Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare

<p>Abstract</p> <p>Background</p> <p>Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare.</p> <p>Main objective</p> <p>To evaluated the effect of a "Hand Hygiene for the reduction of healthcare-associated infections" training program for primary healthcare workers, measured by variation from correct hand hygiene compliance, according to regulatory and specific criteria, 6 months after the baseline, in the intervention group (group receiving a training program) and in the control group (a usual clinical practice).</p> <p>Secondary objectives</p> <p>-To describe knowledges, attitudes and behaviors as regards hand hygiene among the professionals, and their possible association with "professional burnout", stratifying the results by type of group (intervention and usual clinical practice).</p> <p>-To estimate the logistic regression model that best explains hand hygiene compliance.</p> <p>Methods/Design</p> <p>Experimental study of parallel groups, with a control group, and random assignment by Health Center.</p> <p>Area of study.- Health centers in north-eastern Madrid (Spain).</p> <p>Sample studied.- Healthcare workers (physicians, odontostomatologists, pediatricians, nurses, dental hygienists, midwife and nursing auxiliaries).</p> <p>Intervention.- A hand hygiene training program, including a theoretical-practical workshop, provision of alcohol-based solutions and a reminder strategy in the workplace.</p> <p>Other variables: sociodemographic and professional knowledges, attitudes, and behaviors with regard to hand hygiene.</p> <p>Statistical Analysis: descriptive and inferential, using multivariate methods (covariance analysis and logistic regression).</p> <p>Discussion</p> <p>This study will provide valuable information on the prevalence of hand hygiene non-compliance, and improve healthcare.</p

Effectiveness of standardized Nursing Care Plans in health outcomes in patients with type 2 Diabetes Mellitus: a two-year prospective follow-up study.

Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients.A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted.18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01).Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group.ClinicalTrials.gov NCT01482481

Associated factors with HbA1c <7% in 12,800 DM patients with baseline HbA1c≥7%: logistic regression model.

<p>UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; HbA1c: Glycated hemoglobin.</p

Mean values (SD) and changes of baseline and final parameters in both groups.

<p>UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; Hba1c: Glycated hemoglobin; LDL: Low-density lipoprotein; SBP: Systolic Blood Pressure; DBP: Diastolic blood pressure; BMI: Body mass index.</p

Flow diagram of participants.

<p>PCHC: Primary Health Care Center; T2DM: Type 2 Diabetes Mellitus; SNCP: Standardized Nursing Care Plans; UNC: Usual Nursing Care; CCR: Computerized Clinical Records; BP: Blood Pressure; HbA1c: Glycated hemoglobin; LDLc: Low-density lipoprotein cholesterol; BMI: Body Mass Index.</p

Percentage of subjects on-target for cardiovascular risk factors at baseline and at the two-year follow-up, stratified by group (UNC/SNCP).

<p>p*: p value of comparison of the two-year follow-up and baseline values, intragroup differences; Change: Final value (two-years)– Baseline values; UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; SBP: Systolic Blood Pressure; DBP: Diastolic blood pressure. HbA1c: Glycated hemoglobin; LDL c: Low-density lipoprotein cholesterol; BMI: Body mass index.</p

Nursing diagnoses: domains, class, and titles.

<p>Nursing diagnoses: domains, class, and titles.</p

Baseline characteristics of the study population.

<p>UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; DM: Diabetes mellitus; BMI: Body mass index; ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blockers; CHD: Coronary heart disease.</p