Assessment of microbial bioburden on portable medical equipment in a hospital setting.

Objectives: Although routine disinfection of portable medical equipment is required in most hospitals, frontline staff may not be able to disinfect portable medical equipment at a rate that adequately maintains low bioburden on high-use equipment. This study quantified bioburden over an extended time period for two types of portable medical equipment, workstations on wheels and vitals machines, across three hospital wards. Methods: Bioburden was quantified via press plate samples taken from high touch surfaces on 10 workstations on wheels and 5 vitals machines on each of 3 medical surgical units. The samples were taken at three timepoints each day over a 4-week period, with random rotation of timepoints and portable medical equipment, such that frontline staff were not aware at which timepoint their portable medical equipment would be sampled. The mean bioburden from the different locations and portable medical equipment was estimated and compared with Bayesian multilevel negative binomial regression models. Results: Model estimated mean colony counts (95% credible interval) were 14.4 (7.7-26.7) for vitals machines and 29.2 (16.1-51.1) for workstations on wheels. For the workstations on wheel, colony counts were lower on the mouse, 0.22 (0.16-0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43 (0.32-0.55), when compared to the arm, as assessed by incident rate ratios. Conclusions: Although routine disinfection is required, bioburden is still present across portable medical equipment on a variety of surfaces. The difference in bioburden levels among surfaces likely reflects differences in touch patterns for the different portable medical equipment and surfaces on the portable medical equipment. Although the association of portable medical equipment bioburden to healthcare-associated infection transmission was not assessed, this study provides evidence for the potential of portable medical equipment as a vector for healthcare-associated infection transmission despite hospital disinfection requirements.

Development and implementation of a pharmacist-led telehealth medication management program for veterans receiving oral antineoplastic therapies through the MISSION Act.

PURPOSE: Veterans prescribed oral antineoplastic therapies (OATs) by community providers outside the Veterans Health Administration (VA) may lack access to comprehensive medication management. To address this, our multidisciplinary team developed and implemented a pharmacist-led telehealth medication management program for veterans prescribed OATs by community providers. SUMMARY: The program exclusively uses telehealth to connect veterans with a dedicated board-certified clinical oncology pharmacist who provides comprehensive medication management. The program is based on established pharmacy models found in the research literature. We developed a standard operating procedure, communication templates, patient education materials, and a suite of health information technology tools to help streamline pharmacy processes. The Consolidated Framework for Implementation Research was used to design implementation strategies to promote the adoption of the program. In the first year, 64 veterans from 3 VA medical centers were enrolled in the program. The oncology clinical pharmacist performed 342 encounters and 101 interventions. The program saved an estimated $200,724 in medication-related costs. The veterans we surveyed reported high levels of satisfaction with the pharmacy services provided by the program. CONCLUSION: The delivery of comprehensive medication management through telehealth is feasible from a healthcare system perspective and beneficial for patients. The board-certified oncology clinical pharmacist provided remote pharmacy services to Veterans across three sites in a large and rural service area for the VA. The program realized several benefits, including positive clinical outcomes, high levels of patient satisfaction, and cost savings on medication-related costs.

Effect of a "feedback prompt" from a disinfection tracking system on portable medical equipment disinfection.

BACKGROUND: Portable medical equipment (PME) may contribute to transmission of multidrug-resistant organisms without proper disinfection. We studied whether a Disinfection Tracking System (DTS) with feedback prompt, attached to PME, can increase the frequency of PME disinfection. METHODS: DTS devices were placed on 10 workstations-on-wheels (WOWs) and 5 vitals machine (VM). After a 25 day "screen-off" period, the DTS device screens were turned on to display the number of hours since the last recorded disinfection event for a 42 day period. We used a Bayesian multilevel zero-inflated negative binomial model to compare the number of events in the display "screen-off" to the "screen-on" period. RESULTS: During the "screen-off" period, there were 1.26 and 0.49 mean disinfection events and during the "screen-on" period, there were 1.76 and 0.50 mean disinfection events for WOWs and VM, respectively, per day. The model estimated mean events per device per day in the the "screen-on" period for WOW's were 1.32 (1.10 - 1.57) times greater than those in the "screen-off" period and the "screen-on" period for VM devices was 1.37 (0.89 - 2.01) times greater than those in the "screen-off" period. CONCLUSIONS: The rate of disinfection events for WOWs increased following the implementation of the DTS feedback prompt.

Frontline Nurse Feedback During the Development of a System to Track Cleaning of Portable Medical Equipment.

As part of the development and testing of an innovative technology for tracking disinfection of portable medical equipment, end-user feedback was obtained during an initial trial on two acute care hospital units. The disinfection tracking device was installed on the computers-on-wheels and vital signs machines. Each device had the capability of detecting a cleaning event, reporting the event to an online database, and displaying the time since last cleaning event on a visual display. End-user feedback regarding functionality, usefulness of information provided, and impact on workflow was obtained by survey and facilitated group discussions. Seventeen frontline nurses completed the anonymous survey, and 22 participated in the facilitated group discussions. End users found the system functionally easy to use and the information about time since last cleaning useful and reported minimum disruption of workflow. Functionality of the system was confirmed by consistency between recorded and self-reported cleaning patterns. Managers found the data on cleaning of portable medical equipment helpful in validating compliance with hospital equipment cleaning policy. Frontline staff expressed appreciation for technology that helps them and improves outcomes but also discussed concerns about the potential for technology that creates extra work and disruption in the busy frontline nursing care delivery environment. Nurses were appreciative of opportunities to provide feedback and input into efforts to develop and introduce technology. Recorded cleaning events coincided with self-reported equipment cleaning patterns and illustrated that the device efficiently collects information deemed useful by the end user.

Capturing portable medical equipment disinfection data via an automated novel disinfection tracking system.

BACKGROUND: Portable Medical Equipment (PME) such as workstations-on-wheels (WOWs) and vital signs machines (VMs) have been linked to healthcare-associated infections. Routine visual monitoring of PME disinfection is difficult. An automated Disinfection Tracking System (DTS) was used to record and report the number of disinfection events of PME in a hospital setting. METHODS: The study was conducted in 2 acute-care units for 25-days to determine the pattern of recorded events from DTS on PME. Devices record disinfection events as moisture events and automatically store on a central database. DTS devices with "screen-on" feedback and "screen-off" devices with no display were placed on 10 WOWs and 5 VMs on separate units. RESULTS: A total of 421 moisture events were recorded for the "screen-on" and 345 for the "screen-off", during the 25-day implementation period on the 2 different hospital units. The highest number of events occurred between 6:00am-7:00am, with 69 & 75 moisture events recorded for Units 1 and 2, respectively. CONCLUSIONS: The pattern of disinfection events for WOWs and VMs demonstrated that most events occurred regularly at the times corresponding with nursing shift change. The DTS has the potential to continuously record, and report data related to PME disinfection.

Development and Pilot Test of an Online Training to Engage Managers to Support Workplace Wellness.

OBJECTIVE: To contribute to a broader understanding of effective implementation strategies to help managers engage employees in workplace wellness. METHODS: We beta-tested an online training at four Washington state agencies (two test, two control). We administered a post-training evaluation, re-administered an online manager survey and conducted additional interviews with wellness leads. RESULTS: Training participation rate was high. The two test agencies experienced a significant increase in the percentage of managers who: agreed that they received training on employee wellness; agreed their agency's culture supports employee wellness; and encouraged their employees to participate in wellness activities. Approximately 80% of managers who received the training agreed they could apply information learned to support employee wellness. CONCLUSIONS: If proven effective, the training could be administered at a low cost and disseminated to improve employee health.

Treatment Patterns and Outcomes in a Nationwide Cohort of Older and Younger Veterans with Waldenström Macroglobulinemia, 2006-2019.

Little is known about real-world treatment patterns and outcomes in Waldenström macroglobulinemia (WM) following the recent introduction of newer treatments, especially among older adults. We describe patterns of first-line (1 L) WM treatment in early (2006-2012) and modern (2013-2019) eras and report outcomes (overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse event (AE)-related discontinuation) in younger (≤70 years) and older (>70 years) populations. We followed 166 younger and 152 older WM patients who received 1 L treatment between January 2006 and April 2019 in the Veterans Health Administration. Median follow-up was 43.5 months (range: 0.6-147.2 months). Compared to the early era, older patients in the modern era achieved improved ORRs (early: 63.8%, modern: 72.3%) and 41% lower risk of death/progression (hazard ratio (HR) for PFS: 0.59, 95% CI (confidence interval): 0.36-0.95), with little change in AE-related discontinuation between eras (HR: 0.82, 95% CI: 0.4-1.7). In younger patients, the AE-related discontinuation risk increased almost fourfold (HR: 3.9, 95% CI: 1.1-14), whereas treatment effects did not change between eras (HR for OS: 1.4, 95% CI: 0.66-2.8; HR for PFS: 1.1, 95% CI: 0.67-1.7). Marked improvements in survival among older adults accompanied a profound shift in 1 L treatment patterns for WM.

Pharmacist-led collaborative medication management programs for oral antineoplastic therapies: A systematic literature review.

OBJECTIVES: The aim of this systematic review is to summarize the structure, process, and outcomes of pharmacist-led collaborative medication management programs for oral antineoplastic therapies (OATs). METHODS: Included studies were peer-reviewed journal articles published in English, between January 2000 to May 2020, and reporting on pharmacist-led collaborative medication management programs for patients on OATs. To be included, studies had to report on the pharmacy practice model, pharmacist interventions, and outcomes of the medication management program. The Donabedian model informed the data extraction and summary. Two independent researchers assessed the risk of bias (confounding) for all included studies (n = 12) using the NIH tool and Cochrane ROBINS-I for observational research. RESULTS: There were 12 studies that met inclusion criteria. The structure of the programs included hiring oncology pharmacists to deliver interventions, standardized templates for electronic medical record documentation, and administrative workflow changes (e.g., automatic referrals). The most common pharmacist interventions (processes) were patient education and counseling, adverse event monitoring, and dose modifications. All studies reported one or more positive outcomes, including improved patient adherence, safety, cost savings, cost avoidance, and patient satisfaction. All included studies used an observational study designs, and the majority of studies had moderate to high risk of bias. CONCLUSION: The evidence suggests that pharmacist-led collaborative medication management programs may have beneficial clinical and economic outcomes. The implementation of these programs could be strengthened by using a conceptual framework to guide program development, implementation, and evaluation and effectiveness-hybrid study designs to assess clinical and implementation outcomes. The risk of bias should be addressed by using more robust study designs and rigorous data collection and analysis methods.

Germicidal irradiation of portable medical equipment: Mitigating microbes and improving the margin of safety using a novel, point of care, germicidal disinfection pod.

Portable medical equipment (PME) can be an important reservoir of pathogens causing health care-associated infections. To address this, a novel, portable ultraviolet disinfection pod (UVDP) that allows for full 360-degree disinfection was developed. This investigation examined efficacy of the UVDP against microorganisms on clean, patient-ready PME. We found that the UVDP significantly reduced the number of recoverable bacteria on PME.

Efficacy of pulsed-xenon ultraviolet light for disinfection of high-touch surfaces in an Ecuadorian hospital.

BACKGROUND: Hospital environment in patient care has been linked on healthcare-associated infections (HAI). No touch disinfection technologies that utilize pulsed xenon ultraviolet light has been recognized to prevent infection in contaminated environments. The purpose of this study was: 1) to evaluate the effectiveness of pulsed-xenon ultraviolet light (PX-UV) disinfection for the reduction of bacteria on environmental surfaces of Hospital General Enrique Garcés, and 2) to evaluate the in-vitro efficacy against multi-drug resistance microorganisms. METHODS: This was a quality-improvement study looking at cleaning and disinfection of patient areas. During the study, a total of 146 surfaces from 17 rooms were sampled in a secondary 329-bed public medical center. Microbiological samples of high-touch surfaces were taken after terminal manual cleaning and after pulsed xenon ultraviolet disinfection. Cleaning staff were blinded to the study purpose and told clean following their usual protocols. For positive cultures PCR identification for carbapenemase-resistance genes (blaKPC, blaIMP, blaVIM, and blaNDM) were analyzed and confirmed by sequencing. The total number of colony forming units (CFU) were obtained and statistical analyses were conducted using Wilcoxon Rank Sum tests to evaluate the difference in CFU between terminal manual cleaning and after pulsed xenon ultraviolet disinfection. RESULTS: After manual disinfection of 124 surfaces showed a total of 3569 CFU which dropped to 889 CFU in 80 surfaces after pulsed xenon disinfection (p < 0.001). Overall, the surface and environmental contamination was reduced by 75% after PX-UV compared to manual cleaning and disinfection. There were statistically significant decreases in CFU counts of high touch surfaces in OR 87% (p < 0.001) and patient rooms 76% (p < 0.001). Four rooms presented serine carbapenemases blaKPC, and metallo beta-lactamases blaNDM, blaVIM, blaIMP. confirmed by PCR and sequencing. The in-vitro testing with endemic strains found that after five minutes of pulsed xenon ultraviolet exposure an 8-log reduction was achieved in all cases. CONCLUSION: This study is one of the first of its kind in an Ecuador Hospital. We found that pulsed-xenon ultraviolet disinfection technology is an efficacious complement to the established manual cleaning protocols and guidelines in the significant reduction of MDRO.

Environmental effectiveness of pulsed-xenon light in the operating room.

BACKGROUND: Manual cleaning and disinfection of the operating room (OR) environment may be inadequate due to human error. No-touch technologies, such as pulsed-xenon ultraviolet light (PX-UV), can be used as an adjunct to manual cleaning processes to reduce surface contamination in the OR. This article reports the cumulative results from 23 hospitals across the United States that performed microbiologic validation of PX-UV disinfection after manual cleaning. METHODS: We obtained samples from 732 high-touch surfaces in 136 ORs at 23 hospitals, after manual terminal cleaning, and again after PX-UV disinfection (n = 1464 surface samples). Samples were enumerated after incubation, and the results are reported as total colony-forming units (CFU). RESULTS: The average CFU after manual cleaning ranged from 5.8 to 34.37, and after PX-UV, from 0.69 to 6.43. With manual cleaning alone, 67% of surfaces were still positive for CFUs; after PX-UV disinfection, that number decreased to 38% of all sampled surfaces-a 44% reduction. When comparing manual cleaning to PX-UV, the reduction in CFU count was statistically significant. CONCLUSION: When used after the manual cleaning process, the PX-UV device significantly reduced contamination on high-touch surfaces in the OR.

The Role of Managers in Employee Wellness Programs: A Mixed-Methods Study.

PURPOSE: The purpose of this study is to evaluate managers' barriers and facilitators to supporting employee participation in the Washington State Wellness program. DESIGN: Exploratory sequential mixed methods. SETTING: Four Washington State agencies located in Olympia and Tumwater, Washington. PARTICIPANTS: State employees in management positions (executive, middle, and line), whose job includes supervision of subordinates and responsibility for the performance and conduct of a subunit or group. METHODS: We interviewed 23 managers and then used the results to create a survey that was fielded to all managers at the 4 agencies. The survey response rate was 65% (n = 607/935). ANALYSIS: We used qualitative coding techniques to analyze interview transcripts and descriptive statistics to summarize survey data. We used the Total Worker Health framework to organize our findings and conclusions. RESULTS: Managers support the wellness program, but they also face challenges with accommodating employees' participation due to workload, scheduling inflexibility, and self-efficacy to discuss wellness with direct reports. About half the managers receive support from the manager above them, and most have not received training on the wellness program. CONCLUSION: Our findings point to several strategies that can strengthen managers' role in supporting the wellness program: the provision of training, targeted messages, formal expectations, and encouragement (from the manager above) to support employees' participation.

Managers' Support for Employee Wellness Programs: An Integrative Review.

OBJECTIVE: The aim of this integrative literature review is to synthesize the existing evidence regarding managers' support for employee wellness programs. DATA SOURCE: The search utilized multiple electronic databases and libraries. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers' support in the context of a worksite intervention. The final sample included 21 articles for analysis. DATA EXTRACTION: Two researchers extracted and described results from each of the included articles using a content analysis. DATA SYNTHESIS: Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. RESULTS: Factors that may influence managers' support include their organization's management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers' support may influence the organizational culture, employees' perception of support, and employees' behaviors. CONCLUSIONS: When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers' support. Interventions need to include explicit measures of managers' support as part of the evaluation plan.

Factors Associated With Truck Crashes in a Large Cross Section of Commercial Motor Vehicle Drivers.

OBJECTIVE: This large, cross-sectional study calculated prevalence of disorders and assessed factors associated with self-reported lifetime crashes. METHODS: Truck drivers (n = 797) completed computerized questionnaires reporting crashes, demographics, psychosocial factors, and other elements, as well as had taken measurements (eg, height, weight, serum, and blood pressure). RESULTS: Most drivers were male (n = 685, 85.9%), and the mean body mass index was 32.9 ±â€Š7.5  kg/m2 with 493 (61.9%) being obese. Many drivers (n = 326, 39.9%) experienced at least one, with 132 (16.6%) having multiple, lifetime, reportable crashes. Many factors were associated with crashes, including increasing age, increasing truck driving experience, male sex, alcohol, low back pain, heart disease, and feeling tense. The most consistent associations with crashes were pulse pressure, cell phone use, and feeling physically exhausted after work. CONCLUSIONS: Modifiable factors associated with self-reported crashes were identified. These suggest targeted interventions may reduce risks of crashes.

ACOEM practice guidelines: elbow disorders.

OBJECTIVE: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. METHODS: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. RESULTS: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. CONCLUSION: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.