scholarly journals The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes

2018 ◽  
Vol 39 (6) ◽  
pp. 683-687 ◽  
Author(s):  
Lisa Pineles ◽  
Chris Petruccelli ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
Kalpana Gupta ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Home Setting ◽  
Prevention Behavior ◽  
Nursing Home Setting ◽  
Hygiene Compliance ◽  
The Impact

OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683–687

scholarly journals The impact of workload on hand hygiene compliance: Is 100% compliance achievable?

2021 ◽  
pp. 1-3
Author(s):  
Nai-Chung N. Chang ◽  
Marin L. Schweizer ◽  
Heather Schacht Reisinger ◽  
Michael Jones ◽  
Elizabeth Chrischilles ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hygiene Compliance ◽  
The Impact

Abstract Hand hygiene compliance decreased significantly when opportunities exceeded 30 per hour. At higher workloads, the number of healthcare worker types involved and the proportion of hand hygiene opportunities for which physicians and other healthcare workers were responsible increased. Thus, care complexity and risk to patients may both increase with workload.

A Two Year Follow up of Nutrition Status Among Veterans in a Nursing Home Setting: The Impact on Mortality

2012 ◽  
Vol 13 (3) ◽  
pp. B20
Author(s):  
Douglas Faulder ◽  
Anne-Marie Boström ◽  
Deanna Van Soest ◽  
Betty Kolewaski ◽  
Douglas Faulder ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nutrition Status ◽  
Home Setting ◽  
Nursing Home Setting ◽  
The Impact

scholarly journals A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting

2020 ◽  
Author(s):  
Magnus J. M. van Niekerk ◽  
Alfred A. Stein ◽  
Edwina M. H. E. Doting ◽  
Mariëtte M. Lokate ◽  
Annemarie L. M. A. Braakman-Jansen ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Radio Frequency Identification ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Infection Prevention And Control ◽  
Transmission Potential ◽  
Occupation Group ◽  
Frequency Identification ◽  
Hygiene Compliance

Abstract Background: Transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against the transmission and spread of harmful microorganisms is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance are unknown. The objectives of this study are to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.Methods: Spatiotemporal data were collected in a ward of an academic hospital using radio frequency identification technology for seven days. A potential super-spreader healthcare worker occupation group was identified using the contact data derived from the frequency identification sensors. The effects of five probability distributions of hand hygiene compliance and three rates of harmful microorganism transmission were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk factors.Results: Nurses, doctors and patients are together responsible for 78.8% of all contacts. Nurses made up 57% of all contacts, which is more than five times that of doctors (11.1%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonized nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 87 minutes of visiting 22 rooms while colonized. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm). Conclusion: Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of transmissions and spread of harmful microorganism by super-spreaders in a closed healthcare setting. These insights can be used to develop better-informed infection prevention and control strategies.

scholarly journals Increased hand hygiene compliance in nursing homes after a multimodal intervention: A cluster randomized controlled trial (HANDSOME)

2020 ◽  
Vol 41 (10) ◽  
pp. 1169-1177
Author(s):  
Gwen R. Teesing ◽  
Vicki Erasmus ◽  
Daan Nieboer ◽  
Mariska Petrignani ◽  
Marion P.G Koopmans ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Controlled Trial ◽  
Multimodal Intervention ◽  
Randomized Controlled ◽  
Hygiene Compliance ◽  
Cluster Randomized

AbstractObjective:To assess the effect of a multimodal intervention on hand hygiene compliance (HHC) in nursing homes.Design, setting, and participants:HHC was evaluated using direct, unobtrusive observation in a cluster randomized controlled trial at publicly funded nursing homes in the Netherlands. In total, 103 nursing home organizations were invited to participate; 18 organizations comprising 33 nursing homes (n = 66 nursing home units) participated in the study. Nursing homes were randomized into a control group (no intervention, n = 30) or an intervention group (multimodal intervention, n = 36). The primary outcome measure was HHC of nurses. HHC was appraised at baseline and at 4, 7, and 12 months after baseline. Observers and nurses were blinded.Intervention:Audits regarding hand hygiene (HH) materials and personal hygiene rules, 3 live lessons, an e-learning program, posters, and a photo contest. We used a new method to teach the nurses the WHO-defined 5 moments of HH: Room In, Room Out, Before Clean, and After Dirty.Results:HHC increased in both arms. The increase after 12 months was larger for units in the intervention arm (from 12% to 36%) than for control units (from 13% to 21%) (odds ratio [OR], 2.10; confidence interval [CI], 1.35–3.28). The intervention arm exhibited a statistically significant increase in HHC at 4 of the 5 WHO-defined HH moments. At follow-up, HHC in the intervention arm remained statistically significantly higher (OR, 1.93; 95% CI, 1.59–2.34) for indications after an activity (from 37% to 39%) than for indications before an activity (from 14% to 27%).Conclusions:The HANDSOME intervention is successful in improving HHC in nursing homes.

Advance care planning practices in the nursing home setting: A secondary analysis

2021 ◽  
Author(s):  
Bridget L Laging ◽  
Rhonda Nay ◽  
Michael Bauer ◽  
Rohan Laging ◽  
Katie Walker ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Advance Care Planning ◽  
Healthcare Workers ◽  
Secondary Analysis ◽  
Ethnographic Study ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care

Abstract Background and Objectives Advance care planning is intended to support resident’s preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family-members, and healthcare workers engage in advance care planning and how advance care directives are used if conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident’s health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration? Research Design and Methods A secondary analysis of data from an ethnographic study involving 184 hours of participatory observation, 40 semi-structured interviews and advance care planning policies and document review undertaken in in two nursing homes in Melbourne, Australia. Results Advance care planning may result in inaccurate documentation of residents’ preferences and devalue clinical decision-making and communication with residents and family-members at the time of deterioration. Discussion and Implications Advance care planning may contribute towards a reductionist approach to decision-making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and healthcare workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.

scholarly journals The Impact of a Cycled Lighting Intervention on Nursing Home Residents: A Pilot Study

2019 ◽  
Vol 5 ◽  
pp. 233372141989745 ◽  
Author(s):  
Oonagh M. Giggins ◽  
Julie Doyle ◽  
Ken Hogan ◽  
Mable George
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Home Residents ◽  
Activity Monitor ◽  
Circadian System ◽  
Activity Levels ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Robust Measurements ◽  
The Impact

Purpose: Achieving adequate levels of illumination to stimulate the circadian system can be difficult in a nursing home. The aim of this study was to examine the impact that a 4-week cycled lighting intervention had on activity, sleep, and mood in older adults living in a nursing home. Patients and methods: Ten residents were given an activity monitor to objectively measure activity and sleep, and subjective mood scores were also recorded during the study period. The cycled lighting intervention was designed to mimic normal natural daylight. Results: Some participants responded positively to the lighting intervention showing improvements in activity levels, sleep, and mood, while others showed no change or a continued decline. Conclusion: Although the results are inconclusive, a cycled lighting intervention remains a potentially promising intervention in the nursing home setting. Further studies with more robust measurements and a larger, more homogeneous cohort are required to investigate this further.

scholarly journals Synergistic Effect of Combination Interventions for Methicillin-resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

2020 ◽  
Author(s):  
Arthur Tang ◽  
Kin On Kwok ◽  
Vivian Wan In Wei ◽  
Hong Chen ◽  
Woo-Hyun Park ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Home ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Prevalence Rate ◽  
Hand Hygiene Compliance ◽  
Health Administration ◽  
Methicillin Resistant ◽  
Hygiene Compliance ◽  
Mrsa Colonization

Abstract Background The endemic threat of Methicillin-Resistant Staphylococcus aureus (MRSA) in nursing homes pose a serious and escalating challenge to public health administration in infection control. Nursing homes are considered as major reservoirs for MRSA colonization, with considerable high levels of colonization prevalence. Aim Direct contact is the major transmission mode of MRSA colonization. This study employed a computation model to evaluate the effect of 3 intervention scenarios on MRSA colonization prevalence rate in nursing homes. Methods Simulations were conducted using a deterministic compartmental model featuring heterogeneous contact matrix between residents and health-care workers (HCWs). Contact parameters were derived from a nursing home survey. Three intervention scenarios were simulated: (1) hand-hygiene compliance by HCWs, (2) screening-and-isolation upon admission, and (3) implementing both interventions at the same time. Results For every 10% reduction in average contamination duration in HCWs, the estimated average reduction in prevalence rate is 1.29 percentage point compared with the prevalence rate before the intervention was implemented. Screening-and-isolation intervention results in an average reduction of 19.04 percentage point in prevalence rate (s.d. = 1.58; 95% CI = 18.90-19.18) compared with the prevalence rate before the intervention was implemented. In intervention scenario 3, synergistic effects were observed when implementing hand-hygiene compliance by HCWs and screening-and-isolation together. Conclusion Our results provide quantitative data for nursing home administrators in interventions planning, design, adjustment, effect estimation and comparison.

scholarly journals DESCRIBING A CONCEPT OF NURSE INTUITION AND IMPLICATIONS FOR DEMENTIA CARE IN NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S838-S838 ◽  
Author(s):  
Rebekah Perkins ◽  
Katherine Supiano’katherine supiano@hsc utah edu’ kather
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Psychological Symptoms ◽  
Empirical Studies ◽  
Dementia Care ◽  
Limited Information ◽  
Mentor Programs ◽  
Home Setting ◽  
Nurse Residency ◽  
Nursing Home Setting

Abstract The purpose of this concept analysis was to explore nurse intuition historically and in current literature, appraise the value of nurse intuition to research and practice, and discuss implications for practice in caring for residents with behavioral and psychological symptoms of Dementia (BPSD) in nursing homes. To date, no research has examined the presence or utility of nurse intuition in the nursing home setting. A conceptual analysis using pragmatic utility was chosen and based on the work of Walker and Avant (2005). In the literature, nurse intuition is characterized by attributes of knowledge not preceded by inference, knowledge that is holistic in nature, independent of linear thinking, and drawn from synthesis instead of analysis. Nurse intuition is based on preconditions of experience, empathy, limited information, and limited time to make vital decisions about patient care. Studies on nurse intuition have been criticized for their lack of rigor and empirical evidence of the effect of nurse intuition on positive patient outcomes. The attributes of intuitive nursing practice have important implications in nursing applied to residents with BPSD. The nursing home nurse with extensive educational and experiential knowledge is well-situated to understand the complex, changing needs of residents exhibiting various forms of BPSD in an effort to communicate their needs. Future studies on nurse intuition should focus on early education in dementia care, nurse residency-mentor programs to enhance intuitive thinking in the management of BPSD, and more empirical studies on the use of intuition in the context of dementia care.

scholarly journals A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. M. van Niekerk ◽  
A. Stein ◽  
M. H. E. Doting ◽  
M. Lokate ◽  
L. M. A. Braakman-Jansen ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hospital Ward ◽  
Infection Prevention And Control ◽  
Transmission Rates ◽  
Occupation Group ◽  
Frequency Identification ◽  
Hygiene Compliance

Abstract Background Hand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group. Methods Spatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors’ contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes. Results Nurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm). Conclusion Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies.

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