Assessment of Shift Work and Its Health Related Behaviors Among Employees of Petrochemical Company, Saudi Arabia, 2021 (Preprint)

BACKGROUND Shift work has been reported to lead to adverse health effects and is receiving increased attention. OBJECTIVE The study aimed to understand the relationship between shift work schedules and health behaviours among day-shift workers and rotating day-evening-shift workers and to detect the difference between day-shift work or fixed day-shift and rotating day-evening-shift employees. METHODS A cross-sectional study was conducted among employees of Petrochemical Company during 2021. A self-administered questionnaire was used to collect the data. It consisted of two parts demographic data and General Health Questionnaire (GHQ-28). RESULTS Out of 126 employees, 58 (46.0%) were from group age 41-50 years, 55 (43.7%) were overweight and 41 (32.5%) were obese, 38 (30.2%) were smokers, 99 (78.6%) worked in fixed shift. Two thirds 94 (74.6%) reported 6-8 sleeping hours per day, where 41 (32.5%) reported that they were satisfactory about overall quality of sleep and 40 (31.7%) were somewhat unsatisfactory, 62 (49.2%) reported “playing regular moderate to vigorous exercise”. There was no significant relation between shifts type and general health status (p =0.122). There was a significant association between shift types and the following ; age, BMI, education, nationality, household income, Working experience, Chronic diseases, Frequency of shift work, and Overall amount of sleep per day (p<0.0001, p0.017, p=0.027, p<0.0001, p0.042, p=0.002, p=0.024, p<0.0001, and p=0.044). CONCLUSIONS In the current study, rotating shifts were associated with extra sleeping hours, normal weight and having exercise. There was no significant differences in general health between workers in different shift schedules. Further studies need to be conducted to gather more information in order to decrease the additional health burden allied to non-standard work-schedules.

RESEARCH SUMMARY OF CURRENT SITUATION OF NURSES’ ADHERENCE IN ROUTINE HAND HYGIENE IN THE SURGICAL DEPARTMENTS OF GIA DINH PEOPLE’S HOSPITAL IN 2019 AND SOME INFLUENCING FACTORS

The cross-sectional descriptive study was conducted in 04 months, using quantitative data combined with qualitative information. Quantitative data was collected using a non-participating observation method, using a checklist. We observed 498 opportunities to wash hands. Qualitative information was collected from 02 in- depth interviews with experts and 03 group discussions. Data were entered and analyzed by Exel, Epidata and SPSS 18 software. The rate of compliance of nurses was 78.1. The chance of doing the right thing and completing the 6 steps is 71.9%. Practice of routine hand hygiene of nursing varies with working time, the highest was in the morning shift, lowest was evening shift. Factors that positively influenced the compliance are management and attention of the hospital leaders and the Department of Infection controls, regulations, circulars, training documents and guidelines; there is regular inspection and supervision and post-supervision feedback. Factors that adversely affect routine hand hygiene compliance are work overload, provision of unsanitary hand washing water and wash basins; the hospital has no regulations on specific rewards and penalties.

2B-Alert Web 2.0: An Open-Access Tool for Predicting Alertness and Optimizing the Benefits of Caffeine (Preprint)

BACKGROUND One-third of the U.S. population experiences sleep loss, with the potential to impair physical and cognitive performance, and result in reduced productivity and imperil safety during work and daily activities. Computer-based fatigue-management systems, with the ability to predict the effects of sleep schedules on alertness and identify safe and effective caffeine interventions that maximize its stimulating benefits, could help mitigate cognitive impairment due to limited sleep. To provide these capabilities to broad communities, we previously released the 2B-Alert Web, a publicly available tool for predicting the average alertness level of a group of individuals as a function of time of day, sleep history, and caffeine consumption. OBJECTIVE Here, we aimed to enhance the capability of the 2B-Alert Web by providing the means for the tool to automatically recommend safe and effective caffeine interventions (time and dose) that lead to optimal alertness levels at user-specified times, under any sleep-loss condition. METHODS We incorporated a recently developed caffeine-optimization algorithm into the predictive models of the original 2B-Alert Web, allowing the system to search for and identify viable caffeine interventions that result in user-specified alertness levels at desired times of the day. To assess the potential benefits of this new capability, we simulated four sleep-deprivation conditions (sustained operations, restricted sleep with morning or evening shift, and night shift with daytime sleep) and compared the alertness levels resulting from the algorithm’s recommendations with those based on the U.S. Army caffeine-countermeasure guidelines. In addition, we enhanced the usability of the tool by adopting a drag-and-drop graphical interface for the creation of sleep and caffeine schedules. RESULTS For the four simulated conditions, the 2B-Alert Web-proposed interventions increased average alertness by 36 to 94% and decreased peak alertness impairment by 31 to 71%, while using equivalent or smaller doses of caffeine as the corresponding U.S. Army guidelines. CONCLUSIONS The enhanced capability of this evidence-based, publicly available tool increases the efficiency by which diverse communities of users can identify safe and effective caffeine interventions to mitigate the effects of sleep loss in the design of research studies and work/rest schedules. 2B-Alert Web is accessible at: <https://2b-alert-web.bhsai.org>.

Does Nursing Shift Influence Adherence to Central-Line Maintenance Bundles?

Background: Proper care and maintenance of central lines is essential to prevent central-line–associated bloodstream infections (CLABSI). Our facility implemented a hospital-wide central-line maintenance bundle based on CLABSI prevention guidelines. The objective of this study was to determine whether maintenance bundle adherence was influenced by nursing shift or the day of week. Methods: A central-line maintenance bundle was implemented in April 2018 at a 1,266-bed academic medical center. The maintenance bundle components included alcohol-impregnated disinfection caps on all ports and infusion tubing, infusion tubing dated, dressings, not damp or soiled, no oozing at insertion site greater than the size of a quarter, dressings occlusive with all edges intact, transparent dressing change recorded within 7 days, and no gauze dressings in place for >48 hours. To monitor bundle compliance, 4 non–unit-based nurse observers were trained to audit central lines. Observations were collected between August 2018 and October 2019. Observations were performed during all shifts and 7 days per week. Just-in-time feedback was provided for noncompliant central lines. Nursing shifts were defined as day (7:00 a.m. to 3:00 p.m.), evening (3:00 p.m. to 11:00 p.m.), and night (11:00 p.m. to 7:00 a.m.). Central-line bundle compliance between shifts were compared using multinomial logistic regression. Bundle compliance between week day and weekend were compared using Mantel-Haenszel 2 analysis. Results: Of the 25,902 observations collected, 11,135 (42.9%) were day-shift observations, 11,559 (44.6%) occurred on evening shift, and 3,208 (12.4%) occurred on the night shift. Overall, 22,114 (85.9%) observations occurred on a week day versus 3,788 (14.6%) on a Saturday or Sunday (median observations per day of the week, 2,570; range, 1,680–6,800). In total, 4,599 CLs (17.8%) were noncompliant with >1 bundle component. The most common reasons for noncompliance were dressing not dated (n = 1,577; 44.0%) and dressings not occlusive with all edges intact (n = 1340; 37.4%). The noncompliant rates for central-line observations by shift were 12.8% (1,430 of 1,1,135) on day shift, 20.4% (2,361 of 11,559) on evening shift, and 25.2% (808 of 3,208) on night shift. Compared to day shift, evening shift (OR, 1.74; 95% CI, 1.62–1.87; P < .001) and night shift (OR, 2.29; 95% CI, 2.07–2.52; P < .001) were more likely to have a noncompliant central lines. Compared to a weekday, observations on weekend days were more likely to find a noncompliant central line: 914 of 3,788 (24.4%) weekend days versus 3,685 of 22,114 (16.7%) week days (P < .001). Conclusions: Noncompliance with central-line maintenance bundle was more likely on evening and night shifts and during the weekends.Funding: NoneDisclosures: None

Outcomes of Cardiopulmonary Resuscitation and Its Predictors in Hospitalized Patients

Background: Cardiopulmonary resuscitation (CPR) has been a frequently performed medical intervention that increases the chance of survival of a person stricken by cardiac arrest, and there is an excellent value of diversity in the rate of successful rehabilitation in societies. Methods: A retrospective observational study was carried out. The medical records of all in-hospital and out-hospital cardiac arrest patients who underwent CPR were collected. A total of 587 people with who underwent CPR during two years between January 2017 and June 2018, using a designed form were enrolled. Demographic information, the ward which CPR was committed, hospitalization, the delay before the onset of CPR and time of the day were recorded. Results: The overall success rate of CPR in this study was 25.89%. There was no significant difference in the success rate of CPR between men and women. A comparison of age groups revealed a difference between the success rates of CPR in 14 - 64 years group compared with the group above 64. Analysis of the data revealed no difference between CPR success rates in various seasons. Investigating the occurrence of cardiac arrest and its success rate at the hospital shifting showed a significant difference between the success rate of CPR in the morning shift with the evening shift and night. The dual comparison revealed a significant difference in the success rate of CPR only between the emergency department and intensive care units. Conclusions: The current study revealed a significant difference in age group and location, and did not show any significant success rate of CPR in the presence of witnesses, location of cardiac arrest, season and gender.

Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach

Background Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. Objective The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. Methods Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. Results In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78%) and 17 (51%) times, respectively. Overall, 6 units (50%) had ≥0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25%) had ≥0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95% CI 0.86-2.18; P=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95% CI 0.84-32.9; P=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: “shortage of time while seeing patients,” “sometimes the staff forgets,” “concern about drying hands,” “behavior is difficult or requires reminders,” and “there may be issues with resources or access to supplies to perform these behaviors.” Staff also stated that “a process that is considered effective is the Stop the Line program,” and that the “behavior is easy and automatic.” Conclusions Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale.

Just the Facts: how to teach emergency department flow management

Even before starting your evening shift you know it's going to be busy. Ambulances are lined up in front of the hospital, and the charge nurse already seems stressed out. The senior Emergency Medicine (EM) resident is standing in the physician office, ready to start her shift as well. You have worked with her a few times during this rotation. She is competent, you trust in her management plans for all her individual patients. Together you both review the patient tracker: a variety of patient presentations ready to be seen, plus an additional 20 patients in the waiting room. Negotiating the learning objective for the shift, the resident indicates that she would like to work on more efficiently managing patient flow and the administration of the emergency department (ED). But…isn't that a skill you just learn from experience? You wonder what evidence-informed strategies might exist for training her for this next step.

Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach (Preprint)

BACKGROUND Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. OBJECTIVE The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. METHODS Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. RESULTS In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78%) and 17 (51%) times, respectively. Overall, 6 units (50%) had ≥0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25%) had ≥0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95% CI 0.86-2.18; <i>P</i>=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95% CI 0.84-32.9; <i>P</i>=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: “shortage of time while seeing patients,” “sometimes the staff forgets,” “concern about drying hands,” “behavior is difficult or requires reminders,” and “there may be issues with resources or access to supplies to perform these behaviors.” Staff also stated that “a process that is considered effective is the Stop the Line program,” and that the “behavior is easy and automatic.” CONCLUSIONS Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale.

Impact of shift work on the cortisol awakening response and stress: a longitudinal study in female shifting monthly nurses

Background: Although the majority of shift nurses are female, there is still an expectation that they fulfil the traditional role of women in the family, often conflicting with shift work, increases stress, and affects cortisol secretion patterns. This study was to understand the changes in the cortisol awakening response (CAR) and work stress in nursing personnel working in different shifts. Methods: 41 female shift nurses were recruited that fit criteria using purposive sampling. We obtained personal information, administered the Taiwan Nurse Stress Checklist (NSC), and the nurses themselves collected saliva samples upon waking and 30 minutes after waking for three consecutive days at home. We then analyzed the data obtained using a hierarchical linear model. Results: The results revealed that night-shift nurses derived significantly more stress from an inability to complete personal tasks than did day-shift nurses ( B = 4.39, p < .001) or evening-shift nurses ( B = 3.95, p < .001). Night-shift nurses also exhibited significantly lower CARi than did day-shift nurses ( B = -3.41, p < .001) or evening-shift nurses ( B = -2.92, p < .01) as well as significantly lower cortisol levels 30 minutes after waking than did day-shift nurses ( B = -3.88, p < .001) or evening-shift nurses ( B = -3.31, p < .01). Conclusions: This study indicate that female night-shift nurses displayed the lowest CARi and cortisol levels 30 minutes after waking and are more negatively affected by being unable to complete personal tasks.

Relationship Between Workload Performance and Job Satisfaction

In Pakistan’s public health care delivery system, charge nurses hold a very challenging position to perform their workload. They have to work very hard to accomplish nursing and non-nursing care tasks which are imposed on them by the system. Overstretching of workload deprives them from concentration which is badly needed for their performance and this creates dissatisfaction which negatively impact on the quality of nursing care. As a result, this study intends to analyses the relationship between workload performance (WLP) and job satisfaction (JS). This correlation study involved 105 charge nurses in Nishtar Medical College and Hospital Multan Pakistan recruited by convenience sampling. Nurses’ WLP were collected by using self-developed instrument, and JS were collected by using modified Spector 1985. The collected data were analyze descriptively (mean, SD, frequencies, percentage) and inferentially (Pearson’s correlation). The results suggested that nurses’ WLP (average time consumption) in the morning (93.83%) and evening shift (95.63%) were higher compared with night shift (70.69%). Additionally, the proportion of time consumed in the morning and evening shift were higher on nursing care activities (Morning = 57.10%, Evening =52.1%) rather than non-nursing care activities. Oppositely, in the night shifts nurses consumed more than half of their time in non-nursing care activities (55. 66%). Charge nurses observed on moderate level of job satisfaction (mean = 38.6, SD = 5.42). There was no statistically significant correlation between nurses’ job satisfaction and workload performance (p =.137). The findings conclude nurses’ high workload and moderate level of job satisfaction and no statistically significant correlation between both. The results suggested that, it is important for hospital management to adopt some better strategies in order to improve WLP and JS.