Gamifying the Infection Control Curriculum: The Impact on Nursing Students’ Knowledge, Exam Performance, and Course Perception

Background: Unlike passive didactic teaching, the introduction of innovative active-learning approaches to university nursing curricula aims to address the educational content in an interactive learning environment, improving in turn the learning process and problem-solving skills indispensable for future infection control professionals. One such strategy is the use of educational games, which can motivate students and enhance the degree of their engagement. We appraised the effectiveness of introducing an interactive game based on a popular television quiz show “Who Wants to be a Millionaire?” for educational attainment, exam performance, and course perception in nursing students. Methods: A whole generation of second-year undergraduate nursing students (126 female and 27 male participants; age range, 19–41 years) from a public university in Croatia (University Centre Varazdin, University North) were divided into 2 groups by cluster randomization; one group had received additional hours of game play after core training curriculum in a “Hygiene and Epidemiology” course, while the other had not. Game play was accomplished by employing ‘edutaining’ interactive multimedia approach, and covered primarily hand hygiene, cough etiquette, the use of personal protective equipment, sterilization and disinfection, and safe injection practices. Quantitative results of multiple-choice exams were used to evaluate any differences in the knowledge level of respective groups. A satisfaction opinion survey was used to gauge attitudes of students attending the course. Statistical significance was defined as P < .05 (2-tailed). Results: The mean baseline examination score was 28.30±5.79 points for the game group and 24.65±5.94 points for the control group, demonstrating improved knowledge retention when the interactive game was introduced into the curriculum. The statistically significant improvement in knowledge was observed in the domains of personal protective equipment and safe injection practices. There was no statistically significant difference in the overall scores between male and female students. Students who were subjected to game play expressed more agreement on a Likert scale regarding course enjoyment and innovativeness, albeit they did not differ from control group when assessing the educational merit of the course. Conclusions: Introducing interactive games to university courses that cover infection control may boost student enjoyment and enhance long-term retention of information, as confirmed by this study. Nonetheless, extra care should be taken when specific games that have not been assessed objectively are implemented. Further research in this field will elucidate how this increased knowledge retention in infection control principles translates to quotidian practice, for the benefit of students and (ultimately) patients.Funding: NoDisclosures: None

Recurring Severe Injection-related Infections in People Who Inject Drugs and the Need for Safe Injection Sites in Spain

Background and aims: An estimated 68,297 people with opioid use disorder engage in opioid agonist therapy (OAT) in Spain. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in a harm reduction setting without a safe injection site (SCS).Methods: A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to identify who was admitted to a referral hospital for any severe injection-related infections between 1 Jan 2016 and 31 Dec 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection.Results: 237 PWID engaged in OAT were included. After a median follow-up of 5.5 months (IQR 1.3–22.7), a total of 104 episodes of severe injection-related infections occurred in 56 individuals, and admission for a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (20.2–34.8) episodes per 100 PY, and the incidence density of complicated skin and soft tissue infections (SSTIs) that required hospital admission was 20.4 (15.0–27.3) episodes per 100 PY. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had two or more hospital admissions had a higher PDD frequency.Conclusion: Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a SCS. PDD were more frequent in higher-risk individuals who presented two or more hospital readmissions.

Narrative Politics in Policy Discourse: The Debate Over Safe Injection Sites in Philadelphia, Pennsylvania

Safe injection sites are spaces where people who inject drugs can do so under the supervision of staff at the sites who attempt to revive them if they overdose. Public officials in Philadelphia, Pennsylvania, have proposed the sites as a means to reduce opioid overdose deaths in the city, a policy proposal that has been politically and legally contested. This article uses the Narrative Politics model to elucidate the concerns, values, and aspirations of the competing narratives in the public discourse over safe injection sites in Philadelphia. Despite the aspirations expressed within the Harm Reduction narrative to open such a site, opposition from the Nimby (not in my backyard) narrative has, at the time of this research, successfully precluded such a step. Other narratives in the discourse include the Abstinence narrative opposing safe injection sites and the Social Justice narrative opposed to incarceration but also hesitant to wholeheartedly endorse the Harm Reduction narrative for its delayed advocacy of compassionate treatment of people who use drugs now that the face of the person who uses opioids is a white one. In addition to juxtaposing competing narratives against one another and considering their alignments, disagreements, and interactions, the authors consider absences and shared presuppositions. The social construction of the purported drug addict varies in some ways between and among the prevailing narratives; in other ways, all the narratives problematize “addiction” as an affliction that justifies techniques of discipline aimed at caring for and controlling the population.

The main complications of infusion therapy and methods to overcome them

Background. Infusion therapy (IT) is an integral part of the modern treatment process and the most common method of inpatient treatment. Indications for the IT use include dehydration, changes in blood properties, intoxication, the impossibility or inexpediency of the drug administration in other ways, the impossibility of oral nutrition, and impaired immunity. Objective. To describe the main complications of IT and their treatment. Materials and methods. Analysis of literature data on this issue. Results and discussion. Before conducting IT, you should take into account all the indications and contraindications and carefully read the instructions for use of drugs. It is advisable to use several drugs to reduce the number and severity of side effects. The rate of administration is important: in most cases, the safe rate is 20-30 drops per minute. Accidental needle injuries (ANI) and blood contact are potential IT risks for healthcare professionals. The National Union of Nurses of Private Practice has launched a survey of health workers to reduce the prevalence of these injuries. There are three components to injection safety: safe solution preparation, safe injection, and safe disposal. IT via the needle has a number of disadvantages: complications due to frequent punctures, limited ability to conduct long-term IT, increased risk of ANI. The installation of a permanent venous catheter reduces the likelihood of these defects. After catheter placement, before and after infusion, it should be flushed with 0.9 % NaCl, heparin or Soda-Bufer solution (“Yuria-Pharm”). However, as the number of catheterizations increases, the number of catheter-associated infections increases too, ranking third among nosocomial infections and first among the causes of bacteremia. In general, the frequency of complications of venous catheterization is 15 %. Mechanical complications occur in 5-19 % of patients, infectious – in 5-26 %, thrombotic – in 2-26 %. Complications of IT are classified into the complications due to violation of the rules of administration (hematoma, tissue damage, thrombophlebitis (septic, mechanical and chemical), embolism) or blood composition disorders (acidosis, blood thinning), as well as overdose, and specific complications (anaphylactic shock, pulmonary edema, hyperthermia). Anaphylaxis most often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc. The first line of treatment of anaphylactic shock involves drug discontinuation, intravenous adrenaline, 100 % oxygen, rapid intravenous infusion of crystalloids, in case of bronchospasm – 2-3 inhalations of salbutamol. Additionally, antihistamines and glucocorticoids may be prescribed. Conclusions. 1. IT is an integral part of the modern treatment process and the most common method of treatment in the hospital. 2. In IT, it is advisable to use several drugs, which reduces the number and severity of side effects. 3. Potential IT risks for healthcare professionals include ANI and blood contact. 4. Injection safety requires three components: safe solution preparation, safe injection, and safe disposal. 5. Complications of IT are divided into complications due to violations of the rules of installation or violation of blood composition, as well as overdose, and specific complications. 6. Anaphylaxis often accompanies the introduction of nonsteroidal anti-inflammatory drugs, antibiotics, muscle relaxants, radiocontrast, hypnotics, etc.

French People’s positions on supervised injection facilities for drug users

Background Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people’s opinions regarding the setting-up of these facilities. Method A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members’ mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). Results Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. Conclusion French people’s positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.