The impact of guidelines on sterility precautions during indwelling urethral catheterization at two acute-care hospitals in Sweden - a descriptive survey

Abstract Background To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyze factors affecting conformity with sterility precautions in the EAUN-guidelines. Methods A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher’s exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyze variables associated with practicing the sterility precautions in the EAUN-guidelines. Results Answers were obtained from 852 persons (91.5%). Most of the participants called their insertion technique “non-sterile”. Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. Despite that not everyone used sterile equipment to maintain sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69–3.27), use of sterile set for catheterization (OR 2.06, 95% CI 1.42–2.97), use of sterile drapes for dressing on insertion area (OR 1.91, 95% CI 1.24–2.96) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.64, 95% CI 1.11–2.43). Conclusions Only 55–74% of the nurses practiced one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Adherence to the guidelines was associated with factors that facilitated an aseptic performance such as using a sterile set and sterile drapes. Healthcare-settings should ensure education and skill training including measures to ensure that the IUC is kept sterile during insertion.

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The impact of guidelines on sterility precautions during indwelling urethral catheterization at two acute-care hospitals in Sweden - a descriptive survey

10.21203/rs.3.rs-33662/v2 ◽

2020 ◽

Author(s):

Aysel Kulbay ◽

Eva Joelsson-Alm ◽

Ann Tammelin

Keyword(s):

Acute Care ◽

Skill Training ◽

Acute Care Hospitals ◽

National Guidelines ◽

Urethral Catheterization ◽

Chi Square ◽

Actual Performance ◽

Exact Test ◽

Descriptive Survey ◽

The Impact

Abstract Background: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Nevertheless, some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyse factors affecting the participants´ conformity with sterility precautions in the EAUN-guidelines. Methods: A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher´s exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyse variables associated with practicing the sterility precautions in the EAUN-guidelines.Results: Answers were obtained from 852 persons (91.5%). A majority of the participants called their insertion technique “non-sterile”. Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. In spite of that not everyone used sterile equipment to maintain the sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69-3.26), use of sterile set for catheterization (OR 2.08, 95% CI 1.44-3.00), use of sterile drapes for dressing on insertion area (OR 1.87, 95% CI 1.21-2.89) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.70, CI 1.15-2.51). Conclusions: The study showed that only 55-74% of the nurses practised one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Compliance to disinfection of hands prior to the procedure was however around 90%. Healthcare-settings should ensure education and skill training to achieve sterile IUC-insertion according to the requirements in the EAUN-guidelines.

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The Impact of Guidelines on Sterility Precautions During Indwelling Urethral Catheterization at Two Acute-Care Hospitals in Sweden - A Descriptive Survey

10.21203/rs.3.rs-33662/v1 ◽

2020 ◽

Author(s):

Aysel Kulbay ◽

Eva Joelsson-Alm ◽

Ann Tammelin

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Evidence Based ◽

National Guidelines ◽

Insertion Technique ◽

Urethral Catheterization ◽

Chi Square ◽

Factors Affecting ◽

Exact Test ◽

The Impact

Abstract Background: To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Nevertheless, some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide what equipment to use and how to perform the catheterization. The aim of this study was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyse factors affecting the participants´ conformity with sterility precautions recommended in the EAUN-guidelines. Methods: A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher´s exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyse variables associated with practicing the sterility precautions as recommended in the EAUN-guidelines.Results: Answers were obtained from 852 persons (91.5 %). A majority of the participants called their insertion technique “non-sterile”. Regardless of what the insertion technique was called, the participants said that the IUC should be kept sterile during procedure. In spite of that not everyone used necessary sterile equipment to maintain the sterility of the catheter. The nurses´ conformity with all the sterility precautions as advocated in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.50, CI 1.78-3.49) and years in profession (OR 1.54, CI 1.03-2.30). It was also associated with use of sterile set for catheterization (OR 2.03, CI 1.40-2.94), use of sterile drapes for dressing of the insertion area (OR 1.94, CI 1.25-3.00) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.67, CI 1.13-2.47). Conclusions: To achieve a uniform practice in aseptic urethral catheterization national and local hospital guidelines should advocate same sterility precautions. Evidence-based guidelines should describe how sterility precautions are accomplished and should be implemented in healthcare-settings.

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The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/669861 ◽

2013 ◽

Vol 34 (4) ◽

pp. 437-439 ◽

Cited By ~ 6

Author(s):

Adam Weston ◽

Lauren Epstein ◽

Lisa E. Davidson ◽

Alfred DeMaria ◽

Shira Doron

Keyword(s):

Acute Care ◽

Antimicrobial Stewardship ◽

Educational Program ◽

Business Models ◽

National Level ◽

State Level ◽

Acute Care Hospitals ◽

The State ◽

Team Approach ◽

The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.121 ◽

2018 ◽

Vol 39 (8) ◽

pp. 941-946 ◽

Cited By ~ 2

Author(s):

Bradley J. Langford ◽

Julie Hui-Chih Wu ◽

Kevin A. Brown ◽

Xuesong Wang ◽

Valerie Leung ◽

...

Keyword(s):

Observational Study ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prospective Audit ◽

Defined Daily Doses ◽

Prospective Audit And Feedback ◽

The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

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Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.324 ◽

2017 ◽

Vol 38 (4) ◽

pp. 476-482 ◽

Cited By ~ 24

Author(s):

Irene K. Louh ◽

William G. Greendyke ◽

Emilia A. Hermann ◽

Karina W. Davidson ◽

Louise Falzon ◽

...

Keyword(s):

Systematic Review ◽

Hand Hygiene ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Grey Literature ◽

Quality Criteria ◽

Acute Care Hospitals ◽

Cochrane Library ◽

Chlorhexidine Bathing ◽

The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

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Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

Infection Control and Hospital Epidemiology ◽

10.1086/660012 ◽

2011 ◽

Vol 32 (6) ◽

pp. 538-544 ◽

Cited By ~ 15

Author(s):

Angela K. Laramie ◽

Vivian C. Pun ◽

Shona C. Fang ◽

David Kriebel ◽

Letitia Davis

Keyword(s):

Acute Care ◽

Surveillance System ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Acute Care Hospitals ◽

Injury Surveillance System ◽

Hospital Size ◽

Sharps Injury ◽

The Impact ◽

Sharps Injuries

Objective.Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.Design.Prospective surveillance.Setting.Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.Participants.Employees of acute care hospitals who reported Sis to their employers.Methods.Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.Results.During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.Conclusion.SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

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A National Intervention to Prevent the Spread of Carbapenem-Resistant Enterobacteriaceae in Israeli Post-Acute Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/676876 ◽

2014 ◽

Vol 35 (7) ◽

pp. 802-809 ◽

Cited By ~ 29

Author(s):

Debby Ben-David ◽

Samira Masarwa ◽

Amos Adler ◽

Hagit Mishali ◽

Yehuda Carmeli ◽

...

Keyword(s):

Infection Control ◽

Acute Care ◽

Acute Care Hospitals ◽

Control Measures ◽

Resistant Bacteria ◽

Carbapenem Resistant ◽

Control Intervention ◽

The Impact ◽

Carbapenem Resistant Enterobacteriaceae ◽

Post Acute Care

ObjectivePatients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.DesignA prospective cohort interventional study.SettingThirteen PACHs in Israel.InterventionA multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.ResultsThe infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.ConclusionA nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.

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Deep brain stimulation hardware–related infections: 10-year experience at a single institution

Journal of Neurosurgery ◽

10.3171/2017.9.jns1780 ◽

2019 ◽

Vol 130 (2) ◽

pp. 629-638 ◽

Cited By ~ 4

Author(s):

Kingsley O. Abode-Iyamah ◽

Hsiu-Yin Chiang ◽

Royce W. Woodroffe ◽

Brian Park ◽

Francis J. Jareczek ◽

...

Keyword(s):

Risk Factors ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Single Institution ◽

Chi Square ◽

Related Factors ◽

Exact Test ◽

Vancomycin Powder ◽

The Impact ◽

Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

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Malocclusion: Social, Functional and Emotional Influence on Children

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.37.1.y75430328427210j ◽

2012 ◽

Vol 37 (1) ◽

pp. 103-108 ◽

Cited By ~ 21

Author(s):

PA Martins-Júnior ◽

LS Marques ◽

ML Ramos-Jorge ML

Keyword(s):

Quality Of Life ◽

Negative Impact ◽

Negative Influence ◽

Open Bite ◽

Anterior Open Bite ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

The Impact

Objectives: To determine the association between types of malocclusion and quality of life in children between 8-10 years of age and establish correlations between the severity of the malocclusion and particular bio-psychosocial variables. Study design: The sample was made up of 102 schoolchildren aged 8-10 years. Clinical exams were performed using the criteria of the Dental Aesthetic Index (DAI) to determine the presence and severity of malocclusions. The impact on quality of life was assessed using the Child Perceptions Questionnaire (CPQ8-10). Statistical analysis involved the chi-square test, Fisher's exact test and Spearman's correlation analysis. Results: Malocclusions affected 61% of the children examined. There was a positive correlation between total CPQ8-10 and DAI scores (P = 0.034). The following types of malocclusion had a significant effect on the quality of life of the children: upper anterior irregularity ≥ 2 mm, anterior open bite ≥ 2mm and diastema ≥ 2mm. Children with malocclusion experienced a greater negative impact on quality of life in comparison to those without malocclusion. Conclusions: Malocclusions had a negative influence over the quality of life of children between 8-10 years of age. More severe malocclusions had a greater impact with regard to social, emotional and functional aspects.

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Impact Of COVID-19 Lockdown On Vitreo Retina Interventions In A Tertiary Eye Care Hospital In South India- An Observational Study

10.21203/rs.3.rs-418597/v1 ◽

2021 ◽

Author(s):

Anand Rajendran ◽

Prabu Baskaran ◽

Bhavik Jain ◽

Mani Iswarya

Keyword(s):

South India ◽

Virus Disease ◽

Statistical Significance ◽

Significant Proportion ◽

P Value ◽

Care Hospital ◽

National Guidelines ◽

Chi Square ◽

Set Up ◽

The Impact

Abstract Purpose: To study the impact of nationwide lockdown imposed in view of the pandemic caused by corona virus disease (COVID) on Vitreo retina interventions (VRI) in a tertiary Vitreo retina (VR) centre in south India.Methods:Retrospective data of patients who underwent VRI during the time period spanning from a month before (pre-lockdown group) and a month after (post lockdown group) the lockdown period (lockdown group) was analysed. The VRI were sub grouped into medical (lasers and injections) and surgical. Also interventions were categorized as urgent, semi-urgent and less urgent based on national guidelines. Results:A total of 1210 patients underwent VRI during pre-lockdown, lockdown and post-lockdown periods. The proportion of urgent VRI increased significantly to 26.61 % during lockdown as compared to 9.81 % and 13.15 % during pre and post-lockdown period respectively (p value <0.001, chi square test). The proportion of semi-urgent and less urgent VRI decreased significantly during the lockdown period. The median presenting best corrected visual acuity (BCVA) was significantly lesser during the lockdown period. The proportion of retina interventions increased significantly (more than 3 fold) during the lockdown period as compared with cumulative non retina subspecialty interventions. Conclusion:The proportion of urgent VRI during lockdown increased with statistical significance. Our study highlights the value of VR speciality service and its critical place in any ophthalmic set up to address the various vision threatening disorders needing urgent intervention, a significant proportion of which stem from retinal pathologies.

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