Ramon Z. Shaban

Patient experience of source isolation: Lessons for clinical practice

Abstract Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient’s self-control of the situation and in providing adequate information.

Pandemic (H1N1) 2009 Influenza in Australia: Absenteeism and redeployment of emergency medicine and nursing staff.

Objective: The aim of the present study was to examine the impact of Pandemic (H1N1) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment.

Translating research findings to clinical nursing practice.

Aims and objectives To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. Background There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse‐led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well‐established barriers to the conduct and translation of research evidence into practice. Design This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. Methods This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence‐informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse‐led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. Conclusions Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. Relevance to practice Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.

Pandemic (H1N1) 2009 Influenza in Australia: Absenteeism and redeployment of emergency medicine and nursing staff

Objective: The aim of the present study was to examine the impact of Pandemic (H1N1) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment.

Paramedic knowledge of infection control principles and standards in an Australian emergency medical system (EMS)

Abstract Infection control is an essential component of health care. The literature generally suggests that most health professionals’ knowledge of infection control principles and standards is poor or, at the very least, inadequate. There is a paucity of research examining paramedic knowledge of infection control principles and standards, particularly in the Australian pre-hospital context. The purpose of this study was to determine paramedic knowledge of standard infection control definitions and principles in an Australian emergency medical system (EMS). A confidential and anonymous mail survey was distributed to all paramedics working in a State-wide Australian ambulance service (n=2274) A total of 1258 surveys were returned - a response rate of 55.3%. Only 46.2% (n=581) of the participants identified the correct components of the ’chain of infection’. Correct identification of the definition of ’nosocomial’ was made by 27,9% (n=347) of participants. Less than one-fifth (17.2%, n=217) of participants identified standards and additional precautions’ as the current system of infection control. Less than half (41.6%, n=523) of the sample correctly identified hand washing as the primary’ infection control strategy’ to prevent cross-infection. This study suggests knowledge of fundamental principles and standards of infection control among paramedics is poor in this jurisdiction and recommends the introduction of comprehensive in-service education programmes in infection control. Further research is required to investigate if, and how, these results may be realised in practice.

Moving forward with hospital cleaning.

1. Joshi SG, Hamilton RJ, Emery CL, Brooks AD. Institutional MRSA screening practice and policies. Am J Infect Control 2012;40:901. 2. Cunha BA. Clinical manifestations and antimicrobial therapy of methicillin-resistant Staphylococcus aureus (MRSA). Clin Micro Inf 2005;11: 33-42. 3. Otter JA, Herdman MT, Williams B, Tosas O, Edgeworth JD, French GL. Low prevalence of methicillin-resistant Staphylococcus aureus carriage at hospital admission: implications for risk-factor-based vs universal screening. J Hosp Infect 2013;83:114-21. 4. Tubbicke A, Hubner C, Wegner C, Kramer A, Fleba S. Transmission rates, screening methods and costs of MRSAda systematic literature review related to the prevalence in Germany. Eur J Clin Microbiol Infect Dis 2012;31: 2497-511. 5. Davis KA, Stewart JJ, Crouch HK, Florez CE. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776-82.

Can we have a culture of patient safety without one of staff safety

The patient safety movement reached its tipping point in 2000 after the publication, in the 1999 US Institute of Medicine Report, To Err is Human , of the extraordinary finding that there were up to 100 000 preventable deaths in US hospitals every year . 1 The patient safety movement used James Reason’s paradigm of accident causation, the so called “Swiss Cheese Model”, to explain why systems failures cause most adverse events among patients, and identified the “no blame” culture as a way to improve outcomes among patients.2 Removing the fear of reporting errors means that systems failures can be identified and remedied before bad patient outcomes occur. Despite the development of the no blame approach to patient safety, we have observed the opposite culture in relation to staff safety. While demonstrating two safety products to operating room nurses in the United States and Australia, one of the authors (MS) observed reactions that initially caused him concern. The first safety product was a new, sterile version of the popular single handed scalpel blade remover, which, when used with a hands free passing technique, can prevent up to 50% of all scalpel injuries.3 Scalpel injuries—the second most common cause of sharps injuries in the operating room—can cause infection with HIV, hepatitis B, C, and D, and other serious illnesses. They can also damage digital nerves, arteries, or tendons, requiring microsurgery and up to three months off work to undergo extensive rehabilitation. Psychosocial distress, inability to …

Evaluating the orthogeriatric model of care at an Australian tertiary hospital

INTRODUCTION The management of fragility hip fractures requires a collaborative multi-disciplinary approach to care to ensure optimal patient outcomes. It is important to rigorously evaluate the model of care and enable the delivery of evidence based optimal patient care. AIM OF THE STUDY The aim of this study was to document an orthogeriatric model of care (OGMOC) at a major tertiary hospital: assessing how particular indicators within the patients admission were influenced by the OGMOC. METHODS A retrospective case analysis of all patients with fragility hip fracture from two pre-intervention groups and three post-intervention groups was undertaken. Data from (i) length of stay in the emergency department (ii) length of stay in the orthopaedic unit (iii) time from admission to surgery and (iv) time from surgery to admission to rehabilitation were used. RESULTS Implementation of the OGMOC resulted in: reduced time in the emergency department, quicker access to surgery, reduced length of acute hospital stay and an increase in the number of patients accessing the rehabilitation unit. CONCLUSION This study contributes to the increasing body of evidence for best practice in the management of fragility hip fracture within an OGMOC.

It is not your fault: suggestions for building ethical capacity in individuals through structural reform to health care organisations : comment on "moral distress in uninsured health care" by Anita Nivens and Janet Buelow.

Moral distress is known to cause skilled nurses to exit the profession (Schluter et al. 2008), resulting in lessthan-optimal patient outcomes (Aiken et al. 2002). For the case presented by Nivens and Buelow (2013), two broad responses are required. First, management should recognise this field of nursing may cause moral distress. This has implications both for nurse and patient safety. A timely and focussed review or implementation of structures to support staff to maintain moral momentum is required. Second, all nurses need to recognise that moral distress is an occupational hazard and accept support and training in managing the ethical implications of these very difficult cases. We will now explore these recommendations in detail. Health care managers have a clear responsibility to keep their staff safe. This is both an ethical obligation and in some practice environments legally mandated. While concern should be for staff members, the logic of staff safety as requisite for patient safety has been acknowledged (Sinnott and Shaban 2011). Much work has been done to improve staff safety in the physical sense. Yet safeguarding the moral health of nurses who are repeatedly exposed to traumatic and difficult cases, where their best response will be constrained by circumstances beyond their control, is only recently gaining recognition. This is despite a well-established literature on moral distress and the related concepts of compassion fatigue in nursing, stretching across several decades (Jameton 1977). Recognition of the moral impact of particular forms of health care work leads to managerial responsibility for creating and sustaining ethical work environments that Bioethical Inquiry (2013) 10:423–424 DOI 10.1007/s11673-013-9460-9

Flying maggots: a smart logistic solution to an enduring medical challenge

Whilst there is a growing body of research which discusses the use of remotely piloted aircraft systems (RPAS) (otherwise known as “drones”) to transport medical supplies, almost all reported cases employ short range aircraft. The purpose of this paper is to consider the advantages and challenges inherent in the use of long endurance remotely piloted aircraft systems (LE-RPAS) aircraft to support the provision of medical supplies to remote locations – specifically “medical maggots” used in maggot debridement therapy (MDT) wound care.,After introducing both MDT and the LE-RPAS technology, the paper first reports on the outcomes of a case study involving 11 semi-structured interviews with individuals who either have experience and expertise in the use of LE-RPAS or in the provision of healthcare to remote communities in Western Australia. The insights gained from this case study are then synthesised to assess the feasibility of LE-RPAS assisted delivery of medical maggots to those living in such geographically challenging locations.,No insuperable challenges to the concept of using LE-RPAS to transport medical maggots were uncovered during this research – rather, those who contributed to the investigations from across the spectrum from operators to users, were highly supportive of the overall concept.,The paper offers an assessment of the feasibility of the use of LE-RPAS to transport medical maggots. In doing so, it highlights a number of infrastructure and organisational challenges that would need to be overcome to operationalise this concept. Whilst the particular context of the paper relates to the provision of medical support to a remote location of a developed country, the core benefits and challenges that are exposed relate equally to the use of LE-RPAS in a post-disaster response. To this end, the paper offers a high-level route map to support the implementation of the concept.,The paper proposes a novel approach to the efficient and effective provision of medical care to remote Australian communities which, in particular, reduces the need to travel significant distances to obtain treatment. In doing so, it emphasises the importance in gaining acceptance of both the use of MDT and also the operation of RPAS noting that these have previously been employed in a military, as distinct from humanitarian, context.,The paper demonstrates how the use of LE-RPAS to support remote communities offers the potential to deliver healthcare at reduced cost compared to conventional approaches. The paper also underlines the potential benefits of the use of MDT to address the growing wound burdens in remote communities. Finally, the paper expands on the existing discussion of the use of RPAS to include its capability to act as the delivery mechanism for medical maggots.