Impact of infectious exposures and outbreaks on nurse and infection preventionist workload

Are pediatric nurses prepared to respond to monkeypox outbreak?

BACKGROUND

Emphasizing the crucial significance of maintaining a national nursing workforce well-prepared with the necessary knowledge, skills, and abilities to respond effectively is the growing frequency of natural and environmental disasters, coupled with public health emergencies such as the COVID-19 pandemic. So, the study aimed to explore pediatric nurses' preparedness to monkeypox outbreak, and their stress during this outbreak in Egypt.

METHODS

A cross-sectional study was conducted on a 416 nurses direct care for children at selected governmental hospitals in Egypt. Demographic form, Questionnaire for Infectious Disease Outbreak Readiness & Preparedness, factors affecting nurses' preparedness, and the generalized anxiety disorders scale-7 were the tools of the study.

RESULTS

(81.5%) of studied nurses had unsatisfactory level of preparedness to monkeypox outbreak. (96.4%) and (95.4%) of them were affected their preparedness by high workload and inconsistent income with the of risk of infection factors. Also, (57.2%) of them had high stress level.

CONCLUSIONS

The study revealed the importance of ensuring adequate supplies of PPE are available and provided, and protocols must be implemented to ensure availability in case of an outbreak. Moreover, nurse staffing levels and workload distribution should be regularly reviewed to create reasonable nurse-patient ratios.

A narrative review of how infection preventionist (IP) staffing and outcome metrics are assessed by health care organizations and factors to consider

BACKGROUND

Infection Preventionist to date are experiencing staffing shortages, the purpose of this narrative review is to understand how heath care organizations track staffing and outcome metrics in relation to Infection Preventionists.

METHODS

Databases utilized included MEDLINE, PubMed, EMBASE, Web of Science, and Google Scholar.

RESULTS

The initial search included 668 studies. After excluding duplicates, the title and abstract review yielded 50 articles. After screening full texts, 37 studies met the inclusion criteria. Significant variability exists within infection prevention staffing metrics. Common metrics to account for IP staffing levels include the ratio of IPs per facility and IPs per inpatient bed. Frequently tracked outcomes in relation to infection preventionists include Catheter-associated urinary tract infections and central line bloodstream infection incidence rates and standardized infection ratios, as well as Clostridioides difficile incidence rates. Metrics and outcomes from included studies are available in our supporting tables.

CONCLUSIONS

This review highlights the need for a new IP staffing model that focuses on a granular assessment of each program and care setting. Additional studies can then be conducted to examine how ideal staffing impacts outcome metrics.

Influenza transmissibility among patients and health-care professionals in a geriatric short-stay unit using individual contact data

Detailed information are lacking on influenza transmissibility in hospital although clusters are regularly reported. In this pilot study, our goal was to estimate the transmission rate of H3N2 2012-influenza, among patients and health care professionals in a short-term Acute Care for the Elderly Unit by using a stochastic approach and a simple susceptible-exposed-infectious-removed model. Transmission parameters were derived from documented individual contact data collected by Radio Frequency IDentification technology at the epidemic peak. From our model, nurses appeared to transmit infection to a patient more frequently with a transmission rate of 1.04 per day on average compared to 0.38 from medical doctors. This transmission rate was 0.34 between nurses. These results, even obtained in this specific context, might give a relevant insight of the influenza dynamics in hospitals and will help to improve and to target control measures for preventing nosocomial transmission of influenza. The investigation of nosocomial transmission of SARS-COV-2 might gain from similar approaches.

Factors affecting job stress among physical therapists during the COVID-19 pandemic in Saudi Arabia

<b>Background:</b> Physical therapists (PTs), like other healthcare professionals, are susceptible to job stress when involved in patient care, and several factors contribute to it. Therefore, this study aims to assess PTs’ knowledge, attitude, and practices (KAP) adopted by PTs during the COVID-19 pandemic and its impact on their job stress.<br /> <b>Methods:</b> A cross-sectional design was used. 300 PTs from the government and private healthcare organizations in Saudi Arabia were randomly picked and invited to participate. Data were collected using a pre-tested content-validated KAP tool using a Google Form between January and March 2022. Data were analyzed quantitively through SPSS 24.0.<br /> <b>Results:</b> The findings revealed that 85% of PTs whose job involves direct contact with the patients are susceptible to higher stress (perceived stress score [PSS]=22.82) than others. Specifically, female and unmarried PTs are prone to more job stress than others (p&lt;0.05). In addition, PTs who were apprehensive about managing COVID-19 patients and worried about acquiring COVID-19 disease are prone to more job stress. Lastly, 89% of PTs who adopted the practice of wearing N-95 masks and proper handwashing techniques (&gt;80%) experience less stress than others (p&lt;0.05).<br /> <b>Conclusion:</b> The KAP of PTs influences job stress during the COVID-19 pandemic. PTs with sufficient knowledge about measures to adopt, show a positive attitude, and practice wearing proper PPEs, handwashing procedures, and waste disposal systems during patient care are prone to less job stress than others.

Nurses' knowledge, practices and perceptions regarding Clostridioides difficile: Survey results

BACKGROUND

Clostridioides difficile infection (CDI) can cause patients debilitating symptoms, places additional demands on nurses' and midwives' and is increasingly prevalent. Understanding the knowledge base of nurses caring for patients with CDI may contribute to improving care practices.

METHODS

A cross-sectional anonymous survey across our Hospital and Health Services was conducted. Descriptive statistics and thematic analysis techniques were used to analyse, summarise, and report data.

RESULTS

A total of 198 completed surveys by nurses were included in the analysis. Most respondents (73.2%) could not recall having any recent CDI education. Nearly all agreed that CDI is an important infection control issue (80. 8%), and that CDI education was important (94.9%). Knowledge of the potentially fatal outcome of CDI was not well known with only 53% responding correctly to this question. Respondents were confident in fundamental infection control precautions of patient placement (93.4%) and environmental cleaning (86.4%). Knowledge of the microbiological aspects of CDI were less well known. The impact to workload and the additional burden of caring for patients with CDI was evident in the overwhelming response (83%) to the two open-ended questions about what makes it "easy" and what make it "hard" to implement infection control strategies for CDI patients.

CONCLUSION

Respondents identified many factors that could contribute to less-than optimal care and management of inpatients with CDI, and identified some solutions that would facilitate the provision of best practice. An educational intervention, with emphasis on the areas of greatest knowledge deficits, has been developed.

Healthcare workers' experiences of caring for patients colonized with carbapenemase-producing Enterobacterales (CPE) in an acute hospital setting - a scoping review

Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting. The aim of this review was to explore healthcare workers' experiences of caring for patients colonized with CPE. A scoping review method was employed and seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials. gov and WHO International Clinical Trials Registry Platform) were searched using specific search terms and inclusion/exclusion criteria. A PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes. Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints. In conclusion, healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff.

Auditing completion of nursing records as an outcome indicator for identifying patients at risk of developing pressure ulcers, falling, and social vulnerability: An observational study

AIM

To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators.

BACKGROUND

Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary.

METHOD

This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave.

RESULTS

A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit.

CONCLUSIONS

The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions.

IMPLICATIONS FOR NURSING MANAGEMENT

Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.

Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology

This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

OBJECTIVE

To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs).

DESIGN AND SETTING

An ambidirectional observation in a 528-bed teaching hospital.

PATIENTS

All inpatients from July 1, 2012, to February 1, 2021.

METHODS

Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2-3 FTE), below recommended IP levels (4-6 FTE), and at recommended IP levels (7-8 FTE).

RESULTS

The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7-8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line-associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist.

CONCLUSIONS

Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

Defining nursing workload predictors: A pilot study

Aim

To explore predictors of perceived nursing workload in relation to patients, nurses and workflow.

Background

Nursing workload is important to health care organisations. It determines nurses' well‐being and quality of care. Nevertheless, its predictors are barely studied.

Methods

A cross‐sectional prospective design based on the complex adaptive systems theory was used. An online survey asked nurses to describe perceived workload at the end of every shift. Data were gathered from five medical‐surgical wards over three consecutive weeks. We received 205 completed surveys and tested multivariate regression models.

Results

Patient acuity, staffing resources, patient transfers, documentation, patient isolation, unscheduled activities and patient specialties were significant in predicting perceived workload. Nurse‐to‐patient ratio proved not to be a predictor of workload.

Conclusions

This study significantly contributed to literature by identifying some workload predictors. Complexity of patient care, staffing adequacy and some workflow aspects were prominent in determining the shift workload among nurses.

Implications for nursing management

Our findings provide valuable information for top and middle hospital management, as well as for policymakers. Identification of predictors and measurement of workload are essential for optimizing staff resources, workflow processes and work environment. Future research should focus on the appraisal of more determinants.

The Use of a Three-in-One Practice-Management-Innovation Training Model in the Construction of an Infection Control Team

Objective

This study aims to explore the role of a three-in-one practice, management, and innovation training model (also called as three-in-one practice-management-innovation training model) in the construction of an infection control team.

Methods

This study retrospectively analyzed the position structure, mastery of professional knowledge, and working methods of the full-time and part-time personnel of the Changzhou Cancer Hospital, compared the training content of Jiangsu Hospital Infection Control Center with the actual situation of the hospital, and formulated and implemented a three-in-one practice-management-innovation training model. First, the team members were selected for the construction and management of the Hospital Infection Management Department according to the relevant responsibility and management requirements, and their learning and mastery of the basic knowledge and skills concerning infection control were completed based on their professional roles. In line with the regulations of the hospital and department, full-time personnel were ensured of having the opportunity to participate in provincial- and municipal-level academic exchanges and then learn from each other, through collaboration between doctors and nurses, how to exercise basic management skills. At the same time, a fair competitive incentive mechanism was established through the three-level network of the hospital infection committee, the hospital infection management department, and nosocomial infection management department to implement innovative project-based management and cultivate an awareness of hospital infection control in all employees.

Results

The professional structure of the full-time infection control personnel has been optimized, the awareness of the infection control team concerning active participation in practice has gradually increased, and infection control management and innovation has been significantly improved.

Conclusion

After the selection of an infection control management team and the delivery of well-planned training, the quality of infection control management has improved.

Caregivers' perception of the caring challenges in coronavirus crisis (COVID-19): a qualitative study

Background

The nurses act as the guardians of people’s health by preventing, controlling, and curing emerging diseases, including coronavirus, a highly infectious and contagious disease which has presented the caregivers in the Iranian healthcare system with many clinical challenges. In view of lack of research on the clinical challenges which arise during health crises, emerging diseases included, there is need for further investigation of those clinical challenges and dilemmas. The aim in present study was to describe the caregivers’ experiences of the caring challenges in patients with coronavirus (COVID-19).

Methods

The present study is a qualitative work with a phenomenological-descriptive design. Data were collected via semi-structured, in-depth, individual interviews. The collected data were analyzed according to Colaizzi’s method. The participants were 23 members of the medical staff responsible for coronavirus patients in Iran who met the inclusion criteria. The participants were selected via purposeful sampling which was continued to the point of data saturation.

Results

The results yielded 3 main themes “psychological tension”, “inefficient management”, and “contextual factors” with 11 categories.

Conclusion

In dealing with coronavirus patients and providing quality care to them, nurses face various clinical challenges which affect their performance. Administrators must, alongside giving instructions to people on how to prevent the coronavirus disease and taking effective safety measures, make sure that clinical centers are managed efficiently in order for nurses to fulfill their caring objectives satisfactorily.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00607-1.

Predictive factors affecting stress among nurses providing care at COVID-19 isolation hospitals at Egypt

AIMS

To examine predictive factors affecting stress among nurses providing care at COVID-19 Isolation Hospitals at Egypt.

METHODS

A cross-sectional study conducted in five Isolation governmental hospitals for COVID-19. 374 nurses included at the study. Characteristic forms, factors affecting nurses' stress and Nursing Stress Scale (NSS) were used to collect data.

RESULTS

(52.1%) of studied nurses had moderate level of total nursing stress scale. Also, (26.2%) of them had severe level, while (13.4% & 8.3%) of them had mild and normal level, respectively. Mean SD score of studied nurses regarding to total nursing stress scale was 99.47 ± 10.671.

CONCLUSIONS

Training for COVID-19, availability of PPE, educational level and attention of hospital administration were negative predictor factors for nurses' stress, while having children, people showed that COVID-19 is stigma, fears of infection, workplace, fear of transmission infection for family and nurse to patient ratio were positive predictors.

Awareness, Attitudes, Prevention, and Perceptions of COVID-19 Outbreak among Nurses in Saudi Arabia

The newly discovered coronavirus (COVID-19) has become a pandemic, infecting thousands of people around the world. This study examines nurses' demographic information (age, gender, marital status, area of practice, total years of experience in the current hospital, work region, monthly salary, educational level, workplace, nationality, working hours per day, total nursing experience, and the respondents' main source of information on COVID-19), awareness, attitudes, prevention, and perceptions of COVID-19 during the outbreak in Saudi Arabia. A cross-sectional descriptive design of 500 nurses working at government and non-governmental hospitals in five regions in Saudi Arabia were selected using convenience sampling. The Kruskal-Wallis test was applied and the Mann-Whitney test was utilized as a post hoc test. The majority of nurses in this study, 96.85%, had excellent knowledge of COVID-19. Some (83.2%) of nurses reported significant prevention knowledge and treatment skills about COVID-19, while 7.6% had little knowledge about prevention. More than half of the nurses (60.4%) had high positive attitudes toward caring for COVID-19 patients. In conclusion, female nurses, married nurses, and bachelor's degree nurses had greater awareness, better attitude, and prevention clinical experience towards COVID-19. Meanwhile, non-Saudi nurses had higher self-reported awareness, positive attitudes, optimal prevention, and positive perceptions compared to Saudi nurses. This study provides baseline information immediately needed to enable health authorities to prioritize training programs that support nurses during the COVID-19 pandemic.

Health Professionals' Perception of Psychological Safety in Patients with Coronavirus (COVID-19)

BACKGROUND

Medical personnel act as the protectors of people's health by preventing, controlling, and treating emerging diseases, including the coronavirus infection. COVID-19 is a highly infectious and contagious disease which has presented the Iranian healthcare system with a variety of clinical challenges. There is a lack of research on clinical challenges in health crises especially those caused by emerging diseases, hence a need for more exploration of these clinical challenges and dilemmas. The present study aims to determine the different aspects of health professionals' perception of the psychological safety of patients infected with the coronavirus (COVID-19).

METHODS

The present study is a qualitative work which uses conventional content analysis. The participants were 17 health professionals who were responsible for COVID-19 patients and met the inclusion criteria. They were selected via purposeful sampling. The study lasted from February to March 2020. Data were collected through semi-structured, individual interviews which were conducted via video call. The collection of data was kept up to the point of saturation. The collected data were analyzed using the conventional content analysis method.

RESULTS

Three themes such as "respect for dignity", "comprehensive support" and "peaceful environment" with 11 categories were extracted from the findings of the study.

CONCLUSION

According to the results of the present study, patients infected with the coronavirus should be given care in a peaceful environment where they receive comprehensive support and have their dignity respected. Such conditions can guarantee the psychological safety of these patients and produce positive behavioral results on their part. Thus, it is essential that the cultural, professional, and organizational prerequisites of protecting all the dimensions of the psychological safety of these patients be provided.

Relationship among safety culture, nursing care, and Standard Precautions adherence

Standard Precautions (SP) are an essential, although unmet, component of nursing care. Understanding conditions fostering the integration of SP within nursing workflow is imperative. This research describes the relationships among patient safety culture, adherence to SP, and missed nursing care.