Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review.

BACKGROUND: In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered. AIM: Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs. METHODS: Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED. RESULTS: One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8-89.7%). CONCLUSION: Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.

Advances in e-learning in undergraduate clinical medicine: a systematic review.

BACKGROUND: E-learning is recognised as a useful educational tool and is becoming more common in undergraduate medical education. This review aims to examine the scope and impact of e-learning interventions on medical student learning in clinical medicine, in order to aid medical educators when implementing e-learning strategies in programme curricula. METHODS: A systematic review compliant with PRISMA guidelines that appraises study design, setting and population, context and type of evaluations. Specific search terms were used to locate articles across nine databases: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus and Google Scholar. Only studies evaluating e-learning interventions in undergraduate clinical medical education between January 1990 and August 2021 were selected. Of the 4,829 papers identified by the search, 42 studies met the inclusion criteria. RESULTS: The 42 studies included varied in scope, cognitive domain, subject matter, design, quality and evaluation. The most popular approaches involved multimedia platforms (33%) and case-based approaches (26%), were interactive (83%), asynchronous (71%) and accessible from home (83%). Twelve studies (29%) evaluated usability, all of which reported positive feedback. Competence in use of technology, high motivation and an open attitude were key characteristics of successful students and preceptors. CONCLUSIONS: Medical education is evolving consistently to accommodate rapid changes in therapies and procedures. In today's technologically adept world, e-learning is an effective and convenient pedagogical approach for the teaching of undergraduate clinical medicine.

Assessment of the microbial load of airway clearance devices used by a cohort of children with cystic fibrosis.

BACKGROUND: Positive expiratory pressure (PEP) devices are an important element of the management of cystic fibrosis, and of other respiratory diseases. Whereas there have been reports in the literature of contamination of airway clearance devices and their surfaces by microbial pathogens, there is little evidence available regarding such contamination and its contribution to respiratory infection. AIM: To establish whether pathogenic bacteria can contaminate PEP devices in the context of normal cleaning and maintenance practices. METHODS: Patients' home-use clearance devices were brought to a routine clinic appointment and collected for microbiology sampling and analysis. The patients were provided with replacement devices. Nineteen such devices were collected from 17 patients, reflecting use of multiple devices by some patients. Swabs were taken and cultured from each patient's used device, the patient's airway, as well as from new unopened and unused devices that acted as controls. RESULTS: Seven of 19 devices (37%) tested positive for presence of pathogenic bacteria. Device-cleaning methods varied among patients and non-sterilization methods were found to be ineffective at removing pathogens. Microbial species found on the devices did not correlate with those identified from airway swabs. CONCLUSION: This study demonstrates the presence of pathogens on positive expiratory pressure devices. The potential for transmission of these pathogens to the patient's airway and the risk of infection remains unclear and requires further study.

Specialized cleaning associated with antimicrobial coatings for reduction of hospital-acquired infection: opinion of the COST Action Network AMiCI (CA15114).

Recognized issues with poor hand hygiene compliance among healthcare workers and reports of recontamination of previously chemically disinfected surfaces through hand contact emphasize the need for novel hygiene methods in addition to those currently available. One such approach involves antimicrobial (nano) coatings (AMCs), whereby integrated active ingredients are responsible for elimination of micro-organisms that come into contact with treated surfaces. While widely studied under laboratory conditions with promising results, studies under real-life healthcare conditions are scarce. The views of 75 contributors from 30 European countries were collated regarding specialized cleaning associated with AMCs for reduction of healthcare-associated infection. There was unanimous agreement that generation of scientific guidelines for cleaning of AMCs, using traditional or new processes, is needed. Specific topics included: understanding mechanisms of action of cleaning materials and their physical interactions with conventional coatings and AMCs; that assessments mimic the life cycle of coatings to determine the impact of repetitive cleaning and other aspects of ageing (e.g. exposure to sunlight); determining concentrations of AMC-derived biocides in effluents; and development of effective de-activation and sterilization treatments for cleaning effluents. Further, the consensus opinion was that, prior to widespread implementation of AMCs, there is a need for clarification of the varying responsibilities of involved clinical, healthcare management, cleaning services and environmental safety stakeholders.

Uptake of screening for type 2 diabetes risk in general dental practice; an exploratory study.

Aim The objective of this study was to determine dental patients' uptake of two preliminary screening tools for risk of diabetes (the Finnish Diabetes Risk Score -FINDRISC- and HbA1c finger-prick testing) in general dental practice, and to determine the number of patients at risk of type 2 diabetes (T2D) based on the results of these screening tests.Methods Patients aged 45 and over, who did not already have a diagnosis of diabetes, visiting primary dental practitioners for routine appointments in London (N = 244) and Staffordshire (N = 276), were offered the chance to be screened for diabetes risk using the FINDRISC a self-report screening tool to assess risk of development of diabetes in the next ten years. If a patient's score showed them to be at risk, they were offered an instant HbA1c finger-prick test to further screen for possible type 2 diabetes, where they were given their result instantaneously. Patients found to be at risk on either screening test, were referred to their GP for formal diagnostic testing.Results A total of 1,035 patients eligible for inclusion were asked to take part. Five hundred and twenty patients consented to screening. Of these, 258 patients (49.6%) were found to be at risk of developing diabetes based on FINDRISC scores and were referred to the GP for further testing and offered a further screening finger-prick blood test at the dental practice. A total of 242 (93.8% of those offered the test) accepted the on the spot finger-prick test. On this A1c test, had a result of 5.7% or higher, indicating increased risk for diabetes. Of the 258 who were referred to their GP for formal diabetes testing, 155 (60%) contacted their doctor. There was a significant association between the number of 'at risk' screening results a person received and whether or not a patient contacted their GP (P <0.0001). The odds of patients contacting the GP was 3.22 times higher if they were referred with two positive diabetes risk results (positive FINDRISC, positive HbA1c) rather than just one (positive FINDRISC, negative HbA1c).Conclusions The study demonstrates a two-step method of diabetes screening that appears to be acceptable by dental patients, a sizeable proportion of whom were identified as at risk of developing diabetes, and the majority following the recommendation for further testing with their GP. While the majority followed the recommendation for further testing with their GP, patients were three times more likely to contact their GP if they received a positive risk result on both screening tools.

Bespoke video vignettes - an approach to enhancing reflective learning developed by dental undergraduates and their clinical teachers.

This study explores the selective use of video as a medium to support reflective processes as related to dental undergraduate learning. With the objective of developing and enhancing high-quality adult dental care, the use of compiled video materials created in an undergraduate clinical setting was investigated. Video cameras were used to capture elements of reflection-in-action and reflection-on-action typically found during everyday clinical practice. 'Gold standard' or 'textbook outcomes' are rarely, if ever, fully achieved in dental practice. Real-life clinical experiences offer challenges and opportunities for both teachers and students to engage with reflective learning processes. The materials generated allowed for an experience of individual reflective learning and the creation of a data bank or archive with potential use for the benefit of a wider student cohort. Various aspects of the students' views and comments on the process of reflection were reported and explored by means of a semi-structured focus group moderated by a linked educational advisor.

Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper.

BACKGROUND: The regulatory body responsible for the registration of Irish pre-hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), identified the need to implement a continuing professional competence (CPC) framework. The first cycle of CPC (focused on emergency medical technicians) commenced in November 2013 creating for the first time a formal relationship between continuing competence and registration to practice. AIMS: To review current literature and to describe benefits and challenges relevant to CPC, regulation, registration and their respective contributions to professionalism of pre-hospital practitioners: advanced paramedics, paramedics and emergency medical technicians. METHODS: Online search of cumulative index to nursing and allied health literature (CINAHL Plus with Full Text), Allied and Complementary Medicine (AMED) and 'Pubmed' databases using: 'Continuous Professional Development'; 'Continuous Professional Development'; 'emergency medical technician'; 'paramedic'; 'registration'; 'regulation'; and "profession' for relevant articles published since 2004. Additional policy documents, discussion papers, and guidance documents were identified from bibliographies of papers found. RESULTS: Reports, governmental policies for other healthcare professions, and professional developments internationally for allied professions (e.g., nursing, physiotherapy and medicine) link maintenance of competence with requirements for registration to practice. CONCLUSION: We suggest that evolving professionalisation of Irish paramedics should be affirmed through behaviours and competencies that incorporate adherence to professional codes of conduct, reflective practice, and commitment to continuing professional development. While the need for ambulance practitioner CPD was identified in Ireland almost a decade ago, PHECC now has the opportunity to introduce a model of CPD for paramedics linking competence and professionalism to annual registration.

Outreach clinical dental education: the Portsmouth experience - a 4-year follow-up study.

BACKGROUND: The Portsmouth Dental Academy (UPDA) was opened in September 2010 and was a development from the highly successful School of Professionals Complementary to Dentistry (2004-2010). The aim of the Academy was to provide integrated team education for all dental professionals in a primary care setting. The dental students are on outreach from King's College London, and the dental care professional students are registered at the University of Portsmouth. OBJECTIVES: To evaluate the dental students response to the residential outreach educational experience at the UPDA. METHODS: A 49-item questionnaire divided into nine domains that provided both qualitative data and quantitative data were administered at the end of the longitudinal 10-week placement, to four successive cohorts of students in 2010-2014. RESULTS: A 95% return rate was achieved. Students valued highly the quality of the clinical teaching. Through their experience, they felt they understood fully the role of the dentist in care planning in primary care and felt well prepared for dental foundation training. This educational success is unpinned with successful maintenance factors including a well-organised induction period and giving the students a sense of belongingness, empowerment and autonomy for their personal development as new graduates. CONCLUSION: Within the limitations of the questionnaire study over the 4-year period, the students were very positive about all the aspects of this residential outreach education at the UPDA but particularly valued the immersion in clinical dentistry and the bridging from dental school to their dental foundation training.

Listening to older adults: community consultation on a new dental service.

BACKGROUND: Increased life expectancy, retention of a natural dentition often heavily restored, and increasing risks of oral disease mean that older people have particular dental needs and yet uptake of care is low. A new health and wellbeing centre in south London offering student-delivered care has been built to serve the local community. Community views could informed the planning of acceptable care for older people. OBJECTIVE: To explore the views and expectations of older adults towards dental services and ascertain how a new dental centre may best provide dental care. RESEARCH DESIGN: This qualitative study used in-depth and triad interviews to explore the views of older people. Purposive sampling of local centres/groups for older adults was undertaken and all willing clients interviewed. Interviews were audio recorded, transcribed and analysed using Framework Methodology with emerging themes categorised according to Maxwell's six descriptors of quality. RESULTS: Nine sessions (five triad and four in-depth interviews) involving 17 older adults were conducted in local day centres. Barriers to dental care were largely related to fear, cost, transport, lack of perceived need and the attitude of clinicians. Outcomes related to acceptability featured highly in a dental service for older adults; the overarching principles of 'delivering mutual benefit' for students and older people, 'experiencing warm humanity' and 'restoring dignity and worth' were central to their views of quality care. The importance of clinicians, whether student or staff, delivering person centred care with warm humanity was dominant: comprising 'welcoming', 'valuing', 'listening' 'communicating' and 'caring' for older adults to enhance relationships and contributing to 'restoring dignity and worth'. CONCLUSION: Community engagement identified a willingness amongst older adults to utilise dental services where mutual benefit was perceived and, importantly, there were low barriers to care and a warm humanity was exhibited.

Awareness of sexually transmitted infection and protection methods among university students in Ireland.

BACKGROUND: Sexually transmitted infections (STIs) are a major public health challenge. In 2012, young people (20-29 years) represented 59.1 % of STI notifications in Ireland. In studying awareness and knowledge of STIs, methods of protection, and sexual practices of young people, many researchers have accessed university students. AIMS: Survey of 419 university students, investigating awareness and knowledge of sexual health and STIs, and risky sexual behaviour as a surrogate indicator of sexual activity in that age group. METHODS: Self-administered questionnaire on students' demographics, sexual activity, knowledge, attitude and awareness of sexual health and STIs. RESULTS: 419 students responded: 56.1 % female and 78.1 % undergraduate students. 74.2 % remembered receiving sexual education in secondary school and 84 % of those found it useful, but only 51.8 % remembered education regarding STIs. 44.4 % believed that STIs do not pose a long-term health risk. 90.7 % of respondents were sexually active, and 10.3 % had contracted STIs. 94.7 % of sexually active students used contraception, with condoms most frequently used. 69.1 % of those active had experienced penetrative vaginal sex, 86.4 % oral sex and 19.2 % anal sex without a condom in the prior 2 years. Condom usage initiated by women was primarily for STI prevention. CONCLUSION: Young people do not always have the information needed for them to take responsibility for their sexual health. In this study, university-provided medical and information resources were available, but large numbers of students were unaware or uncomfortable accessing them. Future work is needed to determine factors contributing to effective communication of sexual health information to young people.

The impact of integrated team care taught using a live NHS contract on the educational experience of final year dental students.

OBJECTIVE: To investigate the responses of the dental student body in the first three years of outreach education (2010-13) at the University of Portsmouth Dental Academy in the areas of integrated team work and use of a current NHS contact. METHODS: Use of a questionnaire to allow both quantitative and qualitative data to be obtained, administered to the three cohorts of students at the end of their longitudinal attendance at the Academy in their final year of education at King's College London Dental Institute. RESULTS: Data were obtained from 227 students which represented a 95% return rate. Sixty-four percent of students strongly agreed with both statements: 'I am confident with working with a dental nurse' and 'I now understand properly the scope of practice of dental hygiene-therapists'. Sixty-seven percent strongly agreed with the statement 'I have had useful experience of working in NHS primary care during the final year'. Eighty percent either strongly agreed or agreed with the statement 'My experience of real Units of Dental Activity and Key Performance Indicators has encouraged me to positively consider NHS high street dentistry as a career option'. CONCLUSIONS: Within the limitations of this study the dental students reported having gained useful experience of working in integrated team care dentistry. They expressed strong support for the education that is being delivered in an outreach environment and, most importantly, the student body was looking forward to entering general dental practice in the UK.

Communicating new policy on antibiotic prophylaxis with patients: a randomised controlled trial.

OBJECTIVES: This trial aimed to assess the effectiveness of two different communication tools on the levels of anxiety and concern when a change in patients' treatment was introduced. METHOD: Patients previously advised to have antibiotic prophylaxis before their dental treatments were randomised to receive information about the new policy either through a video accompanied by a written leaflet or just the leaflet. All patients completed a questionnaire to assess anxiety and concern as well as intentions regarding accepting dental treatment without antibiotic prophylaxis at enrolment point, after intervention and after meeting the cardiologist. RESULTS: Ninety questionnaires were analysed (45 in each group). The mean level of anxiety and concern scores were significantly reduced after the intervention point (p <0.05). The ANOVA model revealed a significant reduction in the levels of anxiety and concern during the trial (p <0.001). However, the main effect of group (intervention versus control) and the interaction term were not significant. At the end of trial there was no difference in the number of patients accepting dental treatment without cover in the two groups. CONCLUSION: Patients appear more likely to accept a change if it is communicated directly to them by their practitioners via face to face consultation compared with video or leaflet. When there is a lack of time for in-depth consultation, video could be a more effective method than leaflet alone.

Why do general dental practitioners become involved in clinical teaching? A pilot study exploring the views of part-time practitioner teachers, King's College London.

INTRODUCTION: Dental schools in the United Kingdom are becoming increasingly reliant on the services of part-time teachers to deliver the clinical educational component of the dental course. Their background is predominantly from general dental practice but the opportunities to progress in the system are limited. The aim of this study was to ascertain the views and perceptions of such teachers at a dental school. MATERIALS AND METHODS: An anonymous, non-incentivised online survey was used to obtain both qualitative and quantitative views of the part timers. RESULTS: The department has n = 40 part-time teachers and there was a response rate of 78%. Overall 73% were satisfied with their current teaching position, whereas the remaining 27% of teachers were seeking higher rewards both in terms of recognition and status. CONCLUSIONS: This study demonstrated the need for formal teaching skills and training to be made available to part-time clinical teachers. Allied to this is the requirement for a clearly defined and achievable career pathway.

Stress analysis of different post-luting systems: a three-dimensional finite element analysis.

BACKGROUND: The longevity of endodontically treated teeth is usually determined by the adequacy of root canal treatments, coronal seal and favourable stress distribution within the remaining tooth tissues. The aim of this study was to investigate the influence of post material and luting cement on the biomechanics of endodontically treated teeth using three-dimensional finite element analysis (3-D FEA). METHODS: A 3 mm section of endodontically treated canine tooth was scanned and reconstructed for 3-D modelling and FE analyses. A metal post (MP) and a glass fibre post (GFP) were tested individually with four luting cements [zinc phosphate (ZPH), glass ionomer (GI), resin modified glass ionomer (RMGI) and resin based cements (RC)]. A push-out test was conducted by subjecting all models to 100 N perpendicular loading at the post. RESULTS: The maximum stresses generated along the MP-cement interface were significantly higher than corresponding stresses in the GFP-cement interface regardless of the cement type. GFP generated seven times higher stresses within the root dentine than metal posts when ZPH and GI were used, and three times higher when RMGI and RC were used. The displacement of GFP was double (50 µ) the displacement of MP (20 µ) in all groups. CONCLUSIONS: The low elastic modulus of GFP generated lower stresses along its interface and higher stresses within the root dentine, therefore the probability of debonding and root fracture in the GFP group was lower.

An evidence-based assessment of primary care needs in an economically deprived urban community.

BACKGROUND: As healthcare and longevity improve and fertility rates decline, we see a demographic shift towards a predominantly elderly population. Because ageing brings its own physiological changes and complications, the need arises for practical and feasible approaches in providing the healthcare required by this population. With government strategy promoting enhanced community-based healthcare, the development of primary care infrastructure should reflect population needs. AIMS: To describe the profile of older patients attending a general practice in an underprivileged urban setting, specifically initial medical presentation, referrals for secondary care, and the medicines prescribed to them. To thereby enhance our understanding of the primary care requirements of elderly people in this setting. METHODS: The anonymised records of an older patient cohort (n=427, age>55 years) that presented to a General Practice over a 12-month period were retrospectively analysed to determine the nature of the clinical encounters, subsequent referral patterns and drugs prescribed. RESULTS: There were 3,448 discrete clinical encounters (mean=8.0 per patient), predominantly for respiratory conditions, leading to 401 issued scripts and to 216 patients being referred for secondary care. Women were referred more often than men. There was a notable need for specialised dietary advice and drug prescribing was often complex. CONCLUSION: This study provides evidence of primary care needs in an economically deprived area of an Irish city highlighting the complexity of associated prescribing and secondary care referrals in this setting.

The impact of fractured endodontic file removal on vertical root fracture resistance: three-dimensional finite element analysis.

This study investigated by means of finite element analysis the influence of fractured file removal on root fracture resistance in an endodontically-treated canine. A 4mm fragment of an endodontic file was deliberately fractured in the apical third of an upper canine root and removed by ultrasonic tips. Micro-computed tomography scans were carried out before and after fractured file removal on the same tooth. Two 3D-FE models (before and after file removal) were subjected to 100N loading. Results indicate that the fractured file removal increased von Mises stresses by 55%. Peak stresses were located around the root filling/dentine interface prior to file removal. Following file removal, peak stresses were concentrated at the buccal root surface/bone interface that might initiate vertical root fracture buccolingually.