"Did you wash your hands?": a prospective study of patient empowerment to prompt hand washing by healthcare providers.

BACKGROUND: Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers. METHODS: From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients' hand hygiene knowledge and beliefs were objectively elicited pre and post-study. RESULTS: Thirty patients with a median age of 52 years (range 5-91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study. CONCLUSIONS: Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.

Patient motivational dialogue: A novel approach to improve hand hygiene through patient empowerment in ambulatory care.

A novel patient empowerment strategy called Patient Motivational Dialogue purposed to improve hand hygiene compliance is described. Two barriers to sustainability of patients asking health care providers (HCP) to clean their hands were noted in this study: (1) the HCP responding negatively to the patient asking, and (2) the patient misunderstanding that wearing gloves does not replace hand hygiene. Both barriers may be addressed through education of HCP and of consumer.

Environmental Infection Prevention: Priorities of Patient Safety Collaboration.

Although progress has been made in decreasing health care-associated infections (HAI) in intensive care unit (ICU) patients, there has been an increase in HAI caused by drug-resistant pathogens, particularly those that contaminate the environment such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas spp, Acinetobacter spp, and Clostridium difficile. The ICU environment including sinks and medical equipment has been identified as being at risk for contamination and associated with cross-transmission of pathogens between the health care provider, the environment, and the patient. This article addresses the role of the ICU nurse as a team facilitator collaborating with environmental services, infection preventionists, and others to influence ICU design during preconstruction planning and unit environmental hygiene after construction to promote patient safety and prevent HAI associated with contaminated environments and equipment.

Methodology minute: A guide for infection preventionists for sizing up systematic reviews.

Systematic reviews have become a key strategy to identifying evidence-based practice guidelines in infection prevention. They are considered the highest level of evidence providing the most effective answers to practice questions. Infection preventionists need to become familiar with reading systematic reviews and learn to critically appraise the findings and implications for practice. A systematic literature review is a rigorous preplanned process established to answer a specific practice question. The preplanned methods are detailed in the final publication. There are several key components that should be outlined in systematic reviews, which are briefly reviewed here.

Quality gaps in documenting urinary catheter use and infectious outcomes.

OBJECTIVE: To describe the frequency of use of all types of urinary catheters, including but not limited to indwelling catheters, as well as positive cultures associated with the various types. We also determined the accuracy of catheter-days reporting at our institution. DESIGN: Prospective, observational trial based on patient-level review of the electronic medical record. Chart review was compared with standard methods of catheter surveillance and reporting by infection control personnel. SETTING: Ten internal medicine and 5 long-term care wards in 2 tertiary care Veterans Affairs hospitals in Texas from July 2010 through June 2011. PARTICIPANTS: The study included 7,866 inpatients. METHODS: Measurements included patient bed-days; days of use of indwelling, external, suprapubic, and intermittent urinary catheters; number of urine cultures obtained and culture results; and infection control reports of indwelling catheter-days. RESULTS: We observed 7,866 inpatients with 128,267 bed-days on acute medicine and extended care wards during the study. A urinary catheter was used on 36.9% of the total bed-days observed. Acute medicine wards collected more urine cultures per 1,000 bed-days than did the extended care wards (75.9 and 10.4 cultures per 1,000 bed-days, respectively; P<.001). Catheter-days were divided among indwelling-catheter-days (47.8%), external-catheter-days (48.4%), and other (intermittent- and suprapubic-catheter-days, 3.8%). External catheters contributed to 376 (37.3%) of the 1,009 catheter-associated positive urine cultures. Urinary-catheter-days reported to the infection control department missed 20.1% of the actual days of indwelling catheter use, whereas 12.0% of their reported catheter-days were false. CONCLUSIONS: Urinary catheter use was extremely common. External catheters accounted for a large portion of catheter-associated bacteriuria, and standard practices for tracking urinary-catheter-days were unreliable. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01052545.

Isolation: a concept analysis.

TOPIC: Concept analysis of isolation. PURPOSE: This article uses Walker and Avant's methodological approach in distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the concept. BACKGROUND: The importance of social contact has long been recognized as a fundamental need for humans. The concept of isolation is used throughout the lay and scientific literature and has a primarily negative connotation for humans. The experience is sometimes severe enough to result in serious reductions in adaptation and performance. DATA SOURCES: The Medline, CINAHL, and Google Scholar databases were searched using the key terms of concept analysis, human, and isolation with no restriction on the year of publication. English language reports were used exclusively. CONCLUSION: Three attributes were identified: sensory deprivation, social isolation, and confinement. Antecedents included individual perception and situational dimensions. Consequences included anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis, isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement. Systematic studies of isolation using this concept can ultimately enhance nurses' knowledge base and contribute to the quality of life for isolated persons.

Electronic surveillance systems in infection prevention: organizational support, program characteristics, and user satisfaction.

BACKGROUND: The use of electronic surveillance systems (ESSs) is gradually increasing in infection prevention and control programs. Little is known about the characteristics of hospitals that have a ESS, user satisfaction with ESSs, and organizational support for implementation of ESSs. METHODS: A total of 350 acute care hospitals in California were invited to participate in a Web-based survey; 207 hospitals (59%) agreed to participate. The survey included a description of infection prevention and control department staff, where and how they spent their time, a measure of organizational support for infection prevention and control, and reported experience with ESSs. RESULTS: Only 23% (44/192) of responding infection prevention and control departments had an ESS. No statistically significant difference was seen in how and where infection preventionists (IPs) who used an ESS and those who did not spend their time. The 2 significant predictors of whether an ESS was present were score on the Organizational Support Scale (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.18) and hospital bed size (OR, 1.004; 95% CI, 1.00-1.007). Organizational support also was positively correlated with IP satisfaction with the ESS, as measured on the Computer Usability Scale (P = .02). CONCLUSION: Despite evidence that such systems may improve efficiency of data collection and potentially improve patient outcomes, ESSs remain relatively uncommon in infection prevention and control programs. Based on our findings, organizational support appears to be a major predictor of the presence, use, and satisfaction with ESSs in infection prevention and control programs.

HIPP lead to self-health: healthy infection prevention practices in intensive care units.

Healthy infection prevention practices (HIPP) include hand hygiene, respiratory etiquette, environmental cleanliness, and use of personal protective equipment. These healthy practices are most used to protect individuals against exposure to bacterial and viral infections in the workplace, as well as in the home. Most often these infection prevention behaviors in critical care units are promoted to protect the patient from healthcare-associated infections. Yet, these practices are just as important to the health of the critical care nurse. Self-health in the workplace is essential to creating a healthy workplace environment, which is the goal of many intensive care units today. The benefits of creating a healthy work environment are improvement of patient/nurse satisfaction and nurse retention. HIPP reduce the risk of the critical care nurse's exposure to microbial pathogens such as methicillin-resistant Staphylococcus aureus and influenza. Pathogens that cause infections may contaminate the hands, the clothing, equipment, and blood, putting the nurse at risk for unhealthy hands, unhealthy flora, and unhealthy blood. The intensive care nurse is encouraged to embrace HIPP to nurture self, as well as protect the patient.

Perioperative management of multidrug-resistant organisms in health care settings.

Guidelines for managing multidrug-resistant organisms (MDROs) in health care settings were published by the Healthcare Infection Control Practices Advisory Committee (HICPAC) in October 2006. These guidelines outline appropriate strategies to help prevent MDRO cross transmission. Perioperative nurses should be prepared to implement these strategies in an effort to protect their surgical patients from contracting MDRO infections. The HICPAC recommends elevating contact precautions to "intensified interventions" in facilities with endemic outbreaks of MDROs. Perioperative nurses should participate in these efforts by adhering to infection control practices, championing these practices with other health care personnel, and providing clinical support and leadership.