Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control

English, K.M. | 2018| BMC Infectious Diseases |Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

 

A recent article from the BMC Infectious Diseases looks at healthcare-associated infections (HAI) in  care hospitals in Canada.

Abstract

Background:

Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers’ (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and may lead to more targeted and effective control strategies in the hospital setting.

Methods:

Staff at 3 urban university-based tertiary care hospitals in Canada completed a detailed questionnaire on demographics, interpersonal contacts, in-hospital movement, and infection prevention and control practices. Staff were divided into categories of administrative/support, nurses, physicians, and “Other HCWs” – a fourth distinct category, which excludes physicians and nurses. Using quantitative network modeling tools, we constructed the resulting HCW “co-location network” to illustrate contacts among different occupations and with locations in hospital settings.

Results:

Among 3048 respondents (response rate 38%) an average of 3.79, 3.69 and 3.88 floors were visited by each HCW each week in the 3 hospitals, with a standard deviation of 2.63, 1.74 and 2.08, respectively. Physicians reported the highest rate of direct patient contacts (more than 20 patients/day) but the lowest rate of contacts with other HCWs; nurses had the most extended (over  20 min) periods of direct patient contact. “Other HCWs” had the most direct daily contact with all other HCWs. Physicians also reported significantly more locations visited per week than nurses, other HCW, or administrators; nurses visited the fewest. Public spaces such as the cafeteria had the most staff visits per week, but the least mean hours spent per visit. Inpatient settings had significantly more HCW interactions per week than outpatient settings.

Conclusions:

HCW contact patterns and spatial movement demonstrate significant heterogeneity by occupation. Control strategies that address this diversity among health care workers may be more effective than “one-strategy-fits-all” HAI prevention and control programs

The full article is available to read in full from BMC

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Funding opportunity available to UK and Chinese researchers to help tackle antimicrobial resistance (AMR)

Department of Health and Social Care, Innovate UK & Steven Brine |  March 2018  | UK-China collaboration to tackle antimicrobial resistance

The Department of Health and Social Care (DHSC) will invest up to £10 million in UK businesses and academics who work in conjunction with Chinese scientists to advance work on antimicrobial resistance (AMR). The fund is to  support the development and, where appropriate, clinical evaluation of new products or services, which must be of value in addressing the threat from AMR.

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Innovate UK will deliver the funding to UK researchers (£750,000) and The Chinese Ministry of Science and Technology  will invest up to 60 million Renminbi (RMB) to fund the project.  Projects can last up to 3 years.

UK applicants must demonstrate that projects are primarily and directly relevant to the needs of people in low and middle income countries (LMICs), including China, as defined by the Organisation for Economic Co-operation and Development (OECD). There must be a clear economic and societal benefit to LMICs from their proposed project. The competition will open on 3 April 2018  (Innovation Funding Service)

Projects must address the specified criteria at DHSC here  

Full details including eligibility criteria are available from DHSC 

Reducing Catheter Associated Urinary Tract Infections

Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital. Can change be sustained? | Commissioning for Quality and Innovation (CQINN) project. 

This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

Full document: Six Step strategy for reducing cather associated urinary tract_infections

Eight Years of Decreased MRSA Infections Associated With Veterans Affairs Prevention Initiative

Evans, M.E. et al. American Journal of Infection Control. 45(1) pp. 13-16

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Background: Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015.

Conclusions: MRSA HAI rates declined significantly in acute care, SCIUs, and LTCFs over 8 years of the Veterans Affairs MRSA Prevention Initiative.

Read the full article here

Prevention of Surgical Site Infections After Major Gynecologic Surgery

Pellegrini, J. et al. Anesthesia & Analgesia. Published online: December 1 2016

medical-1849086_960_720.pngThe primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women’s Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

Read the full abstract here

The lowbury lecture 2016: can intersectional innovations reduce hospital infection?

Saint, S. The Journal of Hospital Infection. Published online: November 28, 2016

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Preventing healthcare-associated infection remains an international priority given the clinical and economic consequences of this largely preventable patient safety harm. While important strides have been made in preventing hospital infections over the past several decades, thorny issues remain, including how to consistently improve hand hygiene rates and further reduce device-related complications such as catheter-associated urinary tract infection.

Rather than relying solely on directional innovations – incremental changes that continue to serve as the bedrock of scientific advancement – perhaps we should also search for “intersectional innovations,” which represent breakthrough discoveries that emanate from the intersection of often widely divergent disciplines. Several intersectional innovations that have the potential to greatly impact infection prevention efforts include human factors engineering, sociology, and engaging the senses. Indeed, Professor Edward Joseph Lister Lowbury, the namesake of this lecture, exemplified intersectional thinking in his own life having been both an accomplished bacteriologist and poet. By incorporating approaches outside of traditional biomedical science we will hopefully provide patients with the safe care they expect and deserve.

Read the full article here

Practice Transformation Program Increases Adult Influenza Vaccination

Infection Control Today | Published online: 3 November 2016

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An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study by Lin, et al. (2016) was to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.

Twenty-five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions.

A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P < 0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P < 0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P < 0.005).

The researchers say that reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars™ Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults.

Read the full overview here

Read the original article here