‘The gloves are off’ campaign [Shared Atlas of Learning Case Study]

NHS England | December 2018 | ‘The gloves are off’ campaign’

The use of non-sterile gloves has been associated with a significant potential for cross-contamination and transmission of healthcare-associated infections (HAIs). This is because they are often used when they aren’t needed, put on too early, taken off too late or not changed at critical points (Source: NHS England)

A case study recently added to NHS England’s Shared Atlas of Learning, addresses the over-use of non-sterile gloves through education and training. The Lead Nurse for Infection Prevention and Control and two Lead Practice Educators at Great Ormond Street Hospital NHS Foundation Trust (GOSH).

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Actions included establishing a working group to develop an educational awareness programme for staff. This included an updated educational package for when gloves should be worn generally in practice and a risk assessment strategy for use of gloves when preparing intravenous medication.

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Staff were asked to risk assess when they would wear gloves for giving medication. Gloves were only needed for:

  • any medication where you could be in contact with a bodily fluid. e.g. eye drops, nose drops
  • any therapeutically active cream
  • any liquid hormones or cytotoxic medications.

As a result of the nurses’ actions, the case study reports:

Better outcomes – There has been a reduction in staff attendances to occupational health for hand or skin related problems. The CVL infection rate remains within normal parameters and there has been no adverse rise in hospital acquired infections including Vancomycin-resistant Enterococci (VRE), viral respiratory and enteric infections.

Better experience – The father of a child with learning disabilities gave feedback that his child is hospital and gloves phobic and the project has improved the quality of their life.

The main focus of the project was to provide education and training so that staff felt empowered to risk assess when they used gloves, which has been achieved.

Better use of resources – There has been a significant reduction in the amount of gloves ordered into the hospital. The most recent mean for gloves ordered is 163,125 per week, which is taken from the baseline period between the weeks beginning 15 April 2018 and 29 July 2018, which is a significant reduction on the previous mean of 199,733 units per week a difference of 36,608.

The outcomes of the project are continuing to be monitored and are reported quarterly to staff across the Trust and Nursing Board.

Read the case study at NHS England 

How safe is washing your uniform at home?

 Laird K et al  | 2018  | Domestic laundering of nurses’ uniforms: what are the risks? | Nursing Times  | ePub | Vol. 114 | 2 | P. 18-21

Researchers at De Montfort University, Leicester reviewed the literature on domestic laundering of hospital uniforms. An earlier study (2015) also at De Montfort, which  included 265 healthcare staff from across disciplines and in a range of roles  (nurses, healthcare assistants, ward clerks, housekeepers, and physiotherapists) completed a questionnaire.  It showed 43.7% laundered their uniforms below the 60°C recommended by the Department of Health; a third (33%) washed them at 40°C and 5% at 30°C.  Around a quarter of the staff sampled also revealed that they wore their uniform for two or more shifts before washing it, longer than the recommended wash after every shift (via Nursing Times).

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In a laboratory experiment, the scientists repeated the staff’s  most common laundering practices (derived from the 2015 study), and assessed the survival of Staphylococcus aureus and Escherichia colion cotton and polyester fibres (Riley et al, 2017). The data showed that both bacteria were able to survive on polyester for up to seven days and on cotton for up to 21 days.

For the authors this raises the question of the storage of dirty uniforms at home, especially with regard to potential cross-contamination with surfaces in the home environment.  They also experimented to find if cross-contamination occurred in the wash,  including sterile samples with the uniforms. Washing at 40˚C did remove most micro-organisms, but the cells that were left were in excess of 1,000, and similar numbers had been transferred to the sterile items. This highlights the risk that other items of clothing in the home could become contaminated, or that domestically laundered uniforms could re-contaminate the home and/or healthcare environment.

The full article is available from The Nursing Times 

Staff nurses as antimicrobial stewards

An integrative literature review | American Journal of Infection Control

Background: Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored.

Methods: An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis.

Results: Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management.

Discussion: Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce.

Full reference: Monsees, E. et al. (2017) Staff nurses as antimicrobial stewards: An integrative literature review. American Journal of Infection Control. Vol. 45 (no. 8) pp. 917–922

Oral care in ventilated intensive care unit patients

Diaz, T.L. et al. American Journal of Infection Control. Published online: 23 January 2017

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Highlights:

  • A quality improvement project was developed to evaluate the pre/post effects of standardized placement and supply of oral care equipment in patient rooms.
  • Daily audits were performed to assess nursing behavior related to the performance of oral care on intubated patients with components from a 24 hour kit.
  • Increasing supply and creating uniform placement of oral care tools in patient rooms contributes to increased performance of oral hygiene interventions by nurses.

Read the full abstract here

Central venous catheters: latest evidence for nursing practice

Chapman, S. Evidently Cochrane Blog. Published online: 15 September 2016

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Image source: Calleamanecer – Wikipedia // CC BY-SA 3.0

By Sarah Chapman

What are the things that you do to reduce the risk of catheter-related infection in patients with central venous catheters (CVCs)? Take a moment to run through them. Now think about each one and why you do it. I’ll give you some prompts; mentally tick off all that apply:

  1. It’s Trust policy
  2. NICE (or other) guidance recommends it
  3. There’s evidence that it’s effective
  4. I’ve always done it [this way]

That last one always made me (inwardly) howl with frustration whenever I heard it, but I know you evidence-seekers won’t have ticked that one. It would be great to tick the first three, but can you? There might be more howling over those. I was rather shocked (ok, call me naïve) to discover that reliable evidence supporting the replacement of peripheral venous catheters only when clinically indicated, duly recommended by the UK’s epic3 National Evidence-Based Guidelines as being both safe and cost-saving, had not translated into practice in some hospitals. This came to light in a lively #WeNurses tweetchat on the evidence and you can catch up with it in this blog.

Skin antisepsis

I’ve also blogged here about evidence from a number of Cochrane reviews on different aspects of infection prevention for people with CVCs but since then we’ve seen the publication of more reviews, including this one on skin antisepsis. Was that on your list? Here in the UK, NICE guidance (epic3 again) recommends cleansing with chlorhexidine gluconate in 70% alcohol, or povidone iodine in alcohol for patients sensitive to chlorhexidine (tick). Can we tick off evidence of effectiveness?

The review brought together data from 12 randomised studies with 3446 CVCs (number of patients unknown), comparing different skin antisepsis regimens with each other and with none. Whilst there is nothing here to overturn the guidance, the evidence is mostly low or very low quality and, beyond saying that chlorhexidine solution may be more effective than povidone iodine, any questions about which regimen is best or whether skin antisepsis benefits patients are left unanswered.

Read the full post here

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 3: paediatric care.

The article presents an interview with British nurse Jonathan Whitton of Nottingham Children’s Hospital. When asked about his experience of using a chlorhexidine gluconate (CHG) impregnated sponge dressing, Whitton says that he found it easy to apply and remove. He comments on the role infection prevention plays in his daily nursing activities. Whitton believes that all pediatric units should review the available literature about CHG dressings.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 3: paediatric care. Whitton J. Br J Nurs. 2014, vol 23 (14 Suppl):S22.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 2: paediatric intensive care.

The article presents an interview with nurse Norman Franklin of Freeman Hospital in Newcastle upon Tyne, England. When asked what made him decide to use a chlorhexidine gluconate (CHG) impregnated sponge dressing, he says the decision followed the publication of research on the prevention of catheter-related bloodstream infections. He comments on the role that infection prevention plays in his daily nursing activities. Franklin believes that using CHG sponge dressings will benefit patients.

Clinical experiences of using Biopatch: a chlorhexidine gluconate-impregnated sponge dressing. Case study 2: paediatric intensive care. Franklin N. Br J Nurs. 2014, vol 23(14 Suppl):S21.