Compilation of regulations and procedures for monitoring filamentous fungi in hospital environments.

Air and surfaces in the hospital environment are a potential source of exposure to filamentous fungi (FF) that could cause invasive fungal diseases (IFD) in severely immunocompromised patients. The prevalent FF in IFD are species from the genera Aspergillus, Fusarium, Scedosporium, and those within the order Mucorales. We have compiled regulations and described the procedures used in the clinical mycology laboratory to assess the presence of FF in areas at risk for the development of IFD. The infection control committees of each establishment implement hospital policies to regulate and control processes aimed at preventing infections. Fungal load monitoring is an important step in this process to validate air quality in order to ensure a clean and protected environment for severely immunocompromised patients.

Practice priorities for acute care nursing: A Delphi study.

AIMS AND OBJECTIVES: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN: Delphi Method. METHOD: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

Recontamination of Healthcare Surfaces by Repeated Wiping with Biocide-Loaded Wipes: "One Wipe, One Surface, One Direction, Dispose" as Best Practice in the Clinical Environment.

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 µm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a "One wipe, One surface, One direction, Dispose" policy should be implemented and rigorously enforced.

The role of the healthcare environment in the acquisition of infection.

Tracy Doherty, Assistant Director of Infection Prevention & Control, Our Lady of Lourdes Hospital, Drogheda, Co Louth, discusses the maintenance of a clean healthcare environment.

Validity and consistency of an outpatient department user satisfaction rapid scale.

BACKGROUND: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). METHOD: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach's a, Spearman's correlation and intra-class correlation coefficient (ICC) were used. RESULTS: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach's a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman's rho. CONCLUSION: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

ANTECEDENTES: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). MÉTODO: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). RESULTADOS: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. ­. CONCLUSIONES: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

Trauma-Informed Care for Violently Injured Patients in the Emergency Department.

Violent traumatic injury remains a common condition treated by emergency physicians. The medical management of these patients is well described and remains an area of focus for providers. However, violently injured patients disproportionately carry a history of physical and psychological trauma that frequently affects clinical care in the emergency department. The alteration of our clinical approach, taking into consideration how a patient's previous experiences influence how he or she may perceive and react to medical care, is a concept referred to as trauma-informed care. This approach is based on 4 pillars: knowledge of the effect of trauma, recognition of the signs and symptoms of trauma, avoidance of retraumatization, and the development of appropriate policies and procedures. Using this framework, we provide practical considerations for emergency physicians in the delivery of trauma-informed care for violently injured patients.

Quiet Time Improves the Patient Experience.

BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study. METHODS: A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for quiet time (QT) and used HCAHPS "always quiet" scores as the primary outcome measure. INTERVENTIONS: The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. RESULTS: Quiet scores improved on both units after 11 months. CONCLUSIONS: Noise in hospitals is often beyond the scope of nurse-driven improvement; however, a QT protocol led by nurses, developed by multiple stakeholders, and focused on changing expectations for quiet can lead to measurable improvements in patient perception of quiet.

Relationship Between Work Environments, Nurse Outcomes, and Quality of Care in ICUs: Mediating Role of Nursing Care Left Undone.

BACKGROUND: The mechanism of how work environments affect nurse outcomes and quality of care has not been studied in intensive care unit (ICU) settings. PURPOSE: The purpose was to investigate the effects of work environment on nurse outcomes and quality of care in ICUs, through the mediating effects of nursing care left undone. METHODS: This study used survey data from 459 nurses from 22 ICUs in 22 hospitals in China. Hierarchical logistic regression modeling was used to analyze the relationships and the mediating effects. RESULTS: Positive work environments were associated with lower nurse job dissatisfaction, less burnout, higher quality of care, and safer care. Adding nursing care left undone could reduce the effects of work environments, showing partial mediating effects of nursing care left undone. CONCLUSIONS: Cultivating supportive work environments serves as a strategy to reduce nursing care left undone, and to improve nurse outcomes and quality of care in ICUs.

Evaluating and prioritizing hospital service quality.

PURPOSE: Hospital evaluations create competition between healthcare providers. In this study, a multi criteria decision-making (MCDM) method is used to evaluate criteria that affect hospital service quality. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Criteria affecting hospital service quality are identified. Four Iranian public hospitals are evaluated using these criteria. Four hybrid methods, including modified digital logic-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-elimination and choice expressing reality and modified digital logic-elimination and choice expressing reality are used to evaluate hospital service quality. Results are aggregated using the Copeland method and final ranks are determined. FINDINGS: The four main criteria for evaluating hospital service quality are: environment; responsiveness; equipment and facilities; and professional capability. Results suggest that professional capability is the most important criterion. The Copeland method, used to integrate four MCDM hybrid methods, provides the final hospital ranks. PRACTICAL IMPLICATIONS: The criteria the authors identified and their weight help hospital managers to achieve comprehensive organizational growth and more efficient resource usage. Moreover, the decision matrix helps managers to identify their strengths and weaknesses. ORIGINALITY/VALUE: New and comprehensive criteria are proposed for hospital quality assessments. Moreover, a new hybrid MCDM approach is used to achieve final hospital rankings.

Creating the Framework for a Healthy Practice Environment.

The link between healthy work environments and patient safety, nursing satisfaction, and quality outcomes is well established, yet many nurses work in environments that are unsafe and uncivil. What are the essential elements that contribute to a healthy practice environment? How can we create roles and working conditions that enable nurses to be fulfilled and happy in their careers? This month's Magnet Perspectives column explores the relationship between a healthy practice environment and better outcomes and examines how the Journey to Magnet Excellence® leads to higher nurse satisfaction and retention, improved interdisciplinary collaboration, excellent patient care, and exemplary patient results.

A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare.

AIM: To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties. BACKGROUND: The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment. DESIGN: Systematic psychometric review. DATA SOURCES: A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016). REVIEW METHOD: Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported. RESULTS: Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated. CONCLUSIONS: Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.

Addressing Occupational Fatigue in Nurses: Current State of Fatigue Risk Management in Hospitals, Part 1.

OBJECTIVE: The aim of this study was to describe the current state of fatigue risk management systems (FRMS) to address nurse fatigue in hospitals. BACKGROUND: Although multiple studies have examined sources and consequences of fatigue, little is known about the current state of FRMS. METHODS: This study used a sequential exploratory mixed-method design including a survey of nurse leaders from across the United States. FINDINGS: Although healthcare organizations have implemented strategies to address fatigue, most participants' organizations did not have a formal FRMS in place. Monitoring individual nurses' levels of fatigue and using tools to predict fatigue risk were rare. CONCLUSIONS: Significant opportunities exist to implement formal FRMS in healthcare. Nursing leaders, in partnership with other organizational leaders, should develop a formal plan to monitor fatigue and implement multiple levels of interventions to prevent fatigue and mitigate its consequences.

Improving the Patient's Experience With a Multimodal Quiet-at-Night Initiative.

This project describes a multifaceted noise reduction program on 2 hospital units designed to ensure a quiet hospital environment, with the goal of improving the patient experience. The noise committee in an urban city hospital developed a plan to control noise including scripted leadership rounding, staff education, a nighttime sleep promotion cart, and visual aids to remind staff to be quiet. Postintervention improvement in patient satisfaction scores was noted.

Implementation of Quiet Time for Noise Reduction on a Medical-Surgical Unit.

OBJECTIVE: The objective of this evidence-based investigation is to determine the efficacy of a quiet-time intervention to reduce noise in the hospital setting. BACKGROUND: For many reasons, noise continues to increase in the hospital setting. METHODS: In a descriptive comparative design, using a convenience sample of hospitalized patients, 80 patients were assessed on their perceptions of noise using the Patient Survey on Noise During Hospital Stay. RESULTS: Data revealed favorable responses to quiet time, with 70% of subjects reporting quiet-time intervention to be effective in reducing noise. Sixty percent of participants felt that 1 hour of quiet time helped to facilitate a quieter, more restful environment for the whole day. CONCLUSION: A quiet-time intervention is effective in addressing patient perception of noise while in the acute care hospital setting.

In the shadow of the asylum: the Stanley Royd Salmonella outbreak of 1984.

In August 1984, an outbreak of Salmonella at Stanley Royd Psychiatric Hospital in Yorkshire led to the deaths of 19 elderly residents. It was an incident that attracted a good deal of comment in both the local and national press, and one that had enduring relevance for ideas about psychiatric care, food handling and catering provisions, hospital management and the official inspection of medical institutions. This article examines the impact that the 1984 outbreak had on official and popular perceptions of these issues. As well as bringing to public attention the fact that large numbers of vulnerable elderly patients were long-term residents in psychiatric hospitals, the Salmonella outbreak highlighted the inadequacies of Victorian hospital buildings in modern healthcare. Throughout the press reports and official investigations examined here, the provenance of Stanley Royd was repeatedly emphasised; its Victorian fabric persistently interfered with cleaning regimes, cold storage facilities and the conveyance of food to patients. Within institutions like Stanley Royd, 'new' and 'old' risks came together--the microscopic bacterium and the crumbling nineteenth-century building--to create a strong critique of existing psychiatric care. The episode also highlighted broader problems within the NHS, such as systems of management and the status of psychogeriatrics as a specialism.

Patients' Expectations and Perceptions of Service Quality in the Selected Hospitals.

BACKGROUND: Hospital's success depends on patients' expectations, perceptions, and judgment on the quality of services provided by hospitals. This study was conducted to assess the patients' perceptions and expectations from the quality of inpatient health care in Vali-Asr hospital, Ghaemshahr, and Imam Khomeini and Shafa Hospitals, Sari. MATERIALS AND METHODS: This study is applied regarding the objective of the study. Considering the research methodology, it is a descriptive - analytical study. The sample of this study consists of 600 patients with at least 24 hours of being hospitalized in internal, surgery, women, and children sectors of Vali-Asr, Ghaemshahr, Imam Khomeini, and Shafa Hospitals. Using random sampling method, the classifications relevant to the size of each class were selected. The data required was collected through the standard SERVQUAL questionnaire and then it was analyzed using the SPSS software. RESULTS: The overall mean value and standard deviation of expectations were equal to 10.4 and 28, respectively. The mean value for the field of perception was 69.2 and the relevant standard deviation was 26. In terms of patients and hospital visits in concrete cases, the highest priority is related to empathy. The second priority is related to physical appearance, the third priority is related to responsiveness, the fourth priority is related to assurance, and the lowest priority is related to the reliability of the SERVQUAL approach. Examining the gap between patients' perceptions and expectations, the widest gap was observed in the Vali-Asr Hospital with the mean and SD (-92.0±39.0) and the lowest gap was observed in Shafa Hospital with the mean value of (-39.9±44.0). According to The Kruskal-Wallis test, the difference observed in these three hospitals were significant. CONCLUSION: The results showed that patients' expectations had not been met in any of the examined dimensions and their consent has not been achieved. It seemed that necessary for managers and relevant authorities to plan and pay special attention to this important issue.

Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

Impact of professional nursing practice environment and psychological empowerment on nurses' work engagement: test of structural equation modelling.

AIM: This study aimed to investigate the influence of professional nursing practice environment and psychological empowerment on nurses' work engagement. BACKGROUND: Previous researchers have acknowledged the positive influence that nurse work environment and psychological empowerment have on engagement. However, less is known about the mechanisms that explain the links between them. METHOD: A predictive, non-experimental design was used to test the model in a random sample of 300 clinical nurses from two tertiary first class hospitals of Tianjin, China. The Utrecht Work Engagement Scale, the Practice Environment Scale of the Nursing Work Index and the Psychological Empowerment Scale were used to measure the study variables. RESULT: Structural equation modelling revealed a good fit of the model to the data based on various fit indices (P = 0.371, χ(2) /df = 1.056, goodness of fit index = 0.967), which indicated that both professional practice environment and psychological empowerment could positively influence work engagement directly, and professional practice environment could also indirectly influence work engagement through the mediation of psychological empowerment. CONCLUSION: The study hypotheses were supported. Psychological empowerment was found to mediate the relationship between practice environments and work engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Administrators should provide a professional nursing practice environment and empower nurses psychologically to increase nurse engagement.

Consumer perspectives on the therapeutic value of a psychiatric environment.

BACKGROUND: Existing reports of the environmental aspects of recovery from mental illness have been confined to consideration of community spaces and the natural environment. AIMS: This paper aims to extend this literature by assessing the role of psychiatric settings in recovery. METHODS: Nineteen inpatients from the psychiatric unit of a large inner city hospital in Melbourne, Australia, took part in the study, which involved semi-structured interviews and focus groups. RESULTS: Analysis identified three major themes concerning consumers' experience within the unit: the importance of staff; lack of clear architectural identity resulting in confused or confusing space; and limited amenity due to poor architectural design. CONCLUSIONS: These findings have important implications for the delivery of care in psychiatric environments in ways that promote well being within these settings, and align with relevant mental health policy recommendations.