Wilawan Picheansathian

The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit

This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.

Positioning of Preterm Infants for Optimal Physiological Development: a systematic review

Executive Summary Positioning of preterm infants is a basic task of neonatal nursing care. A variety of outcomes are affected by different body positioning of preterm infants. This review evaluates the clinical evidence of the effects of positioning of preterm infants with regard to physiological outcomes and sleep states. Objectives To conduct a systematic review to determine the best available evidence related to the positioning of preterm infants. The specific review questions addressed were: the physiological outcomes affected by different positioning, and the best position for promoting sleep. Criteria for considering studies for this review This review considered all studies that included infants born before 37 weeks of gestational age in any hospital setting. Outcomes included measures for physiologic effects and sleep state. The review primarily considered any randomized clinical trails (RCTs) that explored different positions in preterm infant but also included quasi‐experimental designs. Search strategy for identification of studies The search sought to find published and unpublished studies. The database search included: Pubmed, CINAHL, ProQuest, EMBASE, Science Direct, and Dissertation Abstracts International. Studies were additionally identified from reference lists of all studies retrieved. Assessment and data extraction All studies were checked for methodological quality by two reviewers and data was extracted using tools developed by the Joanna Briggs Institute. Data analysis The study results were pooled in statistical meta‐analysis using Review Manager Software and summarized in narrative form where statistical pooling was not appropriate or possible. Results Thirty two studies were included in the review. The results of this review support the prone position in preterm infants for improvement of arterial oxygen saturation, improved lung and chest wall synchrony of respiratory improvements, decreased incidence of apnea in infants with a clinical history of apnea, promoted sleep, and decreased gastroesophageal reflux. However, the prone position increased postural abnormalities, orthopaedic abnormalities of the feet, and delayed developmental musculature. The combined use of a postural support roll and a postural nappy while very preterm infants are nursed, improved hip and shoulder posture up to term postmenstrual age. The change in body position from horizontal to head‐up tilt in very immature and unstable infants may affect the cerebral homodynamic. The management of position per se may not be sufficient for assisting preterm neonates to cope with the painful procedure. Furthermore, preterm infants are susceptible to oxygen desaturation in car seats and carrying slings. Conclusion Prone positioning was shown to have many advantages for prematurely born infants. But the longer, deep sleep period and fewer awakenings associated with a prone position would support higher vulnerability for preterm infants to sudden infant death syndrome (SIDS). Therefore, all preterm infants placed in the prone position should have continuous cardio‐respiratory and oxygen saturation monitoring. Preterm infants should be placed in a properly supported position to ensure functional support of all parts of the body as well as ensuring physical safety. In addition, preterm infants should not be left unattended in car safety seats and carrying slings.

Effectiveness of alcohol-based solutions for hand hygiene: a systematic review

&NA; Hand hygiene is an important measure in reducing the transmission of nosocomial infections in hospitals, but adherence is poor among health care workers (HCWs).More rapid and effective hand disinfection procedures have been proposed, such as rubbing with alcohol. Hand rubbing with alcohol‐based products is commonly used in some countries instead of handwashing. This review evaluates the scientific and clinical evidence on the use of alcohol‐based hand rubs in health care settings as a new option for hand hygiene. Objectives To conduct a systematic review to determine the best available evidence related to effectiveness of alcohol‐based solutions for hand hygiene. The specific review questions addressed were: the effectiveness in reducing microorganisms, compliance with hand hygiene, and the incidence of skin problems. Application time (consumption) addressed efficiency. Criteria for considering studies in this review This review considered all studies that included alcohol‐based solutions that related to the objectives of the review. Outcomes included measures for the reduction of organisms, compliance with hand hygiene, the types of skin problems, and application time. The review primarily considered any intra‐individual trials (IITs), randomised controlled trials (RCTs) and controlled clinical trials (CCTs) relating to the effectiveness of alcohol‐based solutions but also included quasi‐experimental designs. Search strategy for identification of studies The search sought to find published and unpublished studies. The databases searched included: Medline, CINAHL, ProQuest and Dissertation Abstracts International. Studies were additionally identified from reference lists of all studies retrieved. Assessment and data extraction All studies were checked for methodological quality by two reviewers and data were extracted using a tool. Data analysis The study results were pooled in statistical meta‐analysis using Review Manager software and summarized in narrative form where statistical pooling was not appropriate or possible. Results This systematic review included thirty seven studies that supports the use of alcohol‐based solutions for routine hand hygiene and surgical hand scrub. Alcohol‐based hand rub removes microorganisms from hands of personnel more effectively, requires less time, and irritates hands less often than traditional handwashing with nonmedicated soap or other antiseptic agents and water. The combination of 61% ethanol and 1% chlorhexidine gluconate (CHG) is even more effective in producing residual antibacterial properties on the skin. Furthermore, the availability of bedside alcohol‐based solutions increased compliance with hand hygiene among HCWs. Conclusion Rubbing hands with alcohol‐based agents has been proved to be effective in the reduction of microorganisms from hands. Alcohols are effective for preoperative cleaning of the hands of surgical personnel. Addition of CHG to alcohol‐based solution can produce residual antibacterial properties on the skin. The use of alcohol‐based solutions containing emollients causes less skin irritation and dryness and requires less time than washing hands with soap or other disinfectants. The promotion of bedside, alcohol‐based hand rubs contributes to the increase in compliance with hand hygiene by HCWs

Erratum to: Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC)

Teresa Conceição, Hermínia de Lencastre, Marta Aires-de-Sousa, Rocio Alvarez Marin, Marta Aires de Sousa, Nicolas Kieffer, Patrice Nordmann, Laurent Poirel, Wison Laochareonsuk, Sireekul Petyu, Pawin Wanasitchaiwat, Sutasinee Thana, Chollathip Bunyaphongphan, Woranan Boonsomsuk, Pakpoom Maneepongpermpoon, Silom Jamulitrat, Terrence Rohan Chinniah, Kavitha Prabu, Rashidah Ahmad, Susylawathi Magon, Jauharatud DiniSuhaimi, Aizzuddin Mirasin, Nurul Morni, Boon Chu, Azizah Samsuddin, Aliyah Ahmad, Amalina Sidek, Noraini Ajis, Amalina AbuBakar, 9 9 10 11* 12* Amanie Shafiee , Julaini Safar , Ming-Chin Chan , Chih-Chien Wang , Nattawipa Boonkirdram , Wilawan Picheansathian , Pimpaporn Klunklin , Hang Thi Phan , Anh Pham Phuong Dinh 14 and Tuyet Thi Kim Nguyen