Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings.

BACKGROUND: Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all European countries. This study explores the use of intervention strategies and methods to improve influenza vaccination rates among HCWs in an acute care setting. METHODS: The Intervention Mapping (IM) method was used to systematically develop and implement an intervention strategy aimed at changing influenza vaccination behaviour among HCWs in Dutch University Medical Centres (UMCs). Carried out during the influenza seasons 2009/2010 and 2010/2011, the interventions were then qualitatively and quantitatively evaluated by way of feedback from participating UMCs and the completion of a web-based staff questionnaire in the following spring of each season. RESULTS: The IM method resulted in the development of a transparent influenza vaccination intervention implementation strategy. The intervention strategy was offered to six Dutch UMCs in a randomized in a clustered Randomized Controlled Trial (RCT), where three UMCs were chosen for intervention, and three UMCs acted as controls. A further two UMCs elected to have the intervention. The qualitative process evaluation showed that HCWs at four of the five intervention UMCs were responsive to the majority of the 11 relevant behavioural determinants resulting from the needs assessment in their intervention strategy compared with only one of three control UMCs. The quantitative evaluation among a sample of HCWs revealed that of all the developed communication materials, HCWs reported the posters as the most noticeable. CONCLUSIONS: Our study demonstrates that it is possible to develop a structured implementation strategy for increasing the rate of influenza vaccination by HCWs in acute health care settings. The evaluation also showed that it is impossible to expose all HCWs to all intervention methods (which would have been the best case scenario). Further study is needed to (1) improve HCW exposure to intervention methods; (2) determine the effect of such interventions on vaccine uptake among HCWs; and (3) assess the impact on clinical outcomes among patients when such interventions are enacted.

Multi-level aspects of social cohesion of secondary schools and pupils' feelings of safety.

BACKGROUND. School safety and corresponding feelings of both pupils and school staff are beginning to receive more and more attention. The social cohesion characteristics of a school may be useful in promoting feelings of safety, particularly in pupils. AIMS. To conceptualize theoretically, and check empirically a two-level model of social cohesion between and within schools, in order to explain a pupil's feelings of safety at school. SAMPLES. Data were collected aided by a national Dutch survey in secondary education carried out via the Internet. In 2008, digital questionnaires were completed by about 78,800 pupils, 6,200 teachers and educational support staff, and 600 school managers. METHODS. Data were checked for reliability and representativity. Social cohesion was indicated by self-reported measures of individual pupils and by aggregating scale and item scores of school managers, teachers, and other support staff within schools. Multi-level analysis using individual pupil data and school-level data was performed using MLwiN. RESULTS. A pupil's age, educational attainment level, experience of mild physical violence, prosocial rules of conduct and joint control of these rules, and school measures against playing truant, show positive influences on a pupil's feelings of safety at school. Negative influences are exerted by not feeling most at home in The Netherlands, peers taking drugs and weapons into school, and by experiencing social violence, severe physical violence, and sexual violence. Negative school effects exist simultaneously in severe physical violence experienced by teachers and other staff, and in curriculum differentiation applied by teachers and other staff; a positive school effect is school size. Some interaction effects between pupil and school-level variables were explored. CONCLUSIONS. The variance at school level is relatively low compared with the variance at pupil level. However, a much higher percentage of variance at school level than at pupil level is explained with respect to the pupils' feelings of safety at school. The resulting two-level model also reflects the streaming of pupils in Dutch secondary schools. To improve school safety, the national results emphasize the need to enhance prosocial behaviour rules and to enhance the shared control of these rules between teachers and pupils. They also emphasize the need for the school to take measures that prevent truancy and redefine curriculum differentiation procedures. National educational policy and research can combine efforts to assist schools in developing reliable and valid procedures to increase effectively safety in and around schools.

Microbiology of surgical site infections after gastrointestinal surgery in the south region of The Netherlands.

AIM: To give an overview of the microbiology of blood and wound samples from surgical site infections (SSIs) after gastrointestinal surgery, as well as the antimicrobial susceptibility of the microorganisms involved, and to discuss the appropriateness of the prophylactic antibiotics administered. MATERIALS & METHODS: During a 3.5-year study period, wound swabs and blood samples of patients with an SSI were taken in the first 48 h after surgery until 30 days thereafter. RESULTS: Most pathogens were isolated from wound swabs. Escherichia coli (25%) and Pseudomonas aeruginosa (10%) were the most frequently found microorganisms. Both microorganisms showed a slight tendency towards a decrease in susceptibility for the tested antibiotics, although after correction, this was not significant. CONCLUSION: The comparison between wound swabs taken in the first 48 h after a surgical procedure and swabs in the 30 days thereafter provides important information concerning the microbiology of SSIs and the development of antibiotic resistance of the causative agents over time.

Cross-sectional study on surveillance of surgical site infections after vascular surgery.

AIMS: To determine the incidence and risk factors for surgical site infections (SSI) after vascular surgery, to evaluate the Dutch safety bundle to reduce adverse complications and to analyze causative microorganisms of SSIs. MATERIALS & METHODS: The 3.5-year study was divided into two periods: the control period (before bundle implementation) and intervention period (after implementation). Postdischarge surveillance was performed until 30 days after surgery. Causative microorganisms from in-hospital wound swabs were determined. SSI rates between both periods were compared and a risk analysis was carried out by performing a logistic regression. RESULTS: The study included 1719 operations. The in-hospital SSI rate increased significantly over time. Out of 140 SSIs, 39% were diagnosed postdischarge. Risk factors were diabetes, age >60 years and operations classified as contaminated or dirty. Pseudomonas aeruginosa susceptibility was the highest for gentamicin (97%). All Staphylococcus aureus were methicillin susceptible. CONCLUSION: As patient demographics are important to determine the effectiveness of infection preventive measures, (postdischarge) surveillance is important for developing SSI interventions.

Prevention of biofilm formation in dialysis water treatment systems.

BACKGROUND: Biofilm formations in dialysis systems may be relevant because they continuously release bacterial compounds and are resistant against disinfection. The aim of the study was to compare the development of biofilm between a water treatment system based on a single reverse osmosis unit producing purified dialysate water [bacterial count, 350 colony-forming unit (CFU)/L] (center A) and a water treatment system based on double reverse osmosis and electric deionization, which is continuously disinfected with ultraviolet light and treated with ozone once a week (bacterial count, 1 CFU/L) (center B). METHODS: During a period of 12 weeks, biofilm formation was studied in the tubing segment between the water piping and the dialysis module, using four dialysis monitors in each center. On a weekly basis, tubing samples of 5 cm length (N = 96) were taken under aseptic conditions and investigated for microbiologic contamination [cystine lactose electrolyte-deficient (CLED) Agar], endotoxin levels [limulus amoeben lysate (LAL) gel test, cutoff value, 0.0125 EU/mL], and biofilm formation [electron scanning microscopy (SEM)]. RESULTS: In center A, tube cultures were positive (>100 CFU/mL) in 16% of samples at 22 degrees C and 37 degrees C, compared to 3% of samples of center B (P < 0.05; chi-square). Endotoxin levels were positive in 76% of the tubing samples of center A and negative in all of the samples of center B (P < 0.05). Biofilm was present in 91.7% of the samples of center A (Fig. 1), and only present in one sample (taken after 9 weeks) of center B (P < 0.05) (Fig. 2). In center A, biofilm formation was already observed after 1 week. CONCLUSION: In contrast to a standard water treatment system producing purified water, the use of a system producing highly purified water, which is also treated with regular disinfection procedures, leads to a significant reduction in biofilm formation, bacterial growth, and endotoxin levels in a highly vulnerable part of a water treatment system.