Nurses' awareness on hospital acquired infection risks of the geriatric patients: A descriptive and cross-sectional study.

INTRODUCTION: The increasing number of persons > 65 years of age form a special population at risk for nosocomial and other health care-associated infections. Nosocomial infections are major problems in terms of morbidity and mortality as well as prolonged hospitalization and increased costs. The aim of the present study was determination of nurses' awareness of hospital-acquired infection risks of the geriatric patients. METHODOLOGY: This descriptive and cross-sectional study was conducted at a university hospital in North Cyprus. A total of 164 voluntary nurses composed the sample of the study. A questionnaire that was developed by the researchers based on the literature was used as data collection tool. After the ethical approval, data were collected using a questionnaire in September and October 2017 with self-completion method. The methods used to analyze the data include an analysis of descriptive statistic variables such as frequency and percentages for the categorical variables and the Pearson's Chi-square test for comparisons. RESULTS: Results of the study showed inadequate awareness among nurses on hospital-acquired infection risks of the geriatric patients. It was also determined that there were the statistically significant differences in term of education levels and experiences of nurses with different items on hospital-acquired infection risks of the geriatric patients. CONCLUSIONS: Based on the results of the study, implementations of comprehensive, systematic, and continuous educational programs to enhance awareness of the nurses on health care-associated infections was recommended.

COVID-19 and healthcare-associated infections.

National Health Systems are facing a very serious health emergency related to COVID-19. In this phase of emergency, it is essential to ensure the care of all affected patients but also to ensure the economic stability of the National Health System. This stability is undermined by the potential exponential increase in claims caused by healthcare-associated infections related to COVID-19. That is why it will be essential to use all means necessary to prevent this economic crisis, which could overlap with the health crisis.

Infection prevention knowledge, practice, and its associated factors among healthcare providers in primary healthcare unit of Wogdie District, Northeast Ethiopia, 2019: a cross-sectional study.

BACKGROUND: Adequate knowledge and safe practice of infection prevention among healthcare providers are vital to prevent nosocomial infections. Thus, this study aimed to assess the level of knowledge and practices of healthcare providers towards infection prevention and its associated factors in the health facilities of Wogdie District, Northern Ethiopia. METHODS: Institution based cross-sectional study was conducted among 171 healthcare providers who were selected by a simple random sampling technique. Data were collected using interviewer-administered questionnaire. Multivariable logistic regression was performed to identify factors associated with knowledge and practice of infection prevention. RESULT: About 70.8 and 55.0% of healthcare providers had adequate knowledge and safe practice of infection prevention respectively. Having infection prevention guideline (AOR = 3.65, 95% CI; 1.26, 10.54), taking infection prevention training (AOR = 2.2, 95% CI; 1.01, 4.75), having five years or more work experience (AOR = 1.52:95%CI; 1.13, 4.51), and working in maternity unit (AOR = 1.67:95%CI; 1.38-5.23) were positively associated with adequate knowledge of infection prevention. The odds of safe practice were higher in participants who received infection prevention training (AOR: 2.4; 95% CI; 1.01, 4.75) but lower among healthcare providers who are working in the facility which has no continuous water supply (AOR = 0.48:95% CI; 0.21, 0.83). CONCLUSION: A significant proportion of healthcare providers had inadequate knowledge and unsafe practice of infection prevention. To improve healthcare worker's knowledge of infection prevention, adequate pre-service as well as on job training should be given.

Healthcare Workers' Knowledge and Attitudes Regarding the World Health Organization's "My 5 Moments for Hand Hygiene": Evidence From a Vietnamese Central General Hospital.

OBJECTIVES: Although the World Health Organization (WHO) initiative "My 5 Moments for Hand Hygiene" has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)' hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital. METHODS: A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs' knowledge and attitudes towards hand hygiene. RESULTS: Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts. CONCLUSIONS: Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.

[Appreciating COVID-19 as a child and adolescent psychiatrist on the move]. / Appréhender le COVID-19 au fil de l'eau en tant que psychiatre d'enfant et d'adolescent.

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.

Barriers and facilitators to standardization of ultrasound use and probe disinfection in the ambulatory setting.

To determine barriers and facilitators to standardization of ultrasound probe disinfection at ambulatory sites, we conducted observations and interviews of staff. Variability was noted in disinfection practices and in the use of protective equipment even for procedures with the potential for the probe to contact sterile tissues. Standardization is needed.

Depression and anxiety in hospitalized patients on contact precautions for multidrug-resistant microorganisms.

BACKGROUND: Contact precautions for patients with multidrug-resistant organisms (MDROs) have been associated with adverse effects. The aim of this study was, therefore, to evaluate the level of anxiety and depression through different standardized scales in patients isolated by MDROs. METHODS: This is a case-control study with hospitalized patients on contact precautions for MDROs. A questionnaire survey was conducted to analyse the presence and level of depression and anxiety. A multivariable analysis was performed to define independent questions for anxiety/depression scores to create a short questionnaire facilitating a practical approach to the care of hospitalized patients with MDROs. A receiver operating characteristic (ROC) curve was plotted to determine the diagnostic ability of the simplified score. RESULTS: A total of 141 patients were included in the study, among whom 68 were isolated because of MDRO colonization while 73 were not isolated (control-group). Forty-five (31.9%) patients had some degree of anxiety. Patients in MDRO contact isolation had a higher level of anxiety than those who were not isolated (55.9% vs. 9.6%, p < 0.001). The equation obtained by multivariated analysis allowed for the construction of a score with ROC area of 0.949 and a sensitivity of 91.1%. CONCLUSION: Contact isolation for MDROs is associated with increased depression and anxiety. A simple anxiety score was developed and should be validated for screening.

Prophylactic antibiotics prior to dental procedures: A cross-disciplinary survey of dentists and medical providers.

The prescription of prophylactic antibiotics prior to dental procedures is common, although factors influencing prescribing are poorly understood. We surveyed general and specialist medical providers and dentists on beliefs and attitudes regarding prophylactic antibiotic prescribing prior to dental procedures. There were significant differences in factors influencing decisions and perceived responsibility regarding prophylactic antibiotic prescribing between groups, although interest in additional education on the subject was high across both groups.

Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units.

BACKGROUND: Healthcare-associated infections (HAIs) in neonatal intensive care units (NICUs) result in increased morbidity, mortality and healthcare costs. HAI rates in Greek NICUs are among the highest in Europe. There is a need to identify the factors that influence the transmission of HAIs and implementation of prevention interventions in this setting. AIM: To understand healthcare workers' perceptions about HAI prevention in Greek NICUs. METHODS: Qualitative interviews were conducted with NICU staff (physicians and nurses) and infection prevention stakeholders (infectious diseases physicians and infection control nurses) working in three hospitals in Athens. Interviews were conducted in Greek, transcribed and translated into English, and analysed using a modified grounded theory approach. FINDINGS: Interviews were conducted with 37 respondents (20 physicians and 17 nurses). Four main barriers to HAI prevention were identified: (1) resource limitations leading to understaffing and cramped space; (2) poor knowledge about HAI prevention; (3) Greek-specific cultural norms, including hierarchy-driven decisions, a reluctance for public workers to do more than they are paid for, a belief that personal experience trumps evidence-based knowledge, and reactive rather than proactive approaches to societal challenges; and (4) lack of a national infection prevention infrastructure. Respondents believed that these barriers could be overcome through organized initiatives, high-quality HAI performance data, interpersonal interactions to build engagement around HAI prevention, and leveraging the hierarchy to promote change from the 'top down'. CONCLUSION: Implementing HAI prevention interventions in Greek NICUs will require consideration of contextual features surrounding the delivery of care, with particular attention paid to national culture.

Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey.

BACKGROUND: Individuals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs. METHODS: A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018. RESULTS: Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6-18.9 h). CONCLUSION: The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.

How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life.

INTRODUCTION: Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves. METHODS AND ANALYSIS: The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing. ETHICS AND DISSEMINATION: The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website. TRIAL REGISTRATION NUMBER: NCT03253640; Pre-results.

Hospital epidemiologists' and infection preventionists' opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric.

OBJECTIVE: To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care. DESIGN: Cross-sectional survey. PARTICIPANTS: Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS: A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals. RESULTS: A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital's quality of care. Also, 29% of respondents' hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line-associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone. CONCLUSIONS: Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.

The socio-economic impact of multidrug-resistant nosocomial infections: a qualitative study.

The burden of healthcare-associated infections (HCAIs) has traditionally been measured using clinical and economic outcomes. We conducted semi-structured interviews with 18 patients or their caregivers affected by HCAI caused by multidrug-resistant organisms to better understand the human impact of HCAI. Most patients had misconceptions about HCAI and antimicrobial resistance, leading to strong negative feelings towards HCAIs despite positive views of their healthcare providers. Communication issues across power imbalances need to be addressed to help deal with trauma of HCAIs. A holistic approach to HCAIs incorporating patient perspectives will likely help guide policymakers developing solutions to improve patient outcomes.

Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries.

Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.

Understanding the patient experience of health care-associated infection: A qualitative systematic review.

BACKGROUND: The global burden of health care-associated infection (HAI) is well recognized; what is less well known is the impact HAI has on patients. To develop acceptable, effective interventions, greater understanding of patients' experience of HAI is needed. This qualitative systematic review sought to explore adult patients' experiences of common HAIs. METHODS: Five databases were searched. Search terms were combined for qualitative research, HAI terms, and patient experience. Study selection was conducted by 2 researchers using prespecified criteria. Critical Appraisal Skills Programme quality appraisal tools were used. Internationally recognized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. The Noblit and Hare (1988) approach to meta-synthesis was adopted. RESULTS: Seventeen studies (2001-2017) from 5 countries addressing 5 common types of HAI met the inclusion criteria. Four interrelated themes emerged: the continuum of physical and emotional responses, experiencing the response of health care professionals, adapting to life with an HAI, and the complex cultural context of HAI. CONCLUSIONS: The impact of different HAIs may vary; however, there are many similarities in the experience recounted by patients. The biosociocultural context of contagion was graphically expressed, with potential impact on social relationships and professional interactions highlighted. Further research to investigate contemporary patient experience in an era of antimicrobial resistance is warranted.

Changing the paradigm: messages for hand hygiene education and audit from cluster analysis.

BACKGROUND: Hand hygiene is considered to be the foremost infection prevention measure. How healthcare workers accept and make sense of the hand hygiene message is likely to contribute to the success and sustainability of initiatives to improve performance, which is often poor. METHODS: A survey of nurses in critical care units in three National Health Service trusts in England was undertaken to explore opinions about hand hygiene, use of alcohol hand rubs, audit with performance feedback, and other key hand-hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. RESULTS: Three main clusters of opinion were visualized, each forming a significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. CONCLUSION: Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation for behaviour. Healthcare workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively, cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting.

Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite.

We examined the perceptions and barriers to nonsurgical scrubbed hand hygiene in the operating room and endoscopy procedure room using 2 anonymous Likert-scale surveys. Results indicated poor role modeling, inconvenience, and the need to monitor hand hygiene and feedback data to providers because of poor self-awareness of hand hygiene practices.