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1.
Rev Bras Enferm ; 73(suppl 2): e20200487, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111781

RESUMO

OBJECTIVE: Reflect and propose adaptations to the Multimodal Hand Hygiene Strategy for field hospitals, in the context of the COVID-19 pandemic. METHOD: Reflective study, carried out in April 2020, based on the recommendations of the World Health Organization and the guide for the implementation of the five components of the Multimodal Strategy: system change related to infrastructure; training/education; evaluation and feedback; reminders in the workplace; and institutional security climate. RESULTS: The Multimodal Strategy, proposed for hospitals in general, can be adapted for field hospitals in order to reduce the transmission of the SARS-CoV-2 virus. Investments to adapt the infrastructure and education of workers require foresight and speed and are of special relevance to promote hand hygiene in this care context. FINAL CONSIDERATIONS: Adjusting the Multimodal Strategy, especially for the reduced time in the execution of each component, is necessary for field hospitals with a view to preventing COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Higiene das Mãos/métodos , Unidades Móveis de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Guias como Assunto , Higiene das Mãos/organização & administração , Humanos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Organização Mundial da Saúde
2.
Work ; 66(4): 717-729, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925133

RESUMO

BACKGROUND: COVID-19 is a highly contagious acute respiratory syndrome and has been declared a pandemic in more than 209 countries worldwide. At the time of writing, no preventive vaccine has been developed and tested in the community. This study was conducted to review studies aimed at preventing the spread of the coronavirus worldwide. METHODS: This study was a review of the evidence-based literature and was conducted by searching databases, including Google Scholar, PubMed, and ScienceDirect, until April 2020. The search was performed based on keywords including "coronavirus", "COVID-19", and "prevention". The list of references in the final studies has also been re-reviewed to find articles that might not have been obtained through the search. The guidelines published by trustworthy organizations such as the World Health Organization and Center for Disease Control have been used in this study. CONCLUSION: So far, no vaccine or definitive treatment for COVID-19 has been invented, and the disease has become a pandemic. Therefore, observation of hand hygiene, disinfection of high-touch surfaces, observation of social distance, and lack of presence in public places are recommended as preventive measures. Moreover, to control the situation and to reduce the incidence of the virus, some of the measures taken by the decision-making bodies and the guidelines of the deterrent institutions to strengthen telecommuting of employees and reduce the presence of people in the community and prevent unnecessary activities, are very important.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Local de Trabalho/organização & administração , /epidemiologia , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Tomada de Decisões Gerenciais , Desinfecção/organização & administração , Desinfecção/normas , Guias como Assunto , Higiene das Mãos/organização & administração , Higiene das Mãos/normas , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Programas de Rastreamento/organização & administração , Programas de Rastreamento/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Telecomunicações/organização & administração , Telecomunicações/normas , Local de Trabalho/normas
3.
Indian J Med Microbiol ; 38(2): 139-143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32883925

RESUMO

COVID-19 as a pandemic has spanned across all continents. With the increasing numbers in cases worldwide, even the countries with the best of healthcare facilities are reeling under the burden of the disease. Therefore, in countries with limited access to resources and poor healthcare infrastructure, the low and middle-income countries (LMICs), limiting spread becomes even more challenging. Low- and middle-income countries (LMICs) are severely hit by any outbreak and pandemics and face the lack of infrastructure and problem of overcrowding. Health facilities are compromised and almost exhausted at the time of emergency. There is disruption of normal supply chain, and consumables are not in sufficient quantity. In the current situation, rationalized use of available supplies is important. This paper presents the perspective on the basis of current literature on gaps in various infection prevention and control (IPC) strategies that are being followed currently in LMICs and suggestions for bridging these gaps.


Assuntos
Betacoronavirus/patogenicidade , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Higiene das Mãos/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Controle de Doenças Transmissíveis/métodos , Infecções Comunitárias Adquiridas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Desinfecção/métodos , Instalações de Saúde/provisão & distribução , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto
5.
Oncologist ; 25(6): e936-e945, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32243668

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Oncologia/organização & administração , Neoplasias/terapia , Pandemias/prevenção & controle , Assistência ao Paciente/normas , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Higiene das Mãos/organização & administração , Higiene das Mãos/tendências , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/tendências , Cooperação Internacional , Colaboração Intersetorial , Oncologia/economia , Oncologia/normas , Oncologia/tendências , Assistência ao Paciente/economia , Assistência ao Paciente/tendências , Educação de Pacientes como Assunto , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Alocação de Recursos/economia , Alocação de Recursos/organização & administração , Alocação de Recursos/normas , Alocação de Recursos/tendências , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/tendências , Organização Mundial da Saúde
6.
PLoS One ; 15(3): e0229911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155208

RESUMO

BACKGROUND: The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively. AIM: The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs. METHODS: Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies. FINDINGS: A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks. CONCLUSIONS: This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.


Assuntos
Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Controle de Infecções/organização & administração , Instituições Residenciais/organização & administração , Infecção Hospitalar/epidemiologia , Higiene das Mãos/organização & administração , Higiene das Mãos/normas , Higiene das Mãos/estatística & dados numéricos , Hepacivirus/isolamento & purificação , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Hepatite B/transmissão , Hepatite B/virologia , Vírus da Hepatite B/isolamento & purificação , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Hepatite C/transmissão , Hepatite C/virologia , Humanos , Higiene/normas , Controle de Infecções/normas , Controle de Infecções/estatística & dados numéricos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Influenza Humana/virologia , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/normas , Assistência de Longa Duração/estatística & dados numéricos , Orthomyxoviridae/isolamento & purificação , Orthomyxoviridae/patogenicidade , Instituições Residenciais/normas , Instituições Residenciais/estatística & dados numéricos , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/prevenção & controle , Infecções Estreptocócicas/transmissão , Streptococcus pyogenes/isolamento & purificação
8.
J Hosp Infect ; 101(4): 399-407, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30738912

RESUMO

BACKGROUND: Hand hygiene (HH) plays an important role in infection prevention but is often suboptimal. AIM: To test the potential of goal setting and performance feedback in improving HH. METHODS: A prospective controlled intervention study was conducted at a German hospital. The study involved four phases: habituation to novel count dispensers and observers (T0), baseline (T1), intervention (T2) and postintervention (T3). Four non-intensive-care units were assigned to one of four conditions: goal setting, performance feedback, both goal setting and performance feedback, or none (control). During all phases, dispenser usage was electronically recorded 24/7. In addition, randomly sampled direct observation was conducted by trained external observers during each phase. The main outcome measure was the daily average of electronically counted hand hygiene events (HHEs) per patient room. FINDINGS: In the feedback condition, a marginally significant increase in HHEs was found from T1 to T2 (MT1 = 7.3, MT2 = 10.3, MT3 = 8.2). In the goal-setting condition, HHEs increased only descriptively from T1 to T2 (MT1 = 6.8, MT2 = 8.7, MT3 = 7.8). In the combined condition, HHEs increased significantly from T1 to T2, and were still significantly elevated at T3 (MT1 = 7.9, MT2 = 17.0, MT3= 12.9). Over all wards and study phases, count dispenser usage frequency was highly correlated with HH compliance (ρ = 0.766, P<0.001). CONCLUSION: This study suggests that combining goal setting and feedback is a useful approach for improving HH.


Assuntos
Terapia Comportamental/métodos , Infecção Hospitalar/prevenção & controle , Higiene das Mãos/organização & administração , Higiene das Mãos/estatística & dados numéricos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Planejamento de Assistência ao Paciente , Utilização de Procedimentos e Técnicas/organização & administração , Estudos Controlados Antes e Depois , Retroalimentação , Alemanha , Hospitais , Humanos , Estudos Prospectivos
9.
Rev Gaucha Enferm ; 40(spe): e20180193, 2019 Jan 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30652805

RESUMO

OBJECTIVE: To evaluate the hospital infrastructure and the knowledge of the coordinators about the unit structure for hand hygiene. METHODS: Descriptive cross-sectional design study carried out in a teaching hospital in the South of Brazil, in the period between December 2016 and January 2017. Eighteen inpatient care units were evaluated, and 16 coordinators were interviewed. We used the questionnaire of the World Health Organization multimodal strategy on the structure of the units for hand hygiene. It was used descriptive statistics. RESULTS: All the units had alcohol-based sanitizers, and 93.8% of the dispensers were substituted when they got empty. The difficulties observed were the lack of illustrating posters, the location of sinks and dispensers of alcohol-based hand sanitizers in some nursing infirmarys, and the fact that there were few dispensers at hand reach near the patient's bed. CONCLUSIONS: We concluded that there were protocols for hand hygiene, and professionals were instructed about it. There were gaps in the inpatient units, such as the presence of inadequate sinks and taps.


Assuntos
Higiene das Mãos/organização & administração , Higiene das Mãos/normas , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino/normas , Brasil , Estudos Transversais , Humanos , Autorrelato
10.
J Patient Saf ; 15(1): 49-54, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-26067748

RESUMO

OBJECTIVES: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Mexico, and analyze predictors of poor HH compliance. METHODS: From June 2002 to April 2006, we conducted a prospective, observational, before-and-after study in 8 intensive care units (ICUs) from 6 hospitals in 3 cities of Mexico. The approach included administrative support, availability of supplies, education and training, reminders in the workplace, process surveillance, and performance feedback. RESULTS: A total of 13,201 observations for HH opportunities were done in each ICU, during randomly selected 30-minute periods. Overall, HH compliance increased from 45% to 79% (95% confidence interval [CI], 69.1-86.5; P = 0.01). Univariate and multivariate analyses showed that several variables were significantly associated with poor HH compliance: males versus females (61% versus 66%; 95% CI, 0.91-0.96; P = 0.0001), physicians versus nurses (62% versus 67%; 95% CI, 0.91-0.97; P = 0.0001), and adult versus neonatal ICUs (67% versus 54%; 95% CI, 0.79-0.84; P = 0.0001), among others. CONCLUSIONS: Hand hygiene programs should focus on variables found to be predictors of poor HH compliance.


Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/normas , Higiene das Mãos/organização & administração , Controle de Infecções/métodos , Unidades de Terapia Intensiva/normas , Adulto , Cidades , Feminino , Humanos , Recém-Nascido , Masculino , México , Estudos Prospectivos
11.
Rev. gaúch. enferm ; 40(spe): e20180193, 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-978517

RESUMO

Resumo OBJETIVO Avaliar a infraestrutura hospitalar e o conhecimento dos coordenadores sobre a estrutura da unidade para à higienização das mãos. MÉTODO Estudo transversal descritivo realizado em um hospital universitário no Sul do Brasil, entre dezembro de 2016 e janeiro de 2017. Foram avaliadas 18 unidades de internação e entrevistados 16 coordenadores. Utilizou-se o questionário sobre estrutura da unidade para a higienização das mãos da estratégia multimodal da Organização Mundial de Saúde. Utilizou-se a estatística descritiva. RESULTADOS Todas as unidades possuíam preparações alcóolicas, e 93,8% dos dispensadores eram substituídos quando vazios. Observaram-se falta de cartazes ilustrativos, dispensadores de álcool gel, pias em algumas enfermarias, e pouca disponibilidade de dispensadores ao alcance das mãos próximos ao leito/maca do paciente. CONCLUSÕES Constatou-se que os profissionais recebiam instruções para a higienização das mãos e a existência de protocolos. Lacunas foram observadas na infraestrutura das unidades, como a presença de pias e torneiras não adequadas.


Resumen OBJETIVO Evaluar la infraestructura hospitalaria y el conocimiento de los coordinadores sobre la estructura de la unidad para la higienización de las manos. MÉTODO Estudio transversal descriptivo realizado en un hospital universitario en el Sur de Brasil, entre diciembre de 2016 y enero de 2017. Se evaluaron 18 unidades de internación y 16 coordinadores han sido entrevistados. Se utilizó la encuesta sobre la estructuración de las unidades hospitalarias para la higienización de las manos de la estrategia multimodal de la Organización Mundial de la Salud y se utilizó la estadística descriptiva. RESULTADOS Todas las unidades poseían preparados alcohólicos y el 93,8% de los dispensadores eran reemplazados cuando quedaban vacíos. Se observaron falta de carteles ilustrativos, de dispensadores de alcohol gel, de lavabos en algunas enfermerías, y de poca disponibilidad de dispensadores al alcance de las manos cerca del lecho/ maca del paciente. CONCLUSIONES Se constató que los profesionales recibían instrucciones para la higienización de las manos y que había protocolos para esta práctica. Se observaron algunas fallas en la infraestructura de las unidades, además de la inadecuación de algunos lavabos y grifos.


Resumo OBJECTIVE To evaluate the hospital infrastructure and the knowledge of the coordinators about the unit structure for hand hygiene. Methods Descriptive cross-sectional design study carried out in a teaching hospital in the South of Brazil, in the period between December 2016 and January 2017. Eighteen inpatient care units were evaluated, and 16 coordinators were interviewed. We used the questionnaire of the World Health Organization multimodal strategy on the structure of the units for hand hygiene. It was used descriptive statistics. Results All the units had alcohol-based sanitizers, and 93.8% of the dispensers were substituted when they got empty. The difficulties observed were the lack of illustrating posters, the location of sinks and dispensers of alcohol-based hand sanitizers in some nursing infirmarys, and the fact that there were few dispensers at hand reach near the patient's bed. Conclusions We concluded that there were protocols for hand hygiene, and professionals were instructed about it. There were gaps in the inpatient units, such as the presence of inadequate sinks and taps.


Assuntos
Humanos , Conhecimentos, Atitudes e Prática em Saúde , Higiene das Mãos/normas , Higiene das Mãos/organização & administração , Hospitais de Ensino/normas , Brasil , Estudos Transversais , Autorrelato
12.
Lancet Infect Dis ; 18(11): 1269-1277, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30274723

RESUMO

BACKGROUND: The National Hand Hygiene Initiative (NHHI) is a standardised culture-change programme based on the WHO My 5 Moments for Hand Hygiene approach to improve hand hygiene compliance among Australian health-care workers and reduce the risk of health-care-associated infections. We analysed its effectiveness. METHODS: In this longitudinal study, we assessed outcomes of the NHHI for the 8 years after implementation (between Jan 1, 2009, and June 30, 2017), including hospital participation, hand hygiene compliance (measured as the proportion of observed Moments) three times per year, educational engagement, cost, and association with the incidence of health-care-associated Staphylococcus aureus bacteraemia (HA-SAB). FINDINGS: Between 2009 and 2017, increases were observed in national health-care facility participation (105 hospitals [103 public and two private] in 2009 vs 937 hospitals [598 public and 339 private] in 2017) and overall hand hygiene compliance (36 213 [63·6%] of 56 978 Moments [95% CI 63·2-63·9] in 2009 vs 494 673 [84·3%] of 586 559 Moments [84·2-84·4] in 2017; p<0·0001). Compliance also increased for each Moment type and for each health-care worker occupational group, including for medical staff (4377 [50·5%] of 8669 Moments [95% CI 49·4-51·5] in 2009 vs 53 620 [71·7%] of 74 788 Moments [71·4-72·0]; p<0·0001). 1 989 713 NHHI online learning credential programmes were completed. The 2016 NHHI budget was equivalent to AUD$0·06 per inpatient admission nationally. Among Australia's major public hospitals (n=132), improved hand hygiene compliance was associated with declines in the incidence of HA-SAB (incidence rate ratio 0·85; 95% CI 0·79-0·93; p≤0·0001): for every 10% increase in hand hygiene compliance, the incidence of HA-SAB decreased by 15%. INTERPRETATION: The NHHI has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of HA-SAB. Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes. FUNDING: Australian Commission on Safety and Quality in Health Care.


Assuntos
Bacteriemia/prevenção & controle , Infecção Hospitalar/prevenção & controle , Higiene das Mãos/métodos , Higiene das Mãos/organização & administração , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Infecções Estafilocócicas/prevenção & controle , Austrália/epidemiologia , Bacteriemia/epidemiologia , Fidelidade a Diretrizes , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Incidência , Estudos Longitudinais , Infecções Estafilocócicas/epidemiologia
13.
BMC Infect Dis ; 18(1): 369, 2018 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-30081843

RESUMO

BACKGROUND: Observation and feedback are core strategies of hand hygiene (HH) improvement. Direct overt observation is currently the gold standard method. Observation bias, also known as the Hawthorne effect, is a major disadvantage of this method. Our aim was to examine the variation of the Hawthorne effect on HH observation in different healthcare groups and settings. METHODS: A prospective cohort study was performed in a tertiary teaching hospital during a 15-month period. Up to 38 overt observers (82% nurses) and 93 covert observers (81% medical students) participated in HH observation. The HH events observed overtly were matched for occupation, department, observation time, and location with those observed covertly. The data of matched pairs were then analysed to detect possible Hawthorne effects on different variables. RESULTS: A total of 31,522 HH opportunities were observed (4581 overtly, 26,941 covertly). There were 3047 matched pairs after 1:1 matching of overt and covert observations. The overall HH compliance was higher with overt observation than with covert observation (78% vs. 55%, p < 0.001). The Hawthorne effect was nearly three times larger in nurses (30 percentage points) than in physicians (11 percentage points) and was significantly greater in outpatient clinics (41 percentage points) than in intensive care units (11 percentage points). The magnitude of the Hawthorne effect varied among healthcare worker occupations and observation locations (p values both < 0.001) but not among departments, observation times, or HH indications. CONCLUSIONS: Heterogeneity in the Hawthorne effect may influence the interpretation of overt observations and prevent the correct identification of target populations with poor HH compliance. Therefore, directly observed HH compliance may not be an adequate performance indicator for infection control.


Assuntos
Modificador do Efeito Epidemiológico , Higiene das Mãos/organização & administração , Controle de Infecções/métodos , Estudos de Coortes , Fidelidade a Diretrizes , Higiene das Mãos/estatística & dados numéricos , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros , Ambulatório Hospitalar , Médicos , Estudos Prospectivos , Estudantes de Medicina , Taiwan
15.
Int J Qual Health Care ; 30(9): 724-730, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29788245

RESUMO

Quality issue: Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Initial assessment: Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. Choice of solution: A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. Implementation: To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Evaluation: Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. Lessons learned: The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.


Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos/organização & administração , Ciência da Implementação , Unidades de Terapia Intensiva Neonatal/normas , Gana , Fidelidade a Diretrizes , Pessoal de Saúde/psicologia , Humanos , Recém-Nascido , Controle de Infecções/métodos , Ensino , Centros de Atenção Terciária
16.
Am J Infect Control ; 46(8): 870-875, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29650487

RESUMO

BACKGROUND: Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs' likelihood to speak up. METHODS: A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model. RESULTS: Of surveyed HCPs (n = 1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P < .001), felt more discomfort with speaking up (4.00 vs 3.34, P < .001), and reported a slightly lower likelihood of speaking up (4.41 vs 4.77, P < .001). Clinical function (hierarchy) was strongly associated with speaking-up behavior (P < .001). Higher risk of harm to the patient (P < .001) and higher frequencies of past speaking-up behaviors (P = .006) were positively associated with the likelihood to speak up. Higher frequencies of past withholding voice (P = .013) and higher levels of resignation (P = .008) were both associated with a lower likelihood to speak up. CONCLUSIONS: Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes , Higiene das Mãos/métodos , Pessoal de Saúde/psicologia , Controle de Infecções/métodos , Segurança do Paciente/normas , Adulto , Estudos Transversais , Feminino , Higiene das Mãos/organização & administração , Instalações de Saúde , Humanos , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Suíça
17.
Enferm. glob ; 17(50): 430-445, abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173561

RESUMO

Objetivo: Identificar la adhesión a la Higienización de las manos de los profesionales de enfermería de una Unidad de Cuidados Intensivos para adultos de un hospital universitario público. Metodología: Estudio descriptivo, transversal, observacional, con abordaje cuantitativo, realizado con 68 profesionales en un hospital universitario del estado de Paraná, Brasil. La recolección de datos ocurrió de mayo a octubre de 2016, por 100 horas de observación directa. Se elaboró un formulario para caracterizar a los participantes y utilizado el Instrumento Adaptado del Manual para Observadores - Estrategia Multimodal de la Organización Mundial de Salud para la Mejora de la Higienización de las manos. Los datos fueron sometidos al análisis descriptivo, en medidas de proporción, y al test Chi-cuadrado de Pearson, en el Software SPSS versión 18.0, para verificar la asociación entre la adhesión y la no adhesión a la HM en cada uno de los cinco momentos recomendados y entre los profesionales (enfermero o técnico de enfermería), considerando nivel de significancia del 5%. Resultados: Eran enfermeros 12 (17,6%) profesionales y 56 (82,4%) técnicos de enfermería. La tasa de adhesión general a la Higienización de las manos por el equipo de enfermería fue de 311 (47,8%). No hubo adhesión al momento "antes de la realización de procedimientos asépticos". Los momentos "después" presentaron mayores índices de adhesión. Conclusión: La tasa de adhesión a la HM fue muy baja, y la práctica de higiene antes del contacto con el paciente crítico necesita ser mejorada con mayor urgencia


Objetivo: Identificar a adesão à Higienização das Mãos dos profissionais de enfermagem de uma Unidade de Terapia Intensiva para adultos de um hospital universitário público. Metodologia: Estudo descritivo, transversal, observacional, com abordagem quantitativa, realizado com 68 profissionais em um hospital universitário do estado do Paraná, Brasil. A coleta de dados ocorreu de maio a outubro de 2016, por 100 horas de observação direta. Foi elaborado um formulário para caracterização dos participantes e utilizado o Instrumento Adaptado do Manual para Observadores - Estratégia Multimodal da Organização Mundial de Saúde para Melhoria da Higienização das Mãos. Os dados foram submetidos à análise descritiva, em medidas de proporção, e ao teste Qui-Quadrado de Pearson, no Software SPSS versão 18.0, para verificar a associação entre a adesão e a não adesão à HM em cada um dos cinco momentos recomendados e entre os profissionais (enfermeiro ou técnico de enfermagem), considerando nível de significância de 5%. Resultados: Eram enfermeiros 12 (17,6%) profissionais e 56 (82,4%) técnicos de enfermagem. A taxa de adesão geral à Higienização das Mãos pela equipe de enfermagem foi de 311 (47,8%). Não houve adesão ao momento "antes da realização de procedimentos assépticos". Os momentos "após" apresentaram maiores índices de adesão. Conclusão: A taxa de adesão à HM foi muito baixa, e, a prática de higiene antes do contato com o paciente crítico precisa ser melhorada com maior urgencia


Objective: To identify adherence to Hand Hygiene (HH) of the nursing professionals of an Intensive Care Unit for adults of a public university hospital. Methodology: Descriptive, cross-sectional, observational study with a quantitative approach, carried out with 68 professionals in a university hospital in the state of Paraná, Brazil. Data collection occurred from May to October of 2016 for 100 hours of direct observation. A form was developed for characterization of the participants and the Adapted Instrument of the Handbook for Observers - Multimodal Strategy of the World Health Organization for the Improvement of Hand Hygiene was developed. Data were submitted to descriptive analysis, in proportion measurements and Pearson's Chi-Square test, in SPSS Software version 18.0, to verify the association between adhesion and non-adhesion to HH in each of the five recommended moments and among professionals (nurse or technician of nursing), considering a level of significance of 5%. Results: 12 (17.6%) were professional nurses and 56 (82.4%) were nursing technicians. The nursing staff received a general adhesion rate of 311 (47.8%). There was no adhesion to the moment "before performing aseptic procedures". The "after" moments presented higher accession rates. Conclusion: The rate of adhesion to HH was very low, and hygiene practice before contact with the critical patient needs to be improved with greater urgency


Assuntos
Humanos , Masculino , Feminino , Adulto , Higiene das Mãos/métodos , Cuidados Críticos , Segurança do Paciente , Higiene das Mãos/organização & administração , Higiene das Mãos/tendências , Unidades de Terapia Intensiva/organização & administração , Estudos Transversais/métodos
19.
J Patient Saf ; 14(2): 107-111, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-25803175

RESUMO

OBJECTIVES: Hand hygiene (HH) is critical to prevent health care-acquired infections. However, compliance by health care workers remains between 30% and 70% at most institutions. Most efforts to improve compliance have proven ineffective. The objective of this study was to determine whether a safety stand-down can improve HH compliance. METHODS: We adapted and borrowed from the military an approach known as a stand-down. A mandatory Hand-Hygiene Leadership Safety Summit was called for all hospital leaders-physicians and nonphysicians. Four days later, a hospital-wide 15-minute-long safety stand-down occurred, during which all nonessential activity was suspended and action plans to improve HH compliance were discussed. All medical sections and hospital departments were required to submit written action plans. After the stand-down, HH compliance monitoring was increased, and noncompliers were required to speak to senior hospital administration. RESULTS: Compliance increased from less than 65% to greater than 95% (P < 0.001) and has been sustained for 3½ years. CONCLUSIONS: A health care safety stand-down can be an effective method to rapidly change and sustain culture change regarding HH in the inpatient hospital setting.


Assuntos
Fidelidade a Diretrizes/organização & administração , Higiene das Mãos/organização & administração , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos , Higiene das Mãos/normas , Pessoal de Saúde , Hospitais , Humanos , Controle de Infecções , Liderança
20.
J Adv Nurs ; 74(4): 827-837, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29117448

RESUMO

AIMS: The objectives of the study were to: (1) examine the relationships between three different qualitative perceptions of safety culture and the Canadian Patient Safety Climate Survey factors; (2) determine whether these perceptions are associated with different hand hygiene practices. BACKGROUND: Healthcare-associated infections and safety cultures are a worldwide issue. During the A/H1N1 Influenza pandemic, Europe and North America did not have the same responses. Importantly, healthcare professionals' perceptions can influence patient safety through infection prevention practices like hand hygiene. DESIGN: A cross-sectional design was used with data collected in 2015. METHODS: The Canadian Patient Safety Culture Survey and hand hygiene observations were gathered from three healthcare centres (two Canadian and one European). Descriptive analyses and ANOVAs were conducted to explore healthcare professionals' safety perceptions and practices. RESULTS: The rates of hand hygiene practices varied widely between the three sites, ranging from 35-77%. One site (Site 3) was found to have the highest scores of management follow-up, feedback about incidents, supervisory leadership for safety, unit learning culture and senior leadership support for safety, and the highest levels of overall patient safety grades for the unit and organization. CONCLUSION: The quantitative results of this study support the previously described model based on qualitative results: individual culture, blaming culture and collaborative culture. Differences between continents emerged regarding infection prevention practices and the way we qualify infections. The results raise concerns about infection practices and about safety cultures and challenges worldwide.


Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Higiene das Mãos/organização & administração , Pessoal de Saúde/psicologia , Segurança do Paciente/normas , Gestão de Riscos/organização & administração , Gestão da Segurança/organização & administração , Atitude do Pessoal de Saúde , Bélgica , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
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