Elimination of Routine Contact Precautions for Endemic Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: A Retrospective Quasi-Experimental Study

OBJECTIVETo evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGTwo California hospitals.PARTICIPANTSInpatients.METHODSWe compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing.RESULTSAverage positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million).CONCLUSIONDiscontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.Infect Control Hosp Epidemiol2016;1–8

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Effectiveness of a multisite personal protective equipment (PPE)–free zone intervention in acute care

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.111 ◽

2019 ◽

Vol 40 (7) ◽

pp. 761-766 ◽

Cited By ~ 2

Author(s):

Lindsay D. Visnovsky ◽

Yue Zhang ◽

Molly K. Leecaster ◽

Nasia Safdar ◽

Lauren Barko ◽

...

Keyword(s):

Acute Care ◽

Personal Protective Equipment ◽

Healthcare Personnel ◽

Protective Equipment ◽

Risk Area ◽

Sociotechnical System ◽

Contact Precautions ◽

Free Zone ◽

Before And After ◽

Quasi Experimental

AbstractObjective:Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions.Design:Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls.Setting:All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases.Intervention:A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE.Results:We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently.Conclusions:HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

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Nursing Course on Drug Addiction and its Effects on Beliefs and Intentions: A Quasi-experimental Study

Aquichan ◽

10.5294/aqui.2020.20.2.7 ◽

2020 ◽

Vol 20 (2) ◽

pp. 1-12

Author(s):

Miguel Ángel Villegas-Pantoja ◽

Martha Dalila Méndez-Ruiz ◽

María de Jesús De Valle-Alonso ◽

Laura Alicia García-Perales

Keyword(s):

Experimental Study ◽

Nursing Students ◽

Drug Use ◽

Drug Addiction ◽

University Education ◽

Beneficial Effects ◽

Before And After ◽

Quasi Experimental ◽

Long Course ◽

The Impact

Objective: To determine the impact of a course aimed at the care of persons with drug dependence on the beliefs and intentions of drug use among bachelor nursing students. Materials and methods: A quasi-experimental study conducted with a non-equivalent comparison group composed of 210 Mexican students of both sexes. Two Likert-type instruments were used to measure the beliefs and intentions of drug use, before and after a semester-long course. Results: At the end of the study, a significant interaction was found (F = 3.56, p = 0.050, η2p = 0.025), which suggests a greater decrease in beliefs in favor of drug use among students who took the course on drug addiction. Regarding drug use intentions, a general decrease was observed in the entire sample (F = 10.13, p = 0.002, η2p = 0.059). Conclusions: Courses on the care of drug addiction can have beneficial effects on nursing students by modifying beliefs and intentions to carry out unhealthy behaviors such as the use of substances. These results demand to verify if the effects remain beyond the completion of university education.

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Implementation of SHEA/CDC Outbreak Response Training Program Tools to Develop a Dedicated COVID-19 Hospital in Lucas County, Ohio

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.158 ◽

2021 ◽

pp. 1-8

Author(s):

Jennifer Hanrahan ◽

Joel Kammeyer ◽

Deana Sievert ◽

Brenda Naylor ◽

Sadik Khuder ◽

...

Keyword(s):

Health System ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Care Delivery ◽

Protective Equipment ◽

Conservation Of Resources ◽

Outbreak Response ◽

Response Training ◽

Care Delivery Model ◽

Lucas County

Abstract We describe a care delivery model in which one hospital in a larger health system was dedicated exclusively to treatment of COVID-19 patients. This allowed for rapid training, conservation of resources and promoted safety of healthcare workers, demonstrated by no healthcare worker exposures due to improper personal protective equipment use.

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From natural disaster to pandemic: A health-system pharmacy rises to the challenge

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa180 ◽

2020 ◽

Vol 77 (23) ◽

pp. 1986-1993 ◽

Cited By ~ 2

Author(s):

Autumn D Zuckerman ◽

Pratish C Patel ◽

Mark Sullivan ◽

Amy Potts ◽

Molly Knostman ◽

...

Keyword(s):

Health System ◽

Patient Care ◽

Natural Disaster ◽

Personal Protective Equipment ◽

Care Delivery ◽

Protective Equipment ◽

Staff Members ◽

Quality Patient Care ◽

Pharmacy Department ◽

Virus Exposure

Abstract Purpose This report describes a health-system pharmacy’s response to a natural disaster while staff members simultaneously prepared for the coronavirus disease 2019 (COVID-19) pandemic. By detailing our experience, we hope to help other institutions that are current facing or could encounter similar crises. Summary In early March 2020, a tornado destroyed the health system’s warehouse for storage of most clinical supplies, including personal protective equipment and fluids. The pharmacy purchasing team collaborated with suppliers and manufacturers to recover losses and establish alternative storage areas. Days later, the pharmacy department was forced to address the impending COVID-19 pandemic. Key elements of the COVID-19 response included reducing the potential for virus exposure for patients and staff; overcoming challenges in sourcing of staff, personal protective equipment, and medications; and changing care delivery practices to maintain high-quality patient care while maximizing social distancing. The pharmacy department also created distance learning opportunities for 70 pharmacy students on rotations. After an initial plan, ongoing needs include adjustment in patient care activities if significant staff losses occur, when and how to resume clinical activities, and how to best utilize the resources accumulated. Elements of practice changes implemented to reduce COVID-19 threats to patients and pharmacy personnel have proven beneficial and will be further evaluated for potential continuation. Conclusion The pharmacy department’s efforts to respond to a natural disaster and unprecedented pandemic have proven successful to this point and have illuminated several lessons, including the necessity of cohesive department communication, staff flexibility, prioritization of teamwork, and external collaboration.

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A Survey of Psychiatric Healthcare Workers' Perception of Working Environment and Possibility to Recover Before and After the First Wave of COVID-19 in Sweden

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.770955 ◽

2021 ◽

Vol 12 ◽

Author(s):

Eirini Alexiou ◽

Steinn Steingrimsson ◽

Magnus Akerstrom ◽

Ingibjörg H. Jonsdottir ◽

Linda Ahlstrom ◽

...

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Negative Impact ◽

Working Environment ◽

University Hospital ◽

Protective Equipment ◽

Web Based ◽

Before And After ◽

Survey Responses ◽

The Impact

Objective: This study aimed to investigate the impact of the first wave of the COVID-19 pandemic on perceived working environment, including the possibility to recover, among psychiatric healthcare workers (PHCWs) in comparison with pre-pandemic measures.Method: A link to an anonymous, web-based COVID-19 related survey was sent via email to all PHCWs at a university hospital in Sweden (n = 1,618) in September 2020. The response rate was 38% (566 of 1,507 eligible participants). Working environment survey responses collected in 2019 were used as pre-pandemic comparators. Statistical analyses were performed to assess overall impact over time on work demands, support, motivation, and recovery, stratified by professional role, and considering variables such as access to personal protective equipment.Results: The percentage of individuals responding negatively to statements about working environment increased significantly for most items after the first wave. Similarly, the increase of five of the investigated factors indicated a more negative perception of recovery during the pandemic. Registered nurses reported a greater negative impact of the pandemic on perceived working conditions and ability to recover than other professional groups. PHCWs working with patients with COVID-19 (35%) who reported being worried about becoming infected (12%) or infecting others (17%), or lacking adequate personal protective equipment (22%) were more negatively impacted regarding work environment-related items than those who did not.Conclusions: PHCWs' working environment and possibility for recovery were impacted by the first wave of the COVID-19 pandemic, nurses being most affected. Although psychiatric services do not directly care for patients with severe COVID-19 infection, the results from this study suggests that mental health services should also prepare for future pandemics.

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Promoting Goal Setting: An Experimental Study of Positive Psychology in an EFL Context

World Journal of Educational Research ◽

10.22158/wjer.v5n2p144 ◽

2018 ◽

Vol 5 (2) ◽

pp. 144

Author(s):

Samieh Noori ◽

Mehry Haddad Narafshan

Keyword(s):

Experimental Study ◽

Positive Psychology ◽

Goal Setting ◽

Control Group ◽

Proficiency Level ◽

Strength Based ◽

Before And After ◽

Post Test ◽

Quasi Experimental ◽

The Impact

<em>The present quasi-experimental study addresses the impact of a Character Strength Based Positive Psychology Intervention (CSBPPI) on Goal Setting (GS) of TEFL university students in Iran. In so doing, the study utilized an experimental design with 18 participants in the control group and 18 participants in the experimental group which totalled 7 male and 29 female students. The pretest showed that the participants of the two groups were homogenous with regard to their proficiency level as well as their goal setting. Data was collected over five months using Erickson et al. (2015) goal setting questionnaire before and after an MA course. The results of the post-test revealed that PP has a positive and significant impact on learners’ goal setting. The findings from this research suggest positive paths from positive psychology to understanding, managing and successfully setting the goals. </em>

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Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020

Nuklearmedizin ◽

10.1055/a-1163-3096 ◽

2020 ◽

Vol 59 (04) ◽

pp. 294-299 ◽

Cited By ~ 4

Author(s):

Lutz S. Freudenberg ◽

Ulf Dittmer ◽

Ken Herrmann

Keyword(s):

Nuclear Medicine ◽

Health Systems ◽

Personal Protective Equipment ◽

Large Scale ◽

Diagnostic Procedures ◽

Protective Equipment ◽

Current Crisis ◽

Web Based ◽

Public Versus Private ◽

The Impact

Abstract Introduction Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. Materials and Methods A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. Results 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are –14.4 %, –47.2 %, –47.5 %, –40.7 %, –58.4 %, and –25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (–53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. Conclusions Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

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The COVID-19 Pandemic and nursing challenges: A review of the early literature

Work ◽

10.3233/wor-213458 ◽

2021 ◽

pp. 1-14

Author(s):

Mojtaba K. Danesh ◽

Ehsan Garosi ◽

Hamedeh Golmohamadpour

Keyword(s):

Health Systems ◽

Personal Protective Equipment ◽

Qualitative Studies ◽

Systematic Search ◽

Current Paper ◽

Protective Equipment ◽

Early Literature ◽

The Face ◽

Physical Distress ◽

The Impact

BACKGROUND: The COVID-19 pandemic has put health systems under unprecedented pressure, challenging their workforce, especially nurses. OBJECTIVE: The current paper presented a review of the early literature concerning emerging nursing challenges during the early stages of the COVID-19 pandemic. METHODS: A systematic search of the published literature between January and May 2020 was carried out in Medline, Science Direct, and Google Scholar to identify relevant quantitative and qualitative studies. RESULTS: Twenty-two original articles were retrieved, the majority of which were survey studies from China. Synthesis of the evidence resulted in four overarching themes including “being physically and mentally drained in the face of fear and uncertainty,” “shortage of personal protective equipment and usability issues,” “psychosomatic disturbances among nurses,” and “moderators to mitigate nurses’ challenges.” CONCLUSIONS: Providing care for demanding COVID-19 patients, nurses experienced a gruelling situation, during which a significant amount of psychological and physical distress was inflicted to them. However, receiving proper support from their organization and society could improve the condition substantially. Further research is required to explore the impact of the COVID-19 pandemic on nurses, especially from Western countries.

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The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026955 ◽

2019 ◽

Vol 3 (4) ◽

pp. 545-552

Author(s):

Nathalia De Oro ◽

Maria E Gauthreaux ◽

Julie Lamoureux ◽

Joseph Scott

Keyword(s):

Lactic Acid ◽

Length Of Stay ◽

Community Hospital ◽

Unit Length ◽

Hospital Setting ◽

Control Group ◽

Before And After ◽

Quasi Experimental ◽

Current Cutoff ◽

The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

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Promotion of Early and Exclusive Breastfeeding in Neonatal Care Units in Rural Rwanda: a Quasi-experimental Study

10.21203/rs.3.rs-119415/v1 ◽

2020 ◽

Author(s):

Saidath Gato ◽

Francois Biziyaremye ◽

Catherine M. Kirk ◽

Chiquita Palha De Sousa ◽

Alain Mukuralinda ◽

...

Keyword(s):

Experimental Study ◽

Exclusive Breastfeeding ◽

Child Survival ◽

Neonatal Care ◽

Post Intervention ◽

Factors Associated ◽

Before And After ◽

Quasi Experimental ◽

Evidenced Based ◽

Additional Support

Abstract Background: Early initiation of breastfeeding after birth and ongoing exclusive breastfeeding for the first 6 months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding, aligned with the Baby Friendly Hospital Initiative for small and sick newborns.Methods: A pre-post quasi experimental study was conducted at two District hospital NCUs in rural Rwanda from October 2017–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data was extracted from patient charts for clinical and demographic characteristics, feeding throughout admission, and patient outcomes. Bivariate analyses were conducted using Fisher’s exact and Wilcoxon rank sum tests. Logistic regression was used to evaluate factors associated with exclusive breastfeeding at discharge following a backwards stepwise procedure.Results: Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in the post-intervention period. The percentage of infants who were exclusively breastfed on their day of birth, or day-of-life zero (DOL0) increased from 5.4% to 35.9% (p<0.001). For newborns discharged alive, the proportion exclusively breastfeeding increased from 69.6% to 87.0% (p<0.001). The mortality rate for all admitted newborns decreased from 16.1% to 10.5% (p<0.019). Factors associated with greater odds of exclusive breastfeeding at discharge included post-intervention time point (Odds Ratio (OR): 4.91, 95% Confidence Interval (CI) 1.99-12.11, p<0.001), and admission for infection (OR 2.99, 95%CI 1.13-7.93, p=0.027). Home deliveries (OR 0.15, 95%CI 0.05-0.47, p=0.001), preterm delivery (OR 0.36, 95%CI 0.15-0.87, p=0.0260 and delayed first breastmilk feed (OR=0.04 for DOL3 vs. DOL0, 95%CI 0.01, 0.35, p=0.004) reduced odds of exclusive breastfeeding at discharge. Conclusion: Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns should be expanded and adapted in similar settings to improve outcomes for these infants.

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