Patient experience of hospital screening for carbapenemase-producing Enterobacteriaceae: A qualitative study.

AIM: To explore patients' accounts of screening and being managed for colonisation with the antimicrobial resistant organism, carbapenemase-producing Enterobacteriaceae (CPE), when in hospital. BACKGROUND: Antimicrobial resistance (AMR) has been identified as one of the biggest global health challenges of the 21st Century. As the threat from AMR grows, screening to identify patients who are colonised with resistant organisms such as CPE is becoming an increasingly important aspect of nursing practice, in order to reduce risk of transmission of infection within hospitals. There is currently little research evidence on the patient experience of hospital management of CPE colonisation. METHODS: Qualitative semi-structured telephone interviews were undertaken, using a topic guide. Nine patients participated in the study. The data were analysed thematically, and rigour was maintained through peer review. The COREQ checklist was used. RESULTS: Two main themes were identified: "I can't make sense of CPE," illustrating limitations in patients' understandings of CPE; and, "I feel as if they are saying it is my fault," indicating the feelings of responsibility and blame which patients experienced. CONCLUSIONS: This paper contributes original evidence to the limited literature on patients' experiences of being colonised with CPE. The findings suggest that support and information provided for patients by healthcare professionals needs to be based on current evidence-based guidance on the nature of CPE and its implications for patient care, as well as being responsive to patients' emotional needs. RELEVANCE TO CLINICAL PRACTICE: This study has international relevance for nursing practice. As the global threat of AMR grows, the demands on healthcare providers to manage resistant organisms and their implications for patient care within healthcare settings are increasing. Enabling healthcare professionals to engage sensitively with patients being managed for colonisation with CPE is paramount to providing patient-centred care.

The acceptability of screening for Carbapenemase Producing Enterobacteriaceae (CPE): cross-sectional survey of nursing staff and the general publics' perceptions.

Background: Carbapenemase Producing Enterobacteriaceae (CPE) has spread rapidly and presents a growing challenge in antimicrobial resistance (AMR) management internationally. Screening for CPE may involve a rectal swab, there are limited treatment options for affected patients, and colonised patients are cared for in isolation to protect others. These measures are sound infection prevention precautions; however, the acceptability of CPE screening and its consequences are currently unknown.The aim of this study was 'To determine factors influencing acceptability of CPE screening from the perspectives of nursing staff and the general public.' Methods: National cross-sectional surveys of nursing staff (n = 450) and the general public (n = 261). The Theoretical Domains Framework (TDF) guided data collection and analysis. Regression modelling was used to identify factors that predicted acceptability of CPE screening. Results: For nursing staff, the following predictor variables were significant: intention to conduct CPE screening (OR 14.19, CI 5.14-39.22); belief in the severity of the consequences of CPE (OR 7.13, CI 3.26-15.60); knowledge of hospital policy for screening (OR 3.04, CI 1.45-6.34); preference to ask patients to take their own rectal swab (OR 2.89, CI 1.39-6.0); awareness that CPE is an organism of growing concern (OR 2.44, CI 1.22-4.88). The following predictor variables were significant for the general public: lack of knowledge of AMR (ß - .11, p = .01); social influences (ß .14,p = .032); social norms (ß .21p = .00); acceptability of being isolated if colonised (ß .22, p = .000), beliefs about the acceptability of rectal swabbing (ß .15, p = .00), beliefs about the impact of careful explanation about CPE screening from a health professional (ß .32, p = .00).Integrating results from staff and public perspectives points to the importance of knowledge of AMR, environmental resources, and social influences in shaping acceptability. Conclusions: This is the first study to systematically examine the acceptability of CPE screening across nursing staff and the public. The use of TDF enabled identification of the mechanisms of action, or theoretical constructs, likely to be important in understanding and changing CPE related behaviour amongst professionals and public alike.

Understanding and promoting effective self-care during heart failure.

OPINION STATEMENT: Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain life, healthy functioning, and well-being. The people who help patients most (ie, caregivers/family members) should be involved in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed with once-daily dosing, with pharmacists providing medication review and support. Pill boxes should be provided and patients' health literacy levels assessed. Psychosocial interventions for smoking cessation should be undertaken. Regular aerobic exercise may benefit patients with mild to moderate HF and some with severe but stable HF; therefore, referral to cardiac rehabilitation should be considered. Exercise regimen must take into account patient-related factors, including functional status, comorbid conditions, and patient preferences. Intake of salt, alcohol, and fluid should be restricted, although these steps are supported by limited evidence. Patients should be educated on appropriate sources of help. They should seek help immediately for persistent chest pain, palpitations, syncope, breathlessness at rest, or a weight increase of ≥ 2 lb. Depression, if present, should be addressed with antidepressants (sertraline and citalopram), cognitive behavioral therapy, and regular exercise. HF disease management programs should be offered if available.

Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.

OBJECTIVE: To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions -- heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis -- and for the effectiveness of treatments for depression and anxiety in these settings. DATA SOURCES: Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. DATA EXTRACTION: Each review was examined and summarised by two people before compilation. DATA SYNTHESIS: Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. CONCLUSION: The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.

Changing surgical practice through feedback of performance data.

BACKGROUND: Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit. However, empirical evidence of the effectiveness of clinical audit in changing practice is limited. Few studies have attempted to evaluate practice development or clinical outcomes within the conceptual framework of change theory. Several published studies have used passive feedback in an attempt to promote a change in practice. Sending information to health care workers on their performance is one of the simplest ways of attempting to change performance. AIMS: To evaluate the impact on infection rates of the passive feedback of surgical wound infection rate data to nurses and surgeons within an empirical rational approach to change, and the active feedback of data within a normative re-educative approach to change. METHODS: A prospective cohort study over a 3-year period of all surgical patients undergoing clean elective surgery (n = 2241). Patients were monitored whilst an inpatient and up to 30 days postoperatively by an independent observer to determine surgical wound infection rates. The method employed was 'gold standard' surveillance, whereby patients were followed up into the community setting. INTERVENTIONS: Interventions of feedback and withdrawal of feedback of infection rate data and introduction of guidelines for evidence-based surgical practice within a change theory framework were monitored by the incidence of infection during the periods of the particular intervention. RESULTS: Although the feedback of infection rate data impacted on the subsequent infection rates, the reduction was not statistically significant. However, a significant reduction in the infection rates was achieved following the introduction of guidelines for best surgical practice (P < 0.05). CONCLUSIONS: The findings indicate that if change in practice is to be achieved by the feedback of performance data, then the process of feedback should be active and within a normative re-educative approach to change.