Designing an optimal infection prevention service: Part 2.

Background: The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models. Aim: The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland. Methods: This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like. Results: Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success. Discussion: These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings.

Designing an optimal infection prevention service: Part 1.

Background: Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim: The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods: A survey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results: Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion: An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic.

Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review.

Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.

A comparison of the nationally important infection prevention and control documents in NHS England and NHS Scotland.

BACKGROUND: The devolution of health to Scotland in 1999, led for the first time in the NHS, to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success. AIM: To identify the national IPC priorities alongside national indicators of success. METHODS: Critical analysis of nationally produced documents and publicly available infection-related data up to March 2018. FINDINGS: For both NHS Scotland and England the local and national IPC priorities are evidenced by: (1) people being cared for in an IPC-safe environment; (2) staff following IPC-safe procedures; and (3) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes.

Examining instruments used to measure knowledge of catheter-associated urinary tract infection prevention in health care workers: A systematic review.

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is the most frequently occurring health care-associated infection among hospitalized patients. Adequate knowledge of CAUTI in health care workers supports effective prevention and control of the infection. This systematic review assesses instruments used to assess knowledge of CAUTI prevention in health care workers to inform future research. The catheter lifecycle model was used to evaluate the conceptual framework upon which the measurement instruments were based. Finally, the psychometric quality of these instruments was evaluated. METHODS: Five electronic databases were searched for published studies and instruments. The COnsensus-based Standards for the selection of health status Measurement INstruments checklist was used to assess the psychometric quality reporting of the instruments. RESULTS: Fifteen studies met the review inclusion criteria and 13 instruments were available for review. Most of the instruments did not address all knowledge components essential for CAUTI prevention as defined by the catheter lifecycle model. The psychometric quality of the instruments was not sufficiently evaluated. CONCLUSIONS: Few instruments are available for CAUTI prevention knowledge measurement. The instruments were not closely aligned with the catheter lifecycle model as a framework. If CAUTI knowledge cannot be measured accurately using an effective instrument, this has the potential to impact negatively on clinical care and the focus of interventions. There is a need for a standardized instrument for the evaluation of CAUTI prevention knowledge so that targeted interventions can address knowledge deficits.

Medical students as agents of change: a qualitative exploratory study.

BACKGROUND: There is evidence that medical students have the potential to actively initiate, lead and bring about change through quality improvement within healthcare organisations. For effective change to occur, it is important that students are introduced to, and exposed to the value and necessity of quality improvement early in their careers. The aim of this study was to explore the perspectives and experiences of medical students and their mentors after undertaking quality improvement projects within the healthcare setting, and if such practice-based experiences were an effective way of building improvement capacity and changing practice. METHODS: A qualitative interpretive description methodology, using focus groups with medical students and semi-structured interviews with academic and clinical mentors following completion of students' 4-week quality improvement projects was adopted. RESULTS: The findings indicate that there are a range of facilitators and barriers to undertaking and completing quality improvement projects in the clinical setting, such as time-scales, differing perspectives, roles and responsibilities between students and multidisciplinary healthcare professionals. CONCLUSIONS: This study has demonstrated that quality improvement experiential learning can develop knowledge and skills among medical students and transform attitudes towards quality improvement. Furthermore, it can also have a positive impact on clinical staff and healthcare organisations. Despite inherent challenges, undertaking quality improvement projects in clinical practice enhances knowledge, understanding and skills, and allows medical students to see themselves as important influencers of change as future doctors.

Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation.

BACKGROUND: Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. METHODS: Using the Outcome Logic Model, we conducted an evaluation of the short- and medium-term outcomes with regards to the impact and success of the VHP Framework. RESULTS: This evaluation found that many respondents were aware of the framework and were using it in a range of different ways. Participants saw the framework as being most beneficial to help decisions on device choice and peripheral vein assessment. However, the framework has not fully reached its intended audience. DISCUSSION: Many positive outcomes were reported as a result of using the VHP Framework including improving clinical practice as it relates to the VHP elements. However, further work is required to find the tools to extend the reach of the framework and assist healthcare teams to be able to fully implement it within their clinical settings.

Effective infection prevention and control: the nurse's role.

Healthcare-associated infections and antimicrobial resistance are significant threats to public health. As resistant organisms continue to emerge and evolve, and antimicrobial agents become less effective, infection prevention and control remains a vital aspect of maintaining public health, particularly among vulnerable patient groups such as older people and young children. Because of the increasing complexity of healthcare treatments and interventions, patients are becoming increasingly susceptible to healthcare-associated infections and resistant organisms. This article outlines some of the challenges that nurses may experience in ensuring effective infection prevention and control, and how these can be addressed.

Antimicrobial stewardship and pre-registration student nurses: Evaluation of teaching.

BACKGROUND: Antimicrobial resistance (AMR) is a global health concern. It is therefore imperative that healthcare professionals receive ongoing and relevant education and training to ensure they are competent in contributing to antimicrobial stewardship (AMS). At present, few undergraduate nursing programmes include AMS within their curriculum. OBJECTIVE: The aim of the evaluation was to determine the relevancy of AMS within the undergraduate nursing programme through the perceptions of student nurses. METHODS: A survey questionnaire was used to obtain undergraduate perceptions of AMS and the relevance to them and their clinical practice. RESULTS: Our evaluation of this educational programme demonstrated that providing AMS education to undergraduate student nurses raises awareness of current challenges around AMR and reinforces the vital role nurses play in enhancing AMS and infection prevention and control. DISCUSSION: This evaluation and current literature demonstrate a necessity for AMS to be embedded throughout undergraduate nursing education. Additionally, there is also a requirement to develop clear educational pathways in AMS to ensure continued professional development and contribute towards the advancement of the nursing role in AMS. By doing so, we will continue to build capacity and capability for the future delivery of healthcare.

Understanding risk perceptions and responses of the public and health care professionals toward Clostridium difficile: A qualitative interpretive description study.

BACKGROUND: The occurrence of Clostridium difficile infection is a major health-related risk. How the public and health care professionals perceive and respond to a health-related risk is shaped by socially and contextually structured evaluations and interpretations. Risk perceptions and responses are context dependent and therefore need to be understood within the context in which they are perceived and experienced. METHODS: This interpretive description study used 8 public focus groups (39 participants) and 7 health care professional focus groups (29 participants) in 2 geographic areas (an area that had experienced a C difficile outbreak and an area that had not). RESULTS: Both the public and health care professionals expressed varying concerns about the perceived consequences of C difficile occurring and the potential influence on emotional and physical health and well-being. In doing so, they drew upon a range of direct and indirect experiences and accounts from the media. Conceptual factors found to be important in influencing risk perceptions and responses included feelings of vulnerability, attribution of responsibility, judgments about competence, and evaluations of risk communicators. CONCLUSIONS: If risk management and communication strategies are to achieve desired responses toward C difficile and wider risks, those responsible for managing risk must consider already established risk perceptions in addition to factors that have influenced them.

Is Breast Pain Greater in Active Females Compared to the General Population in the UK?

Cyclic and noncyclic breast pain effect up to 60% of women, decreasing the quality of life. In addition, exercise-induced breast pain (thought to be caused by tension on breast skin and fascia during breast motion) is reported in up to 72% of exercising females. These forms of breast pain may be experienced concurrently; therefore, it is hypothesized that this compound effect may cause higher breast pain prevalence and severity in active populations. This study investigated the prevalence and severity of breast pain in an active cohort, compared to a random cohort. A random sample of 234 UK females completed a self-administered survey reporting physical activity history, prevalence, severity and frequency of breast pain, breast support habits, bra satisfaction, occurrence of bra-related issues, and demographics. This sample was age-matched to a sample of active females (n = 234) from a cross-sectional survey of 1,285 female marathon runners who completed a similar survey. Breast pain prevalence was significantly lower in the active cohort (32.1%) compared to the random cohort (43.6%), however, the severity and frequency of breast pain was similar in both cohorts. Females in the active cohort undertook significantly more physical activity, were lighter, had greater nulliparous rates, greater adherence to sports bra use, but less adherence to professional bra fitting. With lower breast pain rates in the active cohort the hypothesis of a compound effect of multiple forms of breast pain causing an increase in prevalence and severity is rejected. The lower prevalence may be related to increased physical activity, reduced body mass, and increased sports bra use. Sports bra use is already recommended in the literature for symptomatic women, however, this is the first study to report that increased physical activity and weight loss may be an appropriate life style choice to reduce the prevalence of breast pain.

The Influence of the Breast on Physical Activity Participation in Females.

BACKGROUND: The importance of physical activity is well known. However, previous research suggests that breast movement during exercise can be painful, embarrassing, and anecdotally deter exercise participation. Therefore, this research investigates whether the breast influences physical activity participation. METHODS: Female respondents (n = 249) completed a breast health and physical activity survey assessing bras and bra fit, physical activity, breast pain, comments and improvements, breast history, and demographics. RESULTS: Results found that the breast was a barrier to physical activity participation for 17% of women. "I can't find the right sports bra" and "I am embarrassed by excessive breast movement" were the most influential breast related barriers to activity. Breast pain increased with vigorous activity and poor breast support. Breast health knowledge increased the use of a sports bra and levels of physical activity. CONCLUSIONS: The breast was the fourth greatest barrier to physical activity, behind energy/motivation (first), time constraints (second), and health (third), despite its omission from previous physical activity literature. As 33% of women were not meeting physical activity guidelines, increasing breast health knowledge may reduce barriers to physical activity.

Use of hand-held computers to determine the relative contribution of different cognitive, attitudinal, social, and organizational factors on health care workers' decision to decontaminate hands.

BACKGROUND: Observational and survey methods have limitations in measuring hand hygiene behavior. The ability of a personal digital assistant to anonymously gather data at the point of decision making could potentially address these. METHODS: Participants were provided with a personal digital assistant to be used for three 2-hour periods and asked to rate influential factors of the Health Belief Model (HBM). Participants were also required to enter what they thought they should do and what they actually did. RESULTS: A total of 741 hand hygiene opportunities was recorded. All HBM constructs were higher for hand hygiene opportunities where there was compliance versus noncompliance, with a significant difference for patient pressure, my risk, perceived benefits, perceived seriousness, and availability of good facilities. Only 20% of doctors, 28% of nurses, and 66% of physiotherapists always did what they thought they should. There was no correlation between self-reported and actual compliance. CONCLUSION: The HBM appeared to be a useful theoretical framework. Surprisingly, participants rated their compliance as high despite having recorded instances where they did not do what they thought they should do. This suggests that staff may have a different definition of compliance than strict observation of the guidelines.

Constructing identities in the media: newspaper coverage analysis of a major UK Clostridium difficile outbreak.

AIM: To examine how a major Clostridium difficile outbreak in the UK was represented in the media. BACKGROUND: Clostridium difficile is a serious health care-associated infection with significant global prevalence. As major outbreaks have continued to occur worldwide over the last few decades, it has also resulted in increasing media coverage. Newspaper journalists are, however, frequently criticized for sensationalized and inaccurate reporting and alarming the public. Despite such criticisms, nothing is known about how the media frame Clostridium difficile related coverage. DESIGN: Qualitative interpretive descriptive study. METHOD: An interpretive analysis of newspaper articles from the national press that reported about the outbreak from the first day of coverage over 3 weeks (12 June-3 July 2008). FINDINGS: Twenty-eight newspaper articles were included in the study from tabloids, broadsheets, a regional and a Sunday newspaper. Monster and war metaphors were frequently adopted to portray the severity of Clostridium difficile and the impact it can have on patient safety. In addition, the positioning of the affected patients, their families, healthcare professionals and the Government produced representations of victims, villains and heroes. This subsequently evoked notions of vulnerability, blame and conflict. CONCLUSION: The media are and will remain critical convectors of public information and, as such, are hugely influential in risk perceptions and responses. Rather than simply dismissing media coverage, further understanding around how such stories in specific contexts are constructed and represented is needed so that it can help inform future communication and management strategies.

Understanding factors that impact on health care professionals' risk perceptions and responses toward Clostridium difficile and meticillin-resistant Staphylococcus aureus: a structured literature review.

BACKGROUND: Clostridium difficile is the most common health care-associated infection. Despite considerable efforts to prevent and manage C difficile, poor clinical practice and nonadherence to policy continues to compromise patient safety. Risk perception research is essential in gaining understanding about how health care professionals respond. METHODS: A structured literature review examined empirical evidence regarding health care professionals' risk perceptions and responses toward C difficile. Because of limited evidence available, the review was extended to include other health care-associated infections. Only studies related to methicillin-resistant Staphylococcus aureus (MRSA) could be identified. RESULTS: Eleven studies were included. Four were specific to C difficile and 7 to MRSA. All studies found that technical understanding of C difficile was poor and that staff were concerned about risks to patients and themselves. Technical understanding for MRSA, however, was good, and staff were less concerned about their own health. Information provision was perceived to be inadequate and untrustworthy, which included the media. Practice in most studies was poor. CONCLUSION: There is a need to build on the efforts of risk perception research from other disciplines to understand how health care professionals think and make decisions about C difficile. This can help inform the development of effective management and communication strategies to maximize the quality of care provided.

Understanding factors that impact on public and patient's risk perceptions and responses toward Clostridium difficile and other health care-associated infections: a structured literature review.

BACKGROUND: Clostridium difficile is the most common health care-associated infection and a major cause of death and increased morbidity. It is vital that patients and the public are provided with the right information and communication to assist them to understand their role in preventative measures. Successful implementation of communication and management strategies hinges on individuals' risk perceptions. METHODS: We performed a structured literature review to examine the evidence regarding public and patients' risk perceptions and responses toward Clostridium difficile and other health care-associated infections. Fourteen studies were included. RESULTS: Only 1 study was specific to Clostridium difficile, and 7 were related to other health care-associated infections. Many reported limited understanding of the technical issues of the infection, concerns of transmission to family and friends, inadequate information available, and distrust. The media were one of the main sources of information. Both emotional and physical responses highlighted the level of confusion, fear, anxiety, and anger. CONCLUSION: Empirical research of risk perceptions toward Clostridium difficile is limited. Without well-researched studies examining risk perceptions and responses, there is a danger of developing and implementing communication and management strategies that do not meet the needs of our patients or the public.

Perceptions, attitudes, and behavior towards patient hand hygiene.

BACKGROUND: Hand hygiene is the single most important intervention to prevent the spread of health care-associated infection. However, improvement strategies predominantly focus on health care workers with limited emphasis on patient hand hygiene. This study aimed to explore perceptions, attitudes, and self-reported behavior towards patient hand hygiene among clinical ward nurses within an acute hospital environment. METHODS: A mixed methodologic, descriptive, cross-sectional survey design using questionnaires exploring perceptions, attitudes, and self-reported behavior was used. RESULTS: Despite clinical ward nurses demonstrating good perceptions and positive attitudes toward patient hand hygiene, they were not found to be independently associated with positive behavior. A positive, modest correlation was found between perceptions and attitudes (P<.001), but a negative, weak correlation was found between perceptions and self-reported behavior (P=.001) and attitudes and self-reported behavior (P<.001). CONCLUSION: Despite epidemiologic evidence to suggest that hand hygiene is an important part of preventing health care-associated infection, patients are not provided the opportunity to do so. Human behavior is extremely complex and is the consequence of multiple interdependent influences from biology, environment, education, and culture. Major beliefs and barriers that alter nurses' preexisting behavior toward patient hand hygiene must be acknowledged.