Healthcare-associated infection in acute hospitals: which interventions are effective?

Mears, Alex; White, Alexander E.; Cookson, B.; DeVine, Mackenzie N.; Sedgwick, J.; Phillips, Esther S.; Jenkinson, Helen; Bardsley, Martin

doi:10.1016/j.jhin.2008.12.004

Cited by 30 publications

(25 citation statements)

References 12 publications

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“…Several authors have reported the fact that nonadherence to infection control behaviors such as putting on and changing gloves for every patient is typically multifaceted and extends beyond a lack of knowledge or forgetfulness [3,[11][12][13][14]. Therefore, it is important to promote an educational approach that emphasizes behavior change and maximizes the personal freedom of health care workers (HCW) to choose to adhere, yet maximizes the potential healthcare and social costs.…”

Section: Introductionmentioning

confidence: 99%

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Ugandan medical and health sciences interns’ infection control knowledge and practices

Kamulegeya

Kizito

Balidawa

2013

J Infect Dev Ctries

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We assessed the level of knowledge, attitudes, and practices of recent graduates of clinical health sciences who started their one-year internship in Uganda. Methodology: This was a cross-sectional survey responded to by 209 (response rate of 70%) new interns who started their internships in August 2011 in different Ugandan hospitals. Validated self-administered questionnaires with knowledge, attitude, and practices questions were distributed to the participants during a two-day internship orientation organized by the national internship committee. Results: Out of 299 subjects approached, the survey was completed and returned by 209 (70%). More nurses (51.4%) failed the questions on odds of HIV transmission after a needle stick injury compared to 23.0% and 36.4% of medical and dental graduates ,respectively(χ 2 = 24.06 p = 0.001). There was no difference in proportions of those who re-sheath needles. Respondents who had an encounter with positive tuberculosis history when taking clinical notes while unprotected were not more motivated to use masks (χ 2 = 7.06; p = 0.07). Nurses and dentists reported more regular hand washing before and after patient contact compared to medical doctors. Conclusion: Overall, the knowledge of infection control was not impressive and the attitudes and practices appeared to be heavily influenced by the lack of an enabling environment in training hospitals and internship hospitals. There is little likelihood of change due to internship experience except for those who go to missionary hospitals that have stricter infection control protocols. More effort must be made in teaching hospitals to encourage better infection control.

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Section: Introductionmentioning

confidence: 99%

“…There are controversial reports that have shown doctors as being more complacent than nurses about infection control [14][15][16][17]. Unfortunately, this seems to stem from medical training.…”

Section: Introductionmentioning

confidence: 99%

Ugandan medical and health sciences interns’ infection control knowledge and practices

Kamulegeya

Kizito

Balidawa

2013

J Infect Dev Ctries

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“…More than 90% of hospital costs are associated with in-patient care and even small increases in the proportion of patients treated at home can result in large economic savings [6,22]. Hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile, are an increasing problem in the UK and internationally [23,24]. Reducing the proportion of patients treated in hospital will reduce the risk of patients developing these hospital complications.…”

Section: Discussionmentioning

confidence: 99%

Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis

Chalmers¹,

Akram²,

Hill³

2010

Eur Respir J

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In order to identify, synthesise and interpret the evidence relating to strategies to increase the proportion of low-risk patients with community-acquired pneumonia treated in the community, we conducted a systematic review of intervention studies conducted between 1981-2010.Articles were included if they compared strategies to increase outpatient care with usual care. Outcomes were: the proportion of patients treated as outpatients, mortality, hospital readmissions, health related quality of life, return to usual activities and patient satisfaction with care.The main analysis included six studies. The interventions in these studies were generally complex, but all involved the use of a severity score to identify low-risk patients. Overall, a significantly larger numbers of patients were treated in the community with these interventions (OR 2.31, 95% CI 2.03-2.63). The interventions appear safe, with no significant differences in mortality (OR 0.83, 95% CI 0.59-1.17), hospital readmissions (OR 1.08, 95% CI 0.82-1.42) or patient satisfaction with care (OR 1.21, 95% CI 0.97-1.49) between the intervention and control groups. There was insufficient data regarding quality of life or return to usual activities. All studies had significant limitations.The available evidence suggests that interventions to increase the proportion of patients treated in the community are safe, effective and acceptable to patients.

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“…181, [583][584][585][586][587][588][589][590] Such interventions typically encompass (i) mandatory reporting and surveillance programmes; [591][592][593][594] (ii) ensuing targets, standards and performance indicators for IPAC, especially for high-risk clinical practices [600][601][602] and vulnerable patient groups; [603][604][605][606] and (iii) heightened control over the use of antimicrobial drugs in the face of To aid our understanding of the interplay of context and mechanism in the operationalisation of this focal intervention, the perspectives of consultant microbiologists, IPAC nurses and pharmacists specialising in antibiotics medicines management, each directly involved in the operationalisation of the RHAI under the auspices of the 1000 Lives + national programme, enrich our analysis.…”

Section: Health-care-associated Infection Prevention and Controlmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Healthcare-associated infection in acute hospitals: which interventions are effective?

Cited by 30 publications

References 12 publications

Ugandan medical and health sciences interns’ infection control knowledge and practices

Ugandan medical and health sciences interns’ infection control knowledge and practices

Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

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