Hand hygiene compliance and accuracy in a university dental teaching hospital.

OBJECTIVE: This study aimed to evaluate compliance with guidelines on hand hygiene by examining five handwashing categories in postgraduate year (PGY) dentists at a university teaching hospital and to evaluate the accuracy rates of handwashing. METHODS: Through direct observation, trained PGY dentists were monitored throughout their daily care routine of before contact with patients, before using an instrument, after contact with patients, upon direct exposure to patients' fluids, and while touching the patients' surrounding area. Hand hygiene opportunities were considered complete in each category. A total of 16,597 hand hygiene opportunities across 37 individuals were observed from July to October 2012 and from September to October 2013. RESULTS: The overall handwashing compliance rate was 34.7%. The handwashing compliance rate was higher during work in oral surgery services (92.8%) than during work in general clinical practice (34.2%). The accuracy rate of handwashing was also higher during work in oral surgery services (87.5%) than during work in general clinical practice (51.0%). Similar results were obtained across all five handwashing categories. CONCLUSIONS: Handwashing compliance and accuracy rates are low in PGY dentists. More education and continuous monitoring are suggested to improve handwashing compliance, as well as the correct handwashing procedures for dentists.

Sleep-related predictors of quality of life in the elderly versus younger heart failure patients: a questionnaire survey.

BACKGROUND: Research has indicated that sleep disorders reduce the quality of life of heart failure patients. OBJECTIVES: To investigate quality of sleep, and the impact of poor sleep on quality of life among elderly versus younger heart failure patients. DESIGN: A two-group, cross-sectional study. SETTING: A community teaching hospital in Taipei, Taiwan. PARTICIPANTS: Voluntarily self-enrolled heart failure patients who did not have sleep apnea or restless leg syndrome. METHODS: There were 126 elderly and 67 young participants filled out five questionnaires (1) demographic information and current health status; (2) the Chinese Pittsburgh Sleep Quality Index; (3) the Chinese Epworth Sleepiness Scale, and (4) the short form (SF)-36 Taiwanese version. The major statistical procedures applied in this study were t-test, analysis of variance, Pearson's correlation, and a stepwise multiple linear regression. A p-value of <0.05 was adopted as significant. RESULTS: The prevalence of insomnia was 44.4% for the elderly group and 31.4% for the younger group. The top three prevalence sleep-disturbing events were: nocturia, long sleep latency, and early wake-up. In the elderly group, nocturnal dyspnea and long sleep latency were significant determinants of the mental (R(2)=0.23) and physical components (R(2)=0.21) of quality of life. In the young group, nocturnal dyspnea was a significant determinant of the mental component of quality of life (R(2)=0.15), and early wake-up was a significant determinant of the physical component of quality of life (R(2)=0.15). CONCLUSION: The sleep disorder of heart failure patients is disease-specific rather than a matter of age. The prevalence of insomnia of young heart failure patients was higher than that of the healthy elderly. The major determinants of poor night sleep quality in the elderly group were dyspnea and long sleep latency, and in the younger group, these were dyspnea and early wake-up. Those also were significant determinants of quality of life of the heart failure patients. IMPLICATIONS FOR NURSING PRACTICE: Since the sleep-related predictors of quality of life were different in the elderly versus younger heart failure patients, to identify the insomnia factors individually and to provide guidance of appropriate usage of sleep medications and other methods to promote sleep should be considered.