Healthcare infection最新文献

Background

In Australia, little is known about the risk of acquiring methicillin-resistant Staphylococcus aureus (MRSA) from prior room occupants. The aims of the study are to understand the risk of MRSA acquisition from prior room occupants and to further extend the existing knowledge-base on the role of discharge cleaning in hospitals.

Methods

A non-concurrent cohort study was undertaken in five wards at a 250-bed general hospital in Tasmania, Australia. All admitted patients were screened for MRSA. Weekly screenings for all patients who remained in hospital were undertaken. New MRSA acquisitions were identified. The exposed group were patients whose immediate prior room occupant had MRSA, while the unexposed prior room occupant did not have MRSA.

Results

6228 patients were at risk of acquiring MRSA, with 237 new MRSA acquisitions equating to an acquisition rate of 3.8% for each at-risk patient admission. The unadjusted odds ratio for acquiring MRSA when the prior room occupant had MRSA was 2.9 (95% CI 2.2–3.9). Using logistic regression, exposure to a prior occupant harbouring MRSA remained a significant predictor of subsequent acquisition, after controlling for variables, OR 2.7 (95% CI 2.0–3.6).

Conclusion

Admission to a room previously occupied by a person with MRSA increased the odds of acquisition forthe subsequentpatient, independent of other risk factors. It demonstrates the necessity of having effective discharge cleaning practices in place. We believe increased attention to discharge room cleaning in hospitals is required and the reconsideration of additional recommendations for discharge cleaning.

Introduction

In hospitalised patients, the majority of urinary tract infections (UTIs) can be attributed to the use of indwelling urinary catheters (IDCs). However, quality-care practices for catheterised hospitalised patients in Australia are largely unknown. The obj ective of this study was to evaluate the impact of an educational campaign on the quality of care of IDCs in hospitalised patients, and the proportion of hospitalised patients with UTI.

Methods

A multimodal strategy was developed in an Australian centre to educate regarding prevention of infection and to improve documentation regarding IDCs (June to October 2011). Point-prevalence audits of process measures were conducted at baseline and in early and late post-intervention periods. Administrative coding was used to quantify UTI infections in hospitalised patients.

Results

Documentation of clinical practice regarding IDC insertion and maintenance improved post-intervention and was sustained. Compliance with current best practice for managing IDCs improved in the early post-intervention period, but was not sustained. Administratively coded UTIs decreased by 13% following the intervention.

Conclusions

An organisation-wide multimodal strategy to improve processes concerning IDC care and documentation was successfully implemented, with an associated reduction in UTIs arising during hospital stay. To achieve sustainability, practices must be embedded into routine clinical care.

Introduction

Surveillance of healthcare-associated infection (HAI) is aimed at improving patient safety, decreasing healthcare-associated infections and reducing morbidity and mortality.

Methods

The Australian Commission on Safety and Quality in Health Care surveyed Australian states and territories during 2012-13 about state-based approaches to surveillance of healthcare-associated Staphylococcus aureus bacteraemia (SAB) and hospital-identified Clostridium difficile infection (CDI), including collection, validation and reporting of healthcare-associated infection surveillance data against national surveillance definitions.

Results

At the time of the survey, all states and territories classified cases of SAB using the national surveillance definition, while most states and territories classified cases of CDI using the national surveillance definition. Notification of methicillin-resistant Staphylococcus aureus bacteraemia was mandatory in two states. Four states had electronic access to microbiology results in jurisdictional surveillance units. The implementation of national surveillance definitions has led to more consistent practices for reporting of SAB and CDI.

Conclusion

Systems and processes for surveillance of SAB and CDI vary across states and territories; however, the development of national surveillance definitions has led to greater consistency nationally. The presence of an active jurisdictional HAI surveillance unit and a statewide surveillance information system enhances data validation, hospital-level reporting, and education and support for surveillance staff in hospitals.

Introduction

An effective hospital-wide antimicrobial stewardship (AMS) program requires engagement with all healthcare professionals involved in antimicrobial use. It is therefore useful to consider attitudes and perceptions among clinical stakeholders in Australian private hospitals before introducingAMS in these facilities. The aim of this study was to describe perceptions and attitudes towards antimicrobial resistance, antimicrobial use, AMS interventions, and willingness to participate.

Methods

A 26-item attitudinal survey was distributed to visiting specialists, nurses and pharmacists at a large (500 bed) private hospital in Australia. Survey questions utilised ‘Yes/No’ responses and a 7-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. Descriptive analyses were performed and Chi-squared tests conducted.

Results

There were a total of 331 respondents (80 physicians, 58 surgeons, 78 anaesthetists, 105 nurses and 10 pharmacists). The response rate was 42% among clinicians, 100% among pharmacists and 13% among nurses. Only half of the respondents were willing to participate in proposed AMS interventions. A larger proportion of respondents believed that antimicrobial resistance was more of a serious problem in other Australian hospitals compared with the surveyed hospital (62% v. 45%, P < 0.001). Fifty-eight percent agreed that improving prescribing at the hospital would reduce antimicrobial resistance. Twenty-nine percent of respondents had previous exposure to AMS, with pharmacists and physicians more likely to have heard of AMS compared with surgeons, anaesthetists and nurses (P = 0.016 and P < 0.001 respectively).

Conclusions

This study highlights the challenge of making antimicrobial resistance a relevant local issue in private hospitals and engaging key health professionals before implementing change.

Background

High prevalence and high mortality rates associated with healthcare-associated Infections (HAI) indicate there is a need to prevent HAIs from spreading. Cleaning and disinfection of hospital surfaces are fundamental to preventing HAIs, as is the confirmation of the success of these processes. Adenosine triphosphate bioluminescence has been identified as a quicker way to confirm cleaning, but questions remain regarding its specificity regarding microorganisms important to HAIs.

Methods

This study evaluated ATP bioluminescence's efficacy in determining microbial contamination on 17 surfaces from the healthcare environment, and to determine if the ATP measurements of Acinetobacter baumannii, Candida albicans, Enterococcus faecalis, Escherichia coli, Mycobacterium smegmatis, and methicillin-resistant Staphylococcus aureus corresponded to quantitative microbiology.

Results

A strong positive correlation was discovered for each of the six organisms associated with HAIs, as well as an additional ‘all organisms’ analysis that combined all the six organisms.

Conclusion

This study demonstrated a correlation between ATP bioluminescence measurements and quantitative microbiology; however, it was not as strong at low bacterial concentrations.

Implementing polymerase chain reaction (PCR) technology in the context of infection prevention and control (IPC) at Centre Hospitalier Universitaire (CHU) de Québec necessitated organisational change involving new infection prevention and control (IPC) procedures, the organisation of hospital services and attribution of new roles within a network of actors, at the macro, meso and micro levels. Understanding how the adoption of IPC technology can transform healthcare practices and outcomes for patients will remain a challenge as long as the process lacks a theoretical basis. This paper discusses a conceptual framework that will make it possible to understand the dynamics involved in implementing practice change. To identify the outcomes of such a process, both from the point of view of the nursing staff and that of patients, an integrated model was developed based on the Translating Research Into Practice (TRIP) model and on the Actor-Network Theory (ANT). The TRIP-ANT model provides a basis for exploring the complexity of implementing technology in the context of IPC and illustrates the dynamic nature of healthcare organisation in the real world. It identifies how new technology integration can translate into different responses to change and into the practices of a network of actors involved directly or indirectly in the new intra- and inter-organisational processes surrounding the handling of IPC practices. Furthermore, this model could also be applied to other innovations in healthcare organisations.

In response to recent calls for mandatory influenza vaccination policies, we argue that these policies are neither necessary nor sufficient to protect patients from healthcare-associated respiratory viral infection.

Background

Good hand hygiene can prevent healthcare-associated infections. The observer effect is the tendency of research participants to behave differently from the way they otherwise would when aware of being studied. This effect may be associated with improved hand hygiene compliance when utilised in the prior advertisement of auditing.

Methods

An observational study was carried out between 1 June 2012 and 31 August 2012 at the Liverpool Hospital, an 877-bed tertiary teaching hospital in south-western Sydney, Australia, to determine the association between prior notification of hand hygiene auditing by recognisable observers and compliance rates and to evaluate the acceptability of such a practice. Surveys regarding the general acceptability of hand hygiene auditing were conducted, followed by advertised and unadvertised audits over the study period. Participants were made aware of being audited by prior notice and conspicuous identification signs.

Results

The auditors recorded 2080 moments over 3 months, of which 462 (22.2%) were done with prior notification. A significant improvement in overall hand hygiene compliance from 82.3% to 87.9% (P = 0.004) was found. Subgroup analysis revealed improved compliance for the moments ‘before patient contact’ (71.8% to 81.3%; P = 0.018) and ‘after patient contact’ (85.8% to 93.8%; P = 0.019). Over60%of healthcare workers rated hand hygiene as a high priority in daily work and 55% or more regarded weekly auditing as being acceptable.

Conclusion

Advertised auditing is associated with an increase in the overall hand hygiene adherence rate as well as in the subgroups ‘before’ and ‘after patient contact’ and appears to be acceptable to healthcare workers. This association requires validation with multicentre randomised controlled trials.

Introduction

Sharps injuries (SI) among healthcare personnel (HCP) in Australia are of such concern the matter was brought before Parliament in 2013. Many SI from safety-engineered devices (SED) are due to nonactivation. Monitoring of activation is recommended. This paper outlines a sharps container (SC) contents audit conducted in Australian capital cities.

Methods

Reusable, 22 L SC (Sharpsmart, Daniels Corporation, Melbourne) were randomly selected from random healthcare facilities (HCF) in five cities. Wearing protective apparel, the operator opened and decanted SC and sorted hollow-bore needles (HBN) into: capped v. uncapped non-SED, and activated or non-fully activated SED. Volumes and weights were recorded for inter-study comparisons. WinPepi v2.78 was used to calculate probability (significance set at ≤ 0.05), relative-risk and 95% confidence limits.

Results

1212 L of sharps (167.9 kg) from 102 SC from 27 hospitals were audited. Many devices were bloodcontaminated. Of the 9651 HBN, 30.4% were SED and 19.4% of the SED were not, or partially, activated. Of the 6718 non-SED, 30.6% were capped needles or capped needle-syringes. City averages for capped or naked sharps ranged from 64.2% (Sydney) to 97.8% (Adelaide) while hospital averages ranged from 32.6 to 100%. Overall, 54.2% of devices were discarded ‘sharp’.

Conclusions

It is disturbing that 75.5% of hollow-bore needles were capped or naked, indicating a high proportion of Australian HCP are unnecessarily at risk of SI while handling sharps. The high non-use of SED and non-activation of SED needs researching.Widespread SED evaluation and adoption (automatic and semi-automatic SED where feasible), repetitive competency training and safety-ownership are needed. Legislation may be indicated.

Background

The aim of this paper is to determine factors associated with sharps-related injury rates in nurses by analysing the combined data from two state-wide cross-sectional studies of nurses and comparing rates between public and private sectors and between different nurse practice areas in NSW.

Methods

The data from two studies conducted in 2006 and 2007 were combined for 44 similar data items and for similar nurse participants (registered nurses, registered midwives and enrolled nurses). Both studies had recruited nurses from membership of the NSW Nurses’ Association. Data for 256 and 1100 participants respectively were combined for this comparative analysis.

Results

The sharps-related annual injury rate was 7.2% (95% CI: 5.9, 8.7). It was significantly higher in operating theatres, renal, mental health and paediatric practice areas in private compared with public facilities (17.9% versus 5.2%). Positive aspects of sharps safety practices included: 90% of nurses reported their injuries, were aware of processes required for dealing with sharps injuries and found their managers to be approachable. Areas for improvement included the provision of information about persons responsible for follow-up (21% unsure), increased provision of safety-engineered medical devices (SEMDs) (50% not available), decreased provision of non-SEMDs (75% available) and a focus on the highly-resistant practice of recapping needles (35% report recapping non-SEMDs).

Conclusions

There are significant differences in sharps-related injuries between public and private facilities. Opportunities exist to improve safety practices across various nursing practice environments.