A Qualitative Case Study Exploring Hand-Hygiene Standards in an Intensive Care Unit

Healthcare-associated infections (HAIs) are infections that occur in patients during their time of care in a hospital. Considerable emphasis is currently placed on reducing HAIs through improving hand-hygiene (HH) compliance among healthcare professionals because HAIs are a critical challenge to public health in the United States. By focusing on meeting Centers for Disease Control and Prevention HH standards, the purpose of this qualitative research was to explore how noncompliance with these standards and lack of technology usage affect HAIs in the intensive care unit. Additionally, the goal of this research was to explore behavioral factors and best practices that influence compliance rates in intensive care units. Thereafter, the researcher provided recommendations for healthcare leadership to address the phenomenon of HAI

The incorporation of Radio Frequency Identification Technology in health institutions and the determining aspects of adoption

The process of traceability by radio frequency identification system (RFID) is considered one of the biggest contributions of the last years in the health sector. This article aims to study the academic contributions that this technology has brought to the segment in question and the consequent difficulties resulting from the implementation of this technology in the ambit of hospital and outpatient facilities. To carry out this work, we proceeded to survey and literature review in order to select the research related to the topic of RFID in the context of traceability. The data obtained clearly show that the benefits of this tool are numerous, ranging from drug screening to the correct availability of patient data. Although it is imbued with all these advantages, RFID still represents a visible difficulty of insertion in the hospital environment due to economic and security problems in terms of information privacy. However, this new reality is undeniable and its implementation is increasingly present in the medical environment, being a necessity rather than a technological advance

An exploration of the use of theory and visualisation in behaviour change interventions to help healthcare staff prevent and control healthcare-associated infections.

Changing healthcare staff's behaviours is of paramount importance in improving infection prevention and control (IPC), and decreasing healthcare-associated infections (HAIs). Thus many supportive interventions have been developed in pertinent areas, such as hand hygiene (HH). The concepts of theory and visualisation in behaviour change research are well described and embraced across the social sciences as they provide rigorous and innovative interventional solutions. However, the use of each of these concepts within interventions in IPC and HAI-related research has not been systematically investigated, and neither has their use in combination. The current thesis thus aimed to explore this field in depth, with a view to developing evidence-based recommendations for designing behaviour change interventions combining theory and visualisation. The study comprises a sequential multimethod pragmatic inquiry. This commenced by conducting two separate integrative literature reviews, exploring the wider context of theory-based and visualisation-centred interventions respectively - both in the field of IPC and HAIs. The reviews addressed gaps in relation to the theories and visualisations that have been used in pertinent interventions, the structure and application of these, and which of them seem to work. However, they raised further questions, for example which intervention parts work better than others, and how and why parts or whole interventions work. The above questioning formed the basis for the conduct of a Delphi study, with a participating international panel of key experts (n=18) in the fields of IPC, HAIs, intervention development, theory and/or visualisation. Through three questionnaire and survey rounds, the expert panel provided insights into questions (round 1), and were asked to rank subsequent related statements according to the degree of their agreement (rounds 2 and 3). The experts' responses provided sets of theories and visualisations along with other important intervention elements (e.g. behaviour change techniques), which could be prioritised when considering combinations to use for developing focal interventions (i.e. targeted to specific behaviours of individuals or teams) and systems-based interventions (i.e. targeted to whole healthcare organisations). Finally, four focus groups - with nurses and infection control staff (n=18) from two Scottish Health Boards - aimed to obtain staff opinions and perspectives regarding IPC based on their clinical experiences. Participants were also presented with selected recommendations from the Delphi study, and were asked to comment on them and make further suggestions. Findings indicate that posters are less effective, and that work and time pressure as part of clinical practice should be considered when developing pertinent interventions. Taken together, it was possible to formulate a menu of recommendations that had their foundational basis in the combination of participatory theoretical approaches and dynamic forms of visualisation. This research provides novel insight into the role of theory and visualisation in HAIs and IPC practice. The explicit combination of theory and visualisation has been demonstrated to be very under-researched, thus these findings contribute original knowledge and offer value for practice, education and research

Häufigkeit und Art von Eingriffen an zentralvenösen Kathetersystemen bei kritisch kranken Intensivpatienten

Eine der großen Herausforderungen auf Intensivstationen stellen die Risikoabschätzung sowie die Vermeidung und Behandlung nosokomialer Infektionen dar. Sie wird u.a. beeinflusst von Scores, welche die Krankheitsschwere und Arbeitsintensität an Patienten einschätzen (533). Um das Auftreten von Infektionen auf Intensivstationen zu vermeiden bzw. zu reduzieren, wurden entsprechende Risikofaktoren und Präventionsmaßnahmen erforscht. Zu den häufigsten Infektionen gehören beispielsweise CABSI, CAUTI, SSI und VAP (37). Im Falle der CABSI wurden bereits mehrere Studien hinsichtlich steriler Implantation, Verbandswechsel sowie diverser Filter, Spülungen und deren Wechselintervalle (629) durchgeführt. Dennoch zählt die Diskonnektion an Zentralvenösen Kathetersystemen aufgrund einer möglichen Kontamination des Innenlumens zu einem der wichtigsten Auslöser von CABSI (629). Bisher liegen jedoch keine Untersuchungen vor, welche sich mit der Häufigkeit der Diskonnektion bezüglich Gesamtzahl, Arbeitsschichtunterschieden und deren Verteilung nach Indikationen beschäftigten. Dabei werden diese Infektionen wie viele sonstige Infektionen auf Intensivstationen häufig durch mangelhafte Händehygiene seitens des Personals ausgelöst (629). Hierzu liegen bereits viele Studien vor, die diesbezüglich verschiedenste Faktoren untersucht haben. Jedoch beschäftigen sich nur wenige genauer mit dem spezifischen Gebrauch der Spender unter Einbezug ihrer Lokalisation und insbesondere der Indikation vor aseptischer Tätigkeit (439). Deshalb wurden in der vorliegenden Untersuchung über einen Zeitraum von 97 Tagen auf einer Case Report Form täglich Scoringwerte, Betätigungen an ZVKS, Antibiotikatherapie, Isolation und sonstige invasive Maßnahmen erfasst. Ebenso wurden separat die täglichen Betätigungen an Händedesinfektionsmittelspendern an sechs Beobachtungsbetten dokumentiert. Dies geschah, um erstmalig Daten sowohl über die Diskonnektionen am ZVKS als auch über die entsprechend wichtige Händedesinfektion vor aseptischer Tätigkeit zu erheben. Unsere Ergebnisse zeigten, dass Diskonnektionen an ZVKS während eines Behandlungstages in großer Häufigkeit vorlagen. Die Diskonnektionszahl blieb dabei mit 26 pro Tag gleichbleibend hoch, wobei sich eine große Variabilität zwischen den Arbeitsschichten und Indikationen feststellen ließ. Im Gegensatz zu bisherigen Studien zeigten sich keine wegweisenden Befunde in Bezug auf den Verlauf der Scorewerte nach Behandlungstagen. Jedoch korrelierten diese insbesondere am 1. Tag stark mit den Betätigungen am ZVKS. Damit zeigt sich, dass sowohl erhöhter Pflegeaufwand, operationalisiert durch den TISS-28 (520), als 118 auch Morbidität durch den SAPS-II (519) die Patienten dem zusätzlichen Risiko einer CABSI aufgrund von Infektionen, verursacht durch gehäufte Diskonnektionen am ZVKS, aussetzten. Wie unsere Studie zeigte, bleibt diese Gefahr schichtübergreifend hoch, allerdings mit großen Unterschieden nach Indikation der Diskonnektion. Die Betätigungshäufigkeit an Händedesinfektionsmittelspendern ergab ebenfalls einen deutlichen Unterschied hinsichtlich ihrer Lokalisation. Es ließ sich beobachten, dass der Spender am Bett trotz des hohen Bedarfs durch nachgewiesene Indikationen zur Händedesinfektion an ZVKS pro Tag signifikant wenig genutzt wird. Ausgehend von den Befunden dieser Studie lassen sich für zukünftige Untersuchungen mögliche Ansatzpunkte ableiten. So sollte insbesondere die große Diskrepanz zwischen der ermittelten hohen Anzahl an Diskonnektionen an ZVKS bei gleichzeitig geringer Betätigung der bettnahen Spender Gegenstand zukünftiger Untersuchungen sein

Real-Time Feedback for Improving Compliance to Hand Sanitization Among Healthcare Workers in an Open Layout ICU Using Radiofrequency Identification

OBJECTIVE: To increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). METHOD: A wireless, RFID based system was developed and deployed in the ICU. The ICU beds were divded into an intervention arm (n=10) and a control arm (n=14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. RESULTS: A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. CONCLUSION: Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout