Investigation of individual nurses’ relative hand hygiene performance using an anonymous automated electronic hand hygiene monitoring system and a nursing assignment schedule

BackgroundWe investigated whether an anonymous automated electronic monitoring system (EMS) could be used to compare hand hygiene (HH) performance of individual nurses.MethodsProspective observational cohort study. HH performance in 10 acute-care patient rooms was estimated through an EMS that anonymously measured HH events, and room entries and exits. The association between patient room's HH compliance and the nurse in charge of each room was investigated by comparing percentile rank distributions, and through a negative binomial model.ResultsOver 99 days, there were 38,596 HH events and 135,546 room entries and exits (global HH performance, 28%). For 10 of 54 (19%) nurses, the median HH percentile rank of the rooms to which they were assigned was higher than the group average (P < .001; range of percentiles, 64th to 85th). A lower median percentile was seen in 9/54 (17%) participants (P < .001; range of percentiles, 22nd to 39th). The negative binomial model confirmed this association and identified 15 of 54 high performers (range of adjusted incidence rate ratios [aIRR], 1.17-1.83) and 16 of 54 low performers (range of aIRR, 0.37-0.77).Discussion and ConclusionsAn association exists between a room's HH rate and its assigned nurse. This association could hold potential value for an individualized feedback strategy.     

Care work in changing welfare states: Nordic care workers’ experiences

This article focuses on Nordic eldercare workers and their experiences of working conditions in times of change and reorganisation. In recent years New Public Management-inspired ideas have been introduced to increase efficiency and productivity in welfare services. These reforms have also had an impact on day-to-day care work, which has become increasingly standardized and set out in detailed contracts, leading to time-pressure and an undermining of care workers’ professional discretion and autonomy. The empirical data comes from a survey of unionised eldercare workers in home care and residential care in Denmark, Finland, Norway and Sweden (N = 2583) and was analysed by bi- and multi-variate methods. The care workers reported that they found their working conditions physically and mentally arduous. They had to a great extent experienced changes for the worse in terms of working conditions and in their opportunity to provide good quality care. In addition, the majority felt they did not receive support from their managers. An alarming finding was that one out of three care workers declared that they had seriously considered quitting their jobs. Care workers with multiple problems at work were much more likely to consider quitting, and the likelihood was increasing with the number of problems reported. Furthermore, care workers lacking support from their managers had double odds of wanting to quit. The Nordic welfare states with growing older populations are facing challenges in retaining care staff in the eldercare services and ensuring they have good working conditions and support in their demanding work.     

Rheumatology care of migrants from sub-Saharan Africa: a literature review and qualitative pilot study of patients’ perspectives

Clinical Rheumatology - Rheumatologists practising in the UK National Health Service (NHS) are likely to treat migrant patients from sub-Saharan Africa. This study aimed to conduct a literature...     

Improving visitors’ hand hygiene compliance in a pediatric oncology unit

BackgroundHand hygiene (HH) is the single most important method to prevent infections. We aim at improving HH compliance by visitors to a pediatric oncology unit.MethodsA performance improvement project implemented several Plan-Do-Study-Act cycles in July-November 2018. At baseline, a wall-mounted alcohol-based hand sanitizer dispenser was available at the unit entrance. Cycle 1 (visual cue), cycle 2 (visual cue plus verbal symptom screen), and cycle 3 (visual cue, symptom screen, plus HH verbal instructions) were tested. Patient care associates (PCA) positioned at the entrance implemented the cycles and recorded data about visitor's estimated age, day and time of observations, and covert HH compliance monitoring. Participating PCAs were surveyed regarding process feasibility.ResultsOf 1230 (97%) analyzed observations; 204 (17%) were baseline, 293 (24%) in cycle 1, 374 (30%) in cycle 2, and 359 (29%) in cycle 3. The visitors’ HH compliance significantly increased to 16.0%, 22.5%, and 48.5% in cycles 1, 2, and 3, respectively, from a baseline of 4.9% (P < .001). Visitors were more likely to perform HH when directly instructed (cycle 3) compared to baseline (adjusted OR = 19.77, 95% CI, 10.30-42.09, P < .001). Although the surveyed PCAs agreed the process is easy and fast, they reported few barriers.ConclusionsDirect verbal instructions for HH were the most effective in improving visitors’ HH compliance.     

Understanding HIV-infected patients’ experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal,South Africa: a qualitative study

South Africa was the largest recipient of funding from the President's Emergency Plan for AIDS Relief (PEPFAR) for antiretroviral therapy (ART) programs from 2004 to 2012. Funding decreases have led to transfers from hospital and non-governmental organization-based care to government-funded, community-based clinics. We conducted semi-structured interviews with 36 participants to assess patient experiences related to transfer of care from a PEPFAR-funded, hospital-based clinic in Durban to either primary care clinics or hospital-based clinics. Participant narratives revealed the importance of connectedness between patients and the PEPFAR-funded clinic program staff, who were described as respectful and conscientious. Participants reported that transfer clinics were largely focused on dispensing medication and on throughput, rather than holistic care. Although participants appreciated the free treatment at transfer sites, they expressed frustration with long waiting times and low perceived quality of patient–provider communication, and felt that they were treated disrespectfully. These factors eroded confidence in the quality of the care. The transfer was described by participants as hurried with an apparent lack of preparation at transfer clinics for new patient influx. Formal (e.g., counseling) and informal (e.g., family) social supports, both within and beyond the PEPFAR-funded clinic, provided a buffer to challenges faced during and after the transition in care. These data support the importance of social support, adequate preparation for transfer, and improving the quality of care in receiving clinics, in order to optimize retention in care and long-term adherence to treatment.     

Asian Americans’ reports of their health care experiences

OBJECTIVE: To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN: Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING: White (N = 3,205) and Asian-American (N = 521) respondents, weighted to represent all such adults living in the continental U.S. in telephone households. MEASUREMENTS: Reports of health care experiences and trust in the doctor at the last visit, and overall satisfaction with care and desire to change doctors in the last 2 years. MAIN RESULTS: Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues (P < or =.01). They were more likely to report that their regular doctors did not understand their background and values (P < or =.01). When asked about the last visit, they were more likely to report that their doctors did not listen, spend as much time, or involve them in decisions about care as much as they wanted (all P < or =.0001). In multivariable analyses, Asian Americans were less likely than whites to report that they were very satisfied with care (odds ratio [OR], 0.64, 95% confidence interval [CI], 0.42 to 0.99). However, they were not significantly less likely than whites to trust their doctors (OR, 0.79, 95% CI, 0.52 to 1.20), or to change doctors (OR, 0.93, 95% CI, 0.56 to 1.56). CONCLUSIONS: In a national survey, Asian Americans were less likely to receive counseling and less likely to report positive interactions with their doctors than white respondents. More research is needed to determine the reasons for these differences.