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Livshiz-Riven I, Hurvitz N, Nativ R, Borer A, Gushansky A, Eilig D, Kopitman A, Ziv-Baran T. Nursing students led simulations to improve healthcare workers' hand hygiene compliance. Contemp Nurse 2024:1-14. [PMID: 38470983 DOI: 10.1080/10376178.2024.2322994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. OBJECTIVE This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC. METHOD A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. RESULTS Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. CONCLUSION Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.
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Affiliation(s)
- Ilana Livshiz-Riven
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
- Quality Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Nancy Hurvitz
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alex Gushansky
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dynai Eilig
- Orthopaedic Department, Assuta-Ashdod Medical Center, Ashdod, Israel
| | - Alina Kopitman
- Obstetrics and Gynaecology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv, Israel
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Brachio SS, Gu W, Saiman L. Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:381-397. [PMID: 37201987 DOI: 10.1016/j.clp.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.
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Affiliation(s)
- Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA.
| | - Wendi Gu
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH1-470, New York, NY 10032, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Kiggundu R, Waswa JP, Nakambale HN, Kakooza F, Kassuja H, Murungi M, Akello H, Morries S, Joshi MP, Stergachis A, Konduri N. Development and evaluation of a continuous quality improvement programme for antimicrobial stewardship in six hospitals in Uganda. BMJ Open Qual 2023; 12:e002293. [PMID: 37336576 DOI: 10.1136/bmjoq-2023-002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Appropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated. METHODS Six Ugandan hospitals implemented AMS interventions between June 2019 and July 2022. We used the WHO AMS toolkit to set-up hospital AMS programmes and implemented interventions using continuous quality improvement (CQI) techniques and targeting conditions commonly associated with antibiotic misuse, that is, urinary tract infections (UTIs), upper respiratory tract infections (URTIs) and surgical antibiotic prophylaxis (SAP). The interventions included training, mentorship and provision of clinical guidelines to support clinical decision-making. Quarterly antibiotic use surveys were conducted. RESULTS Data were collected for 7037 patients diagnosed with UTIs. There was an increase in the proportion of patients receiving one antibiotic for the treatment of UTI from 48% during the pre-intervention to 73.2%, p<0.01. There was a 19.2% reduction in the number of antimicrobials per patient treated for UTI p<0.01. There was an increase in use of nitrofurantoin, the first-line drug for the management of UTI. There was an increase in the use of Access antibiotics for managing UTIs from 50.4% to 53.8%. The proportion of patients receiving no antimicrobials for URTI increased from 26.3% at pre-intervention compared with 53.4% at intervention phase, p<0.01. There was a 20.7% reduction in the mean number of antimicrobials per patient for URTI from the pre-intervention to the intervention phase, from 0.8 to 0.6, respectively, p<0.001 and reduction in the number of treatment days, p=0.0163. Among patients undergoing surgery, 49.5% (2212) received SAP during the pre-intervention versus 50.5% (2169) during the intervention. CONCLUSIONS Using CQI approaches to focus on specific causes of inappropriate antibiotic use led to desirable overall reductions in antibiotic use for URTI and UTI.
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Affiliation(s)
- Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - J P Waswa
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Hilma N Nakambale
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Francis Kakooza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hassan Kassuja
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Marion Murungi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | | | - Seru Morries
- Department of Pharmaceuticals and Natural Medicines, Ministry of Health, Kampala, Uganda
| | - Mohan P Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, Virginia, USA
| | - Andy Stergachis
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, Virginia, USA
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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