HIV/AIDS: A Case-Based Learning Module for First-Year Medical Students.

In medical and healthcare-related education, case-based learning (CBL) is a teaching strategy that uses clinical cases to engage students in active learning using course concepts to solve important problems. Here we describe the design and implementation of a CBL module to teach first year medical students about the human immunodeficiency virus (HIV), acute retroviral syndrome, clinical progression to acquired immunodeficiency syndrome, HIV diagnostics, assays used to assess stage of disease and response to antiretroviral treatment, and highly active antiretroviral therapy. A team of basic science and clinical faculty in the disciplines of microbiology, immunology, infection prevention and control, clinical medicine, pharmacology, and medical ethics collaboratively designed the CBL module. The results of a questionnaire indicated that the students found the CBL case interesting, engaging, and a useful educational strategy for linking basic science concepts to important clinical problems. In our experience, the CBL promoted student synthesis of basic science concepts across disciplines and engaged learners in the application of basic science knowledge to address significant real-world clinical problems.

Effect of hand sanitizer location on hand hygiene compliance.

BACKGROUND: Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. METHODS: The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. RESULTS: The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). CONCLUSION: Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene.

Observer accuracy and behavior analysis: Data collection procedures on hand hygiene compliance in a neurovascular unit.

BACKGROUND: Although observational studies are popular, little has been done to study the integrity of human observers and the data collection process. Issues of data collection integrity threaten functional findings, leading to problematic interpretation and decreased replication. In our study the response effort associated with hand hygiene data collection in a hospital setting was manipulated using an altered data collection tool. METHODS: A counterbalanced ABAB design was implemented across 2 semesters of a hand hygiene data collection practicum course. RESULTS: When response effort increased, compliant audits decreased and when response effort decreased, compliant audits increased. These results were statistically significant, with an overall level change z that had a P value of .001 (first semester) and .007 (second semester). CONCLUSION: These findings may warrant an increased awareness of data collection procedures where recording options include a less effortful response. The results of our study support basic research on response effort and choice behavior in an applied setting, bringing into question the integrity of data collection procedures and the integrity of the data collected. These results also suggest the need for standardizing reporting systems to ensure hand hygiene collection and reporting procedures are comparable across settings.

A systematic approach for the location of hand sanitizer dispensers in hospitals.

Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.

Comparison of private room with multiple-bed ward neonatal intensive care unit.

OBJECTIVE: This study determined whether a private room or open ward design better met optimal environmental conditions for a neonatal intensive care unit with regard to sound level, light level, temperature and humidity. BACKGROUND: Multiple-bed designs for hospital neonatal intensive care units were the standard until recently. Now, private room designs promise to provide better conditions for neonate development and patient care quality. METHODS: The study compared an eight-bed open ward design with a private room design of a 45-bed neonatal intensive care unit, measuring the environmental parameters of sound, light, temperature, and humidity before and after the construction and occupation of a new private room unit. RESULTS: Average light levels were higher in the private room design because of the increased number of windows, but both designs were within the recommended levels. Mean temperature readings were two degrees cooler in the private room environment, and readings were more stable. Mean humidity readings in the two environments were the same, but humidity levels in the private room design were more stable. Median sound level in the private room design was lower than the open ward design, but the range was similar. CONCLUSION: The private room design allows for a more controlled patient care environment that can be maintained within a smaller range of variation nearer optimal environmental conditions.

Effects of linezolid on staphylococcal adherence versus time of treatment.

Staphylococcus epidermidis has emerged as a major nosocomial pathogen that is often associated with infections of indwelling medical devices. Microbial adhesion to implanted foreign materials is a prerequisite for establishing infection. We studied the time-dependent anti-adhesion effects of linezolid and vancomycin on three S. epidermidis clinical isolates. Minimum inhibitory concentration (MIC) values were identical for both agents for all three isolates (2 mg/l). Bacterial suspensions were added to polystyrene wells and treated with 0.5-4 times the MIC of linezolid or vancomycin at 0, 2, 4 or 6 h post-inoculation. Supra-inhibitory (2 and 4 x MIC) and inhibitory (MIC) concentrations of linezolid demonstrated potent anti-adhesion activity following 2 and 4 h deferred treatments. Even at sub-inhibitory concentrations (0.5 x MIC), suppression of staphylococcal adherence to polystyrene was still evident in most cultures. Linezolid at two and four times the MIC also exerted significant inhibitory effects in cultures that had been treated with a 6-h delay. Supra-inhibitory and inhibitory concentrations of vancomycin administered 2 h post-infection appeared equally effective as linezolid. However, sub-inhibitory concentrations of vancomycin showed minimal or no activity against bacterial adhesion. When vancomycin treatments were delayed by 4 h, only concentrations above the MIC prevented adherence. Linezolid has promising in vitro anti-adhesion activity that merits further studies to determine its role in the management of foreign-body infections.