Maher M. El-Masri

Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice

BACKGROUND Nurses and other health care providers (HCPs) continue to be noncompliant with the guidelines of proper hand hygiene practices. PURPOSE The purpose of this study was to explore the factors associated with hand hygiene compliance among HCPs during routine clinical. METHODS An observational study was conducted at an oncology hospital to examine hand hygiene practices observed during 612 procedures that were performed by 67 HCPs. RESULTS Hand hygiene compliance was 41.7% (n = 255) before procedure and 72.1% (n = 441) after the procedure. The overall compliance was only 34.3% (n = 210). Compliance with the standards of hand hygiene was higher in high-risk procedures (odds ratio [OR] = 1.77; 95% confidence interval [CI], 1.18-2.65) and when HCPs were exposed to blood (OR = 1.40; 95% CI, 1.07-1.73). CONCLUSION The findings highlight the need to continue to push compliance with hand hygiene using innovative approaches that go beyond teaching and in-service training.

Predictors of nosocomial bloodstream infections among critically ill adult trauma patients

OBJECTIVE To identify the independent predictors of nosocomial bloodstream infections (BSIs) among critically ill adult trauma patients. DESIGN A prospective, cohort design was used to study patients who met predetermined inclusion criteria. Basic descriptive and univariate statistical analyses were performed to identify unadjusted predictors. A forward stepwise multivariate logistic regression analysis was then conducted to identify independent predictors of nosocomial BSI. SETTING Level I university-affiliated shock trauma center. PATIENTS Three hundred sixty-one critically ill adult trauma patients, 55 of whom developed nosocomial BSIs (15.2%). RESULTS Data analysis of 45 variables indicated that only 9 were independent predictors of nosocomial BSI: presence of a chest tube, use of immunosuppressive agents, presence of microbial resistance, length of stay, presence of preexisting infection, percentage change of serum albumin levels, patient disposition, transfusion of 10 or more units of blood, and number of central venous catheters (CVCs) for patients who had 4 or more. The classification index of the final regression model at a cut-off point of 0.5 had a specificity of 97.4%, a sensitivity of 60%, a positive predictive value of 76.7%, a negative predictive value of 93%, and an overall precision of 91%. CONCLUSION In this study, only 9 variables were independent predictors of nosocomial BSI. Our findings are specific to critically ill adult trauma patients and should be interpreted within the context of this particular population.

Evaluating Undergraduate Nursing Students' Learning Using Standardized Patients

BACKGROUND The use of standardized patients is an established training technique in medical education. However, this problem-based learning approach is relatively new to the field of nursing education. Its benefits to undergraduate nursing education continue to be underinvestigated in the nursing literature. PURPOSE The purpose of this study was to examine the effectiveness of using standardized patients in improving health assessment skills among first-year nursing students. METHODS A comparative design was conducted on a convenience sample of 108 first-year undergraduate nursing students. Study participants were recruited from a university and community college collaborative nursing program in southwestern Ontario. RESULTS Analysis of covariance results showed that after adjusting for baseline differences, the intervention group had higher objective structured clinical examination mean scores than the control group (M = 78.57 and 69.28, F = 24.13, P ≤ .001). However, the two groups were not different in their theory scores (M = 77.23 and 77.29, F = .002, P = .963). CONCLUSION The findings suggest that the use of standardized patients is an effective educational technique in undergraduate nursing education.

Testing a model of delayed care-seeking for acute myocardial infarction.

A theory-testing approach to the study of delay in seeking treatment for acute myocardial infarction (AMI) was performed using a descriptive design with 135 AMI patients. Participants provided information pertaining to history of AMI, symptom congruence, responses to symptoms, cardiac symptom attribution, and AMI care-seeking delay. Structural equation modeling fit indices suggested that the independent predictors of AMI care-seeking delay were cardiac symptom attribution and emotion-focused coping. History of AMI had a direct relationship with AMI care-seeking delay, but its total effect through symptom attribution and symptom congruence was not significant. The total effect of symptom congruence on AMI care-seeking delay was significant. In conclusion, the study findings highlight the importance of targeting cardiac symptom attribution and emotion-focused coping in interventions that are aimed at reducing AMI care-seeking delay.

Exploring the benefits of double gloving during surgery.

Breaches in the glove barrier pose a risk for transmission of bloodborne pathogens during surgical procedures. Double gloving or double gloving with an indicator glove system may provide added protection. For this 24-month study, we used a comparative design to examine the effect of double gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. The frequency of seeing blood on the hand after surgery was greater with single gloving than with double gloving, and the frequency of changing gloves during surgery was significantly higher among those who double gloved with an indicator glove system versus double gloving alone. The majority of health care providers in our study expressed favorable views about double gloving.

A Laboratory-based Study to Assess the Performance of Surgical Gloves

The inherent tear resistance and elasticity of latex and the touch sensitivity it provides has made it the traditional material of choice for surgical gloves, protecting both health care workers and patients from the transmission of bloodborne infections. Although increased incidence of latex allergy has led to increased use of nonlatex surgical gloves, the effectiveness of these gloves as a barrier to infection has not been examined thoroughly. This laboratory-based study compared the performance of latex and nonlatex surgical gloves in a simulated stress protocol. The propensity of surgical gloves to fail was dependent on glove material, manufacturer, and stress. Nonlatex neoprene and nitrile gloves were comparable to latex and can provide a good alternative to latex for allergic patients and health care workers. In this study, isoprene was found to be inferior to latex and other nonlatex materials. The presence or absence of glove powder had no significant influence on the probability of glove failure.

Development and psychometric assessment of the undergraduate nursing student academic satisfaction scale (UNSASS).

Background and Purpose: To examine the psychometric properties of a newly developed instrument: The Undergraduate Nursing Student Academic Satisfaction Scale (UNSASS). Methods: A self-report test–retest questionnaire was administered to a convenience sample of 313 students enrolled in Bachelor of Science in Nursing (BScN) program in Ontario, Canada. Results: The psychometric analysis yielded a 48-item multidimensional instrument. Validity testing revealed a content validity index (CVI) of .83. Factor analysis suggested a four-dimension scale with distinct factor loadings that all exceeded .4 and explained 50% of the variance. The scale had an overall Cronbach’s alpha coefficient of .96 and a test–retest correlation coefficient of .88, indicating a highly reliable instrument. Conclusions: The newly developed instrument provides a tool to comprehensively measure the satisfaction of nursing students with the academic aspects of their nursing programs.

A descriptive study of functions, symptoms, and perceived health state after radiotherapy for prostate cancer

PURPOSE To explore the impact of prostate cancer treatment on: (a) the experience of symptoms (i.e. sexual, urinary, and bowel), and (b) perceived health state of men with prostate cancer one month following their radiation treatment. METHODS A prospective pre-test-post-test descriptive survey was conducted on a convenience sample of 73 men with prostate cancer who were recruited from a Regional Cancer Centre in Southwestern Ontario, Canada. Participants receiving radiation treatment (brachy therapy, high dose radiation [HDR] and external beam radiation [EBR], or EBR alone) completed a questionnaire that elicited information pertaining to quality of life (QOL), symptom experiences, and perceived health state prior to, and one month after completion of their radiation treatment. RESULTS Post-treatment scores showed increased problems with urinary bother (p<0.001) and function (p<0.001), bowel bother (p=0.002) and function (p=0.001), and sexual function (p<0.001). The results also suggested that urinary bother, sexual bother, and pain were independent predictors of the perceived health state of participants after radiation treatment. DISCUSSION Our findings suggest that prostate cancer treatment presents a challenge with regard to symptom experiences and perceived health state in men with prostate cancer. Therefore, strategies for patient education to assist men to cope with their symptoms and to provide them with support in the initial weeks following treatment are discussed.

Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: A retrospective study

Summary Background Although strict adherence to infection control strategies is recognised as the simplest and most cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the direct impact that such adherence may have on the risk of developing such infections has always been a challenge. Purpose The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak. Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of infection control strategies during the SARS outbreak may have had on the risk of HAIs. Methods A retrospective chart review was conducted on the medical records of 400 intensive care patients who were admitted to the ICU three months before and during the 2003 SARS outbreak. Results The rate of HAIs was higher in the pre-SARS period than the SARS period. Specifically, 61.7% of all reported infections were diagnosed in the pre-SARS period. The rate of HAIs in the pre-SARS period was 14.5% as opposed to 9% during the SARS period. Adjusted logistic regression analysis suggested that the odds of HAIs were 2.2 times higher in the pre-SARS period as compared to the SARS period (OR =2.2; 95%CI =1.08–4.49). Conclusion Our findings suggest that strict enforcement of infection control strategies may have a positive impact on the efforts to minimise the risk of HAIs. These findings carry a clinical significance that shall not be ignored with regard to our overall efforts to minimise the risk of developing HAIs in the ICU.

Alternative coping strategies and decision delay in seeking care for acute myocardial infarction.

Background and Objective:In attempting to manage acute myocardial infarction (AMI) symptoms, individuals often engage in coping strategies that cause them to delay seeking timely medical care. Review of the literature revealed that several coping strategies were examined in relation to AMI delay, but there were no studies investigating the extent of use of each coping strategy. The purpose of this study was to examine the extent of use of 15 coping strategies and their associations with the time taken to decide to seek medical care. Subjects and Methods:Secondary data analyses were performed on a sample of 135 patients with AMI from Canada and the United States from whom data were collected via structured interviews. Descriptive analyses were used to identify the extent of use of alternative coping strategies. Spearman &rgr; was used to test the associations of these strategies with decision delay. Results and Conclusions:The 3 most frequently used coping strategies were trying to relax, wishing/praying for symptoms to disappear, and discussing symptoms with someone. Nine coping strategies were significantly associated with decision delay. The findings of this study are useful in teaching patients about avoiding the use of coping strategies when faced with AMI symptoms. This can potentially help reduce delays in seeking care for AMI, which will result in better health outcomes for patients with AMI.