Infection prevention and control core practices: A roadmap for nursing practice

Using a handheld UV device for disinfection in the patient care environment: A descriptive qualitative study

Frontline nurses play a critical role in the prevention of healthcare-acquired infections (HAIs) through daily practices of hand hygiene and decontamination of surfaces. Despite these practices, environmental contamination and HAIs persist. Emerging use of UV light at wavelengths safe for human exposure provides additional strategies for disinfecting the patient care environment. The purpose of this qualitative study is to explore frontline nursing feedback regarding a novel handheld UV device prototype. A convenience sample of nurses were invited to participate in facilitated individual or small group discussions led by one member of the research team. Thematic analysis of discussion transcripts was completed by two members of the research team. Sixteen registered nurses participated. Four themes found in the study were time considerations, complexity, safety (patient and nurse), and characteristics of technology to improve patient care. Findings suggest that while nursing staff are willing to use technology, it must be considered valuable to patient care and should not hinder the provision of care. Inclusion of inputs from nursing staff for development of technology identifies potential barriers to acceptance and use in the practice environment.

Occurrence rate and risk factors for long-term central line-associated bloodstream infections in patients with cancer: A systematic review

INTRODUCTION

Central line-associated bloodstream infection (CLABSI) is a public health problem that harms patients' outcomes and healthcare costs, especially in susceptible populations such as patients with cancer. Overall, systematic queries about etiology, risks, and epidemiology are explained by data from observational studies, which better underline the relationship between factors and incidence of disease. However, no recent systematic reviews of observational studies on adult patients with cancer have been conducted on this topic, considering the wide range of all potential factors which can contribute to the increase in infection rate in the hospitalized adults with cancer. This study systematically reviewed observational studies investigating the occurrence rate of CLABSI and its risk factors for long-term inserted central catheter-related infections in hospitalized adult cancer patients.

METHODS

A systematic review was performed on four databases from the earliest available date until December 2020. Retrospective and prospective cohort studies focused on the occurrence rate of CLABSI and its risk factors in hospitalized adult cancer patients. The pooled occurrence rate of CLABSI (95% CI) was calculated by applying a random-effects model.

RESULTS

Of 1712 studies, 8 were eligible, and the data of device-related infection rate were meta-analyzed. The pooled occurrence rate of CLABSI was roughly 8% (95% CI [4%, 14%]). The device characteristics, device's management aspects, therapies administration, and select patients' clinical conditions represent the main risk factors for long-term catheter-related infection in cancer patients.

LINKING EVIDENCE TO ACTION

Considering the substantial infection rate among cancer patients, identifying risk rate factors is pivotal to support evidence-grounded preventive strategies and maximize cancer patient safety. This study's results could guide policymakers and healthcare leaders and future research studies to disseminate appropriate risk-reducing management culture and implement standardized research and clinical approach to the investigated phenomenon as an infection surveillance strategy.

Conhecimento dos enfermeiros recém-formados sobre Precauções Específicas na pré-pandemia da COVID-19

RESUMO Objetivo Avaliar o conhecimento dos enfermeiros recém-formados sobre as medidas das Precauções Específicas (PE). Método Estudo transversal descritivo-exploratório, com abordagem quantitativa, realizado em um hospital privado de São Paulo, em fevereiro de 2019. Os enfermeiros foram abordados para participar da pesquisa enquanto aguardavam o início do processo seletivo para “Enfermeiro Junior”. Para avaliar o conhecimento, foi utilizado um instrumento validado, contendo 29 questões de múltipla escolha, divididas em cinco eixos temáticos, sendo definida como ponto de corte a média 7,0 (de zero a 10). Para análise dos dados, foi usado o pacote estatístico R Core, e o lme4 para os modelos mistos generalizados, sendo adotado nível de significância de 5%. Resultados Participaram do estudo 190 enfermeiros recém-formados com nota geral de 5,82, sendo a maior média (7,9) no eixo “Equipamento de Proteção Individual”. Nos demais eixos, as médias foram abaixo de 7,0, tendo a menor pontuação (4,35) no eixo “Cuidados com o Ambiente”. Conclusão e Implicações para a prática O estudo evidenciou déficit de conhecimento sobre as PE entre os enfermeiros recém-formados, com implicações para a segurança dos pacientes e dos profissionais de saúde, desde a prática assistencial na graduação (estágios) ao início da carreira profissional.

Newly graduated nurses’ knowledge about Specific Precautions in the pre-pandemic of COVID-19

ABSTRACT Objective To assess the knowledge of newly graduated nurses about Specific Precautions/Isolation measures. Method A cross-sectional descriptive-exploratory study with a quantitative approach was conducted in a private hospital in São Paulo in February 2019. The researcher approached the nurses waiting for the “Junior Nurse” position selection process to participate in the survey. The participants answered a validated instrument with 29 multiple-choice questions, divided into five thematic categories. A score of 7.0 (from zero to 10) was defined as the cut-off point. The R Core statistical package and the lme4 for generalized mixed models were used for data analysis, with a significance level of 5%. Results 190 newly graduated nurses participated in the study, with an overall knowledge of Specific Precautions score of 5.82, with the highest mean (7.9) in the “Personal Protective Equipment” category. In the other four categories, the nurses scored below 7.0, with the lowest score (4.35) in the “Care for the environment”. Conclusion and Implications for the practice The study showed a deficiency of Specific Precautions knowledge among newly graduated nurses, with implications for the patients’ and healthcare professionals’ safety from graduation practice (internship) to the beginning of their professional career.

Lessons Learned During the COVID-19 Pandemic to Strengthen TB Infection Control: A Rapid Review

In light of competing health priorities of COVID-19 and TB, we propose recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic.

Introduction:

Over the past 5 years, substantial global investment has resulted in reduced TB incidence rates by 9% and mortality rates by 14%. However, the coronavirus disease (COVID-19) pandemic has hindered access and availability of TB services to maintain robust TB control. The objective of this rapid review was to describe the challenges to be addressed and recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic.

Methods:

Five databases were used to systematically search for relevant articles published in 2020. The 5-step framework proposed by Arskey and O'Malley and adapted by Levac et al. guided the review process. Thematic analysis with grounded theory principles was used to summarize themes from selected articles and integrate analyses with barriers reported from authors' previous TB research.

Results:

Of the 218 peer-reviewed articles, 20 articles met the inclusion criteria. Four emerging themes described challenges: (1) unprepared health system leadership and infrastructure, (2) coexisting health priorities, (3) insufficient health care workforce support for continued training and appropriate workplace environments, and (4) weak connections to primary health centers hindering community engagement. Four recommendations were highlighted: (1) ensuring leadership and governance for sustainable national health budgets, (2) building networks of community stakeholders, (3) supporting health care workforce training and safe workplace environments, and (4) using digital health interventions for TB care.

Conclusions:

National health systems must promote patient-centered TB care, implement ethical community interventions, support operational research, and integrate appropriate eHealth applications. TB program managers and primary care practitioners can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving the targets of the End TB Strategy.

Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) guideline implementation in the Veterans Affairs Medical Centers using the consolidated framework for implementation research

Background

Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veterans Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to analyze qualitative interview data to identify contextual factors and best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs). The overall goals were to determine CFIR constructs to target to improve CRE guideline/directive implementation and understand how CFIR, as a multi-level conceptual model, can be used to inform guideline implementation.

Methods

Semi-structured interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing qualitative CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE-positive cultures was conducted using Fisher’s exact test.

Results

Forty-three semi-structured interviews were conducted between October 2017 and August 2018 with laboratory staff (47%), Multi-Drug-Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants requested more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified CRE screening or presence of CRE as being significantly associated with the following qualitative CFIR constructs: leadership engagement, relative priority, available resources, team communication, and access to knowledge and information.

Conclusions

Effective CRE identification, prevention, and treatment require ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including access to resources, improving communication, and facilitating successful implementation of the CRE guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00170-5.