The role of patient isolation and compliance with isolation practices in the control of nosocomial MRSA in acute care

Background: Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin resistant Staphylococcus aureus (MRSA) transmission continues to rise. Various isolation practices are used to minimise MRSA transmission in acute care. However, the effectiveness of these practices has seldom been evaluated. Objectives: This review sought to evaluate the efficacy of isolation practices in minimising MRSA transmission in the acute hospital setting and explore staff, visitor and patient compliance with isolation practices. This review updates a review published in 2002. Search strategy: A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. Selection criteria: All English language research reports published between 1990 and August 2005 that focused on the role of isolation practices on the nosocomial transmission of MRSA in adult, paediatric or neonatal acute care settings were eligible for inclusion in the review. Studies that evaluated multiple infection control strategies or control of MRSA outbreaks were excluded. The main outcome of interest was the incidence of new cases of MRSA. The secondary outcome was staff, visitor and patient compliance with the isolation practices. Data collection and analysis: Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results: Seven studies met the inclusion criteria. Given the small number of included studies and variable methodological quality, care must be taken when interpreting the review findings. There is some evidence that cessation of single room isolation and cohorting of MRSA patients does not increase nosocomial MRSA transmission when hand-washing compliance and standard precautions are maintained. Indeed, there is some evidence that reduced MRSA transmission can be achieved by improving compliance with contact precautions alone. The low level of hand hygiene compliance reported in the literature suggests that staff compliance with isolation practices is a significant factor in evaluating any infection-controlled intervention in the clinical setting. While staff compliance data are conflicting, regular audit and feedback of performance may improve compliance. Implications for clinical practice: The heterogeneous nature of the topic and methodological weaknesses of included studies impairs the ability to aggregate data and develop specific practice recommendations. While this review presents evidence to suggest that ceasing single room or cohort isolation does not lead to increased MRSA transmission, these studies maintained high levels of hand hygiene or standard precautions. Additionally, the role of extraneous factors, such as environmental reservoirs, specific MRSA strains and patient mix, is unclear. None of the included studies measured financial, social or psychological factors associated with isolation practices. There is an urgent need for well-designed research with significant sample sizes to develop an evidence base upon which to underpin future clinical practice

Role of MRSA reservoirs in the acute care setting

Background  Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. Objectives  This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). Search strategy  A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included  Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). Selection criteria  All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. Data collection and analysis  Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results  Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area

Administration of medications by enrolled nurses : perceptions of metropolitan and non-metropolitan registered nurses and nursing unit managers

Objective: The objective of this study was to investigate the views and current practices of registered nurses (RNs) and nurse unit managers (NUMs) working in metropolitan and non-metropolitan health facilities relating to medication administration by enrolled nurses (ENs). Background: The advanced scope of practice role relating to medication administration is one area currently challenging Registered and Enrolled Nurses from the perspectives of the education, knowledge and skills required to support competence in this area of practice. Method: A self-administered survey comprising questions on participant demographics, their perceptions and their current practices relating to ENs administering medications was completed by 272 RNs and Nums from metropolitan and non-metropolitan health care facilities within Australia. Results: There were statistically significant differences among metropolitan and non-metropolitan based RNs relating to their views on the various routes by which ENs should be allowed to administer medications. Significantly more RNs from metropolitan hospitals indicated that they asked ENs to administer S3, S4 and S4D medications. Overall, a large proportion of RNs were opposed to ENs administering injectable medications. Conclusion: This study describes the current practices and view points of RNs relating to administration of medications by ENs. While the findings suggest that practice change could be slow, appropriate ongoing education for and consultation with RNs will support change of practice at the clinical level. Further formalising a medication administration role for ENs that acknowledges current practice will have potential organisational and patient safety benefits

Changes in general nurses' knowledge of alcohol and substance use and misuse after education

PURPOSE. This study aims to assess the impact of an education program on Australian general nurses' knowledge and competence in identifying and managing patients with alcohol and substance use and misuse, and compare findings with existing literature on mental health nurses. DESIGN AND METHODS. Pre- and posttest design without a control group. FINDINGS. The nurses' knowledge of safe drinking limits and alcohol withdrawal management improved following the education. Nevertheless, overall the nurses reported a lack of adequate knowledge and competence. Compared to mental health nurses, the nurses in this study had lower levels of knowledge and competence. PRACTICE IMPLICATIONS. We suggest several opportunities for general nurses to strengthen their knowledge and skills and the need for a comprehensive and regular education program

Perceptions of the impact of health-care services provided to palliative care clients and their carers

A wide range of services are provided to palliative care clients to alleviate pain and improve their quality of life. The purpose of this study was to explore the perceptions of clients and their carers regarding palliative care services in New South Wales, Austalia. Ten patients and their carers (n=7) were randomly selected from a sample of palliative care clients and were informed of the study and interviewed. Interview data were coded independently by three researchers and thematic analysis was undertaken. The themes identified were similar for both clients and carers and included: access to services; service provision; impact on way of life; usefulness of services; and staffing. An additional theme identified by clients was the burden of caregiving on carers. Knowledge of perceptions and concerns of client and carers is important to consider when planning palliative care services

Diversity and demographic heterogeneity of Australian nursing students : a closer look

Background:  In the last decade, there has been a rapid growth of international students undertaking nursing studies in Australian universities. At the same time, nursing courses continue to attract local students from a diversity of backgrounds. Aim:  The aim of this study is to examine first year nursing students by enrolment classification and country of birth: i) international; ii) local, overseas-born; and iii) local, Australian-born student, and demographic differences of academic performance at the 12-month follow-up. Methods:  A prospective, correlational design was used to identify nursing student characteristics as predictors of academic performance in a large university in the western region of Sydney. Results:  Of the 806 students enrolled in the course, 540 (67%) completed the survey and consented to data linkage. Fifty-six per cent of the 540 participants were born overseas, of which 38% were local and 18% were international students. Local, overseas-born students originated from 55 different countries, in contrast to international students who were representative of only 16 different countries. International students were younger, spent less time in paid work and were more likely to have a close friend in the same course. Although age was positively related to academic performance, local, overseas-born and international enrolment classifications, and hours in paid work during semester were negatively associated to academic performance. Conclusion:  This study has taken a closer look at an important issue that requires further examination, given that international and local, overseas-born students were two distinctive groups. Although both groups underperformed academically compared with Australian-born students, the differences in characteristics between local, overseas-born students and international students suggest that these two student groups are likely to experience different challenges during their nursing studies in Australia

COVID-19 : knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students : a cross-sectional study

Aims and Objectives: To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID-19 pandemic. Background: Based on the World Health Organization's direction for containment of the novel coronavirus (COVID-19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education. Methods: Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID-19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data. Results: Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID-19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about ‘attending clinical placement’ (MD-1.08; 95% CI −1.94, −0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77)