scholarly journals Healthcare Worker Experiences Implementing CRE Infection Control Measures at a vSNF—A Qualitative Analysis

2020 ◽  
Vol 41 (S1) ◽  
pp. s244-s245
Author(s):  
Katharina Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl Froilan ◽  
Ellen Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Qualitative Analysis ◽  
Healthcare Worker ◽  
Family Environment ◽  
Healthcare Workers ◽  
Control Measures ◽  
Contact Precaution ◽  
Improvement Project ◽  
Infection Control Measures ◽  
Semistructured Interviews

Background: During 2017–2019 in the Chicago region, several ventilator-capable skilled nursing facilities (vSNFs) participated in a quality improvement project to control the spread of highly prevalent carbapenem-resistant Enterobacteriaceae (CRE). With guidance from regional project coordinators and public health departments that involved education, assistance with implementation, and adherence monitoring, the facilities implemented a CRE prevention bundle that included a hand hygiene campaign that promoted alcohol-based hand rub, contact precautions (personal protective equipment with glove/gown) for care of CRE-colonized residents, and 2% chlorhexidine gluconate (CHG) wipes for routine resident bathing. We conducted a qualitative study to better understand the ways that vSNF employees engage with the implementation of such infection control measures. Methods: A PhD-candidate medical anthropologist conducted semistructured interviews with management (N = 5), nursing staff (N = 6), and certified nursing assistants (N = 6) at a vSNF in the Chicago region (Illinois) between September 2018 and November 2018. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis focused on identifying healthcare worker experiences during an infection control intervention. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Healthcare workers described the facility using language associated with a family environment (Table 1). Furthermore, healthcare workers demonstrated motivation to implement infection control policies (Table 2). However, healthcare workers expressed cultural and structural challenges encountered during implementation, such as their belief that some infection control measures discouraged maintenance of a home-like environment, lack of time, and understaffing. Some healthcare workers perceived that alcohol-based hand rub was ineffective over time and left unpleasant textures on the skin. Additionally, some workers did not trust the available gown and gloves used to prevent transmission. Lastly, healthcare workers typically did not prefer 2% CHG wipes over soap and water, citing residual resident postbathing smell as one indicator of CHG ineffectiveness. Conclusions: In a vSNF we found both considerable support and challenges implementing a CRE prevention bundle from the healthcare worker perspective. Healthcare workers were dedicated to recreating a home-like environment for their residents, which sometimes felt at odds with infection control interventions. Residual misconceptions (eg, alcohol-based hand rub is not effective) and negative worker perceptions (eg, permeability of contact precaution gowns and/or residue from alcohol-based hand rub) suggest that ongoing education and participation by healthcare workers in evaluating infection control products for interventions is critical.Funding: NoneDisclosures: None

scholarly journals Infection Control of 2019 Novel Corona Virus Disease (COVID-19) in Cancer Patients undergoing Radiotherapy in Wuhan

2020 ◽  
Author(s):  
Conghua Xie ◽  
Xiaoyong Wang ◽  
Hui Liu ◽  
Zhirong Bao ◽  
Jing Yu ◽  
...  
Keyword(s):  
Infection Control ◽  
Head And Neck ◽  
Cancer Patients ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Virus Disease ◽  
Hubei Province ◽  
Control Measures ◽  
Infection Control Measures ◽  
Corona Virus

AbstractBackgroundA pandemic of 2019 novel corona virus disease (COVID-19), which was first reported in Wuhan city, has affected more than 100,000 patients worldwide. Patients with cancer are at a higher risk of COVID-19, but currently, there is no guidance on the management of cancer patients during this outbreak. Here, we report the infection control measures and early outcomes of patients who received radiotherapy (RT) at a tertiary cancer centre in Wuhan.MethodsWe reviewed all patients who were treated at the Zhongnan Hospital of Wuhan University (ZHWU) from Jan 20 to Mar 6, 2020. This preceded the city lock-down date of Jan 23, 2020. Infection control measures were implemented, which included a clinical pathway for managing suspect COVID-19 cases, on-site screening, modifications to the RT facility, and protection of healthcare workers. Primary end-point was infection rate among patients and healthcare staff. Diagnosis of COVID-19 was based on the 5th edition criteria.Findings209 patients completed RT during the study period. Median age was 55 y (IQR = 48-64). Thoracic, head and neck, and lower gastrointestinal and gynaecological cancer patients consisted the majority of patients. Treatment sites included thoracic (38.3%), head and neck (25.4%), and abdomen and pelvis (25.8%); 47.4%, 27.3%, and 25.4% of treatments were for adjuvant, radical, and palliative indications, respectively. 188 treatments/day were performed prior to the lock-down, in contrast to 12.4 treatments/day post-lock-down. Only one (0.48%) patient was diagnosed with COVID-19 during the study period. No healthcare worker was infected.InterpretationHerein, we show that in a susceptible population to COVID-19, strict infection control measures can curb human-to-human transmission, and ensure timely delivery of RT to cancer patients.FundingThis study was funded by Health Commission of Hubei Province Scientific Research Project, WJ2019H002, Health Commission of Hubei Province Medical Leading Talent Project.Research in contextEvidence before this studyThe 2019 novel coronavirus disease (COVID-19) is now a global pandemic. Cancer patients are at risk of COVID-19 pneumonia, and thus infection control measures are crucial to mitigate their risk of infection. We searched PubMed and Medline for articles published up to Mar 12, 2020, using the following keywords: “COVID-19”, “SARS”, “SARS-CoV-2”, “infection control”, and “cancer”. No evidence exists that informs on the appropriate infection control measures for COVID-19.Added value of this studyWe report our single centre experience on the detailed infection control measures that were undertaken to minimise cross transmission between cancer patients undergoing radiotherapy, and between patients and healthcare workers. Measures entailing screening of suspect cases, re-organisation of the treatment facility, and protection of healthcare workers were described. With our infection control protocol, we recorded only one COVID-19 case among the 209 patients (0.48%) who were treated at our centre during the period of Jan 20 to Mar 6, 2020. No healthcare worker was affected.Implications of all the available evidenceThe effective infection control measures outlined in this study will help institutions worldwide affected by COVID-19 to formulate guidelines to mitigate nosocomial human-to-human transmission, especially among susceptible patients.

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

2021 ◽  
pp. 1-7
Author(s):  
Katharina R. Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl M. Froilan ◽  
Ellen C. Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Skilled Nursing ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Resident Care ◽  
Semistructured Interviews ◽  
Self Protection

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

Personal Healthcare Worker (HCW) and Work-Site Characteristics That Affect HCWs' Use of Respiratory-Infection Control Measures in Ambulatory Healthcare Settings

2009 ◽  
Vol 30 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Wayne Turnberg ◽  
William Daniell ◽  
Terri Simpson ◽  
Jude Van Buren ◽  
Noah Seixas ◽  
...  
Keyword(s):  
Infection Control ◽  
Healthcare Worker ◽  
Respiratory Infection ◽  
Emergency Care ◽  
Control Measures ◽  
Management Support ◽  
Cross Sectional ◽  
Work Site ◽  
Infection Control Measures ◽  
Site Characteristics

Objectives.To identify healthcare worker (HCW) and work-site characteristics associated with HCWs' reported use of recommended respiratory-infection control practices in primary and emergency care settings.Design.A cross-sectional study using a self-administered questionnaire for HCWs during the summer and fall of 2005.Setting.Primary and emergency care clinics at 5 medical centers in King County, Seattle, Washington.Results.Nurse professionals who reported receiving training (odds ratio [OR], 2.5 [confidence interval {CI}, 1.1–5.9]; P = .029), instructional feedback from supervisors (OR, 3.0 [CI, 1.5–5.9]; P = .002), and management support for implementing safe work practices had a higher odds of also reporting adherence to recommended respiratory precautions, compared with nurses who did not. Training was the only important determinant for adherence to respiratory precaution measures among medical practitioners (OR, 5.5 [CI, 1.2–25.8]; P = .031). The reported rate of adherence to hand hygiene practices was higher among nurse professionals who were male (OR, 2.2 [CI, 1.0–4.9]; P = .045), had infants, small children, or older adults living at home (OR, 2.2 [CI, 1.2–3.9]; P = .007), reported cleanliness and orderliness of the establishment where they worked (OR, 2.0 [CI, 1.1–3.5]; P = .019), had received respiratory-infection control training (OR, 3.2 [CI, 1.8–6.0]; P<.001), and reported fears about catching a dangerous respiratory infection at work (OR, 2.3 [CI, 1.2–4.5]; P= .011).Conclusion.A number of HCW and work-site characteristics associated with HCWs' use of recommended respiratory-infection control measures have been identified. These potentially influential characteristics should be considered as targets or guides for further investigation, which should include the evaluation of intervention strategies.

scholarly journals Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

PLoS ONE ◽  
2013 ◽  
Vol 8 (10) ◽  
pp. e76272 ◽  
Author(s):  
Mareli M. Claassens ◽  
Cari van Schalkwyk ◽  
Elizabeth du Toit ◽  
Eline Roest ◽  
Carl J. Lombard ◽  
...  
Keyword(s):  
South Africa ◽  
Infection Control ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Control Measures ◽  
Healthcare Facilities ◽  
Infection Control Measures

scholarly journals COVID-19 Critical Care Simulations: An International Cross-sectional Survey

2020 ◽  
Author(s):  
Mohamad-Hani Temsah ◽  
Abdulkarim Alrabiaah ◽  
Ayman Al-Eyadhy ◽  
Fahad Al-Sohime ◽  
Abdullah Al Huzaimi ◽  
...  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Primary Outcome ◽  
Control Measures ◽  
Team Leaders ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Transport ◽  
Infection Control Measures ◽  
Better Than

Abstract Background: Many healthcare systems initiated rapid training with COVID-19 simulations for their healthcare workers (HCWs) to build surge capacity and optimize infection control measures. This study aimed to describe COVID-19 simulation drills in international healthcare centers. Methods: This is a cross-sectional survey among simulation team leaders and HCWs, based on each center's debriefing reports from simulation centers from 30 countries in all WHO regions where COVID-19 simulation drills were conducted. The primary outcome measures were the COVID-19 simulations' characteristics, outcomes, facilitators, obstacles, and challenges encountered during the simulation sessions. Results: Invitation was sent to 500 simulation team leaders and HCWs, and 343 responded. Those who completed the study comprised 121 participants: 62.8% females; 56.2% physicians; 41.3% from East Mediterranean (EMRO) countries; 25.6% from Southeast Asian countries (SERO); and 12.4% from Europe. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Among participants, 55.6% reported the team's full engagement in the simulation sessions. The average session length was 30–60 minutes. The most commonly reported debriefing leaders were ICU staff, simulation lab staff, and E.R. facilitators, and the least common were infection control staff. A total of 80% reported "a lot" to "a great improvement" in terms of clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 simulation sessions and thought they were better than expected. Most of the perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. Conclusion: Simulation centers team leaders and HCWs reported positive feedback on COVID-19 simulation sessions. The presence of multiprofessional personnel during drills is warranted. These drills are a valuable tool for rehearsing safe dynamics of HCWs on the frontline of COVID-19.Trial registration: Not applicable.

scholarly journals Management of a Hospital-Wide COVID-19 Outbreak Affecting Patients and Healthcare Workers

2020 ◽  
Vol 2 (12) ◽  
pp. 2540-2545
Author(s):  
Steffen Höring ◽  
René Fussen ◽  
Johannes Neusser ◽  
Michael Kleines ◽  
Thea Laurentius ◽  
...  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Spatial Separation ◽  
Control Measures ◽  
Medical Conditions ◽  
Hospital Workers ◽  
Infection Control Team ◽  
Healthcare Facilities ◽  
Infection Control Measures ◽  
Control Team

AbstractTo the best of our knowledge, here, we describe the first hospital-wide outbreak of SARS-CoV-2 that occurred in Germany in April 2020. We aim to share our experience in order to facilitate the management of nosocomial COVID-19 outbreaks in healthcare facilities. All patients and hospital workers were screened for SARS-CoV-2 repeatedly. An infection control team on the side was installed. Strict spatial separation of patients and intensified hygiene training of healthcare workers (HCW) were initiated. By the time of reporting, 26 patients and 21 hospital workers were infected with a cluster of cases in the geriatric department. Fourteen patients developed COVID-19 consistent symptoms and five patients with severe pre-existing medical conditions died. The outbreak was successfully contained after intensified infection control measures were implemented and no further cases among patients were detected over a period of 14 days. Strict application of standard infection control measures proved to be successful in the management of nosocomial SARS-CoV-2 outbreaks.

scholarly journals Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review

2019 ◽  
Vol 53 (4) ◽  
pp. 1801789 ◽  
Author(s):  
Lika Apriani ◽  
Susan McAllister ◽  
Katrina Sharples ◽  
Bachti Alisjahbana ◽  
Rovina Ruslami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Infection Control ◽  
Healthcare Workers ◽  
Latent Tuberculosis ◽  
Annual Incidence ◽  
Control Measures ◽  
Middle Income ◽  
Middle Income Countries ◽  
Infection Control Measures ◽  
Increased Risk

Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005–June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14–98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9–86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41–69%; IGRA: pooled estimate 56%, 95% CI 39–73%). Annual incidence estimated from the TST was 1–38% (mean 17%); annual incidence estimated from the IGRA was 10–30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.

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