The effect of an isolation-coping programme on patients isolated for colonization or infection with multidrug-resistant organisms: a quasi-experimental study

Development and evaluation of a nursing educational program: A quasi-experimental study

BACKGROUND

Multidrug-resistant organisms (MDROs) are transmitted through the hands of healthcare workers who touch the environments of patients with MDROs. Patients identified as being infected with MDROs are subjected to contact precautions and isolated in a single room. Nurses need to have the correct knowledge of infection prevention and be interested in the psychological conditions of isolated patients with MDROs.

AIM

To develop and evaluation of an education program for nurses to emphasize the psychological care of isolated patients with MDROs.

DESIGN

To evaluate the effectiveness of the educational program, this study employed a quasi-experimental design.

PARTICIPANTS AND SETTING

Seventy-eight nurses working in inpatient wards at four medical facilities were assigned to the program participant group (N = 25) and the non-participant group (N = 53).

METHODS

This experimental study utilized the five steps of the ADDIE instructional model (analysis, design, development, implementation, and evaluation) to design an educational program. The first step was to identify educational needs. The next steps were to design the program and develop educational materials. In the fourth step, training on infection control measures for MDROs and psychological care for patients with MDROs in isolation was conducted. Finally, in the fifth step, the effectiveness of the educational program was evaluated by scoring on expected behaviors to improve the psychological state of patients in isolation.

RESULTS

The program participants group exhibited behavioral changes and attitudes that observed physiological and psychological responses related to patient anxiety and depression (p < .05).

CONCLUSIONS

The education program increased the understanding of the psychological state of patients with MDROs and the observation of physiological and psychological reactions. This suggests that an education program based on ID is likely to have the potential to change nurses' behavior to improve the quality of care for patients with isolated infections.

Development and Implementation of a Mobile-Integrated Simulation for COVID-19 Nursing Practice: A Randomized Controlled Pretest-Posttest Experimental Design

This study developed and evaluated the effects of a mobile-integrated simulation training program on infection prevention and nursing practices based on past experiences of coronavirus disease (COVID-19) care. We developed mobile videos for the experimental group and an educational booklet for the control group based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. The effects of the simulation program with the use of mobile videos on knowledge of COVID-19 management, infection prevention practice confidence, and clinical decision-making anxiety and confidence were analyzed through a randomized controlled pretest-posttest experimental design. Data from 109 participants were analyzed. Five mobile videos were developed with a total duration of 43 min and 13 s. The experimental group showed significantly greater improvement in knowledge of COVID-19 management (p = 0.002) and infection prevention practice confidence (p < 0.001). Using the mobile-integrated COVID-19 nursing practice simulation program, nurses who have no experience with emerging infectious diseases can increase their infection control knowledge and infection prevention practice confidence. In conclusion, the mobile-integrated COVID-19 nursing practice simulation program was effective in increasing infection control knowledge and infection prevention practice confidence in nurses without COVID-19 care experience.

Potential causal effect of contact precautions and isolation on Clostridioides difficile infection in the hyperendemic setting: Interrupted time-series analyses before and after implementation

BACKGROUND

Recent studies disputed the effectiveness of efforts to comply with contact precautions and isolation (CPI) considering relatively low intra-hospital transmission rate of healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). We evaluated the potential causal effect of CPI on HCFA-CDI occurrence by comparing the incidence rate (IR) for different time periods with and without CPI implementation.

METHODS

Long-term observational time-series data were separated into three periods (pre-CPI: January 2012-March 2016, CPI: April 2016-April 2021, post-CPI: May 2021-December 2022). CPI was suspended owing to the restriction of isolation rooms during the COVID-19 pandemic. We inferred potential causal outcomes by comparing predicted and observed IRs of HCFA-CDI using interrupted time-series analyses, including the Bayesian structural time-series or autoregressive integrated moving average (ARIMA) model in the R-language or SAS software.

RESULTS

The monthly observed IR (44.9/100,000 inpatient-days) during the CPI period was significantly lower than the predicted IR (90.8) (-50.6% relative effect, P = 0.001). However, the observed IR (52.3) during the post-CPI period was significantly higher than the predicted IR (39.1) (33.6%, P = 0.001). The HCFA-CDI IR decreased during CPI (-14.3, P < 0.001) and increased post-CPI (5.4, P < 0.001) in the multivariable ARIMA model, which controlled for antibiotic usage, handwashing with soap and water, and number of toxin tests.

CONCLUSIONS

Various time-series models revealed that CPI implementation had a potential causal effect on the reduction of HCFA-CDI incidence.

Increased evidence for no benefit of contact precautions in preventing extended-spectrum β-lactamases-producing Enterobacteriaceae: Systematic scoping review

INTRODUCTION

Extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) is a critical antimicrobial resistance pathogen, to which we need to pay the greatest attention. This study was aimed at uncovering the present evidence for the preventive effectiveness of contact precautions for patients colonized or infected with ESBL-E.

METHODS

According to the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, we searched MEDLINE for articles with relevant keywords from the beginning of 2010 to October 18, 2022.

RESULTS

Of the 355 articles found, 9, including 8 observational studies and 1 randomized controlled trial, were selected. Safety of discontinuing contact precautions was evaluated mainly in acute-care and long-term care hospitals. Consistently, all authors concluded that contact precautions can be safely discontinued in patients colonized or infected with ESBL-E.

CONCLUSION

The clinical impact of discontinuing contact precautions for patients with ESBL-E is minimal and can be safely withdrawn at acute, noncritical, adult care wards. Relevant data from pediatric and geriatric wards, as well as intensive care units, were insufficient and should be investigated in future research.