Contamination Of Hospital Chart Covers

BackgroundVancomycin-resistant enterococci (VRE) have been increasingly associated with patients with renal failure attending large metropolitan teaching hospitals. Monash Medical Center has been following guidelines issued by the Department of Human Services to reduce the spread of VRE, but unfortunately this has had limited impact, especially in the renal unit. In an attempt to investigate the causes of the sustained VRE prevalence in the renal unit, this study sought to determine if renal patient chart covers were contaminated with VRE and if there was any genetic similarity to patient VRE isolates.Method  Using convenience sampling, chart covers of patients colonised or infected with VRE were swabbed from July to September 2010 (n=46). Samples were also collected from chart covers of non-VRE patients. Molecular typing of all matching VRE patient and chart isolates was performed using pulsed field gel electrophoresis (PFGE) by the public health laboratory (Microbiological Diagnostic Unit, University of Melbourne). ResultsNone of the patients who were VRE negative (n=14) had contaminated chart covers. VRE was recovered from two drug chart covers (patient A and B) from the 31 VRE positive patients sampled. One patient (patient C) was misidentified as a VRE patient for two weeks and was subject to contact precautions while being dialysed, yet three chart types belonging to this patient were found to be contaminated with VRE.ConclusionThe findings of this study demonstrate that it is possible for patients’ hospital chart covers to be contaminated with VRE even though there was no genetic similarity to the current patient strain. In this regard, the study reveals that patient charts may have an important role in spreading VRE

Stemming the impact of health professional brain drain from Africa: a systemic review of policy options

Africa has been losing professionally trained health workers who are the core of the health system of this continent for many years. Faced with an increased burden of disease and coupled by a massive exodus of the health workforce, the health systems of many African nations are risking complete paralysis. Several studies have suggested policy options to reduce brain drain from Africa. The purpose of this paper is to review possible policies, which can stem the impact of health professional brain drain from Africa. A systemic literature review was conducted. Cinahl, Science Direct and PubMed databases were searched with the following terms: health professional brain drain from Africa and policies for reducing impact of brain drain from Africa. References were also browsed for relevant articles. A total of 425 articles were available for the study but only 23 articles met the inclusion criteria. The review identified nine policy options, which were being implemented in Africa, but the most common was task shifting which had success in several African countries. This review has demonstrated that there is considerable consensus on task shifting as the most appropriate and sustainable policy option for reducing the impact of health professional brain drain from Africa

Interventions to reduce falls among dialysis patients: a systematic review

Abstract Introduction Despite all available evidence regarding increased morbidity and mortality among dialysis patients due to falls and their complications, and an increase in risk factors for falls, relatively little attention has been focused on evidence-based interventions that can reduce falls. We evaluated the effectiveness of fall prevention interventions among dialysis patients. Methods We searched Ovid-Medline, Ovid-Embase, PubMed, Cumulated Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials (Central) from inception to 19 July 2023 for studies that evaluated the effectiveness of fall prevention interventions among dialysis patients. The search, screening and extraction of data followed standardised processes and the methodological quality of studies was independently assessed by two reviewers. Data was analysed using a narrative synthesis approach. Results Of the 18 studies that had full text review, five were eligible. Three studies were performed in the USA and one each in UK and Japan. Four studies were conducted in outpatient hemodialysis centres and one in a hospital-based nephrology unit. Reported sample sizes ranged from 51 to 96 participants per study with a follow-up period of 3 to 35 months. There was moderate-quality evidence that exercises reduce the rate of falls compared to usual care and low to moderate quality of evidence that multifactorial falls prevention interventions reduce the rate of falls. However, treatment effects could not be quantitatively estimated for all interventions due to substantial heterogeneity of included studies. Conclusions This systematic review reflects that there is insufficient evidence regarding falls prevention strategies specific to dialysis patients. Available data based on low to moderate quality studies, suggest that among dialysis patients, exercises may reduce falls and the effectiveness of multifactorial interventions such as staff and patient education still need to be explored using high-quality prospective studies

A need-based approach to self-management education for adults with co-morbid diabetes and chronic kidney disease

Abstract Background Self-management education needs have not been assessed in patients with complex co-morbid conditions such as diabetes and chronic kidney disease (CKD). The objectives of this study were to 1) determine the self-management education needs for patients with co-morbid diabetes and CKD and 2) co-develop an educational resource meeting the self-management education needs of patients with co-morbid diabetes and CKD. Methods Patients with co-morbid diabetes and CKD attending a co-designed, patient-centred outpatient diabetes and kidney clinic at a tertiary metropolitan hospital were recruited for semi-structured interviews. Maximal variation sampling was used, ensuring adequate representation of different gender, age, diabetes duration and stage of CKD. Data were thematically analysed using grounded theory. Results Forty-two patients participated. Most were male (67%) and the mean age was 64.8 (11.1) years. The majority of patients preferred an educational resource in the form of a Digital Versatile Disc (DVD) and they thought that current education could be improved. In particular patients wanted further education on 1) management of diabetes and kidney disease (including nutrition and lifestyle, and prevention of the progression of kidney disease) and 2) complications of comorbid diabetes and kidney disease. Conclusion Patients with co-morbid diabetes and kidney disease have education gaps on the management of, and complications of diabetes and kidney disease. Interventions aimed at improving patient education need to be delivered through education resources co-developed by patients and health staff. A targeted education resource in the form of a DVD, addressing these needs, may potentially close these gaps

Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis

Abstract Background Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes. Methods Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death. Results Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p < 0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference − 4.26 mmHg, 95% CI − 7.81 to − 0.70, p = 0.02) and glycated hemoglobin (mean difference − 0.5%, 95% CI − 0.8 to − 0.1, p = 0.01) compared to usual care. Conclusions Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs. Systematic review registration PROSPERO CRD42015017316

Additional file 3: of Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis

Table S3. Characteristics of excluded studies (ordered alphabetically). (DOCX 12 kb