Maryanne McGuckin

Occlusive dressings: a microbiologic and clinical review.

This review discusses the microbiology of normal skin and wounds and examines the rates of infection reported under both conventional (nonocclusive) dressings and all occlusive dressings, together with cost factors. The overall infection rate under conventional dressings was 7.1% in 1085 wounds, whereas under occlusive dressings on 3047 wounds the rate was 2.6%. In studies in which the two dressing types were directly compared, the respective rates were 7.6% and 3.2%. The reasons for this difference may include both dressing-specific and host-specific factors, and these factors are discussed.

Patient education model for increasing handwashing compliance.

BACKGROUND A review of the literature on handwashing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding handwashing compliance. The primary objective of this project was to conduct a prospective control study of the effect of patient handwashing education on staff compliance with handwashing. METHOD A prospective, controlled, 6-week intervention/control study was performed in 4 community hospitals in South Jersey. Each hospital served as its own control. Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their hands. Soap usage and handwashing was calculated by bed-days. Patient follow-up was conducted through telephone interviews 2 weeks after discharge. RESULTS The patient handwashing education model increased soap usage by health care workers an average of 34% (P =.021); this increase was consistent across hospitals regardless of the initial soap usage rates. Of the patients interviewed, 81% read the materials provided, 57% asked health care workers whether they had washed their hands, and 81% of this 57% said they received positive responses. CONCLUSIONS For the first time, our findings document that education of patients regarding their role in monitoring handwashing compliance among health care workers can increase soap usage and handwashing and provide sustainable reinforcement of handwashing principles for health care workers.

Increasing Handwashing Compliance With More Accessible Sinks

The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).

Validation of venous leg ulcer guidelines in the United States and United Kingdom

BACKGROUND Venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of 3 billion dollars and loss of 2 million workdays per year. The purpose of this study was to validate the clinical efficacy and cost effectiveness of multidisciplinary guidelines for the diagnosis and treatment of venous leg ulcers. METHODS Eighty (40 retrospective, 40 prospective) patients from the United States and United Kingdom were enrolled. RESULTS United States patients were 6.5 times and United Kingdom 2 times more likely to heal if a guideline was followed (P <0.001). A significant decrease was noted in healing time for both the United States and United Kingdom (P <0.01), and the median cost decreased significantly when the guideline was followed (P <0.01). CONCLUSIONS Implementation of a guideline for diagnosis and treatment of venous leg ulcers resulted in improvement in diagnosis, decrease in healing time, and an increase in healing rates resulting in lower costs.

Hand Hygiene Compliance Rates in the United States—A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement and Feedback

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product usage and providing feedback, compliance increased to 37% for ICUs and 51% for non-ICUs. (ICU, P = .0119; non-ICU, P < .001). HH compliance in the United States can increase when monitoring is combined with feedback. However, HH still occurs at or below 50% compli- ance for both ICUs and non-ICUs.

Duration of handwashing in intensive care units: A descriptive study

The duration of handwashing was studied in two community hospitals (teaching and nonteaching). The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded. The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing. The duration of handwashing was two times longer in health care personnel vs. non-health care personnel (8.62 +/- 0.29 vs. 4.14 +/- 0.42; t = 7.7; p less than 0.001). Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations. The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control. This may be an important factor in the transmission and persistence of nosocomial infection in critical care units. The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.

The clinical relevance of microbiology in acute and chronic wounds.

PURPOSE To improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participants understanding of how wound microbiology affects healing. TARGET AUDIENCE This CME/CE activity is intended for physicians and nurses with an interest in interpreting the role of microorganisms in wound healing. OBJECTIVES At the conclusion of this course, participants should be able to: 1. Identify the microbiology of acute and chronic wounds, risk factors for infection, and advantages and disadvantages of wound culturing. 2. Identify methods of debridement and wounds for which they are appropriate. 3. Identify systemic antibiotic treatment options for acute and chronic wound infections.

Consumer Attitudes About Health Care-Acquired Infections and Hand Hygiene

Mandatory reporting and disclosure of health care-acquired infections have resulted in controversy over the perceived notion that consumers will not understand how to interpret data and that such information may negatively influence utilization of hospitals. The objective was to determine consumers’ attitudes about health care-acquired infections, hand hygiene practices, and patient empowerment. A telephone survey based on a random digit dialing sample of all households in the United States was conducted. Consumers were asked about choosing a hospital, hand hygiene practices, and health care-acquired infections. Some 94% of respondents rated environmental cleanliness as very important. Hospital infection rates would influence decision making for 93% of consumers. Four in 5 consumers said they would ask their health care worker to wash and sanitize his or her hands. Our findings strongly suggest that (1) consumers will use infection data in selecting and/or leaving a hospital system and (2) consumers are ready to be empowered with information to ensure a positive outcome.

Interventional patient hygiene model: Infection control and nursing share responsibility for patient safety

Interventional patient hygiene (IPH) has been defined as a comprehensive evidence-based intervention and measurement model for reducing the bioburden of both the patient and health care worker. The components of IPH are hand hygiene, oral care, skin care/antisepsis, and catheter site care. This practice form will provide evidence-based information for each of the components of IPH model and provide a strategy for the development, implementation, and monitoring of IPH protocols.

Significance of pyuria in urinary sediment.

Microscopic examination of the urinary sediment to determine the degree of pyuria is an accepted method to screen for urinary tract infection. We investigated the significance of pyuria in relation to the method of specimen acquistion, number of white blood cells and isolation of pathogens on culture. Only 36 per cent of our patients with more than 10 white blood cells per high power field on examination of the first random specimen had more than 10 white blood cells per high power field when a repeat clean catch midstream specimen was examined, and only 20 per cent of the patients had more than 10(5) pathogens per ml. on culture. However, the finding of more than 10 white blood cells per high power field on a clean catch mid stream specimen indicated more than 10(5) pathogens per ml. in 40 per cent of the cases. The use of a higher threshold for significant pyuria (more than 20 white blood cells per high power field) on examination of a random specimen increased the incidence of more than 10(5) bacteriuria found in specimens with initial pyuria by 43 per cent and represents the additional detection of 8.7 per cent of the total poputation studied. These data indicate that when screening for pyuria and infection one should either obtain a clean catch midstream specimen for examination of urinary sediment or increase the threshold for significant pyuria on a random specimen.