scholarly journals Measuring the Impact of Continuous Disinfection Strategies on Environmental Burden in Outpatient Settings: A Prospective Randomized Controlled Trial

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Bobby G Warren ◽  
Nicholas Turner ◽  
Becky Smith ◽  
Rachel Addison ◽  
Samantha Marden ◽  
...  
Keyword(s):  
Environmental Contamination ◽  
Quaternary Ammonium ◽  
Uv Light ◽  
Controlled Trial ◽  
Primary Objective ◽  
Outpatient Clinics ◽  
Environmental Surfaces ◽  
Before And After ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Our primary objective was to determine the effectiveness of 2 enhanced disinfection strategies compared with standard disinfection: “near-UV” light (Arm 1) and a persistent organosilane quaternary ammonium disinfectant (Arm 2) using a triple-blind study design. Our secondary objective was to characterize environmental contamination of outpatient clinics. Methods This trial was conducted at 2 clinics: the wound and pulmonary outpatient clinics at Duke University Health System in Durham, North Carolina. In Arm 1, room overhead lights were replaced with 405-nm near-UV visible light bulbs. In Arm 2, the organosilane quaternary ammonium disinfectant was applied to all room surfaces. The control arm received no intervention. All arms received routine disinfection. Room contamination was measured twice daily (before and after clinic) over 25 clinic days. Results The primary outcome was the change in total contamination, measured in colony forming units (CFUs), on environmental surfaces at the end of the clinic day compared with the beginning of the clinic day. Results from each intervention arm were compared against results from the control arm. The median delta total CFU for Arm 1 was 2092 CFUs (interquartile range [IQR], −1815 to 8566); the median delta for Arm 2 was 2016 CFUs (IQR, −1443 to 7430). Compared with the control arm (median delta = 1987 [IQR, −1611 to 15 857]), neither intervention led to a significant decrease in daily room contamination change (P for Arm 1 = 0.78 and P for Arm 2 = 0.71). Conclusions Neither near-UV lights or a persistent organosilane quaternary ammonium disinfectant reduced environmental contamination in 2 outpatient clinics compared with control rooms but did reduce the number of clinically important pathogens recovered.

Cross-sectional evaluation of surface contamination with 9 antineoplastic drugs in 93 Canadian healthcare centers: 2019 results

2020 ◽  
Vol 26 (8) ◽  
pp. 1921-1930
Author(s):  
Marie Palamini ◽  
Sébastien Gagné ◽  
Nicolas Caron ◽  
Jean-François Bussières
Keyword(s):  
Occupational Safety ◽  
Ultra Performance Liquid Chromatography ◽  
Primary Objective ◽  
Outpatient Clinics ◽  
Antineoplastic Drugs ◽  
Cross Sectional ◽  
Health Group ◽  
Liquid Chromatography Tandem Mass ◽  
Kolmogorov Smirnov ◽  
The Impact

Introduction The primary objective was to describe environmental contamination with National Institute for Occupational Safety and Health Group 1 hazardous drugs in oncology pharmacies and outpatient clinics in Canada in 2019, as part of an annual surveillance project. Methods In each participating center, 12 standardized sites (6 in the oncology pharmacy and 6 in outpatient clinic) were sampled. Each sample was prepared to allow quantification of six antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, gemcitabine, 5-fluorouracil, and irinotecan) by ultra-performance liquid chromatography-tandem mass spectrometry. Samples were also tested for three additional antineoplastic drugs (docetaxel, paclitaxel, and vinorelbine) without quantification. The impact of certain characteristics of the sampling sites was evaluated with a Kolmogorov–Smirnov test for independent samples. Results Ninety-three Canadian centers participated in 2019, with a total of 1045 surfaces sampled. Cyclophosphamide was the drug most often found in the surface samples (32.4% of samples with positive result), followed by gemcitabine (20.3%). The front grille inside the biological safety cabinet (81.5% of samples positive for at least one antineoplastic drug) and the armrest of a treatment chair (75.8%) were the most frequently contaminated surfaces. Centers with more oncology inpatient and outpatient beds, those that prepared more antineoplastic drugs each year, and those that used more cyclophosphamide each year had higher concentrations of cyclophosphamide contamination on the surfaces tested ( p <  0.0001). Conclusion Traces of dangerous drugs were found in oncology pharmacies and oncology outpatient clinics in 93 Canadian hospitals in 2019. However, the quantities measured were very small. Every healthcare worker should consider these work areas to be contaminated and should wear appropriate protective equipment.

P42 The impact of a change to hospital guidelines on prescribing practices of nebulised 3% w/v ‘hypertonic’ saline

2018 ◽  
Vol 103 (2) ◽  
pp. e1.47-e1 ◽  
Author(s):  
Semple Diarmaid ◽  
McNally Paul ◽  
Fitzpatrick Anne ◽  
Adeyemi Kenny ◽  
McGrory Niamh ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Clinical Guideline ◽  
Controlled Trial ◽  
Inappropriate Prescribing ◽  
Prescribing Patterns ◽  
List Type ◽  
Guideline Compliance ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

AimsRecent conclusive evidence has suggested that, contrary to previous limited evidence, there is no benefit to the use of 3% hypertonic saline (3% HS) in the treatment of bronchiolitis in infants.1,2 This led to a change in the clinical guideline during the 2015/2016 bronchiolitis season. We hypothesised that the use of hypertonic saline was preventing the use of other un-necessary treatments and that inappropriate prescribing would increase following the advice not to give hypertonic saline.The primary aim of the study was to determine if the removal of 3% hypertonic saline from the institutional clinical guideline would result in reduced prescribing patterns. A secondary aim was to evaluate the overall prescribing compliance with the guideline including in the prescribing of antibiotics and bronchodilators, and identify if the change in the clinical guideline impacted the prescribing of other agents in children admitted with a diagnosis of bronchiolitis.MethodsData on medical treatments and hospital outcomes were prospectively collected on all infants in the 2015/2016 season both before and after the change in guideline. Details of all medicines prescribed on the patients Medication Record particularly bronchodilators, antimicrobials and inhaled agents were collected. Patient demographics were collected from medical notes. Results were analysed using chi square and Mann Whitney in Excel and Stata.Results128 children (86 before, 42 after the change in guideline) were recruited to the study. Baseline demographics were similar except for a higher proportion of children with RSV in the pre-group. Overall guideline compliance was achieved by 2 infants pre, and 3 infants post guideline change (4%). The use of hypertonic saline decreased significantly after the change in guideline but did not cease (90% pre, 71% post p<0.01). Bronchodilators were used in one in 4 infants and antibiotics in one in 3 infants, and there was no significant difference in these rates before or after the change in guidelines.ConclusionThe change to the guideline reduced the use of 3%HS, however overall guideline compliance in children with bronchiolitis is poor. Hypertonic saline use decreased when the guideline changed but a significant portion of children before and after the guideline change received medications not indicated in the treatment of bronchiolitis, including bronchodilators and antibiotics. It appears that it remains difficult to ‘do nothing’ for bronchiolitis. Poor clinical practice remains and education of clinical staff is necessary in this regard.ReferencesGuidance: Bronchiolitis in children: diagnosis and management, NICE (NG9) Published date: June 2015.Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% hypertonic saline versus normal saline in inpatient bronchiolitis: A randomised controlled trial. Paediatrics2015;136:1036–1043.

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 Biomarkers-based Personalized Follow-up in Chronic Heart Failure Improves Patient’s Outcomes and Reduces Care Associate Cost

2020 ◽  
Author(s):  
Antonio Leon Justel ◽  
Jose Ignacio Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Incidence Rates ◽  
Primary Objective ◽  
Economic Problem ◽  
Functional Class ◽  
Post Intervention ◽  
Number Of Patients ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Abstract BACKGROUNDHeart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF.METHODSThis is a real-world, before-and after-intervention trial, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before and after an intervention. The primary objective was the rate of readmissions, due to a HF event, post-intervention compared to pre-intervention. Secondary outcomes compared the rate of ED visits and the number of patients who had reduced NYHA score pre and post-intervention. A cost- analysis was also performed on these data.RESULTSAdmission rates significantly decreased by 41% after the intervention (total length of stay was reduced by 55%). The rate of ED visits was reduced by 55%. Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was €139,717.65 for the whole group over 1 year.CONCLUSIONSA personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care- associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals 1379Has the reporting quality of published randomised controlled trial protocols improved since the SPIRIT statement?

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Aidan Tan ◽  
Zet Tan ◽  
Tom Li ◽  
Ian Harris ◽  
Justine Naylor ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
English Language ◽  
Controlled Trial ◽  
Reporting Quality ◽  
Recent Period ◽  
Before And After ◽  
Trial Protocols ◽  
Randomised Controlled ◽  
The Impact

Abstract Background The impact of the SPIRIT statement on the reporting quality of RCT protocols in health research is unknown. This methodological study aimed to determine the reporting quality of published randomised controlled trial (RCT) protocols before and after the SPIRIT statement, and any association with author, trial or journal factors. Methods RCT protocols were identified by searching MEDLINE, Embase and CENTRAL, included if published in full-text, English language and a peer-reviewed journal, and assessed with the SPIRIT statement checklist items. Results 300 RCT protocols were retrieved; 150 from the period immediately before the SPIRIT statement and 150 from a recent period after the SPIRIT statement. 47.9% (95% CI, 46.5% to 49.3%) of checklist items were adequately reported in RCT protocols before the SPIRIT statement and 56.7% (95% CI, 54.9% to 58.5%) after the SPIRIT statement. This represents an 8.8% (95% CI, 6.6% to 11.1%; p &lt; 0.0001) mean improvement in the overall proportion of checklist items adequately reported since the SPIRIT statement. The factors associated with higher reporting quality of RCT protocols in multiple regression analysis were author expertise or experience in epidemiology or statistics, multicentre trials, longer protocol word length and publicly reported journal policy of compliance with the SPIRIT statement. Conclusions The overall reporting quality of RCT protocols has significantly improved since the SPIRIT statement, although a substantial proportion of individual checklist items remain poorly reported. Key messages Continued, concerted and coordinated efforts are required by journals, editors, reviewers and investigators to improve the completeness and transparency of RCT protocols.

scholarly journals Assessing the impact of retraction on the citation of randomized controlled trial reports: an interrupted time-series analysis

2018 ◽  
Vol 24 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Andrew Mott ◽  
Caroline Fairhurst ◽  
David Torgerson
Keyword(s):  
Time Series ◽  
Randomized Controlled Trial ◽  
Randomized Controlled Trials ◽  
Controlled Trial ◽  
Interrupted Time Series ◽  
Controlled Trials ◽  
Interrupted Time Series Analysis ◽  
Randomized Controlled ◽  
Before And After ◽  
The Impact

Objectives To assess the impact of retraction on the citation of randomized controlled trials. Methods We used an interrupted time-series with matched controls. PubMed, CINHAL, Google and the Retraction Watch Database were searched. We identified retracted publications reporting the results of randomized controlled trials involving human participants with two years of available data before and after retraction. We obtained monthly citation counts across all articles for the 24 months before and after retraction, from Web of Science. We used a Poisson segmented regression to detect changes in the level and trend of citation following retraction. We also undertook a matched control analysis of unretracted randomized controlled trials and a sensitivity analysis to account for cases of large-scale, well-advertised fraud. Results We identified 387 retracted randomized controlled trial reports, of which 218 (56.3%) were included in the interrupted time-series analysis. A reduction of 22.9% (95% CI 4.0% to 38.2%, p = 0.02) was observed in the number of citations in the month after retraction, and a further reduction of 1.9% (95% CI 0.4% to 3.5%, p = 0.02) per month in the following 24 months, relative to the expected trend. There was no evidence of a statistically significant reduction among the matched controls. Authors with a large number of retractions saw a 48.2% reduction at the time of retraction (95% CI 17.7% to 67.3%, p = 0.01). Other cases had a more gradual reduction with no change at the time of retraction and a 1.8% reduction per month in the following 24 months (95% CI 0.2% to 3.4%, p = 0.03). Conclusions Retractions of randomized controlled trial reports can be effective in reducing citations. Other factors, such as the scale of the retractions and media attention, may play a role in the effectiveness of the reduction.

Global Anticoagulant Registry in the Field – Venous Thromboembolism (GARFIELD-VTE)

2016 ◽  
Vol 116 (12) ◽  
pp. 1172-1179 ◽  
Author(s):  
Sylvia Haas ◽  
Walter Ageno ◽  
Pantep Angchaisuksiri ◽  
Henri Bounameaux ◽  
Joern Nielsen ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Good Practice ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Primary Objective ◽  
Vein Thrombosis ◽  
Local Practices ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Outpatient Settings ◽  
The Impact

SummaryVenous thromboembolism (VTE) is a common disorder associated with significant rates of morbidity and mortality. VTE management aims to reduce mortality, the risks of recurrence, and long-term complications. VTE treatment is evolving with the introduction of non-vitamin K antagonist anticoagulants (NOACs). The Global Anticoagulant Registry in the FIELD – Venous Thromboembolism (GARFIELD-VTE) is a prospective, multicentre, observational study that will enrol 10,000 patients treated for acute VTE from ∼500 sites in 28 countries. Identified sites reflect the diversity of care settings, including hospital and outpatient settings. Patients will be managed according to local practices and followed for at least three years. The primary objective is to determine the extent to which VTE treatment varies in the real-world setting and to assess the impact of such variability on clinical and economic outcomes. Evolving patterns of care will be captured using two sequential cohorts. The GARFIELD-VTE registry will provide insights into the evolving global treatment patterns for VTE, both deep-vein thrombosis and pulmonary embolism. By enrolling patients from diverse care settings, the registry will provide information on adherence to national and international guidelines, identify good practice as well as treatment deficiencies, and relate patient outcomes to clinical management. The incidence of death, recurrent VTE, bleeding, post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension will be documented. By capturing information during and after anticoagulation treatment, the registry will not only define aspects of the natural history of VTE, but also its economic and societal impact at a regional and global level.

Terminal Decontamination of Patient Rooms Using an Automated Mobile UV Light Unit

2011 ◽  
Vol 32 (8) ◽  
pp. 737-742 ◽  
Author(s):  
John M. Boyce ◽  
Nancy L. Havill ◽  
Brent A. Moore
Keyword(s):  
Uv Light ◽  
Patient Discharge ◽  
Test Method ◽  
Cycle Times ◽  
Ozone Concentrations ◽  
Environmental Surfaces ◽  
Before And After ◽  
American Society ◽  
Carrier Test ◽  
Uv C

Objective.To determine the ability of a mobile UV light unit to reduce bacterial contamination of environmental surfaces in patient rooms.Methods.An automated mobile UV light unit that emits UV-C light was placed in 25 patient rooms after patient discharge and operated using a 1- or 2-stage procedure. Aerobic colony counts were calculated for each of 5 standardized high-touch surfaces in the rooms before and after UV light decontamination (UVLD). Clostridium difficile spore log reductions achieved were determined using a modification of the ASTM (American Society for Testing and Materials) International E2197 quantitative disk carrier test method. In-room ozone concentrations during UVLD were measured.Results.For the 1-stage procedure, mean aerobic colony counts for the 5 high-touch surfaces ranged from 10.6 to 98.2 colony-forming units (CFUs) per Dey/Engley (D/E) plate before UVLD and from 0.3 to 24.0 CFUs per D/E plate after UVLD, with significant reductions for all 5 surfaces (all P<.02). Surfaces in direct line of sight were significantly more likely to yield negative culture results after UVLD than before UVLD (all P<.001). Mean C. difficile spore log reductions ranged from 1.8 to 2.9. UVLD cycle times ranged from 34.2 to 100.1 minutes. For the 2-stage procedure, mean aerobic colony counts ranged from 10.0 to 89.2 CFUs per D/E plate before UVLD and were 0 CFUs per D/E plate after UVLD, with significant reductions for all 5 high-touch surfaces. UVLD cycle times ranged from 72.1 to 146.3 minutes. In-room ozone concentrations during UVLD ranged from undetectable to 0.012 ppm.Conclusions.The mobile UV-C light unit significantly reduced aerobic colony counts and C. difficile spores on contaminated surfaces in patient rooms.

scholarly journals Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e048064
Author(s):  
Yong Wang ◽  
Yang Liu ◽  
Renyu Liu ◽  
Jing Zhao
Keyword(s):  
Usual Care ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Education Programme ◽  
Primary Objective ◽  
Prehospital Delay ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
The Impact

IntroductionStroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public’s knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted.Methods and analysisStroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time (‘onset-to-door time’, ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects.Ethics and disseminationThis study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations.Trial registration numberChiCTR2000040782.

scholarly journals How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL – the development, reliability and validity of a new scale

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Selman Repišti ◽  
Nikolina Jovanović ◽  
Martina Rojnić Kuzman ◽  
Sara Medved ◽  
Stefan Jerotić ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Clinical Sample ◽  
Controlled Trial ◽  
Reliability And Validity ◽  
Primary Objective ◽  
Clinical Samples ◽  
Strong Positive Correlation ◽  
The Impact

AbstractObjectiveThe primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples.MethodsThe scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.ResultsMain findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.DiscussionThe COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.

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