Nursing & Health

Permanent URI for this collectionhttps://research.avondale.edu.au/handle/123456789/457

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Start date: 2020

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    Cleaning Time and Motion: An Observational Study on the Time Required to Clean Shared Medical Equipment in Hospitals Effectively
    (Elsevier, 2024) Matterson, Georgia; Browne, Katrina; Tehan, Peta E.; Russo, Philip L.; Kiernan, Martin; Mitchell, Brett G.
    Background Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively. Methods An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process. Main results The time to clean equipment effectively ranged from 50 s [blood glucose testing kit; 95% confidence interval (CI) 0:40–1:00 (min:s)] to 3 min 53 s [medication trolley; 95% CI 3:36–4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (N = 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning. Conclusion This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.
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    Air Purifiers and Acute Respiratory Infections: A Randomised Clinical Trial
    (JAMA Network, 2024) Thottiyil Sultanmuhammed Abdul Khadar, Bismi; Sim, Jenny; McDonald, Vanessa M.; McDonagh, Julee; Clapham, Matthew; Mitchell, Brett G.
    Importance The effectiveness of in-room air purification for the reduction of acute respiratory infections (ARIs) in residential aged-care facilities (RACFs) is unknown. Objective To investigate the effectiveness of in-room air purifiers with high-efficiency particulate air (HEPA)–14 filters in reducing the incidence of ARIs among residents of RACFs. Design, Setting, and Participants This randomized clinical trial used a multicenter, double-blind, 2-period, 2-treatment crossover design for 6 months from April 7 to October 26, 2023, in 3 RACFs with a bed capacity of 50 to 100 in New South Wales, Australia. The purposive sampling approach included permanent residents in private rooms in the enrolled RACFs. Data collection was performed every 2 weeks and required no additional follow-up beyond the final data collection on October 31, 2023. Intervention An air purifier containing a HEPA-14 filter was placed in rooms of participants in the intervention group, and an air purifier without a HEPA-14 filter was placed in rooms of the control participants. The groups crossed over after 3 months. Main Outcomes and Measures The primary outcome was the incidence of ARIs, assessed with logistic mixed-model regression. Results Among 135 participants randomized (70 to the intervention-first group and 65 to the control-first group), 78 (57.8%) were female; mean (SD) age was 85.2 (8.6) years. In the intention-to-treat analysis, the use of air purifiers with HEPA-14 filters did not reduce ARIs compared with the control (OR, 0.57; 95% CI, 0.32-1.04; P = .07). Among the 104 participants who completed the entire study, the intervention reduced ARI incidence from 35.6% (37 participants) in the control group to 24.0% (25 participants) in the intervention group (OR, 0.53; 95% CI, 0.28-1.00; P = .048). Conclusions and Relevance In this clinical trial investigating use of air purifiers with HEPA-14 filters for reducing ARIs, no significant between-group difference was found in the intention-to-treat analysis. However, a significant reduction in ARIs was identified among participants who completed the entire study. These findings may help inform future large-scale studies of respiratory infectious diseases.
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    Oral Care Practices and Hospital-acquired Pneumonia Prevention: A National Survey of Australian Nurses
    (Elsevier, 2024) Tehan, Peta E.; Browne, Katrina; Matterson, Georgia; Cheng, Allen C.; Dawson, Sonja; Graves, Nicholas; Johnson, Douglas; Kiernan, Martin; Madhuvu, Auxillia; Marshall, Caroline; McDonagh, Julee; Northcote, Maria; O'Connor, Jayne; Orr, Liz; Rawson, Helen; Russo, Philip; Sim, Jenny; Stewardson, Andrew J.; Wallace, Janet; White, Nicole; Wilson, Rhonda; Mitchell, Brett G.
    Background Hospital-acquired pneumonia (HAP) also known as non-ventilator associated pneumonia, is one of the most common infections acquired in hospitalised patients. Improving oral hygiene appears to reduce the incidence of HAP. This study aimed to describe current practices, barriers and facilitators, knowledge and educational preferences of registered nurses performing oral health care in the Australian hospital setting, with a focus on the prevention of HAP. We present this as a short research report. Methods We undertook a cross sectional online anonymous survey of Australian registered nurses. Participants were recruited via electronic distribution through existing professional networks and social media. The survey used was modified from an existing survey on oral care practice. Results The survey was completed by 179 participants. Hand hygiene was considered a very important strategy to prevent pneumonia (n = 90, 58%), while 45% (n = 71) felt that oral care was very important. The most highly reported barriers for providing oral care included: an uncooperative patient; inadequate staffing; and a lack of oral hygiene requisite. Patients' reminders, prompts and the provision of toothbrushes were common ways believed to help facilitate improvements in oral care. Conclusion Findings from this survey will be used in conjunction with consumer feedback, to help inform a planned multi-centre randomised trial, the Hospital Acquired Pneumonia PrEveNtion (HAPPEN) study, aimed at reducing the incidence of HAP. Findings may also be useful for informing studies and quality improvement initiatives aimed at improving oral care to reduce the incidence of HAP.
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    Which Trial do we Need? Gown and Glove use Versus Standard Precautions for Patients Colonized or Infected with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus
    (Elsevier, 2024-08) Browning, Sarah; White, Nicole M.; Raby, Edward; Davis, Joshua S.; Mitchell, Brett G.
    Background Gown and glove use as a component of ‘contact precautions’ was first recommended by the United States Healthcare Infection Control Practices Advisory Committee in 1996 and remains widely adhered to today. Despite a lack of randomized trial evidence in support of this practice, donning of gowns and gloves upon entry to the patient area (room or cubicle) continues to be ‘strongly recommended’ when the patient is infected or colonized with pathogens of epidemiological importance
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    Infection Prevention and Control Programme Priorities for Sustainable Health and Environmental Systems
    (Springer Nature, 2024-02-01) Saravanos, Gemma L.; Islam, Md Saiful; Huang, Yuanfei; Basseal, Jocelyne M.; Seale, Holly; Mitchell, Brett G.; Sheel, Meru
    Infection prevention and control (IPC) programmes reduce infection risk for patients, health workers, and the community. They are fundamental to achieving resilient, responsive, and sustainable health systems that align with the Sustainable Development Goals. Paradoxically, IPC programmes contribute to environmental harm, and this must be addressed alongside longstanding programme priorities.
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    Sustainability and Novel Technologies to Improve Environmental Cleaning in Healthcare - Implications and Considerations
    (Elsevier, 2025-02-01) Jain, S; Dempsey, K; Clezy, K; Mitchell, B. G.; Kiernan, Martin A.
    Along with emerging technologies electrolysed water (EW) systems have been proposed for cleaning and/or disinfection in clinical areas. There is evidence for the use of EW in food-handling and the dairy industry however there is lack of evidence for EW as an effective cleaning and disinfecting agent in a clinical setting. Existing publications mostly are either laboratory based or from non-clinical settings. This is in direct contrast to other approaches used in healthcare cleaning. The aim of this paper is to provide infection prevention and control professionals with a risk assessment checklist using an evaluation of electrolysed water as an example of the analysis and consideration required prior to the introduction of any new technology and, in particular, the inclusion of sustainability.
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    Evaluating the Accuracy of an Automatic Counting System to Detect Dispensing of Hand Hygiene Product
    (Elsevier, 2024) Matterson, Georgia; Browne, Katrina; Russo, Philip L.; Dawson, Sonja; Kent, Hannah; Mitchell, Brett, G.
    Background Hand hygiene (HH) is an essential element of infection prevention and control programs. Direct observation of adherence to the 5 moments for HH is considered the gold standard in compliance monitoring. However, as direct observation introduces potential bias, other strategies have been proposed to supplement HH compliance data in healthcare facilities. This study evaluated the accuracy of an automatic counting system (MEZRIT™) to detect when a HH product (soap or alcohol-based hand rub) was dispensed, and thus measure product usage as opposed to compliance with the 5 moments for HH. Methods A quasi-experimental study was conducted in a nursing simulation lab where seven participants undertook basic nursing tasks which included performing HH. Sensors were attached to soap and alcohol-based hand rub dispensers to record the time at which a product was dispensed. HH events were video recorded (time-stamped) and validated against timestamps from the automatic counting system. Results 260 HH events were detected by the automatic counting system and confirmed by video recordings. 5182 non-HH events were calculated from analysis of the video recordings. The automatic counting system had 90 % sensitivity (95%CI 85.8–93.1 %), and 100 % specificity (95%CI 99.9–100 %). This model generated a positive predictive value of 100 % (95%Cl 98.4–100 %), and a negative predictive value of 99.5 % (95%CI 99.3–99.7 %). Conclusion The MEZRIT™ system accurately identified 90 % of HH events and excluded 100 % of non-HH events. The real-time monitoring of HH product usage may be beneficial in responding quickly to changes in product usage.
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    Use of the Supportive and Palliative Care Indicators Tool (SPICT™) for End-of-Life Discussions: A Scoping Review
    (BioMed Central (BMC), 2024-05-16) Mahura, Melanie; Karle, Brigitte; Sayers, Louise; Dick-Smith, Felicity; Elliott, Rosalind
    Background In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this. Aim The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness. Methods In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global. Results From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries. Conclusions Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.
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    Investigating the Effect of Enhanced Cleaning and Disinfection of Shared Medical Equipment on Health-Care-Associated Infections in Australia (CLEEN): A Stepped-Wedge, Cluster Randomised, Controlled Trial
    (Elsevier, 2024) Browne, Katrina; White, Nicole M; Russo, Philip L; Cheng, Allen C; Stewardson, Andrew J; Matterson, Georgia; Tehan, Peta E; Graham, Kirsty; Amin, Maham; Northcote, Maria; Kiernan, Martin; King, Jennie; Brain, David; Mitchell, Brett G
    Summary Background There is a paucity of high-quality evidence based on clinical endpoints for routine cleaning of shared medical equipment. We assessed the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections (HAIs) in hospitalised patients. Methods We conducted a stepped-wedge, cluster randomised, controlled trial in ten wards of a single hospital located on the central coast of New South Wales, Australia. Hospitals were eligible for inclusion if they were classified as public acute group A according to the Australian Institute of Health and Welfare, were located in New South Wales, had an intensive care unit, had a minimum of ten wards, and provided care for patients aged 18 years or older. Each cluster consisted of two randomly allocated wards (by use of simple randomisation), with a new cluster beginning the intervention every 6 weeks. Wards were informed of their allocation 2 weeks before commencement of intervention exposure, and the researcher collecting primary outcome data and audit data was masked to treatment sequence allocation. In the control phase, there was no change to environmental cleaning practices. In the intervention phase, a multimodal cleaning bundle included an additional 3 h per weekday for the dedicated cleaning and disinfection of shared medical equipment by 21 dedicated cleaning staff, with ongoing education, audit, and feedback. The primary outcome was the number of confirmed cases of HAI, as assessed by a fortnightly point prevalence survey and measured in all patients admitted to the wards during the study period. The completed trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12622001143718). Findings The hospital was recruited on July 31, 2022, and the study was conducted between March 20 and Nov 24, 2023. We assessed 220 hospitals for eligibility, of which five were invited to participate, and the first hospital to formally respond was enrolled. 5002 patients were included in the study (2524 [50·5%] women and 2478 [49·5%] men). In unadjusted results, 433 confirmed HAI cases occurred in 2497 patients (17·3%, 95% CI 15·9 to 18·8) in the control phase and 301 confirmed HAI cases occurred in 2508 patients (12·0%, 10·7 to 13·3) in the intervention phase. In adjusted results, there was a relative reduction of –34·5% (–50·3 to –17·5) in HAIs following the intervention (odds ratio 0·62, 95% CI 0·45 to 0·80; p=0·0006), corresponding to an absolute reduction equal to –5·2% (–8·2 to –2·3). No adverse effects were reported. Interpretation Improving the cleaning and disinfection of shared medical equipment significantly reduced HAIs, underscoring the crucial role of cleaning in improving patient outcomes. Findings emphasise the need for dedicated approaches for cleaning shared equipment. Funding National Health and Medical Research Council.
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    Challenges in Building and Running a 4,000-bed COVID-19 Intensive Care Unit in an Exhibition Center
    (Cambridge University Press, 2023-03-16) Kiernan, Martin