New patient privacy curtains to provide passive infection prevention.

Background: Cloth privacy curtains represent a potentially overlooked high touch surface. Inconsistent cleaning schedules paired with frequent contact allow curtains to provide a surface for the transmission of healthcare associated pathogens. Privacy curtains integrated with antimicrobial and sporicidal agents are shown to reduce the number of bacteria found on the surface of the curtains. The purpose of this initiative is to utilize antimicrobial and sporicidal privacy curtains to mitigate the transmission of healthcare associated pathogens from curtains to patients. Methods: The pre/post-test study design compared the bacterial and sporicidal burden of cloth curtains to the bacterial and sporicidal burden of Endurocide curtains following 20-weeks of use within the inpatient setting of a large military medical hospital. The Endurocide curtains were installed on two inpatient units in the organization. We also compared the overall costs associated with the two different types of curtains. Results: The antimicrobial and sporicidal curtains had a significant reduction in bacterial contamination (32.6 CFUs vs 0.56 CFUs, P < 0.05) after instillation on both units. There were no additional hospital associated infections during the study period. In addition, the direct cost savings of replacing the antimicrobial and sporicidal curtains is estimated to be $20,079.38 annually with a reduction of 66.95 hours in environmental services workload. Conclusion: These curtains represent a cost-effective intervention effective at reducing CFUs with the potential to mitigate the transmission of hospital associated pathogens to patients.

A systematic review of the germicidal effectiveness of ultraviolet disinfection across high-touch surfaces in the immediate patient environment.

Background: There is not yet a consensus regarding the in-use effectiveness of ultraviolet irradiation (UV-C) as a supplementary tool for terminal room disinfection. Aims and Objectives: To summarize and evaluate literature detailing the germicidal effectiveness of UV-C disinfection on high-touch surfaces in the patient environment. Methods: A literature search was carried out utilizing PRISMA guidelines. Studies were included if intervention included UV-C after standard room disinfection in hospital rooms evaluated microbiologically by surface type. Findings/Results: Twelve records met our criteria for inclusion. Studies predominantly focused on terminal disinfection of patient rooms, including five reports carried out in isolation rooms and three studies including operating room (OR) surfaces. Bedrails, remote controls, phones, tray tables, assist rails, floors, and toilets were the most commonly reported surfaces. Across study designs, surfaces, and room types, flat surfaces tended to showcase UV-C effectiveness best, particularly isolation room floors. In contrast, handheld surfaces (i.e., bed controls and assist bars) tended to show reduced efficacies (81-93%). In the OR, complex surfaces similarly demonstrated reduced UV-C effectiveness. Bathroom surfaces demonstrated 83% UV-C effectiveness overall, with surface characteristics uniquely impacted depending on the room type. Isolation room studies tended to include effectiveness comparison with standard treatment, reporting UV-C superiority most of the time. Discussion: This review highlights the enhanced effectiveness of UV-C surface disinfection over standard protocols across various study designs and surfaces. However, surface and room characteristics do appear to play a role in the level of bacterial reduction.

Effect of SARs-CoV-2 pandemic on infection prevention behaviors and bacterial burden of high touch surfaces in a medical/surgical setting.

This study aimed to determine the longitudinal efficacy of ultraviolet germicidal disinfection (UV-C) in a non-terminal disinfection context. Moreover, factors influencing enhanced infection prevention behaviors during the SARS-CoV-2 pandemic were evaluated. Sixty nursing staff from three medical/surgical wards in a large military hospital were recruited for a survey and microbiological sampling of high-touch surfaces (stethoscope, personal electronic device, common access card, and hospital ID badge) and portable medical equipment (wheelchairs and mobile commodes). Surveys included hand hygiene estimates, frequency/method of cleaning items of interest, perception of UV-C, and factors influencing the use of enhanced disinfection tools. Surveys and microbiological samples were performed prior to and after the installation of a rapid, automated ultraviolet disinfection enclosure for staff use. Both time points preceded the SARS-CoV-2 pandemic in the United States. A final survey/sampling time point was carried out eight months after the declaration of the COVID-19 pandemic. Participants' hand hygiene frequency did not increase throughout the study, with > 80% reporting a minimum of 4 hand hygiene events per patient hour. The cleaning frequency of high-touch surfaces (non-clinical) but not portable medical equipment increased after installation of a UV-C disinfection tool and was sustained eight months into the COVID-19 pandemic. While a modest decrease in bacterial burden was observed after UV-C intervention, a more significant reduction was observed across all surfaces during pandemic time sampling, though no detectable decrease in pathogenic contamination was observed at either time point. Motivators of UV-C use included fear of SARS-CoV-2 contamination and transmission, ease of device use, and access to rapid, automated disinfection tools while deterrents reported included technical concerns, lack of time, and preference for other disinfection methods. Automated, rapid-cycle UV-C disinfection can be efficacious for high-touch surfaces not currently governed by infection prevention and control guidelines. The introduction of enhanced disinfection tools like UV-C can enhance the overall cleaning frequency and is correlated with mild decreases in bacterial burden of high-touch surfaces, this is enhanced during periods of heightened infection threat. Evidence from this study offers insights into the factors which prompt healthcare workers to internalize/dismiss enhanced infection prevention procedures.

Limited impact of an ultraviolet disinfection intervention on hygienic behaviors of nursing staff in a military hospital.

Ultraviolet disinfection (UV-C), though effective, has not been thoroughly evaluated at the level of the clinical end user. We assessed behavioral outcomes related to environmental hygiene among 60 nursing staff in a medical-surgical section after introduction of a UV-C tool aimed at disinfecting 4 high-touch surfaces, and we noted limited changes.

Assessment of surgical instrument bioburden after steam sterilization: A pilot study.

In environments in which manual decontamination and steam sterilization remains the primary method of sterilization, biofilm formation can increase the risk of disease transmission. To determine the risk of bacterial survival and contamination on surgical instruments, inoculated blood was dried on one instrument and steam sterilized (wrapped or unwrapped) in a set of 4 (including 3 clean). Two of 3 pathogens were recovered at a rate of 15% for unwrapped sets and 33% for wrapped sets.

Standing desks for sedentary occupations: Assessing changes in satisfaction and health outcomes after six months of use.

BACKGROUND: Standing desks are a low cost option for the reduction of sedentary behavior. OBJECTIVE: This study evaluated changes in utility and health outcomes during a standing desk intervention. METHODS: Thirty-five participants (BMI >25) who reported sitting an average of≥six hours per workday were recruited. Participants were randomized into a control or intervention group. Eleven were enrolled in the control group and 24 in the intervention group. Participants in the intervention group were outfitted with an adjustable standing desktop accessory while participants in the control group maintained a standard work desk. Self-reported and objective measures of sedentary time during an eight hour workday were captured for a baseline and intervention period. Changes in health outcomes and workplace satisfaction were assessed after six months. RESULTS: Self-recorded sedentary behavior decreased by 25% after six months though no changes in health outcomes were observed. Subjective assessments of standing time were over-estimated by 10% (compared to accelerometer recordings) in the intervention group. The intervention group reported higher levels of satisfaction with comfort, customizability, and overall personal workplace. CONCLUSIONS: Despite a decrease in sedentary behavior, no changes in health outcomes occurred after a six month intervention. Future studies should incorporate objective measures of diet and physical activity to assess compensatory behaviors that may offset sedentary reduction. More sensitive health outcome measures should also be considered.

Comparative effectiveness of rapid-cycle ultraviolet decontamination to chemical decontamination on high-touch communication devices.

BACKGROUND: This quantitative, comparative-descriptive study of inpatient units in a large military medical center was designed to compare the effectiveness of compact ultraviolet (UV-C) decontamination to standard chemical decontamination in reducing the microbial burden on Vocera (San Jose, CA) communication devices and to characterize changes in staff cleaning practices following UV-C device implementation. METHODS: Aerobic and anaerobic swabs were used to collect microbial samples from Vocera devices (n = 60) before and after chemical decontamination (first sampling) and before and after UV decontamination (second sampling). Cleaning behaviors were assessed by observation and oral inquiry during the baseline sampling and surveyed 8 weeks after UV-C device implementation. Outcomes included aerobic and anaerobic colony-forming units and prevalence of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or Clostridium difficile, as determined by standard microbiological methods. RESULTS: No differences were found between the two cleaning methods in their ability to reduce aerobic bacteria; however, UV-C was significantly more effective at reducing bacteria grown anaerobically (P < .01). This study elucidated an 8.3% prevalence of methicillin-resistant Staphylococcus aureus on Vocera devices in the inpatient environment. Initially, 42% of respondents reported deviations from manufacturer's cleaning guidelines, and 16.7% reported daily or more frequent cleaning of the Vocera devices. CONCLUSIONS: After implementation, UV-C decontamination reduced average cleaning time by 43% and increased the rate of daily Vocera cleaning to 86.5%. Respondents reported an overall 98% user satisfaction with the UV-C device.

Usability of and Satisfaction With Vocera Wireless Communication.

Qualitative reports of hands-free communication devices highlight numerous improvements in communication. The purpose of this study was to assess both usability and satisfaction scores at approximately 1 year after the implementation of a hands-free communication device at two different large military facilities. To do this, a survey that included the System Usability Scale and questions to assess satisfaction with regard to use, quality, and user satisfaction was provided to staff at both of these facilities. System usability scores indicated moderate satisfaction (61.7 at facility A, 63.8 at facility B). User satisfaction rated highest levels of agreement with the hands-free devices as an important system and being useful (35%-37% at facility A, 46% at facility B). Scores regarding improving the quality of work (A = 12%, B = 16%); safety of patients (A = 23%, B = 29%); and ability to do their job in a timely manner (A = 23%, B = 29%) were the lowest. The results highlight the potential benefits of Vocera for improving communication within the healthcare team. Given the large percentage of staff turnover at both of these facilities, the sustained benefit of hands-free devices will require ongoing training and continued evaluation of workflow processes.

Bacterial Contamination of Military and Civilian Uniforms in an Emergency Department.

INTRODUCTION: The emergency department is a fast-paced, high-volume environment, serving patients with diverse and evolving acuities. Personnel providing direct care are continually exposed to pathogenic microorganisms from patients and everyday surfaces, to which the organisms may spread. Indeed, hospital items-such as electronic devices, stethoscopes, and staff clothing-have demonstrated high rates of contamination. Despite this, policies governing the use, disinfection, and wear of various environmental surfaces remain relaxed, vague, and/or difficult to enforce. This study aimed to examine the bacterial contamination on 2 hospital uniform types in a large military hospital within the emergency department. METHODS: Environmental sampling of military and civilian nursing staff uniforms was performed on 2 separate occasions. Emergency nurses wore hospital-provided freshly laundered scrubs on the first sampling day and home-laundered personally owned uniforms complicit with ED policy on the second sampling day. Samples were collected by impressing of contact blood agar growth medium at arrival (0 hour), 4 hours, and 8 hours of wear. Microbiological methods were used to enumerate and identify bacterial colonies. RESULTS: Bacterial contamination of personally owned uniforms was significantly higher than freshly laundered hospital-provided scrubs on 4 different sampling sites and across the span of an 8-hour workday. No significant differences were observed between military and civilian personally owned uniforms. However, several risk factors for nosocomial infection were increased in the military subgroup. DISCUSSION: Re-evaluating organizational factors (such as uniform policies) that increase the propensity for pathogenic contamination are critical for mitigating the spread and acquisition of multidrug-resistant organisms in the emergency department.

Comparing colony-forming units in inpatient nurses: Should military nurses who provide patient care wear hospital-provided scrubs?

OBJECTIVE: To compare bacterial contamination of military-approved uniforms and hospital-provided scrubs donned by nursing staff in an inpatient setting. DESIGN: Randomized experimental crossover study. SETTING: Large academic military medical center. METHODS: Inpatient units were randomized to predetermine the order of uniform sampling. Participants included nursing staff who provided direct patient care across 7 eligible inpatient units. Sampling of 6 designated sites on the uniform was completed on arrival to work, at ~4 hours into their shift, and at the 8-hour time point, for a total of 18 samples. Sampling of each participant occurred on 2 separate occasions, once in a military-approved uniform, and once in hospital-provided scrubs. After 24 hours of incubation, a colony-counting machine was used to calculate the total colony-forming units (CFU) of the sample. RESULTS: Across all time points, military-approved uniforms demonstrated a 2-fold bacterial increase at the abdominal site and 3-fold increases at the sleeve cuff and waist pocket regions compared to the same regions on hospital-provided scrubs. CONCLUSION: Nurses should be aware that bacteria are present at much higher levels on their personal military uniforms compared to hospital-provided scrubs. Additional research is needed to determine whether these findings are a function of wear, laundering, or environmental factors. Nurses should adhere to daily uniform washing to reduce bacterial load and minimize risk of nosocomial infections to the patients they care for.

Ensuring Capability to Provide Safe Patient Care Prior to Occupying Renovated Clinical Area.

OBJECTIVE:: To determine the effectiveness of simulation in improving staff confidence to provide safe patient care in a new or unfamiliar patient care area. BACKGROUND:: Hospitals undergo constant renovation to meet the needs of the populations they serve. Relocating to a newly renovated care area can potentially impact patient safety through workflow process changes. METHOD:: Simulated patient care scenarios were used to assess functionality of equipment and staff orientation to a newly renovated ward. Additionally, staff confidence to provide safe patient care was assessed prior to patient relocation. RESULTS:: All participating staff reported feeling confident in their ability to provide safe patient care within the newly renovated ward at the conclusion of the exercise. CONCLUSIONS:: In this case study, the use of simulated patient care scenarios was successful to orientate staff to a new clinical space. Additionally, staff were able to identify workflow changes and access the functionality of newly installed equipment. This exercise allowed staff to gain confidence in their ability to provide safe patient care in a newly renovated area.

Utilizing selected social determinants and behaviors to predict obesity in military personnel.

OBJECTIVE: Like the general population, the military is experiencing an increase in the number of obese personnel. This study aimed to identify predictors of obesity by assessing social determinants of health and behaviors in relation to Body Mass Index (BMI), and to use these variables to build a model to predict obesity in Active Duty Military Personnel (ADMP). Predicting obesity would allow early intervention of at risk personnel, potentially reducing the number of ADMP who are separated from the service for failing to meet weight standards. DESIGN: A secondary data analysis of the 2011 Survey of Health-Related Behaviors of Active Duty Military Personnel was performed. The survey included 39,197 responders. MEASURES: Descriptive statistics, bivariate analyses, and logistic regression analysis were conducted to examine the relationship between social determinants of health, behaviors in relation to Healthy People 2020 recommendations, and obesity. Moderator variables were used to determine what affects the direction and/or strength of the relationship between the independent variables (e.g., social determinants and behaviors) and the outcome variable of obesity. RESULTS: At the bivariate level, these variables mirror existing research. However, logistic regression identified few statistically significant obesogenic lifestyle behaviors in relation to Healthy People 2020 recommendations and a weak interactive effect between the variables. CONCLUSION: The low number of significant variables identified to predict obesity highlights the multifactorial nature of obesity making it difficult for weight-loss interventions to be effective if limited to one group or one specific behavior.

Use of Rifapentine and Isoniazid Directly Observed Therapy for the Treatment of Latent Tuberculosis Infection in a Military Clinic.

BACKGROUND: There are 8.6 million cases of active tuberculosis (TB) worldwide, and an estimated one-third of the world population has latent tuberculosis infection (LTBI). In the United States, up to 80% of active cases may be caused by untreated reactivated latent infection. A case of TB can spread rapidly impacting the readiness of a unit. To prevent the development of TB, it is critical that active duty service members with LTBI complete treatment. The use of isoniazid (INH) and rifapentine (RPT) as a directly observed therapy (DOT) treatment option was recommended by the Centers for Disease Control and Prevention in late 2011. Since then, there have been limited studies on the use of this treatment regimen in a civilian clinic setting and to our knowledge no studies within a military setting. METHODS: This study compares the completion rate of LTBI treatment in 2 military public health clinics, using a retrospective chart review of 179 subjects who attempted treatment with INH/RPT DOT and 186 with the non-INH/RPT non-DOT regimen. FINDINGS: When compared to other LTBI regimens completed or attempted in this period, completion rates were higher in INH/RPT DOT regimens. The INH/RPT DOT treatment regimen allowed enough flexibility with completion between 11 and 16 weeks for active duty service members to increase completion to 94.6%, compared to 73% in the non-INH/RPT regimen. RECOMMENDATIONS: This project demonstrated the feasibility of INH/RPT DOT treatment within the military population resulting in a higher completion rate than the non-INH/RPT non-DOT regimen. The use of the INH/RPT DOT regimen should be considered for use in all military or similar populations.

Pedometry to Prevent Cardiorespiratory Fitness Decline-Is it Effective?

INTRODUCTION: Physically active providers are more likely to prescribe exercise. Unfortunately, many become sedentary during their training. We examined pedometry as an incentive to promote physical activity in a cohort of medical students. METHODS: This was a prospective, unblinded clinical trial of pedometry. 107 preclinical medical students volunteered. 50 students received Fitbit pedometers and 57 served as controls. All students ran 1.5- or 2-mile timed runs before pedometer issue, and again 1 year after. Change in run times were the primary outcome measure. Step counts, body composition, and exercise frequency were secondary outcomes. RESULTS: 76% of students with pedometers reported increased motivation to exercise and 57% reported changing daily routines as a result of pedometry. Active pedometry participants declined from 48/50 initially to 22/50 over 13 months. Run times slowed an average of 5.0 seconds for pedometry users vs. 12.3 seconds for the control group. This difference was not statistically significant (p = 0.48). CONCLUSIONS: A subset of future physicians reported increased motivation to exercise after a trial of pedometry. However, adherence over the long term was poor and it seems to have a limited impact on aerobic exercise performance in this population.

Exploring the impact of a pedometer on body composition and physical fitness in a cohort of U.S. military medical students: a pilot study.

Military medical professionals play a central role in preventing and treating obesity among America's warriors through training, medical care, and their personal example. Unfortunately, medical students in both undergraduate and graduate settings often experience declines in physical fitness. Pedometry has been demonstrated as one means of promoting fitness with 10,000 steps/day generally accepted as a key benchmark. With this in mind, we used pedometry as an incentive during the preclinical years to encourage students to adopt a more active lifestyle. Findings suggest that participants that consistently report meeting the 10,000 steps/day maintained or improved their aerobic fitness.

Assessing psychosocial differences in stages of change: an analysis of military healthcare system patients with type 2 diabetes.

INTRODUCTION: Provider advice is considered key to behavioral change for a healthier lifestyle. However, a healthcare professional simply telling an individual to change does not prompt behavior change. This study intends to link patient knowledge, attitudes, and beliefs to the stages of change. By incorporating a stages-of-change assessment and tailoring interventions to patient with diabetes, outcomes can improve. METHODS: This study is a secondary data analysis of a single-site, prospective intervention study promoting walking in patients with type 2 diabetes (n = 111) in an Army community hospital. RESULTS: Analysis of variance provided evidence of significant knowledge and attitude differences between precontemplation and contemplation groups, and for significant self-efficacy and social norms differences across the stages of change. DISCUSSION: Results here provided evidence for the application of stages of change in promoting exercise to patient with type 2 diabetes. Specifically, this study makes message recommendations for patients in the various stages of change.

Accuracy of adults' perception of childhood obesity in a military environment.

OBJECTIVES: The aim of this study was to determine how accurately adults in a military environment identified images of children within four different categories: underweight, normal weight, overweight, and obese. DESIGN AND SAMPLE: For this descriptive correlational research study, the sample was composed of 1,016 adults. MEASURES: Chi-square analysis of participant's demographic characteristics and accuracy of identification of six different images of children was conducted. RESULTS: Statistical significance was demonstrated with participant's self-image and accuracy of identification in four of the six images. CONCLUSIONS: This research supports the conclusion that individuals who classify themselves as overweight or obese are very accurate in correctly classifying images of children in these categories. While this is true our findings demonstrate that a large number of participants do not correctly self-identify themselves. This suggests that educational campaigns need to include educational components to increase awareness of what children are considered overweight or obese. Without this, the potential exists for the message to be missed as the parent could potentially perceive the overweight or obese child as normal.