“I Was Like an Autumn Leaf That Looks Pretty From the Outside, but Would Break Once You Touched It”: A Case Study of the Lived Experience of Breast Cancer Survival

In this hermeneutic phenomenological case study, we explored the lived experiences of one Saudi Arabian woman, Sahara, living with breast cancer and after, identifying her culture’s impact on the “meaning-making” process. We derived the data from a semi-structured interview and analyzed using interpretive phenomenological analysis (IPA). The themes were: (1) “discourse”: being a breast cancer patient; (2) “sociality”: the complex sense of living with visibility and invisibility; and (3) “selfhood”: regaining the sense of being normal. The study benefits healthcare providers, who need to understand women’s life-world, the impact of culture when designing a program of survival care, and the response to their needs

A qualitative study of senior hospital managers' views on current and innovative strategies to improve hand hygiene

Background Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers’ compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers’ views on current and innovative strategies to improve hand hygiene compliance. Methods Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. Results Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. Conclusions To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness

Understanding aseptic technique: an RCN investigation into clinician views to guide the practice of aseptic technique

Aseptic technique is recognised as an essential component of all infection prevention programmes but terminology used to define it varies. This publication is an RCN investigation into clinical views to guide the practice of aseptic technique. BD have funded this report. BD has had no influence on, or involvement in its content

Leadership and management for infection prevention and control: what do we have and what do we need?

Leadership is widely considered to be vital for infection prevention and control (IPC).1 Its purpose is to maintain progress in the reduction of risks of healthcare-associated infections, especially those caused by antimicrobial-resistant organisms, and to achieve continuous quality improvement.2 However, given its importance, there is little rigorous research on effective leadership for IPC. While there is indirect evidence that IPC experts and clinicians working at the frontline of patient care can assume leadership, almost nothing has been written about IPC leadership at senior level. This situation is all the more surprising given international interest in the senior managerial model of IPC adopted throughout the National Health Service (NHS) in England, and claims that ‘top down’ intervention for IPC is effective.1 and 2 The terms ‘management’ and ‘leadership’ are often used interchangeably in relation to the organization and delivery of health care. Greater conceptual clarity could prompt consideration of what is needed for IPC

Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website

Undergraduate nursing students' education and training in aseptic technique: a mixed methods systematic review

Abstract Aim: To appraise and synthesize empirical studies exploring undergraduate nursing students' education and training in aseptic technique. Design: Mixed methods, systematic literature review adopting Joanna Briggs Institute methodology. Data sources: Thirteen electronic databases were searched 1996–2020, followed by searches with a general browser, hand-searching key journals and reviewing reference lists of retrieved papers. Review methods: Potentially eligible papers were scrutinised by two reviewers. Those eligible were critically appraised and quality assessed using the Critical Appraisal Skills Programme and Specialist Unit for Review Evidence checklists. Results: Of 538 potentially eligible studies, 27 met the inclusion criteria. There was limited evidence of the effectiveness of different teaching methods. Students' knowledge, understanding and competency varied and were often poor, although they reported confidence in their ability to perform aseptic technique. Students and qualified nurses perceived that education and training in aseptic techniques might be improved. Conclusion: Education and training in aseptic technique might be improved but the review findings should be viewed cautiously because the studies lacked methodological rigour. Impact: This appears to be the first systematic review to explore undergraduate nursing students' education and training in relation to aseptic technique. There was limited evidence to support the effectiveness of different teaching methods and scope for improving nursing students' knowledge, understanding and competency in aseptic technique. Students and qualified nurses suggested that education and training might be enhanced. More robust studies are required to support education, practice and policy

The validity of hand hygiene compliance measurement by observation: a critical systematic review

BACKGROUND: Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS: This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS: Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS: Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

Objectives To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. Design A modelling study based on a combination of published data and clinical practice. Setting NHS hospitals in England. Primary and secondary outcome measures Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. Results In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs. Conclusion This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole

National cross-sectional survey to explore preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom

Background Aseptic technique is a core nursing skill. Sound preparation is required during pre-registration nursing education to enable student nurses to acquire the knowledge and skills necessary to prevent and control healthcare-associated infection and promote patient safety. Few studies have explored nursing students' education and training in aseptic technique. Objectives To investigate what, when and how pre-registration nursing students are taught aseptic technique and how they are assessed in undergraduate, pre-registration nursing programmes in the United Kingdom. Design National cross-sectional survey exploring preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom. Setting Universities providing undergraduate, pre-registration adult nursing programmes in the United Kingdom. Participants Nurse educators. Methods Structured telephone interviews were conducted with nurse educators. Descriptive and inferential statistical data analyses were undertaken. Results Response rate was 70% (n = 49/70). A variety of different learning and teaching methods were reported to be in use. Teaching in relation to aseptic technique took place in conjunction with teaching in relation to different clinical procedures rather than placing emphasis on the principles of asepsis per se and how to transfer them to different procedures and situations. Wide variation in teaching time; use of multiple guidelines; inaccuracy in the principles identified by educators as taught to students; and limited opportunity for regular, criteria based competency assessment were apparent across programmes. Conclusions Pre-registration preparation in relation to aseptic technique requires improvement. There is a need to develop a working definition of aseptic technique. The generalisability of these findings in other healthcare students needs to be explored

Understanding aseptic technique: an RCN investigation into clinician views to guide the practice of aseptic technique

Aseptic technique is recognised as an essential component of all infection prevention programmes but terminology used to define it varies. This publication is an RCN investigation into clinical views to guide the practice of aseptic technique. BD have funded this report. BD has had no influence on, or involvement in its content