Barriers and Facilitators in Perioperative Antibiotic Prophylaxis: A Mixed-Methods Study in a Small Island Setting

Few studies have addressed antibiotic guideline adherence in small island settings, such as Aruba. This study aimed to evaluate the appropriateness of perioperative antibiotic prophylaxis (PAP) and identify barriers for PAP guideline adherence. A mixed-methods study was carried out at the operating theatre (OT) in the Dr. Horacio E. Oduber Hospital (HOH) in Aruba. First, a prospective audit was performed on the appropriateness of guideline-derived quality indicators (QIs). Then, interviews based on the Flottorp framework were conducted to identify barriers for guideline adherence. Finally, a survey was distributed to verify the outcomes of the interviews. The appropriateness of QIs was measured: correct indication (50.6%); antimicrobial agent (30.8%); dose (94.4%); timing (55.0%); route of administration (100%); duration (89.5%); and redosing (95.7%). The overall appropriateness was 34.9%. The main barriers discovered were poor knowledge about PAP and the guidelines and professional interactions regarding PAP, specifically poor communication and lack of clarity about responsibilities regarding PAP. This study was the first to evaluate the appropriateness and to identify barriers for PAP guideline adherence in a small island hospital. The overall appropriateness of PAP was poor with just 34.9%. Future interventions should be focused on communication, education and awareness of the possibility to consult an ID physician or microbiologist.

How Can We Improve Hand Hygiene Compliance and its Clinical Implications in Healthcare Professionals?

Hand washing is one of the most important things that an individual can do to help prevent and control, the spread of bacteria, infections, and many illnesses from occurring. This study aimed to investigate the importance of hand hygiene compliance in nurses who practice at Rhode Island Hospital (RIH) in Rhode Island. The research in this study focuses on the compliance of hand hygiene created by the nursing staff. The branches of RIH target the Neurosurgery, Pulmonary, Dermatology, and the Dialysis Unit, to examine whether the implementation of visual reminders (i.e., "healthy hands" posters) create awareness amongst the nurses in each department. In this mixed-method, prospective, and quasi-experimental study, self-reporting was used to study the frequency of handwashing before and after the implementation of visual reminders. An additional method was created to measure the amount of Germ X Hand Sanitizer used in collaboration with visual reminders in a pre and post-intervention. A Focus Group Discussion was also conducted with the participants to obtain feedback that would increase hand hygiene awareness and its compliance. The results indicated that visual reminders create awareness and increase handwashing frequency among Rhode Island Hospital nurses. The implementation of visual reminders provided nurses with the knowledge and understanding of the importance of the issue.

Nurses’ Bullying Experiences: A Case study of a Caribbean Major Island Hospital

PURPOSE: The study was aimed at determining the self-reported experiences of the nurses in the major Island hospital in The Commonwealth of The Bahamas with regard to workplace bullying and their assessment of the support they received following the experience. METHODS: A descriptive quantitative case study was undertaken using all the registered nurses in the Island Hospital. The study utilized a modified pre-validated instrument from the International Labour Office (ILO), International Council of Nurses (ICN), World Health Organization (WHO), and Public Services International (PSI). Analysis was done using the SPSS version 20. The result was presented as frequencies. RESULTS: Eighty-one (81) respondents completed and returned their copies of the questionnaire giving a response rate of 97.5%. Also, 85.2% of the respondents reported having moderate bullying experience while 14.8% reported having maximum bullying experience. As it relates to the self-reported support for bullying, 60.5% of the respondents indicated that they received little support following a bullying experience. Further, 39.5% reported that they received some support following a bullying experience. There was no significant relationship between the respondents’ demographics and their self-reported experience of bullying or support following a bullying experience (p≤ 0.05). RECOMMENDATION/DISCUSSION: Among others, we recommended that a more deliberate policy instrument be developed for dealing with cases of bullying and to monitor the use of this instrument, noting that the mental health of the nurses are also at risk. CONCLUSION: The study revealed that bullying was reportedly high while measures to support staff were reportedly low, a combination the investigators see as concerning in the Island Hospital.

Medroxyprogesterone Acetate in Gender-Affirming Therapy for Transwomen: Results From a Retrospective Study

Context Medroxyprogesterone acetate (MPA) is a widely used progestin in feminizing hormone therapy. However, the side effects and hormonal changes elicited by this drug have never been investigated in the transgender population. Objective We evaluated the incidence of self-reported effects among transwomen using MPA and this drug’s impact on hormonal and metabolic parameters. Design, Setting, and Participants We retrospectively collected data from 290 follow-up visits (FUVs) of transwomen treated at Rhode Island Hospital from January 2011 to July 2018 (mean duration of therapy 3.4 ± 1.7 years). FUVs followed regimens of estradiol (E) and spironolactone, with MPA (n = 102) or without MPA (n = 188). Main Outcome Measures We assessed the incidence of self-reported effects after MPA treatment. We also compared blood levels of E, testosterone, and various laboratory parameters between MPA and non-MPA groups. Results Mean weighted E level was 211 ± 57 pg/mL after MPA treatment and 210 ± 31 pg/mL otherwise; this difference was nonsignificant [t(274) = 0.143, P = 0.886]. Mean weighted testosterone level was 79 ± 18 ng/dL after MPA treatment and 215 ± 29 ng/dL otherwise; testosterone levels were significantly lower in the MPA group [t(122) = 32.4, P < 0.001]. There were minimal changes in other laboratory parameters. Of 39 patients receiving MPA, 26 reported improved breast development and 11 reported decreased facial hair. Five patients experienced mood swings on MPA. Conclusions In our cohort of transwomen, we found minimal side effects, unchanged E levels, and a decline in testosterone associated with MPA, outcomes consistent with feminization. Prospective studies are needed to confirm our findings.