Evaluation of the joint nurse scientist role across academia and practice.

BACKGROUND: Mapped with the guiding principles of academic-practice partnerships (APPs) outlined by the American Association of Colleges of Nursing and the American Organization for Nursing Leadership, a joint nurse scientist role between a nursing school and acute care facility at a large academic health center was developed and characterized by a PhD-prepared nurse appointed in a research role across organizations. To date, eight faculty are now appointed across the School and four health systems. PURPOSE: Describe outcomes, facilitators and vulnerabilities of the joint nurse scientist role. METHODS: Review of administrative records. DISCUSSION: Outcomes include the 1) conduct and dissemination of joint research, 2) translation of evidence into practice, 3) development of educational programs for health system nurses, 4) scholarly activities among health system nurses, and 5) improved visibility and valuation of the PhD-prepared nurse. Role facilitators include those previously reported for APPs, the joint nurse scientists' ability to broker opportunities across settings, and the evolving nature of the role. Role vulnerabilities pertain to the negotiation of workload, promotion, and institutional priorities. CONCLUSION: The joint nurse scientist role fosters shared scholarly successes across academia and service.

Comparison of Measures to Predict Mortality and Length of Stay in Hospitalized Patients.

BACKGROUND: Patient risk adjustment is critical for hospital benchmarking and allocation of healthcare resources. However, considerable heterogeneity exists among measures. OBJECTIVES: The performance of five measures was compared to predict mortality and length of stay (LOS) in hospitalized adults using claims data; these include three comorbidity composite scores (Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, and V W Elixhauser age-comorbidity score), 3 M risk of mortality (3 M ROM), and 3 M severity of illness (3 M SOI) subclasses. METHODS: Binary logistic and zero-truncated negative binomial regression models were applied to a 2-year retrospective dataset (2013-2014) with 123,641 adult inpatient admissions from a large hospital system in New York City. RESULTS: All five measures demonstrated good to strong model fit for predicting in-hospital mortality, with C-statistics of 0.74 (95% confidence interval [CI] [0.74, 0.75]), 0.80 (95% CI [0.80, 0.81]), 0.81(95% CI [0.81, 0.82]), 0.94 (95% CI [0.93, 0.94]), and 0.90 (95% CI [0.90, 0.91]) for Charlson/Deyo age-comorbidity score, V W Elixhauser comorbidity score, V W Elixhauser age-comorbidity score, 3 M ROM, and 3 M SOI, respectively. The model fit statistics to predict hospital LOS measured by the likelihood ratio index were 0.3%, 1.2%, 1.1%, 6.2%, and 4.3%, respectively. DISCUSSION: The measures tested in this study can guide nurse managers in the assignment of nursing care and coordination of needed patient services and administrators to effectively and efficiently support optimal nursing care.

Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events.

BACKGROUND: A strong patient safety culture (PSC) may be associated with improved patient outcomes in hospitals. The mechanism that explains this relationship is underexplored; missed nursing care may be an important link. PURPOSE: The purpose of this study was to describe relationships among PSC, missed nursing care, and 4 types of adverse patient events. METHODS: This cross-sectional study employed primary survey data from 311 nurses from 29 units in 5 hospitals and secondary adverse event data from those same units. Analyses include analysis of variance and regression models. RESULTS: Missed nursing care was reported to occur at an occasional level (M = 3.44, SD = 0.24) across all 29 units. The PSC dimensions explained up to 30% of the variance in missed nursing care, 26% of quality of care concerns, and 15% of vascular access device events. Missed care was associated with falls (P < .05). CONCLUSIONS: Prioritized actions to enhance PSC should be taken to reduce missed nursing care and adverse patient outcomes.

National Testing of the Nursing-Kids Intensity of Care Survey for Pediatric Long-term Care.

PURPOSE: The purpose of this study is to test the Nursing-Kids Intensity of Care, a measure of the intensity of nursing care needs, defined as the quantity and type of direct and indirect care activities performed by caregivers in a national sample. DESIGN AND METHODS: A 40-item tool previously tested in a small sample was psychometrically tested on a sample of 116 children with complex medical conditions by 33 nurse raters across 11 pediatric sites. RESULTS: The Nursing-Kids Intensity of Care tool demonstrated components of usability, feasibility, inter-rater, test-retest and internal consistency reliability and construct validity in the national study sample. CONCLUSIONS: Additional testing to further establish psychometric sufficiency and expanded use to quantify the intensity of nursing care needs of children with complex medical conditions in pediatric long-term care settings is recommended. PRACTICE IMPLICATIONS: This novel measure could assist the nursing administrators, educators and staff of pediatric long-term care facilities assess the intensity of care needs of their residents.

Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities.

BACKGROUND: The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. OBJECTIVES: The aims of this study were to explore direct care providers' knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others' hand hygiene practices, and their ideas and advice for improving infection prevention efforts. METHODS: This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. RESULTS: From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust "us" and "them" mentality between professionals. DISCUSSION: One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.

Impact of Heath Information Technology on the Quality of Patient Care.

OBJECTIVE: To examine the relationships among Electronic Health Record (EHR) adoption and adverse outcomes and satisfaction in hospitalized patients. MATERIALS AND METHODS: This secondary analysis of cross sectional data was compiled from four sources: (1) State Inpatient Database from the Healthcare Cost Utilization Project; (2) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute; (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) and (4) New Jersey nurse survey data. The final analytic sample consisted of data on 854,258 adult patients discharged from 70 New Jersey hospitals in 2006 and 7,679 nurses working in those same hospitals. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption stage on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. RESULTS: Advanced EHR adoption was independently associated with fewer patients with prolonged length of stay and seven-day readmissions. Advanced EHR adoption was not associated with patient satisfaction even when controlling for the strong relationships between better nursing practice environments, particularly staffing and resource adequacy, and missed nursing care and more patients reporting "Top-Box," satisfaction ratings. CONCLUSIONS: This innovative study demonstrated that advanced stages of EHR adoption show some promise in improving important patient outcomes of prolonged length of stay and hospital readmissions. Strongly evident by the relationships among better nursing work environments, better quality nursing care, and patient satisfaction is the importance of supporting the fundamentals of quality nursing care as technology is integrated into practice.

Associations between Negative Patient Safety Climate and Infection Prevention Practices.

The relationships among positive perceptions of safety climate and healthcare worker behaviors have been increasingly documented in the literature. The potential influence of negative perceptions is underexplored and has not been examined specifically in relation to standard precaution adherence. We addressed this gap using data collected as part of a multi-site, cross-sectional study that included responses from 452 nurses working on 43 medical surgical hospital units. This brief report describes associations identified between negative perceptions of patient safety climate and standard precaution adherence of hospital-based nurses.

Infection preventionists in public health, consultant and academic roles: Results from the 2020 APIC MegaSurvey.

BACKGROUND: Infection preventionists (IPs) work and practice in a variety of roles across many practice settings. While the health care-based IP role has been well studied, less is known about IPs who work in public health, consultant, and academic roles. METHODS: Data were collected as a subset of the Association for Professionals in Infection Prevention and Control and Epidemiology 2020 MegaSurvey. Descriptive and bivariate analyses were performed to compare the responses of 147 IPs working in public health, consulting, or academic roles. RESULTS: Respondents identified their primary IP role as public health (40%), consulting (39%), or academic (21%). Most were White and non-Hispanic females working in long-term care, acute care, and outpatient settings. Most had over 11 years of experience in health care before IP, with nursing being the most common. More consultants were certified in infection control (74%). While half of the respondents in public health reported being certified in infection control, and a third had 6 or more years of experience in infection prevention and control, they reported the lowest annual salary and satisfaction with total compensation. DISCUSSION: These findings highlight the characteristics and contributions of infection prevention and control in nontraditional roles and settings. Certification and fair compensation are crucial factors for professional development and job satisfaction. CONCLUSIONS: These insights can guide future education, recruitment, and retention strategies for IPs in public health, consulting, and academic roles.

Utilization of patient-reported outcomes in joint replacement care design.

Analysis finds health disparities among the elective surgery population.

Nurse Engagement in Antibiotic Stewardship Programs: A Scoping Review of the Literature.

INTRODUCTION: Hospital-based antibiotic stewardship programs (ASPs) are an important strategy in combating antibiotic resistance. Four antibiotic stewardship interventions are recommended by the CDC as particularly well-designed to engage nurses. However, there is limited information on whether and how existing hospital-based ASPs reflect these practices. PURPOSE: To describe how nurses are being engaged in hospital ASPs and to what extent this overlaps with the CDC framework. METHODS: This scoping review included studies published in the last 10 years on engaging nurses in hospital-based ASPs. Three databases, PubMed, CINAHL, and Embase, were searched. RESULTS: The search yielded 195 unique articles. Ten articles were retained for review detailing how nurses are engaged. One CDC recommended intervention, initiating discussion of antibiotic treatment, appeared in nine studies. CONCLUSIONS: Although hospitals are engaging nurses in antibiotic stewardship programs, their selected approaches do not reflect the full breadth of the opportunities identified by the CDC. More detail as to how exactly nurses engage would also be a useful addition to the literature. IMPLICATIONS: More research is needed on nurse engagement on culturing or testing and penicillin allergy evaluation. Standardized measures should be collected and reported to measure the impact of engaging nurses in ASPs.

APIC Megasurvey 2020: Methodology and overview of results.

BACKGROUND: In 2015, The Association for Professionals in Infection Control and Epidemiology (APIC) conducted the first MegaSurvey of its members to understand key aspects of their practice. Given the evolving role of Infection preventionists (IPs), it is important to understand changes in and the current practice environments of IPs, their demographics, the organizations in which they practice and the relative importance of different domains of IP practice. METHODS: The MegaSurvey 2020 was a cross-sectional, electronic survey of IPs conducted by APIC between January 21 and February 28, 2020. Descriptive statistics were calculated to describe the participants in terms of their characteristics, practice setting, compensation and IP competencies. RESULTS: 2,030 APIC members (response rate 13%) participated in the study. Results indicated that the demographic characteristics of IPs remained the same between the 2015 and 2020 surveys. Similar to 2015 data, slightly less than half of respondents are currently certified and plan to recertify. Less than 50% of IPs reported feeling adequately satisfied with their overall compensation. IPs reported spending the largest proportion of their time on surveillance and epidemiologic investigations and the least amount of time on employee and occupational health, cleaning and sterilization and education/research. CONCLUSIONS: As the healthcare industry continues to evolve, public health emergencies persist, and regulatory requirements expand, the results of the APIC MegaSurvey can inform future educational initiatives, the development of programs and ongoing hiring and retention strategies for this critical profession.

Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes.

BACKGROUND: Standard precautions may prevent patient health care associated infections and provider occupational exposures but are not often used by health care workers. A positive patient safety climate might contribute to improved adherence. The aim of this study was to determine the relationships among patient safety climate, standard precaution adherence, and health care worker exposures and HAIs. METHODS: This multi-site, cross-sectional study included survey data from nurses on patient safety climate, observational data on adherence, and existing health care worker exposure and health care associated infections data. Data were aggregated to hospital unit level for correlational and multivariable regression analyses. RESULTS: A total of 5,285 standard precaution observations and 452 surveys were collected across 43 hospital units. Observed adherence to all categories of standard precautions was 64.4%; there were significant differences by provider role. Multivariable models identified key predictors explaining sizeable variance in methicillin-resistant Staphylococcus aureus (41%), catheter associated urinary tract infections (23%), mucotaneous exposures (43%) and needlestick and sharps injuries (38%). DISCUSSION: This study produced findings not previously published thus advancing the state of the science in patient and occupational health safety. These include identifying modifiable features of the safety climate and key organizational characteristics associated better outcomes. CONCLUSIONS: In this novel study we identified that a positive patient safety climate and adherence to standard precautions predict key HAI and occupational health outcomes.

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update.

Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

State of infection prevention and control in nonacute care US settings: 2020 APIC MegaSurvey.

BACKGROUND: Strengthening infection prevention and control programs in nonacute care settings is a national priority. Efforts require thorough and ongoing appraisal of organizational structures, human resources including personnel training and competencies, system challenges and adaptive strategies implemented. Assessment of those in infection preventionist (IP) roles outside of the acute care setting is necessary to capture ongoing changes and challenges in the IP profession. METHODS: This cross-sectional study utilized data derived from the 2020 APIC MegaSurvey and applied descriptive and bivariate analyses to describe the state of infection prevention and control programs and personnel across nonacute clinical settings in the United States. RESULTS: Of 1,991 respondents, 57% of frontline IPs or administration/director IPs (1,051) indicated working in 1 or more nonacute care clinical settings. Of these, 33% (343) worked exclusively in only 1 type of nonacute care setting. Consistent with findings from the 2015 APIC MegaSurvey, IPs employed in nonacute care settings are a homogenous group with 88% of respondents indicating they are white, non-Hispanic (88%), female (94%), with nursing as their primary discipline (95%). A notable change in the proportion of time spent on health care-associated infection (HAI) activities in general was found, with a 31% decrease in reported time spent compared to respondents from the 2015 survey. Nearly half (47%) of respondents reported an annual salary of $50,000-$80,000; only 35% of respondents reported they were satisfied with their overall compensation. More than half (57%) of respondents reported having 5 or less years' experience in IPC and the majority, 82% reported they expected to be working in the IP profession in the next 5 years. CONCLUSIONS: The majority of IPs in nonacute care settings also worked in acute care. Of those who exclusively worked in nonacute care settings, they were predominately female, white, and had an educational background in nursing. A decrease in time spent on HAI activities was noted compared to respondents in 2015. Although the 2020 APIC MegaSurvey captured information previously not assessed in 2015, further studies are necessary to more robustly characterize the IP profession in nonacute care settings. Enhancements to current resources and services provided by APIC may serve to fill gaps in nonacute care settings related to gaining experience in research, general expertise, advocacy, and diversity.

Relationship among safety culture, nursing care, and Standard Precautions adherence.

Standard Precautions (SP) are an essential, although unmet, component of nursing care. Understanding conditions fostering the integration of SP within nursing workflow is imperative. This research describes the relationships among patient safety culture, adherence to SP, and missed nursing care.

Epidemiology and Impact of Healthcare-Associated Infections in Trauma Patients: A National Data Analysis.

Background: Traumatic injuries are a leading cause of death and morbidity. Despite their comprising a small (<5%) segment of all hospitalizations, the length of stay (LOS) is above average; and the cost of care for the more than 20 million trauma inpatients nears $30 billion per year. Adding insult to injury, risk factors for health-care-associated infections (HAI), including invasive devices and comprised integrity, may be particularly pronounced in this population, potentially exacerbating the clinical and economic burden. Our aim was to determine the distribution, determinants, and burden of HAI after traumatic injury using LOS as a surrogate for health-care-related expense. Patients and Methods: This retrospective cohort study used the Trauma Quality Improvement Project (TQIP) database (2013-2016). Patients 16 to 89 years of age were included. Those who developed at least one of the following were counted as cases: Catheter-related central blood stream infection, catheter-related urinary tract infection, ventilator-associated pneumonia, surgical site infection, osteomyelitis, and severe sepsis. Outcomes included the hospital LOS, intensive care unit (ICU) days, and ventilator days. Uni-variable and propensity-matched analyses were conducted to determine differences among patients with and without an HAI. Results: Of 806,066 patients, 5.6% (n = 44,844) developed an HAI. A higher proportion of patients with HAI had co-morbid risk factors of chronicity and history of blood transfusion and rated higher on the Abbreviated Injury Scale than those without HAI. After matching, those with HAI also had significantly longer (3 × ) overall LOS, ICU LOS, and prolonged mechanical ventilation (p < 0.05). Conclusions: This updated epidemiology study of trauma patients showed the HAI burden to be higher than past estimates and disproportionate of all patient estimates. The associated economic burden of a longer ICU stay with a tripling of the LOS and longer mechanical ventilation demands responsible administrative policies and support for infection prevention programs and interventions.

Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis.

OBJECTIVES: Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting. METHODS: Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha. RESULTS: The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized. CONCLUSIONS: This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.

Dissemination and implementation science for infection prevention: A primer.

Dissemination and implementation science (D&I) is a rapidly growing area of investigation. Although many evidence-based guidelines for infection prevention are available, not all are systematically implemented into clinical practice. This evidence-to-practice gap has been linked to poor health outcomes. D&I science bridges the gap between research and everyday practice by providing a knowledge base about how health information, interventions, and new clinical practices and policies are translated for use in specific settings. D&I science can expedite and sustain the successful integration of evidence into practice to improve care delivery, population health, and health outcomes. This article offers an introductory overview of D&I and addresses issues such as variation in terminology, finding and appraising evidence, theories and models, implementation strategies, and the future of D&I. Examples from the infection prevention literature are presented throughout.

Missed Opportunities: The Development and Testing of Standard Precaution Case Vignettes.

Standard precautions are a recommended set of actions health care workers should take to prevent health care-associated infections and potentially infectious exposures. However, they are not reliably practiced, many opportunities are missed, and a substantial discrepancy between workers' stated performance and actual performance exists. This article presents findings from developing and testing standard precaution case scenarios to enhance nursing knowledge. Infusion nursing is high risk and entails highly complex care in dynamic settings. Challenges may exist when integrating this advanced care with fundamental standard precaution requirements. For this reason, findings from this study have implications for infusion nursing practice.