Mary-Louise McLaws

Sexual behaviour in aids‐related research: Reliability and validity of recall and diary measures

In order to assess the reliability and validity of two data collection instruments for measuring sexual practices in homosexual men, we administered a recall data collection instrument to 30 sexually active men, and a diary instrument to a subset of 19 participants. Each instrument covered a period of one month. For the recall instrument, the correlation coefficients between the test‐retest showed a good level of reliability for a number of infrequent sexual practices but was poor for frequent sexual practices. Correlation coefficients were calculated for sexual practices recorded in the first two and the second two weeks for both the recall and the diary. Generally, the level of agreement between the first and second two weeks for sexual practice data recorded in the diary was lower than the recall questionnaire. While the reliability of the recall method was found to be limited to certain sexual practices, it was concluded to be the most reliable and efficient method presently available for the collecti...

Highly endemic hepatitis B infection in rural Vietnam

Background and Aim:  Hepatitis B is a major public health problem in Vietnam; however, estimates of the prevalence of hepatitis B virus (HBV) and hepatitis delta virus (HDV), and risk factors in rural Vietnam are limited. The aim of this study was to determine HBV and HDV prevalence, and identify risk factors for HBV infection.

Three successful interventions in health care workers that improve compliance with hand hygiene: Is sustained replication possible?

BACKGROUND Hand hygiene (HH) compliance by health care workers has been universally disappointing. Two major programs (Washington and Geneva) have demonstrated interventions that induce sustained improvement. The introduction of alcohol-based hand rub (AHR) together with education also has been reported to improve compliance. METHODS These interventions were replicated concurrently for 2 years in selected wards of an 800-bed university teaching hospital, with compliance assessed only within, not between, programs. RESULTS No significant improvement in HH compliance was observed after the introduction of AHR (incidence rate ratio [IRR] = 1.11; 95% confidence interval [CI] = 0.93 to 1.33; P = .238) or substitution of AHR for a similar product (IRR = 1.10; 95% CI = 0.91 to 1.32; P = .328) with concomitant education. The Washington program achieved a 48% (IRR = 1.48, 95% CI = 1.20 to 1.81; P < .001) improvement in compliance, sustained over 2 years. The Geneva program failed to induce a significant increase in HH compliance in 3 wards, but achieved a 56% (IRR = 1.56; 95% CI = 1.29 to 1.89; P < .001) improvement over the already high HH rate in 1 ward (infectious disease unit). CONCLUSIONS The Washington program demonstrated effectiveness in achieving sustained improved HH compliance, whereas the effect of the Geneva program was limited in those wards without strong medical leadership. Introduction of AHR without an associated behavioral modification program proved ineffective.

Student nurses in Taiwan at high risk for needlestick injuries

PURPOSE To describe the prevalence and characteristics of needlestick injuries (NSI) in student nurses in Taiwan. METHODS A self-administered questionnaire was completed by 931 student nurses from 16 hospitals randomly selected from the 132 accredited hospitals. RESULTS The questionnaire was completed by 708 of 931 students who were contacted for participation in this study. NSI during internship was reported by 61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority (70.1%) of NSI occurred in the patients room. Hollow-bored needles contributed to half (219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those items involved in NSIs had been used on patients. Of the hollow-bored needles involved in NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against hepatitis B virus (HBV) was lacking in 47.6% of students. CONCLUSIONS NSIs and non-reporting of NSIs were highly prevalent in nursing students. More intensive education programs should be directed at students to increase their awareness of and compliance with Universal Precautions (UP) before commencing their practical work experience. Students need to practice prompt post-exposure evaluation so that the need for early intervention can be assessed. In addition, any public health and infection control strategy should include a universal catch-up HBV vaccination program among students before commencement of internship.

Needlestick injuries in a major teaching hospital: The worthwhile effect of hospital-wide replacement of conventional hollow-bore needles

BACKGROUND Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital. METHODS NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004). RESULTS Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US

Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran

90,000 per annum. CONCLUSION Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay.

Protecting healthcare workers from pandemic influenza: N95 or surgical masks?

Summary Objective To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran. Method In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups – surgeons, surgical residents, physicians and medical residents – were assessed using a questionnaire. Results Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r =0.397, p =0.030 and r =0.554, p =0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r =0.399, p =0.029) relationship between attitude and practice was found in surgical residents. Conclusion Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.

Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers

Objective: The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infections and N95 masks to protect against aerosol-spread infections. A literature review was undertaken for evidence of superior protective value of N95 masks or surgical masks for healthcare workers against influenza and extraneous factors influencing conferred protection. Methods: Four scientific search engines using 12 search sequences identified 21 mask studies in healthcare settings for the prevention of transmission of respiratory syncytial virus, Bordetella pertussis, and severe acute respiratory syndrome. Each was critically assessed in accordance with Australian National Health Medical Research Council guidelines. An additional 25 laboratory-based publications were also reviewed. Results: All studies reviewed used medium or lower level evidence study design. In the majority of studies, important confounders included the unrecognized impact of concurrent bundling of other infection control measures, mask compliance, contamination from improper doffing of masks, and ocular inoculation. Only three studies directly compared the protective value of surgical masks with N95 masks. The majority of laboratory studies identified both mask types as having a range of filtration efficiency, yet N95 masks afford superior protection against particles of a similar size to influenza. Conclusions: World Health Organization guidelines recommend surgical masks for all patient care with the exception of N95 masks for aerosol generating procedures. Because of the paucity of high-quality studies in the healthcare setting, the advocacy of mask types is not entirely evidence-based. Evidence from laboratory studies of potential airborne spread of influenza from shedding patients indicate that guidelines related to the current 1-meter respiratory zone may need to be extended to a larger respiratory zone and include protection from ocular inoculation.

Nonuniform risk of bloodstream infection with increasing central venous catheter-days.

We conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.

SEPSIS KILLS: early intervention saves lives.

OBJECTIVE To determine whether the conventional rate for central venous catheter (CVC)-associated bloodstream infection (BSI) accurately reflects risk for patients exposed for a variety of in situ periods. PATIENTS AND METHODS Intensive care unit patients (n = 1,375) were monitored for 7,467 CVC-days. They were monitored until catheter removal, until diagnosis of CVC-associated BSI, or for 24 hours after discharge. RESULTS The BSI rate was 3.7 per 1,000 CVC-days. Ninety-three percent of these patients had CVCs in situ for 1-15 days. These patients were exposed to 59.7% of all CVC-days; the remaining 7% were exposed to 40.3% of all CVC-days. BSI rates stratified by exposure periods of 1-5 and 6-15 days were 2.1 and 4.5 per 1,000 CVC-days, respectively. The rates for 16-30 and 31-320 days were 10.2 and 2.1 per 1,000 CVC-days, respectively. The probability of BSI with a CVC in situ was 6 in 100 by day 15, 14 in 100 by day 25, 21 in 100 by day 30, and 53 in 100 by day 320. CONCLUSION The conventional aggregated rate better reflects the risk for the majority of patients rather than for patients exposed to the majority of CVC-days. It does not reflect the true probability of risk for all exposures, especially beyond 30 days. CVCs in situ from 1 to 15 days had less risk of BSI than CVCs in situ more than 15 days, which may explain why scheduled CVC replacement at days 5 to 7 has not been found beneficial.