A helping hand: The impact of a central line insertion support team.

As part of a central line-associated bloodstream infections prevention initiative, our academic medical center formed a dedicated nursing team to assist with central line insertions and provide support with caring for difficult lines and dressings. During the program's first 3 years, the proportion of insertion-related central line-associated bloodstream infections occurring in areas within the team's scope declined overall by 47%.

Building a personal protective equipment monitor team as part of a comprehensive COVID-19 prevention strategy.

We instituted Personal Protective Equipment (PPE) Monitors as part of our care of COVID-19 patients in high-risk zones. PPE Monitors aided health care personnel (HCP) in donning and doffing, which contributed to nearly zero transmission of COVID-19 to HCP, despite their care of over 1400 COVID-19 patients.

The holy grail of hand hygiene compliance: Just-in-time peer coaching that leads to behavior change.

We describe the delivery of real-time feedback on hand hygiene compliance between healthcare personnel over a 3-year time period via a crowdsourcing web-based application. Feedback delivery as a metric can be used to examine and improve a culture of safety within a healthcare setting.

The compliance coach: A bedside observer, auditor, and educator as part of an infection prevention department's team approach for improving central line care and reducing central line-associated bloodstream infection risk.

A compliance coach who audits central line maintenance and provides feedback and education to bedside nurses through timely, nonpunitive conversation is an effective addition to busy infection prevention departments. Staff nurses and nurse managers reported receiving clearly communicated and actionable information from the coach and compliance improved over time in multiple areas of central line maintenance.

Preventable Patient Harm: a Multidisciplinary, Bundled Approach to Reducing Clostridium difficile Infections While Using a Glutamate Dehydrogenase/Toxin Immunochromatographic Assay/Nucleic Acid Amplification Test Diagnostic Algorithm.

Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods.

A comparison of a homemade central line simulator to commercial models.

BACKGROUND: Simulation is quickly becoming vital to resident education, but commercially available central line models are costly and little information exists to evaluate their realism. This study compared an inexpensive homemade simulator to three commercially available simulators and rated model characteristics. MATERIALS AND METHODS: Seventeen physicians, all having placed >50 lines in their lifetime, completed blinded central line insertions on three commercial and one homemade model (made of silicone, tubing, and a pressurized pump system). Participants rated each model on the realism of its ultrasound image, cannulation feel, manometry, and overall. They then ranked the models based on the same variables. Rankings were assessed with Friedman's and post hoc Conover's tests, using alphas 0.05 and 0.008 (Bonferroni corrected), respectively. RESULTS: The models significantly differed (P < 0.0004) in rankings across all dimensions. The homemade model was ranked best on ultrasound image, manometry measurement, cannulation feel, and overall quality by 71%, 67%, 53%, and 77% of raters, respectively. It was found to be statistically superior to the second rated model in all (P < 0.003) except cannulation feel (P = 0.134). Ultrasound image and manometry measurement received the lowest ratings across all models, indicating less realistic simulation. The cost of the homemade model was $400 compared to $1000-$8000 for commercial models. CONCLUSIONS: Our data suggest that an inexpensive, homemade central line model is as good or better than commercially available models. Areas for potential improvement within models include the ultrasound image and ability to appropriately measure manometry of accessed vessels.

A Comprehensive Initiative to Prevent Falls Among Newborns.

Our hospital experienced seven instances of newborns falling over a 7-month period. Until that time, there had been no reported newborn falls. We formed a committee to study the situation and make recommendations for change. Common factors observed were early morning hours and an exhausted parent, usually the mother, falling asleep while feeding the newborn. The committee developed a policy and procedure addressing falls among newborns, created staff education and tools, and posted signage in mothers' rooms. We also updated crib cards to include information about falls and safe sleep, and we revised newborn admission education for parents with additional information about falls. The incidence of newborns falling has decreased since we implemented these changes.

Declining tobacco use among North Carolina middle and high school students: 1999-2007.

BACKGROUND: In 1999, North Carolina first conducted the Youth Tobacco Survey (YTS) among middle and high school students and found current smoking rates higher than the national average. In 2003, school and community grants across the state were funded to prevent and reduce youth tobacco use. METHODS: The North Carolina YTS has been conducted every other year since 1999 with high response rates by schools and students. The YTS is a written survey administered during the school day. It is voluntary and anonymous. RESULTS: In 2007 middle and high school student tobacco use rates reached their lowest point in the last decade. Nineteen percent of high school students reported current cigarette smoking, while 4.5% of middle school students said that they currently smoke. Almost every type of tobacco product use (cigarette, cigar, pipe, and bidi) has decreased since the 1999 YTS, with increasing rates of decline in cigarette use from 2003-2007 compared to 1999-2003. LIMITATIONS: This is a cross-sectional survey conducted every other year where students self-report use, attitudes, and perceptions. CONCLUSIONS: North Carolina's youth tobacco use rates have declined more steeply since 2003 when the tobacco initiatives started by the North Carolina Health and Wellness Trust Fund (HWTF) began to mobilize communities statewide. Continuing to fund and expand evidence-based tobacco prevention strategies is likely necessary in order to sustain steady declines in youth smoking rates.

Promoting tobacco-free school policies through a statewide media campaign.

BACKGROUND: Comprehensive, enforced tobacco-free school (TFS) policies lead to significant reductions in youth tobacco use. North Carolina is the first state in the United States to develop a statewide mass media campaign to promote the adoption of and compliance with TFS policies. METHODS: In order to guide campaign development, researchers conducted a literature review as well as interviews with 45 TFS-policy experts, stakeholders, and North Carolina legislators. The experts included state and national TFS researchers and advocates, and the majority of stakeholders were North Carolina school administrators and personnel selected because of their personal knowledge of and experience with TFS policy. Interviewees provided information on messages they believed would be most salient to highlight in the media campaign and the best type of people to appear in ads. RESULTS: Recommended themes included (1) a positive message about TFS becoming the norm in the state, (2) experiences of school districts that had successfully passed TFS policies, (3) the importance of adult role modeling, and (4) personal stories from youth about the importance of TFS policy. Recommended people to appear in ads included youth and adults with a personal connection to and experience with TFS policy. Using these recommended themes and people, the TFS media campaign began in the fall of 2006. In the 8 months following the campaign launch, 9 additional school districts adopted TFS policies, increasing the total from 78 to 87 (out of 115) by June 2007. In July 2007, the North Carolina legislature passed legislation mandating that all school districts adopt TFS policies by August 2008. CONCLUSIONS: Media campaigns can serve as part of a comprehensive strategy to advance TFS policies. Other states should consider these results in designing and evaluating a media campaign to promote adoption of and compliance with TFS policies.

A statewide movement to promote the adoption of tobacco-free school policies.

BACKGROUND: Since most tobacco users become addicted to nicotine as teenagers, prevention efforts for youth remain central to comprehensive prevention programs. National and state efforts that encourage adoption and enforcement of comprehensive tobacco-free school (TFS) policies can lead to significant reductions of youth tobacco use. In 2003, North Carolina (NC) Health and Wellness Trust Fund grantees began to focus statewide on the adoption of and compliance with TFS policies in NC schools. This study examined 46 NC districts that passed TFS policies between 2003 and early August of 2005 to see what factors were important in policy passage in order to support the continued promotion of TFS policy adoption across the state. METHODS: Detailed interviews were conducted with 118 key informants who were intimately involved with passage of their school districts' TFS policies, and results were coded and analyzed for common themes. RESULTS: The study found several strategies key to adoption of TFS policies: effective leadership from organizations and individuals in positions of influence, grassroots organizing from community coalitions and youth groups, and communication strategies that optimally position policy adoption and compliance. CONCLUSION: States that have not yet achieved TFS policy adoption can focus on leadership development, grassroots organizing, and improved communication to advance their advocacy efforts.