Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals

2008 ◽  
Vol 29 (11) ◽  
pp. 1035-1041 ◽  
Author(s):  
Philip C. Carling ◽  
Michael M. Parry ◽  
Mark E. Rupp ◽  
John L. Po ◽  
Brian Dick ◽  
...  
Keyword(s):  
Acute Care ◽  
Performance Feedback ◽  
Hospital Setting ◽  
Acute Care Hospitals ◽  
The United States ◽  
Multidrug Resistant ◽  
Environmental Services ◽  
Environmental Surfaces ◽  
Before And After ◽  
Quasi Experimental

Objective.The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.Design.Prospective quasi-experimental, before-after, study.Setting.Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.Methods.We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.Results.Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).Conclusions.Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers

2019 ◽  
Vol 40 (9) ◽  
pp. 1024-1029 ◽  
Author(s):  
Elena K. Martin ◽  
Elizabeth L. Salsgiver ◽  
Daniel A. Bernstein ◽  
Matthew S. Simon ◽  
William G. Greendyke ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Culture Change ◽  
Acute Care Hospitals ◽  
Role Playing ◽  
Environmental Services ◽  
Audience Response ◽  
Post Intervention ◽  
Before And After ◽  
Quasi Experimental

AbstractObjective:To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.Design:Prospective, quasi-experimental, before-and-after intervention study.Setting:The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.Participants:Frontline environmental services workers.Intervention:A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.Results:On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.Conclusion:A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.

Preparation of Children for Hospitalization in Acute Care Hospitals in the United States

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 361-368
Author(s):  
Pat Azarnoff ◽  
Patricia D. Woody
Keyword(s):  
United States ◽  
Acute Care ◽  
Group Discussion ◽  
Acute Care Hospitals ◽  
The United States ◽  
Pediatric Care ◽  
Children's Hospitals ◽  
General Hospitals ◽  
Psychological Preparation ◽  
Children’S Hospitals

To study the prevalence and nature of psychological preparation for pediatric care, children's hospitals and acute care general hospitals were surveyed, and 24 hospitals were visited. Of 1,427 hospitals responding, 468 (33%) provided regular, planned preparation services. Prior to hospitalization, group tours and group discussion were the two most frequently used methods. During hospitalization, children learned informally as events occurred, usually through conversations.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

Pressure Ulcers and Prevention Among Acute Care Hospitals in the United States

2013 ◽  
Vol 39 (9) ◽  
pp. 404-414 ◽  
Author(s):  
Sandra Bergquist-Beringer ◽  
Lei Dong ◽  
Jianghua He ◽  
Nancy Dunton
Keyword(s):  
United States ◽  
Acute Care ◽  
Pressure Ulcers ◽  
Acute Care Hospitals ◽  
The United States

Simulation Use in Acute Care Hospitals in the United States

2018 ◽  
Vol 34 (5) ◽  
pp. 242-249 ◽  
Author(s):  
Mary G. Harper ◽  
Gregory E. Gilbert ◽  
Marie Gilbert ◽  
Linda Markey ◽  
Krista Anderson
Keyword(s):  
United States ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States

scholarly journals Communication behavior of cognitively impaired older inpatients

2019 ◽  
Vol 52 (S4) ◽  
pp. 264-272
Author(s):  
Eva-Luisa Schnabel ◽  
Hans-Werner Wahl ◽  
Susanne Penger ◽  
Julia Haberstroh
Keyword(s):  
Cognitive Impairment ◽  
Psychometric Properties ◽  
Acute Care ◽  
Older Patients ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Well Being ◽  
Communication Behavior ◽  
Care Hospital

Abstract Background and objective Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients’ well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. Material and methods Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. Results Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. Conclusion CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.

Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions

2019 ◽  
Vol 40 (05) ◽  
pp. 559-565 ◽  
Author(s):  
Koh Okamoto ◽  
Yoona Rhee ◽  
Michael Schoeny ◽  
Karen Lolans ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Healthcare Worker ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Research Personnel ◽  
Contact Precautions ◽  
Patient Interaction ◽  
Environmental Surfaces ◽  
Before And After ◽  
Cdc Guidelines ◽  
The Impact

AbstractObjective:We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).Design:Prospective, observational study.Setting:The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital.Participants:HCWs who cared for patients on contact precautions for methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines.Results:We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69;P= .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76;P= .025).Conclusion:When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.

scholarly journals A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250455
Author(s):  
Raeseok Lee ◽  
Su-Mi Choi ◽  
Sung Jin Jo ◽  
Songyi Han ◽  
Yun Jeong Park ◽  
...  
Keyword(s):  
Experimental Study ◽  
Education And Training ◽  
Multidrug Resistant ◽  
Blood Agar Plate ◽  
Resistant Bacteria ◽  
Contamination Rate ◽  
Nosocomial Pathogens ◽  
Before And After ◽  
Quasi Experimental ◽  
And Training

Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and effectiveness of disinfection training to reduce. This study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in disinfection of stethoscopes among healthcare workers (HCWs) before and after education and training. We performed a prospective pre and post quasi-experimental study. A total of 100 HCWs (55 doctors and 45 nurses) were recruited. HCWs were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis was performed to determine the relatedness of carbapenem-resistant Enterobacteriaceae. Most of the stethoscopes were contaminated with microorganisms before and after the intervention (97.9% and 91.5%, respectively). The contamination rate of stethoscopes with nosocomial pathogens before and after education was 20.8% and 19.2%, respectively. Stethoscope disinfection habits improved (55.1% vs 31.0%; p<0.001), and the overall bacterial loads of contamination were reduced (median colony-forming units, 15 vs 10; p = 0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae isolates from a stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used. Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and might act as a vehicle of MDR bacteria. Continuous, consistent education and training should be provided to HCWs using multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Sign in / Sign up

Export Citation Format

Share Document