More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.

Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world. In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands. Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy. A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects. The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.

Gram-negative infection has been linked to hospital water although few studies have examined whether water systems are reservoirs of nosocomial pathogens. This study investigated longitudinal recovery of the opportunistic pathogens Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii from water outlets of a haematology unit and evaluated Point-Of-Use Filtration (POU-F) as a control measure. In a two-year double cross-over trial, water samples and swabs were taken weekly from 39 showers/taps on the unit. Four study phases alternated between non-filtered (Phases 1 & 3), and filtered outlets (Phases 2 & 4) using Pall AquasafeTM 14-day filters. In Phases 1 & 3; 99% of 1396 samples yielded bacterial growth, with colonies generally too numerous to count. Target species were isolated from 22% of water samples (P. aeruginosa 14%; S. maltophilia 10%) and 10% of swabs. P. aeruginosa was particularly associated with handwash stations and S. maltophilia with showers. A. baumannii was not isolated. With POU-F; 22% of 1242 samples yielded bacterial growth (mean CFU/100ml ,4.6). S. maltophilia was isolated only once from water but never from outlet swabs. PCR typing identified clusters of isolates colonizing different outlets over time but no clear association between water and patient isolates was identified. The incidence of Gram negative infections remained low throughout the study. Without POU-F, water from taps/showers represented a source of bacteria including the target species. POU-F substantially reduced the frequency and number of target species from every outlet, and merits further investigation as an intervention to protect immunocompromised patients from opportunistic pathogens.

Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world. In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands. Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy. A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects. The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.

Malgré les avancées en matière de prévention, Pseudomonas aeruginosa reste un pathogène fréquent et délétère en réanimation. Des facteurs de risque d’acquisition de ce micro-organisme ont déjà pu être identifiés, mais jamais dans un contexte multicentrique et rarement en ajustant sur des caractéristiques du service. Si l’analyse de la littérature était jusqu’alors en faveur d’une forte origine individuelle, la part du contexte d’hospitalisation et des caractéristiques de la réanimation paraît de moins en moins négligeable. Notre travail a permis non seulement de faire un état des lieux concernant les connaissances actuelles sur Pseudomonas aeruginosa en réanimation mais également d’identifier des profils type de patients et services de réanimation plus à risque vis à vis de ce micro-organisme. L’intérêt majeur est non seulement de pouvoir ainsi orienter les cliniciens face à une conjonction d’éléments mais surtout, là où les facteurs patients restent souvent peu modifiables, d’identifier des éléments contextuels d’acquisition sur lesquels il serait possible d’agir afin de réduire le risque infectieux. / Despite major advance in techniques and reinforcement of infection control measures, Pseudomonas aeruginosa remains frequent in intensive care unit (ICU) and is responsible for severe hospital-acquired infections. Several patient and pathogen-specific risk factors have been associated with acquisition of P. aeruginosa in ICUs Nevertheless those risk factors were identified in monocentric studies which rarely took in account the context of cares. If individual risk factors for P. aeruginosa acquisition have appeared to be predominant since then, the role of contextual variables seems to have been underestimated. This thesis provides insight into the epidemiology of P. aeruginosa in ICU, identifies individual and contextual risk factors for P. aeruginosa infection and P. aeruginosa acquisition and emphasizes the interest of contextual variables which gives new perspectives to P. aeruginosa prevention.

Methicillin-resistant staphylococcus aureus (MRSA) has become resistant to antibiotics. The purpose of this quantitative, retrospective cohort study was to examine the relationship between length of hospitalization and invasive MRSA infection rates among different racial and ethnic groups in the 8 service planning areas (SPAs) of Los Angeles County. Cane, O'Connor, and Michie's theoretical domain framework was used. Secondary data from the Healthcare-Associated (HA) Infections Program of the California Department of Public Health were analyzed. For the first research question, a Pearson correlation analysis was conducted to assess the relationships between length of hospitalization and invasive HA-MRSA infection rates and counts. Length of hospital stay was not correlatedwith HA-MRSA infection rates; however, it was strongly and positively correlated with HA-MRSA infection counts. For the second research question, a one-way ANOVA was conducted on the infection count rate data, with SPA as the between-subjects factor. The results were statistically significant, indicating that HA-MRSA infection counts varied among the 8 SPAs. The findings might help medical professionals better understand the risk factors associated with MRSA infections. In doing so, findings may relieve some of the burden on the U.S. health care system and improve the overall quality of life of the patients involved.

Healthcare-associated infections (HAIs) are used as a measure for federal value-based payment programs. Using data for 2015, the Centers for Disease Control and Prevention (CDC) developed newer risk adjustment models to calculate the standardized infection ratio (SIR) for various infections occurring in hospitals. New national baselines were set to compare performance among medical facilities and states. Despite adjustments for various facility-level factors that contribute to HAI risk, there are ongoing concerns that SIR calculations do not adequately account for non-hospital risk factors that have been linked to clinical outcomes. This explanatory study evaluates state-level data using simple linear regression to determine relationships between the standardized infection ratio (SIR) for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and several socioeconomic and geographic factors. Bivariate analysis produced significant correlation between SIR and high school education, with states exhibiting lower SIR relative to the percent of adults who completed high school. Higher SIRs were found relative to the percent of state populations subjected to poverty, obesity, and diagnosis of diabetes. Percent of nonprofit hospitals, adults with bachelor’s degrees, and rural residents were not significantly correlated with state measures of MRSA bacteremia. These findings can help guide efforts to reduce HAIs, improve safety of care, and advance population health efforts. The results from this study reinforce the notion that non-hospital factors may have significant effects on the incidence of MRSA bacteremia events occurring in hospitalized patients. Current risk adjustment models that predict MRSA bacteremia events for quality reporting purposes may not adequately account for these risk factors. The present study highlights some ways that hospitals, patients, and policymakers can work together to address social risk factors as a strategy for promoting better and safer care, and healthier communities. This study investigates aspects of the bigger picture of health care quality, performance measurement, and population health. This “feel for the whole” underscores the implications on state performance in infection prevention in the context of socioeconomic and medical vulnerabilities. The study emphasizes the need for greater multidisciplinary collaboration to address community health needs and reduce social and medical disparities.

Bakgrund: Centrala venkatetrar förekommer idag inte bara på intensivvårdsavdelningar utan har även blivit en vanlig företeelse på vårdavdelningar där allmänsjuksköterskan arbetar. Med CVK följer risker för infektioner, både lokala och systemiska. Vårdrelaterade infektioner, specifikt kateterrelaterade sådana, är ett stort problem inom sjukvården och medför såväl ökade vårdtider som ökade kostnader. Allmänsjuksköterskan ansvarar för handhavande och skötsel av CVK och har därmed en nyckelroll i att förebygga infektioner. Syfte: Att sammanställa vetenskaplig litteratur rörande hur allmänsjuksköterskan kan förebygga infektioner hos patienter med CVK inneliggande på vårdavdelning.Metod: Den valda undersökningsmetoden var en litteraturstudie. Databassökningar utfördes i Cinahl, PubMed och Cochrane Library. Efter kvalitetsgranskning inkluderades tio vetenskapliga artiklar med kvantitativ metod. Resultat: Åtgärder för förebyggande av infektion sorterades in under fyra rubriker: desinfektion, utbildning, omläggning och teknik vid byte av koppling. Åtgärderna inom dessa grupper visades minska förekomsten av kateterrelaterad infektion.Konklusion: Klorhexidinlösningar, desinfektionsproppar, utbildning samt semipermeabla förband kan leda till minskad förekomst av kateterrelaterade infektioner hos patienter med CVK. Eventuellt kan ”non-touch”-teknik vara ett alternativ vid byte av kopplingar. Mer forskning krävs gällande sjuksköterskans förebyggande åtgärder utanför IVA samt en mer enhetlig forskning för att skapa tydligare riktlinjer. / Background: Central venous catheters today are not only common in intensive care units but have become a regular phenomenon in wards where non-specialised nurses work. With CVCs comes a risk for infections, both local and systemic. Hospital acquired infections, in particular catheter-related infections, are a major problem in health care and cause prolonged length of hospital stay as well as increased costs. The general nurse is responsible for the handling and care of CVCs, and therefore has a key part in preventing infections. Aim: To compile scientific literature regarding how the general nurse can prevent infections in patients with CVCs on general wards. Method: The chosen method of investigation was a literature review. A literature search was undertaken using Cinahl, PubMed and Cochrane Library. Following a quality assessment, ten scientific papers with a quantitative method were included. Results: Measures to prevent infection were sorted under four headlines: disinfection, education, dressing care, and technique for line changes. The measures within these groups were shown to reduce prevalence of catheter-related infections.Conclusion: Chlorhexidine solutions, disinfection caps, education and semipermeable dressings can lead to reduced prevalence of catheter-related infections in patients with CVCs. A “non-touch” technique may be a possible alternative when changing lines. More research is needed regarding preventive nursing measures outside the intensive care units, as well as more unified research to create clear guidelines.

Gram-negative infection has been linked to hospital water although few studies have examined whether water systems are reservoirs of nosocomial pathogens. This study investigated longitudinal recovery of the opportunistic pathogens Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii from water outlets of a haematology unit and evaluated Point-Of-Use Filtration (POU-F) as a control measure. In a two-year double cross-over trial, water samples and swabs were taken weekly from 39 showers/taps on the unit. Four study phases alternated between non-filtered (Phases 1 & 3), and filtered outlets (Phases 2 & 4) using Pall AquasafeTM 14-day filters. In Phases 1 & 3; 99% of 1396 samples yielded bacterial growth, with colonies generally too numerous to count. Target species were isolated from 22% of water samples (P. aeruginosa 14%; S. maltophilia 10%) and 10% of swabs. P. aeruginosa was particularly associated with handwash stations and S. maltophilia with showers. A. baumannii was not isolated. With POU-F; 22% of 1242 samples yielded bacterial growth (mean CFU/100ml ,4.6). S. maltophilia was isolated only once from water but never from outlet swabs. PCR typing identified clusters of isolates colonizing different outlets over time but no clear association between water and patient isolates was identified. The incidence of Gram negative infections remained low throughout the study. Without POU-F, water from taps/showers represented a source of bacteria including the target species. POU-F substantially reduced the frequency and number of target species from every outlet, and merits further investigation as an intervention to protect immunocompromised patients from opportunistic pathogens. / School of Life Sciences, University of Bradford and Pall Medical (Pall Europe Ltd)

The multi-million-dollar medical uniform industry has not utilized advancements in garment and textile technology that could positively impact the protection of healthcare professionals and patients. In most cases the uniforms meet basic requirements – they clothe the professional in a recognizable way. Little innovation in design, function and performance, has been applied to these garments. This is particularly evident in the case of the stereotypical white lab coat worn by many physicians, despite evidence indicating that these lab coats may carry contamination and play a role in the spread of deadly bacteria. Healthcare Associated Infections (HAIs) are among the most serious problems facing modern medical care, costing millions of lives and dollars annually worldwide. This research investigates the design and use of the physician’s lab coat – an immediately recognizable symbol of Western medicine. The research identifies the medical, functional, cultural and symbolic roles of the lab coat within the hospital environment and beyond, to the larger the global society. This thesis examines the extent to which the design of medical wear can impact the effect of hospital-acquired infections, support doctor/patient relationships and enhance the performance and behavior of the healthcare professional by envisioning a future lab coat which offers increased protection for physician and patient, aids in communication and enhances the performance of the doctor by utilizing digital technologies incorporated into the lab coat whereby the lab coat becomes the only tool necessary for the physician.