Nursing & Health
Permanent URI for this collectionhttps://research.avondale.edu.au/handle/123456789/457
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Item 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.Item 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.Item 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.Item 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 importanceItem 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, MeruInfection 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.Item 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.Item 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.Item Decision-making in Nursing Research and Practice—Application of the Cognitive Continuum Theory: A Meta-Aggregative Systematic Review(Wiley, 2023-12) O'Connor, Tricia; Gibson, Jo; Lewis, Joanne; Strickland, Karen; Paterson, CatherineAim To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM). Background Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent. Design A meta-aggregative systematic review. Methods Databases CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process. Results The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses’ level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature. Conclusion The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making. Relevance to Clinical Practice Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.Item Roles, Responsibilities and Scope of Practice: Describing the ‘State of Play’ for Infection Control Professionals in Australia and New Zealand(2015-03-01) Mitchell, Brett G.; Gardner, Anne; MacBeth, Deborough; Halton, Kate; Hall, LisaBackground: In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice.
Methods: A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken.
Results: A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams.
Conclusion: This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.
Item Breakfast Size is Related to Body Mass Index for Men, but not Women(2010-04-01) Worsley, Anthony; Kent, LillianThe objective of this study was to examine the effect of self-reported breakfast size, daily eating, and other health habits on body mass index (BMI). We hypothesized that a consumption of a substantial breakfast compared with skipping or small breakfasts would be associated with lower BMI. Three independent, cross-sectional, screening surveys were conducted by Sydney Adventist Hospital in 1976, 1986, and 2005 in the surrounding community. The archived survey forms of 384 men and 338 women in 1976, 244 men and 229 women in 1986, and 270 men and 62 women in 2005 were randomly selected. Body mass index was determined from height and weight measured by hospital staff. The reported amount consumed at breakfast was one of several eating habits that predicted BMI for men but not women. It explained 5% to 6% of the variance in male BMI in all 3 years examined. As the reported breakfast amount increased, men's BMI decreased. Lifestyle confounders including vegetarianism and physical activity did not affect this relationship. However, the consumption of breakfast was significantly positively associated with consumption of cereals, bread, fruit, and spreads, while coffee consumption was significantly associated with smaller breakfasts or breakfast skipping. The consumption of relatively large breakfasts may influence BMI in men, and its promotion may help reduce the prevalence of obesity in Australia and elsewhere.