Bugs on Cuffs and Pockets: A Cross-sectional Study of the Contamination of Healthcare Personnel Attire at Salmanyia Medical Complex

Background: Hospital acquired infections increase the morbidity and mortality of the inpatient population. Pathogens like Staphylococcus aureus and Enterococci are transmitted by direct contact or transmitted by fomites such as healthcare personnel’s attires. This is a cross-sectional study aimed to explore the prevalence ofcontamination of the attires of healthcare personnel working atSalmanyia Medical Complex. Method: We randomly selected 100 doctors and nurses working in different departmentsand swabbed their attire's sleeves and pockets. We then stored both swabs in their accompanying syringe that contains a bacterial transportation media, and sent them to the lab for culturing. SPSS 23 was used for data entry and analysis. After that, percentages and frequencies were computed for different categorical variables, and a cross-tabulation was computed between each two categorical variables. Chi-Squared test was used to determine whether there were significant relationships between each two categorical variables. Results:Of the total samples, 44 pocket and 45 cuff samples were contaminated with staphylococcus epidermidis (skin flora). Thirty eight participants were found to have contamination of both the cuff and pocket. Nurseshad slightly higher prevalence of cuff contamination than doctors (P=0.032). Amongst doctors, surgeons had the highest prevalence (P=0.006). Discussion:Compared to the data available in the literature, our data did not reveal contamination with significant pathogens such as staphylococcus aureus or MRSA.Nevertheless, contamination with staphylococcus epidermidis could be whether from autoinoculation or contamination from the hospital environment and could correlate to level of hygiene. Frequent washing of attire doesn’t reduce the level of contamination

Effectiveness of Nurse-Driven Protocol for Blood Pressure Management

Statement of Problem Or Question: Is the nurse-driven protocol more effective in controlling blood pressure in patients with hypertension in the outpatient setting than the traditional physician-driven approach? Objectives of Program/Intervention: Improve blood pressure control with dedicated follow-up visits performed by nurses Improve access to health care in traditionally underserved patient populations Utilize a team-based approach in the management of chronic diseases Description of Program/Intervention: The nurse-driven protocol is based on the MUPD campaign (Measure Up Pressure Down) using a team-based approach to improve blood pressure control and counteract clinical inertia in the ambulatory outpatient clinic setting. After patients are referred to the program by their physician, the MUPD nurse will follow up with the patient during cost-free appointments for blood pressure measurements, patient education, and medication titration based on a set protocol. The patients continue in the program until their blood pressures are controlled. The Henry Ford Clinics traditionally treat a disproportionately high number of medically underserved patients from the Detroit City area. The majority of the patients identify as African American. Measures of Success: This was a retrospective case-controlled study including all adults (\u3e 18 years) with hypertension (SBP \u3e 140 and/or a DBP \u3e 90) that presented to a Henry Ford internal medicine clinic between 1/2015 and 9/2017 and who participated in the nurse-driven protocol. The control consisted of a matched cohort who only followed up with their physicians. Blood pressures at 6 months and 1 year following enrollment in the nurse-driven HTN program were obtained from electronic medical records. Categorical variables were compared using chi-square tests. Crude and adjusted odds ratios were obtained using generalized estimating equations with a logit link function presence of blood pressure control as the dependent variable. Findings To Date: The rate of controlled blood pressure (BP) at 6 months is significantly higher in patients who were in the program as compared to those who were not (61% versus 45%, p\u3c 0.001). Similarly, the rate of medical management change was significantly higher in patients who were in the program as compared to those who were not (30% versus 21%, p\u3c 0.001). However, for both endpoints, the rates were similar at all other time points. Patients with at least 1 MUPD visit had 1.46 times the odds of having controlled BP in later visits compared to those with no MUPD visits. When controlling for gender, race, baseline systolic BP, and ratio of the medication change, patients with at least one MUPD have 1.48 times the odds of having controlled BP in later visits compared to those with no MUPD visits. Key Lessons For Dissemination: Nurse-driven clinic visits seem to be more effective in controlling blood pressures in the primary care setting than traditional physician visits. This project furthermore showed that this is also true in outpatient settings with a high proportion of underserved patients with multiple other comorbidities and complex social Backgrounds