Patient safety culture as a space of social struggle: understanding infection prevention practice and patient safety culture within hospital isolation settings - a qualitative study.

BACKGROUND: In recent times, infection prevention and patient safety have become a global health policy priority with thought being given to understanding organisational culture within healthcare, and of its significance in initiating sustained quality improvement within infection prevention and patient safety. This paper seeks to explore the ways in which engagement of healthcare workers with infection prevention principles and practices, shape and inform patient safety culture within the context of hospital isolation settings; and vice-versa. RESEARCH METHODS: In this paper, we utilise focus group interviews at two hospital sites within one health board in order to engage healthcare staff in elaborating on their understandings of infection prevention practices and patient safety culture within isolation settings in their organisation. Focus group transcripts were analysed inductively using thematic analysis in order to identify and develop emerging empirical themes. RESULTS: Positioned against a background of healthcare restructuring and ever-increasing uncertainty, our study found two very different hospitals in regard to patient safety culture and infection prevention practice. While one hospital site embodies a mixed picture in regard to patient safety culture, the second hospital is best characterised as being highly fragmented. The utilisation of focus group interviews revealed themes that capture the ways in which interviewees position and understand the work they perform within the broader structural, political and cultural context, and what that means for infection prevention practice and patient safety culture. CONCLUSION: Drawing on the insights of Bourdieu, this paper theorises the field of patient safety as a space of social struggle. Patient safety is thus positioned within its structural, cultural and political context, rather than as merely an epidemiological dilemma.

COVID-19 and hand hygiene: the vital importance of hand drying.

The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.

Quality of life, recovery and decision-making: a mixed methods study of mental health recovery in social care.

PURPOSE: Mental health care is a complex system that includes social care organisations providing support for people with continuing needs. The relationship over time between decisional conflict, social support, quality of life and recovery outcomes across two time periods for people experiencing mental health problems in receipt of social care was investigated. METHODS: This is a mixed methods study comprised of a quantitative survey at two time points using measures of decisional conflict, social support, recovery and quality of life in a random sample (n = 122) using social care services in Wales, UK. In addition, 16 qualitative case studies were developed from data collected from individuals, a supportive other and a care worker (n = 41) to investigate trajectories of care. Survey responses were statistically analysed using SPSS and case study data were thematically analysed. RESULTS: Participants reported increasing decisional conflict and decreasing social support, recovery and quality of life over the two time points. Linear regression indicated that higher recovery scores predict better quality of life ratings and as ratings for social support decline this is associated with lower quality of life. Correlational analysis indicated that lower decisional conflict is associated with higher quality of life. Thematic analysis indicated that 'connectedness and recovery' is a product of 'navigating the system of care' and the experience of 'choice and involvement' achieved by individuals seeking help. CONCLUSIONS: These results indicate that quality of life for people experiencing mental health difficulties is positively associated with social support and recovery and negatively associated with decisional delay.

Infection prevention control and organisational patient safety culture within the context of isolation: study protocol.

BACKGROUND: Healthcare associated infection (HCAI) is a major cause of morbidity and mortality. In recent years, there have been high profile successes in infection prevention control (IPC), such as the dramatic reductions in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (which is viewed as one proxy indicator of overall harm) and Clostridium difficile in the UK. Nevertheless, HCAI remains a costly burden to health services, a source of concern to patients and the public and at present, is receiving priority from policy makers as it contributes to the global threat of antimicrobial resistance. METHODS: The study involves qualitative case studies within isolation settings at two National Health Service (NHS) district general hospitals (DGHs) in Wales, in the UK. The 18-month study incorporates Manchester Patient Safety Framework (MaPSaF) workshops with health workers and other hospital staff, in depth interviews with patients and their relative / informal carer, health workers and hospital staff, and periods of hospital ward observation. DISCUSSION: The present study aims to investigate the ways in which engagement of health workers with IPC strategies and principles, shape and inform organisational patient safety culture within the context of isolation in surgical, medical and admission hospital settings; and vice-versa. We want to understand the meaning of IPC 'ownership' for health workers; the ways in which IPC is promoted, how IPC teams operate as new challenges arise, how their effectiveness is assessed and the positioning of IPC within the broader context of organisational patient safety culture, within hospital isolation settings.

A review of isolation practices and procedures in healthcare settings.

The notion of 'isolation' in infectious diseases refers to the possibility of people known or suspected to be infected from the wider population, and has historically been used to control and prevent the spread of infectious diseases. Isolation practices in healthcare settings evolved over the 20th century resulting in a focus on the disruption of known routes of potential transmission. There was renewed attention to infection prevention and control (IPC) in the UK at the turn of the 20th century after high-profile reports acknowledged the importance of IPC as a key indicator of high-quality clinical care, and the impact of healthcare-acquired infections. There has been a shift away from isolation wards towards isolation in single rooms on general wards. For infections that are spread by the airborne, droplet or contact routes, placing the patient in single-room isolation is considered to be an important component of transmission-based precautions (TBPs). However, in practice isolation is complex and a number of challenges are involved in implementing IPC procedures.

Source isolation and patient wellbeing in healthcare settings.

Multi-resistant bacteria pose an increasing and significant challenge to public health. Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Although few would dispute the need for such practices in preventing the spread of transmissible infections, patients' perspectives of isolation suggest that the imposed environment creates barriers to their physical, social and emotional needs. This article reviews the literature to uncover any reliable evidence supporting the assertion that the experience of isolation in healthcare settings impacts adversely on patient wellbeing. Database searches identified 25 relevant papers published between 1990 and 2017. A number of studies claimed to have uncovered an association between negative patient experiences and isolation.

Asian Urban Environment and Climate Change: Preface.

The Asian Network on Climate Science and Technology (www.ancst.org), in collaboration with Tsinghua University, held a conference on environmental and climate science, air pollution, urban planning and transportation in July 2015, with over 40 Asian experts participating and presentation. This was followed by a meeting with local government and community experts on the practical conclusions of the conference. Of the papers presented at the conference a selection are included in this special issue of Journal of Environmental Science, which also reflects the conclusions of the Paris Climate meeting in Dec 2015, when the major nations of the world agreed about the compelling need to reduce the upward trend of adverse impacts associated with global climate change. Now is the time for urban areas to work out the serious consequences for their populations, but also how they should work together to take action to reduce global warming to benefit their own communities and also the whole planet!

Buoyancy and turbulence-driven atmospheric circulation over urban areas.

In the buoyancy and turbulence-driven atmospheric circulations (BTDAC) that occur over urban areas where the approach means wind speeds are very low (less than turbulent fluctuations and typically <3m/sec), the surface temperatures are significantly higher than those in the external rural areas, and the atmosphere above the mixing layer is stably stratified. In this paper, the mechanisms of BTDAC formation are studied through laboratory experiments and modelling, with additional low-level inflow from external rural areas and a divergent outflow in the opposite direction in the upper part of the mixed layer. Strong turbulent plumes in the central region mix the flow between lower and higher levels up to the inversion height. There are shear-driven turbulent eddies and weaker buoyant plumes around the periphery of the urban area. As the approach flow is very weak, the recirculating streamlines within the dome restrict the ventilation, and the dispersion of pollution emitted from sources below the inversion height leading to a rise in the mean concentration. Low-level air entrained from rural areas can, however, improve ventilation and lower this concentration. This trend can also be improved if the recirculating structure of the BTDAC flow pattern over urban areas breaks down as a result of the surface temperature distribution not being symmetrical, or as the approach wind speed increases to a level comparable with the mean velocity of circulation, or (except near the equator) the urban area is large enough that the Coriolis acceleration is significant.

Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery).

BACKGROUND: Recovery in mental health care is complex, highly individual and can be facilitated by a range of professional and non-professional support. In this study we will examine how recovery from mental health problems is promoted in non-medical settings. We hypothesise a relationship between involvement in decisions about care, social support and recovery and quality of life outcomes. METHODS: We will use standardised validated instruments of involvement in decision-making, social contacts, recovery and quality of life with a random sample of people accessing non-statutory mental health social care services in Wales. We will add to this important information with detailed one to one case study interviews with people, their family members and their support workers. We will use a series of these interviews to examine how people build recovery over time to help us understand more about their involvement in decisions and the social links they build. DISCUSSION: We want to see how being involved in decisions about care and the social links people have are related to recovery and quality of life for people with experience of using mental health support services. We want to understand the different perspectives of the people involved in making recovery possible. We will use this information to guide further studies of particular types of social interventions and their use in helping recovery from mental health problems.

Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy.

Background: Hand hygiene and its significance for reducing the spread of infection is well evidenced and has been brought into sharp focus following the COVID-19 pandemic. Although a crucial clinical skill in ensuring safe healthcare, little is known regarding nursing students' effectiveness of hand hygiene practice. Aim: The aim of this study was to evaluate the impact of an educational intervention on hand hygiene practice, designed by the research team for first year pre-registration nursing students. Particular emphasis was placed upon hand drying technique and time. Methodology: 825 nursing students were observed and assessed for their hand hygiene practice in a clinical suite at a university setting. Nursing students were observed for compliance against set outcome measures involving hand hygiene preparation, hand and wrist washing technique, hand drying technique and time. Data were analysed quantitatively using SPSS. Results: The educational intervention had a significant impact on the clinical skills learning of nursing students. 779 students passed the assessment at the first attempt (94.4%). Of the 46 students that failed to meet the necessary criteria, 45 satisfied the criteria at the second attempt; giving an overall optimal compliance of 99.9%. 99.6% of students complied with recommended hand drying standards. Conclusion: This study offers an important contribution to the development and delivery of nursing education programmes. The educational intervention improved compliance with recommended hand hygiene technique and practice. Lack of attention to hand drying may negate effective hand hygiene in healthcare.

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting.

AIM: To examine the contribution of the Healthcare Assistant (HCA) as the recogniser, responder and recorder of acutely ill patients within the general ward setting. BACKGROUND: Concerns have been highlighted regarding the recognition and management of the acutely ill patient within the general ward setting. The contribution of the HCA role to this process has been given limited attention. METHODS: A postal survey of HCAs was piloted and conducted within two district general hospitals. Open and closed questions were used. RESULTS: Results suggest that on a regular basis HCAs are caring for acutely ill patients. Contextual issues and inaccuracies in some aspects of patient assessment were highlighted. It would appear normal communication channels and hierarchies were bypassed when patients' safety was of concern. Educational needs were identified including scenario-based learning and the importance of ensuring mandatory training is current. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: HCAs play a significant role in the detection and monitoring of acutely ill patients. Acknowledgement is needed of the contextual factors in the general ward setting which may influence the quality of this process. The educational needs identified by this study can assist managers to improve clinical supervision and educational input in order to improve the quality of care for acutely ill patients.

The hidden contribution of the health care assistant: a survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting.

AIM: To examine the feelings, support and feedback available to health care assistants (HCA) when caring for acutely ill ward patients. BACKGROUND: The role of the HCA continues to evolve with increased responsibility for patient care. Contextual issues that affect their contribution to acute care management of the ward patient have been given limited attention. METHODS: A survey of HCAs (n = 131) was conducted within two district general hospitals. RESULTS: There were a number of emotions and stressors associated with the care of acutely ill patients. While normal hierarchical systems were in place in order to obtain help HCAs additionally bypassed these normal channels. Support mechanisms included registered nurses, ward doctors, peers and family. Feedback regarding performance was limited. CONCLUSION: HCAs play a significant role in the care of the acutely ill patient. Feedback mechanisms need to be developed and associated emotions recognized. IMPLICATIONS FOR NURSING MANAGEMENT: HCAs support needs to be more evident and clinical feedback mechanisms need to be reviewed in order to improve care delivery.

Extreme dissipation and intermittency in turbulence at very high Reynolds numbers.

Extreme dissipation events in turbulent flows are rare, but they can be orders of magnitude stronger than the mean dissipation rate. Despite its importance in many small-scale physical processes, there is presently no accurate theory or model for predicting the extrema as a function of the Reynolds number. Here, we introduce a new model for the dissipation probability density function (PDF) based on the concept of significant shear layers, which are thin regions of elevated local mean dissipation. At very high Reynolds numbers, these significant shear layers develop layered substructures. The flow domain is divided into the different layer regions and a background region, each with their own PDF of dissipation. The volume-weighted regional PDFs are combined to obtain the overall PDF, which is subsequently used to determine the dissipation variance and maximum. The model yields Reynolds number scalings for the dissipation maximum and variance, which are in agreement with the available data. Moreover, the power law scaling exponent is found to increase gradually with the Reynolds numbers, which is also consistent with the data. The increasing exponent is shown to have profound implications for turbulence at atmospheric and astrophysical Reynolds numbers. The present results strongly suggest that intermittent significant shear layer structures are key to understanding and quantifying the dissipation extremes, and, more generally, extreme velocity gradients.

A scoping review to assess the impact of public education campaigns to affect behavior change pertaining to antimicrobial resistance.

BACKGROUND: Years of global antibiotic misuse has led to the progression of antimicrobial resistance (AMR), posing a direct threat to public health. To impact AMR and maintain antimicrobial viability, educational interventions toward fostering positive AMR behavior change have been employed with some success. METHODS: This scoping review sought to identify research-supporting use of public educational AMR campaigns, and their efficacy toward informing positive AMR behaviors to inform current debate. To enable credible and reflexive examination of a wide variety of literature, Arksey and O'Malley's (2005) methodological framework was used. RESULTS: Three primary themes were identified: (1) behavior change and theoretical underpinnings, (2) intervention paradigm, and (3) educational engagement. From 94 abstracts identified, 31 articles were chosen for review. More attention is required to identify elements of intervention design that inform and sustain behavior change, and the impact of how an intervention is delivered and targeted is needed to limit assumptions of population homogeneity, which potentially limits intervention efficacy. Moreover, research on the impact of hospital-based inpatient interventions is needed. CONCLUSIONS: The existing body of research fails to provide robust evidence to support sound evidential interventions supported by theoretical justifications. Furthermore, interventions to ensure long-term sustained behavior change are unclear and not addressed.

Global resource potential of seasonal pumped hydropower storage for energy and water storage.

Seasonal mismatches between electricity supply and demand is increasing due to expanded use of wind, solar and hydropower resources, which in turn raises the interest on low-cost seasonal energy storage options. Seasonal pumped hydropower storage (SPHS) can provide long-term energy storage at a relatively low-cost and co-benefits in the form of freshwater storage capacity. We present the first estimate of the global assessment of SPHS potential, using a novel plant-siting methodology based on high-resolution topographical and hydrological data. Here we show that SPHS costs vary from 0.007 to 0.2 US$ m-1 of water stored, 1.8 to 50 US$ MWh-1 of energy stored and 370 to 600 US$ kW-1 of installed power generation. This potential is unevenly distributed with mountainous regions demonstrating significantly more potential. The estimated world energy storage capacity below a cost of 50 US$ MWh-1 is 17.3 PWh, approximately 79% of the world electricity consumption in 2017.

The neglected element of hand hygiene - significance of hand drying, efficiency of different methods and clinical implication: A review.

Hand hygiene is a fundamental strategy for controlling the spread of infection. Careful hand drying is integral to the process of hand hygiene, which aims to optimise the removal of potentially pathogenic microorganisms. Ineffective hand drying results in wet hands that are an infection risk increasing the potential for cross-infection, occupational contact dermatitis for healthcare practitioners, harm to patients and environmental contamination. Evidence indicates that there has been limited research regarding the significance of hand drying and the efficacy and clinical impact of different drying methods. The purpose of this review paper was to scope and evaluate the existing literature pertaining to hand drying; to examine the clinical consequences associated with wet hands for patients, healthcare practitioners and the clinical environment; to assess the efficacy of different drying methods; to consider the impact on patient safety; and to progress the research, debate and practice relating to hand drying. The methodological framework applied in this review was that of Arksey and O'Malley (2007). Twenty-one papers identified from 112 abstracts screened were included in the review. Analysis identified three primary themes emerging from the literature: (1) efficacy of hand drying methods; (2) drying method and microbial translocation, dispersion and environmental contamination; and (3) drying methods and environmental sustainability. This review highlights the equal importance of hand drying in the process of hand hygiene and suggests that the efficacy of hand drying is a critical factor in the prevention of the transfer of microorganisms to the environment, and from person to person following hand washing. In conclusion, this paper argues that greater attention needs to be given to hand drying in terms of practice, policy and research and its importance in clinical settings given greater focus.

The stigmatisation of source isolation: a literature review.

BACKGROUND: Isolation precautions in patients with multi-drug-resistant bacteria and other communicable infectious agents can be associated with adverse effects. Patients' perspectives of isolation suggest that the imposed environment and procedures create barriers to their physical, social and emotional needs. AIMS: The purpose of this paper is to review the literature to uncover any reliable evidence supporting the assertion that stigma is a significant characteristic of the experience of source isolation in healthcare settings. METHODS: The methodological framework of Arksey and O'Malley was applied to this review. A total of 14 papers identified from 189 abstracts screened were included in the review. RESULTS: The research reviewed suggests a clear association between stigmatisation and isolation in which stigma does have a direct negative effect on patients placed in hospital isolation. None of the studies found evidence to the contrary. CONCLUSIONS: The implications of this literature review for policy-makers and healthcare professionals suggest that when isolation or other forms of constraint are implemented and in use, patients must be provided with strengthened forms of support, including social and emotional support, and given access to healthcare of optimal quality to prevent the associated adverse effects of isolation as much as possible.

Knowledge of and preferred sources of assistance for physical activity in a sample of urban Indigenous Australians.

BACKGROUND: To examine urban Indigenous Australians' knowledge of the current Physical Activity Guidelines (PAG) and identify their preferred sources of assistance or advice regarding physical activity. METHOD: Self-completed questionnaire data were collected from 194 participants; the questionnaires sought information on standard demographics including an assessment of their perceived physical activity level relative to peers. Outcome measures were agreement with five statements from the current PAG and indicators of preferred sources of assistance or advice regarding physical activity. RESULTS: Most participants demonstrated excellent knowledge of the current PAG, with 92% to 88% of participants agreeing with the statements. Significantly more older participants (> 44 years) identified that 'blocks of 10 minutes of activity are OK' compared to younger participants (aged 18-44 years: 60%; X2 = 6.23; p = .04). Significantly more higher educated participants agreed (96%) that 'brisk walking for half an hour most days was good for health' compared to the less educated participants (85%; X2 = 8.08; p = .02). The most preferred source of physical activity advice identified by men was the GP/health professional (62% vs. 53%; men and women respectively, NS), while for women it was a group to be active with (60% vs. 42%; women and men respectively; X2 = 6.09; p = .01). CONCLUSION: Urban Indigenous Australians have similar levels of knowledge regarding the PAG to non-Indigenous Australians. However, the option of accumulating 10-minute activity bouts needs to be better communicated to younger Indigenous people. Most participants expressed a preference for advice about physical activity to be delivered via health professionals, and groups to be active with. Indigenous and age-specific resources that promote the unique aspects of the current PAG (e.g., that vigorous exercise is not essential for health and blocks of 10 minutes of activity are OK) should be developed and disseminated.

Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians.

ISSUE ADDRESSED: There is evidence that many of the chronic lifestyle-related problems faced by Australia's Indigenous population are related to physical inactivity. However, little is known as to how to introduce physical activity programs that will be meaningful, relevant and acceptable to Australia's Indigenous people. METHODS: Seventeen focus groups involving 96 Indigenous adult participants, explored the meaning of, the barriers to, and potential strategies for promoting physical activity among urban Indigenous Australians. Indigenous researchers moderated the groups and data were transcribed verbatim and analysed independently. RESULTS: The relationship between physical activity and health was well understood by participants. Commonly reported activities undertaken by participants included walking, domestic chores and specific sports. Barriers to activity included being judged by others when in public spaces, cost and accessibility. Family engagement and group-based activities were strong motivators for participation. CONCLUSIONS: Attempts to increase physical activity among urban Indigenous Australians must engage the community from the outset, and focus on increased opportunities for family-orientated activities, and/or group walking programs; cost and safety must also be addressed.