institution, can be used at any time of day according to individual needs and has proved suitable for presenting learning modules in infection prevention.No doubt, traditional didactic learning continues to be the most important approach, but new technologies such as "problem based learning" (PBL) are becoming more popular, and allow students to acquire knowledge in concrete situations. Translating knowledge into behavior calls for an ability to convert scientific theoretic knowledge quickly, efficiently and clearly into practical behavior. Hence E learning is an ideal way to ensure that the latter requirements are met. While it is obvious that knowledge can be easily imparted by this method, further research is needed to establish whether and to what extent it is possible to use this method to translate the acquired knowledge into altered behavior too. Experts believe that novel media technologies hold out several new prospects for accomplishing this.