Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran

De-medicalized and decentralized HIV testing: a strategy to test hard-to-reach men who have sex with men in Cameroon

Conventional HIV testing performed by a health professional has shown its limitations in targeting marginalized and vulnerable populations. Indeed, men who have sex with men (MSM) due to social discrimination are often uncomfortable using this service at the health facilities level. In this perspective, new differentiated approaches have been thought through de-medicalized and decentralized HIV testing (DDHT). This HIV testing strategy enables overcoming the structural, legal, and social barriers that prevent these populations from quickly accessing HIV services. This article discusses the prerequisites and added value of implementing this strategy for MSM living in a criminalized context and its implication in decentralizing health services toward the community level.

Iranian Nurses' Knowledge of Neutropenia and Their Practice for Infection Prevention in Patients with Cancer

Neutropenia is one of cancer disease and treatment complications. Suboptimal management of neutropenia may interfere with cancer treatment and result in patient death. This study aimed to evaluate the nurses' knowledge of neutropenia and their practice for infection prevention in cancer patients in hospitals of Kerman, in southeast Iran. This study had a descriptive-analytical cross-sectional design. 203 nurses working in oncology, bone marrow transplantation, and medical wards of teaching hospitals of Kerman University of Medical Sciences participated in the study. A demographic questionnaire, a neutropenia knowledge questionnaire, and a checklist of nurses' care practice for infection control in cancer patients were used for data collection. The mean score of knowledge about neutropenia in nurses was 16.96 ± 2.8 which was moderate. Only 11.8% of the participants had good knowledge of neutropenia. The mean score of nurses' overall practice for infection control in cancer patients was 7.88 ± 4.63 which was moderate. Only 19.2% of nurses had a good care practice for infection control in patients with cancer. There was no significant correlation between nurses' knowledge of neutropenia and their practices for infection control in cancer patients (P = 0.05). Based on the results, nurses' knowledge of neutropenia and their practice for infection control in patients with cancer are not optimal. Therefore, in addition to promoting educational programs to enhance nurses' knowledge in this field, other factors affecting the promotion of nurses' practices in controlling infection in patients with cancer should also be identified.

Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy

Background

The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers’ (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting.

Methods

We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations.

Results

According to the independent observation, participants had 2.4 times (95%CI: 1.12–5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11–0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used.

Conclusion

In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.

PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTION: WHAT IS THE GAP IN CLINICAL PRACTICE?

ABSTRACT Objective: to identify the gap in the prevention of catheter-associated urinary tract infection. Method: an observational study conducted by an audit of process indicators in relation to the recommendations for preventing catheter-associated urinary tract infection during its maintenance and handling. The collection was carried out between July and September of 2017 in an adult intensive care unit located in the State of Minas Gerais, Brazil. The observations were made with the help of a developed instrument for the present study and the data were analyzed by means of descriptive statistics. Results: 451 evaluations were performed related to maintenance of the urinary catheter with a focus on its fixation, the collector bag maintenance, and volume and urinary flow of the drainage system. Regarding clinical practice gaps, inadequate fixation of the urinary catheter and drainage pocket were found, with more than three-quarters of its capacity filled (97.7% and 3.5%, respectively). Regarding the handling of 556 urinary catheters, there was non-conformity in the hygiene of the urethral meatus in 22.9% of the situations, and non-adherence to hands hygiene before and after handling the urinary catheter was 94.2% and 66.5%, respectively (p=0.002). Conclusion: isolated measures had good adherence rates, but prevention of catheter-associated urinary tract infection should be based on adherence to several measures simultaneously. The prevention gap is in the awareness of health professionals that the recognized prevention measures of catheter - associated urinary tract infection should be adopted collectively in order to guarantee patient and clinical practice safety.

Mixed-methods analysis of glove use as a barrier to hand hygiene

Examination gloves have been previously noted as a possible barrier to hand hygiene. We performed a prospective quantitative and qualitative study to investigate. Glove usage was found to be a potential barrier to hand hygiene; this was driven by desire for personal safety and potentially learned during professional training.

A Survey of Nurses' Compliance with Hand Hygiene Guidelines in Caring for Patients with Cancer in a Selected Center of Isfahan, Iran, in 2016

Background

Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016.

Materials and Methods

The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the "five moments for hand hygiene" approach.

Results

In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001).

Conclusions

The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses.

Implementation of WHO multimodal strategy for improvement of hand hygiene: a quasi-experimental study in a Traditional Chinese Medicine hospital in Xi'an, China

Background

Hand hygiene (HH) is an essential component for preventing and controlling of healthcare-associated infection (HAI), whereas compliance with HH among health care workers (HCWs) is frequently poor. This study aimed to assess compliance and correctness with HH before and after the implementation of a multimodal HH improvement strategy launched by the World Health Organization (WHO).

Methods

A quasi-experimental study design including questionnaire survey generalizing possible factors affecting HH behaviors of HCWs and direct observation method was used to evaluate the effectiveness of WHO multimodal HH strategy in a hospital of Traditional Chinese Medicine. Multimodal HH improvement strategy was drawn up according to the results of questionnaire survey. Compliance and correctness with HH among HCWs were compared before and after intervention. Also HH practices for different indications based on WHO “My Five Moments for Hand Hygiene” were recorded.

Results

In total, 553 HCWs participated in the questionnaire survey and multimodal HH improvement strategy was developed based on individual, environment and management levels. A total of 5044 observations in 23 wards were recorded in this investigation. The rate of compliance and correctness with HH improved from 66.27% and 47.75% at baseline to 80.53% and 88.35% after intervention. Doctors seemed to have better compliance with HH after intervention (84.04%) than nurses and other HCWs (81.07% and 69.42%, respectively). When stratified by indication, compliance with HH improved for all indications after intervention (P < 0.05) except for “after body fluid exposure risk” and “after touching patient surroundings”.

Conclusion

Implementing the WHO multimodal HH strategy can significantly improve HH compliance and correctness among HCWs.

Electronic supplementary material

The online version of this article (10.1186/s13756-017-0254-4) contains supplementary material, which is available to authorized users.

Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols

BACKGROUND

We used videorecordings of routine care to analyze health care providers' deviance from protocols and organized follow-up interviews that were conducted by an anthropologist and a nurse.

METHODS

After consent, health care workers were recorded during routine care by an automatic video remote control. Each participant was invited to watch her or his recorded behaviors on 2 different videos showing routine practices and her or his deviance from protocols, and to comment on them. After this step an in-depth interview based on preestablished guidelines was organized and explanations regarding the observed deviance was discussed. This design was intended to reveal the HCWs' subjectivity; that is, how they perceive hand hygiene issues in their daily routine, what concrete difficulties they face, and how they try to resolve them.

RESULTS

We selected 43 of 250 videorecordings created during the study, which allowed us to study 15 out of 20 health care professionals. Twenty out of 43 videos showed 1 or more breaches in the hand hygiene protocol. The breaches were frequently linked to glove abuse. Deviance from protocols was explained by the health care workers as the result of an adaptive behavior; that is, facing work constraints that were disconnected from infection control protocols. Professional practices and protocols should be revisited to create simple messages that are adapted to the mandatory needs in a real life clinic environment.

Cultural Adaptation and Reliability of the Compliance with Standard Precautions Scale (CSPS) for Nurses in Brazil

Objective:

this study aimed to carry of the cultural adaptation and to evaluate the reliability of the Compliance with Standard Precautions Scale (CSPS) for nurses in Brazil.

Method:

the adaptation process entailed translation, consensus among judges, back-translation, semantic validation and pretest. The reliability was evaluated by internal consistency (Cronbach alpha) and stability (test-retest). The instrument was administered to a sample group of 300 nurses who worked in a large hospital located in the city of São Paulo/SP, Brazil.

Results:

through the semantic validation, the items from the scale were considered understandable and deemed important for the nurse´s clinical practice. The CSPS Brazilian Portuguese version (CSPS-PB) revealed excellent interpretability. The Cronbach`s alpha was 0.61 and the intraclass correlation coefficient was 0.85.

Conclusion:

the initial study showed that CSPS-PB is appropriate to assess compliance with standard precautions among nurses in Brazil. The reliability was considered acceptable. Furhter study is necessary to evaluate its comprehensive psychometric properties.