Adherence to personal protective equipment use among nurses in Japanese tertiary care hospitals: what determines variability?

BACKGROUND: Though nurses have frequent contact with patients, their personal protective equipment (PPE) compliance rate is low, which poses a significant challenge in infection control. AIM: To investigate the relative influence of specific factors on PPE compliance. METHODS: A sequential two-stage mixed-methods design was applied. In a qualitative study, semi-structured interviews were conducted from May to July 2018. In a quantitative study, a nationwide, cross-sectional survey was conducted from January to March 2019, in which a questionnaire was mailed to 735 nurses in 28 tertiary care hospitals in Japan. FINDINGS: In the quantitative study, 435 (59.2%) analysable responses were obtained. In the linear regression analysis, the lack of the knowledge that 'standard precaution was the fundamental infection countermeasure applied when patients had signs of infections, and these countermeasures could be terminated if there was no infection found' was significantly associated with decreased PPE adherence, whereas an antimicrobial-resistant bacteria outbreak or a ward shutdown due to an outbreak and the belief 'I must never be the cause of spreading infection' were significantly associated with increased PPE adherence. The ß of standard coefficients and t-values of the items were -0.344, -7.784, 0.090, 2.089, 0.088, 2.018, respectively. CONCLUSION: This survey systematically identified nursing-associated factors that contribute to PPE compliance. As a practical approach to ensure positive outcomes, we suggest educating nurses by providing adequate knowledge on appropriate PPE use and sharing outbreak or ward shutdown experiences.

Adherence to contact precautions by different types of healthcare workers through video monitoring in a tertiary hospital.

BACKGROUND: Contact precautions are required to prevent transmission of multi-drug-resistant organisms; however, reports on adherence rates vary. This study used video monitoring to evaluate adherence to the use of personal protective equipment (PPE) by different types of healthcare workers. METHODS: This observational study was conducted in a 781-bed tertiary hospital from July 2016 to March 2017. Cameras were installed in areas where staff don PPE. Infection control teams observed the videos and assessed adherence rates. RESULTS: In total, 1097 opportunities for donning PPE were observed. Most staff observed were nurses and nursing assistants (Ns/Nsas) (880/1097, 80.2%). Overall, the adherence rate to appropriate PPE use was 34.0%. The adherence rate among Ns/Nsas was lower (239/858, 27.9%) compared with infectious disease doctors (18/18, 100%) and cleaning staff (42/49, 85.7%). The adherence rate for PPE use for Clostridium difficile infection (CDI) with toxin detection was significantly higher than that for CDI without toxin detection and multi-drug-resistant organisms (P<0.001 for both). The adherence rate for patients with an independent functional status was higher than that for patients with a dependent functional status (P=0.018). The adherence rate was lower in the intensive care unit (ICU) than in non-ICU wards (27.6% vs 36.5%; P=0.006). CONCLUSION: Video monitoring is a useful tool for monitoring adherence to PPE use, facilitating observation of more PPE opportunities than direct observation. Adherence to contact precautions varied by occupation; however, overall adherence was insufficient. The lower adherence rate in nurses might be due to more frequent care visits.

[Detection of ventricular late potentials and the incidence of ventricular tachycardia in diabetic patients, with reference to myocardial infarction].

To clarify the relationship between diabetes mellitus (DM) and fatal ventricular arrhythmias, such as ventricular tachycardia (VT), in patients with ishcemic heart disease, signal-averaged electrocardiograms were recorded in 107 patients with DM and/or myocardial infarction (MI). During the acute stage of MI (within 6 weeks of onset), patients with DM had significantly greater amplitude in the last 40 msec of filtered QRS as compared to those without DM (69.1 +/- 55.1 vs 33.9 +/- 17.5 microV, p < 0.01), thus signifying a lower incidence of late ventricular potential (LP) and VT. We therefore investigated the incidence of VT in 257 consecutive patients with acute MI (74 with DM, 183 without DM). Although there was no significant difference in the incidence of VT between the two groups, a subgroup with congestive heart failure (CHF, Killip > or = II) in the DM group had a significantly lower incidence of VT than a subgroup with CHF but not DM (18.5% vs 41.9%, p < 0.05). It is concluded that patients with DM have a lower incidence of LP and VT during the acute stage of MI.

Coronary artery-left ventricular fistulae with atrial septal defect.

We describe a 65-year-old woman who had coronary artery-left ventricular fistula associated with atrial septal defect of the sinus venosus type, and left-sided heart failure. Although a cardiac valve anomaly associated with coronary artery fistula has been described, atrial septal defect has not been reported previously in this condition.

Paradoxical motion of the posterior left ventricular wall seen in healthy subjects in the upright position.

Paradoxical motion of the posterior left ventricular wall in patients in the upright but not in the supine position was demonstrated in a high percentage of normal volunteers. There was no significant difference in age, body surface area, heart rate, and blood pressure between the groups, with or without paradoxical motion. This echocardiographic finding probably represents a physiologic phenomenon and should be taken into consideration during the interpretation of upright exercise echocardiograms.

Hemodynamic characteristics of echocardiographic findings in hypertensive patients with negative U waves and effect of an antihypertensive drug, tripamide.

Twenty-four hypertensive patients were divided into a group A with negative U waves (n = 8, mean age, 50 +/- 11 years) and a group B without negative U waves (n = 16, mean age, 49 +/- 11 years). Echocardiographic findings were compared with a group of 20 age-matched normotensive subjects without cardiovascular disease (mean age, 49 +/- 11 years). In addition, the effects of the antihypertensive agent tripamide were assessed in groups A and B. Although hemodynamic parameters such as left ventricular end-systolic and diastolic dimensions, stroke volume and cardiac output were elevated in group A, group B showed an increase in total peripheral resistance. Thus, group A was characterized by high cardiac output, while group B displayed increased peripheral resistance. Tripamide was administered to 14 patients. In group A (6 patients receiving tripamide), left ventricular end-systolic and end-diastolic dimensions were significantly reduced by tripamide along with stroke volume and cardiac output. However, in group B the only significant change in hemodynamic parameters after tripamide administration was a drop in total peripheral resistance. These findings suggest that both the hemodynamics of hypertensive patients and responses to tripamide vary with the presence of negative U waves.

Utility of echocardiography for the early assessment of patients with nondiagnostic chest pain.

A two-dimensional (2D) echocardiogram was recorded shortly after admission in 46 patients with nondiagnostic chest pain. Eighteen patients were studied during chest pain and 28 were studied following the resolution of chest pain. Of the 18 patients studied during chest pain, six of the eight patients who had a regional wall motion abnormality (RWMA) evolved an acute infarction and the remaining two patients had evidence of significant coronary artery disease. Only 1 of 10 patients without a RWMA evolved an infarction and none had significant coronary artery disease. Of the 28 patients studied following the resolution of chest pain, 8 of the 10 patients with a RWMA evolved an acute infarction and one patient had evidence of significant coronary artery disease, whereas of 18 patients without a RWMA, none evolved an acute infarction and five had evidence of significant coronary artery disease. These data suggest that in patients presenting with nondiagnostic chest pain, an early assessment of regional wall motion by 2D echocardiography can reliably differentiate patients with myocardial ischemia or early infarction from patients with nonischemic chest pain when performed during an episode of chest pain; can also identify those patients with early acute myocardial infarction, even when performed following the resolution of chest pain; but is not useful for the detection of patients with significant coronary artery disease without infarction when performed following the resolution of chest pain.