Knowledge, Attitude and Use of Evidence-Based Practice among Nurses and Midwives in Bucharest Hospitals

Background and Aim: Evidence-based practice (EBP) is considered a critical element in safe and quality health care delivery. This paper is a report of a study describing the EBP knowledge, attitudes, and use of nurses and midwives practicing in hospitals in Bucharest. Materials and Methods: The descriptive, cross-sectional research design was conducted with a random sample of 245 nurses and midwives. The study used an online version 24-item validated questionnaire (adapted from Upton and Upton, 2006) to collect the data. Each item was measured using a 7-point Likert scale. Values between 1 and 3 were considered negative, between 3 and 5 were average values, and between 5 and 7 were positive values. Data were analyzed using the SPSS Statistics 20 program. The chi-square test (p) was used to perform the comparative analysis of the scores of the three subscales (Knowledge, Attitudes, and Practices) according to socio-demographic characteristics. Results: Most of the average scores of the 24 items do not register positive values (m<5), with the exception of item “Level of knowledge in information technology” (m=5.20). The weighting of scores with high values is relatively low, for all three subscales, the lowest percentage being recorded by the Knowledge subscale (approx. 4% of respondents), and the highest percentage by the Practices subscale (almost 38%). There are no significant differences according to certain socio-demographic characteristics, the only exception being university education, which is assigned significantly higher scores for the Attitudes and Knowledge subscales. Conclusions: This study demonstrates the priority need to improve the level of knowledge and use of EBP in the evaluated medical units. Also, this study can be extended to the national level, and its results can represent the basis of the decision to develop a policy regarding the professional training of nurses and midwives in the field of EBP

Assessment Study of Nurses' Attitudes Regarding the Safety of Care in Surgical Patients

Background and Aim: The modern surgical environment is complex and has a high potential risk of medical errors. In this context, the attitudes of healthcare professionals regarding patient safety represent an important component of organizational safety culture. Materials and Methods: We conducted a study in which we used the "Safety Attitudes Questionnaire", a standardized questionnaire with six scales: Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Work Conditions. The scores ≥75 signified positive attitudes of the respondents. Statistical data analysis was performed with the SPSS Statistics 20 program. Results: We included in the study 70 nurses, 46% from Anesthesia and Intensive Care Units (AICU) and 54% from surgical wards, most with secondary education (81%) and female gender (88%). The average age was 42.2±7.6 years and the average professional experience was 14.05±8.7 years. The lowest percentage of respondents with a positive attitude was identified for the Management Perception scale (53%), followed by the Stress Recognition scale (57%) and the Work Conditions scale (63%). On the other hand, the highest percentage of respondents with a positive attitude was associated with the Job Satisfaction scale (91%), followed by the Safety Climate scale (74%) and the Teamwork Climate scale (73%). The comparison of the average scores of the six scales for nurses from the two types of departments showed that there are significant differences in two scales: Stress Recognition, with higher scores in AICU, and Work Conditions, with lower scores in AICU. Conclusions: The low percentages of nurses with positive attitudes regarding the institutional management, stress recognition and work conditions highlight the need to implement effective strategies to improve organizational safety culture in hospitals, especially in AICU. The results are consistent with the literature and argue for the development of institutional educational programs and voluntary error reporting systems to achieve proactive professional safety attitudes

Assessment of Nurses’ Knowledge Level Regarding the Procedure of Blood Transfusion in a Hospital from Bucharest

Background and Aim: Blood transfusion is an invasive procedure with a high risk that could have unwanted consequences for both the patient and the nurses. Therefore, nurses must have the necessary knowledge to perform their roles safely and effectively. The aim of the study was to assess nurses’ knowledge level regarding the procedure of blood transfusion. Materials and Methods: The cross-sectional research study was conducted with a randomly selected sample of 26 nurses (response rate of 100%) and used a paper version validated questionnaire to collect the data. The scores of the knowledge <50% were considered as poor, between 50–74% - moderate, and ≥75% - high. The statistical data analysis was carried out using the SPSS version 20. Results: This study included nurses (45.35 ± 7.12 years average age and 18.96 ± 8.31 years average experience) from the medical wards (n=12), surgical wards (n=7), Intensive Care Units (ICU) (n=6) and Blood Transfusion Unit (BTU) (n=1). Most nurses were female, between 40 and 55 years old, post-secondary school graduates, and without specific blood transfusion courses. Based on the scoring system, nurses' overall knowledge of blood transfusion was estimated to be moderate (54 ± 5.16%). The percentage of knowledge calculated for each assessed dimension was 85.5% (Transfusion safety), 15.4% (The last pre-transfusion control), 46.2% (Transfusion administration), 46.2% (Patient monitoring), and 30.8% (Transfusion complications). In general, nurses from BTU, ICU, and surgical wards provided the most correct answers. Conclusions: The findings of this study indicated that the nurses’ knowledge of blood transfusion was at a moderate level, which also corresponds with international research. Extending this study could demonstrate the need to implement courses in the field of transfusion management at the national level

STUDIU DE EVALUARE A CUNOȘTINȚELOR, ATITUDINILOR ȘI PRACTICILOR ASISTENȚILOR MEDICALI DIN ROMÂNIA ÎN CEEA CE PRIVEȘTE IGIENA MÂINILOR ȘI INFECȚIILE ASOCIATE ASISTENȚEI MEDICALE

INTRODUCTION. Healthcare-associated infections (HAIs) represent adverse events of medical care, an important threat to patient safety that affects a significant number of patients annually. Hand hygiene is universally recognized as being the most effective method of preventing and limiting HAIs. Nurses have a critical contribution in providing clean and safe care to patients and preventing HAIs. METHODOLOGY. The nurses’ knowledge level, attitudes and self-reported practices regarding hand hygiene and HAIs was evaluated by using an original questionnaire which was applied at the beginning of the National Conference of The Order of Nurses, Midwives and Medical Assistants in Romania which took place between September 13-14, 2018, in Bucharest. The applied questionnaire included 32 items in 3 sections with the following structure: (1) 8 items related to demographic and professional data; (2) 10 items for assessing the level of knowledge; and (3) 14 items for assessing self-reported attitudes and practices. RESULTS. We analyzed the results of the assessment of the knowledge level, attitudes and self-reported practices of 576 Conference participants nurses who performed their professional activity in healthcare institutions in Romania. The analysis of the results obtained from assessing the knowledge showed that 16% (95%CI: 13.0-18.9) of the participants had a high level of knowledge (scores between 8 and 10), 58% (95%CI: 53.8-62.2) had a medium level (scores between 5 and 7) and 26% (95%CI: 22.4-29.7) a low level (scores lower than 5). The average score of the group was 5,51±2,07, reflecting an overall medium level of the group. Regarding the practice of workplace hand hygiene and the level of self-reported compliance, most participants (79% of them) declared high levels of compliance (at least 70-80%). The analysis of the answers to the items regarding the attitudes of the participants, which referred to the role of jewelry and nails in the occurrence and transmission of HAIs, the role and the importance of hand hygiene in HAIs prevention and the relationship between patient safety and HAIs prevention, showed an almost unanimous agreement with the statements that they contain (96%, 96% and 99%, respectively). CONCLUSIONS. Nurses in Romania have an inadequate knowledge level regarding hand hygiene and HAIs, which could represent a cause of HAIs and a barrier to patient safety, have positive attitudes and overestimated self-reported practices. Future research is needed to assess the level of observed compliance and its relationship with the nurses' knowledge and attitudes in the field of hand hygiene and HAIs.   Keywords: nurses, knowledge, attitudes, practices, hand hygiene, healthcare-associated infectionsINTRODUCERE . Infecțiile asociate asistenței medicale (IAAM) reprezintă evenimente adverse asociate &icirc;ngrijirilor medicale, o amenințare importantă la adresa siguranței pacienților, care afectează un număr semnificativ de pacienți anual. Igiena m&acirc;inilor este universal recunoscută ca fiind cea mai eficientă metodă de prevenire și limitare a IAAM. Asistenții medicali au o contribuție critică &icirc;n furnizarea &icirc;ngrijirilor curate și sigure pacienților și &icirc;n prevenirea IAAM. METODOLOGIE. Nivelul cunoștințelor, atitudinile și practicile auto-raportate ale asistenților medicali &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM au fost evaluate prin utilizarea unui chestionar original care a fost aplicat la &icirc;nceputul Conferinței Naționale a Ordinului Asistenților Medicali Generaliști, Moașelor și Asistenților Medicali din Rom&acirc;nia, care a avut loc &icirc;n perioada 13-14 Septembrie 2018, la București. Chestionarul aplicat a inclus 32 itemi &icirc;n 3 secțiuni, cu următoarea structură: (1) 8 itemi pentru caracteristici demografice și profesionale; (2) 10 itemi pentru evaluarea nivelului de cunoștințe; și (3) 14 itemi pentru evaluarea atitudinilor și practicilor auto-raportate. REZULTATE. Au fost analizate rezultatele evaluării nivelului de cunoștințe, a atitudinilor și practicilor auto-raportate pentru 576 asistenți medicali participanți la Conferință, care &icirc;și desfășoară activitatea profesională &icirc;n instituții medicale din Rom&acirc;nia. Analiza rezultatelor obținute &icirc;n urma evaluării cunoștințelor a arătat că 16% (95%CI: 13.0-18.9) dintre participanți au avut un nivel &icirc;nalt de cunoștințe (scoruri &icirc;ntre 8 și 10), 58% (95%CI: 53.8-62.2) au avut un nivel mediu (scoruri &icirc;ntre 5 și 7) și 26% (95%CI: 22.4-29.7) un nivel scăzut (scoruri mai mici de 5). Scorul mediu a fost 5.51 &plusmn; 2.07, reflect&acirc;nd un nivel general mediu al grupului. &Icirc;n ceea ce privește practica de igiena m&acirc;inilor la locul de muncă și nivelul complianței auto-raportate, majoritatea participanților (79%) au declarat niveluri &icirc;nalte de complianță (de cel puțin 70-80%). Analiza răspunsurilor la itemii privind atitudinile participanților, care se referă la rolul bijuteriilor și unghiilor &icirc;n apariția și transmiterea IAAM, la rolul și importanța igienei m&acirc;inilor &icirc;n prevenirea IAAM și la relația dintre siguranța pacientului și prevenirea IAAM, a arătat un acord aproape unanim cu afirmațiile pe care le conțin (96%, 96% și 99%). CONCLUZII. Asistenții medicali din Rom&acirc;nia au un nivel inadecvat de cunoștințe &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM, ceea ce poate reprezenta o cauză a IAAM și o barieră pentru siguranța pacientului, au atitudini pozitive și practici auto-raportate supraestimate. Sunt necesare cercetări viitoare pentru evaluarea nivelului complianței observate și a relației acesteia cu cunoștințele și atitudinile asistenților medicali &icirc;n ceea ce privește igiena m&acirc;inilor și IAAM. &nbsp; Cuvinte cheie: asistenți medicali, cunoștințe, atitudini, practici, igiena m&acirc;inilor, infecții asociate asistenței medical

Environmental quality assessment of reservoirs impacted by Hg from chlor-alkali technologies: case study of a recovery

Mercury (Hg) pollution legacy of chlor-alkali plants will be an important issue in the next decades with the planned phase out of Hg-based electrodes by 2025 within the Minamata convention. In such a context, the present study aimed to examine the extent of Hg contamination in the reservoirs surrounding the Oltchim plant and to evaluate the possible improvement of the environmental quality since the closure of its chlor-alkali unit. This plant is the largest chlor-alkali plant in Romania, which partly switched to Hg-free technolo- gy in 1999 and definitely stopped the use of Hg electrolysis in May 2012. Total Hg (THg) and methylmercury (CH3Hg) concentrations were found to decrease in the surface waters and sediments of the reservoirs receiving the effluents of the chlor-alkali platform since the closure of Hg units. Hence, calculated risk quotients (RQ) indicated no adverse effect of Hg for aquatic organisms from the ambient water exposure. RQ of Hg in sediments were mostly all higher than 1, showing important risks for benthic organisms. However, ecotoxicity testing of water and sediments suggest possible impact of other contaminants and their mixtures. Hg hotspots were found in soils around the platform with RQ values much higher than 1. Finally, THg and CH3Hg concentrations in fish were below the food safety limit set by the WHO, which contrasts with previous measurements made in 2007 revealing that 92 % of the studied fish were of high risk of consumption. Discontinuing the use of Hg electrodes greatly improved the surrounding environment of chlor-alkali plants within the following years and led to the decrease environmental exposure to Hg through fish consumption. However, sediment and soil still remained highly contaminated and problematic for the river reservoir management. The results of this ecological risk assessment study have important implications for the evaluation of the benefits as well as limits of the Minamata Convention implementation

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (&lt; 2 h), 'urgent' (2-6 h), and 'delayed' (&gt; 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value &gt; 12, p &lt; 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (&lt; 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome