Improving adherence to Standard Precautions for the control of health care-associated infections

Moralejo, D., El Dib, R., Prata, R.A, Barretti, P., Corrêa, I.| 2018|Improving adherence to Standard Precautions for the control of health care-associated infections |Cochrane Database Systematic Review|Feb |26 | 2|CD010768| DOI: 10.1002/14651858.CD010768.pub2

bacteria-163711_1280.jpg

Abstract

Background:

‘Standard Precautions’ refers to a system of actions, such as using personal protective equipment or adhering to safe handling of needles, that healthcare workers take to reduce the spread of germs in healthcare settings such as hospitals and nursing homes.

Objectives:

To assess the effectiveness of interventions that target healthcare workers to improve adherence to Standard Precautions in patient care.

Search Methods:

We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, two other databases, and two trials registers. We applied no language restrictions. The date of the most recent search was 14 February 2017.

Selection Criteria:

We included randomised trials of individuals, cluster-randomised trials, non-randomised trials, controlled before-after studies, and interrupted time-series studies that evaluated any intervention to improve adherence to Standard Precautions by any healthcare worker with responsibility for patient care in any hospital, long-term care or community setting, or artificial setting, such as a classroom or a learning laboratory.

Data collection and analysis:

Two review authors independently screened search results, extracted data from eligible trials, and assessed risk of bias for each included study, using standard methodological procedures expected by Cochrane. Because of substantial heterogeneity among interventions and outcome measures, meta-analysis was not warranted. We used the GRADE approach to assess certainty of evidence and have presented results narratively in ‘Summary of findings’ tables.

Main Results:

We included eight studies with a total of 673 participants; three studies were conducted in Asia, two in Europe, two in North America, and one in Australia. Five studies were randomised trials, two were cluster-randomised trials, and one was a non-randomised trial. Three studies compared different educational approaches versus no education, one study compared education with visualisation of respiratory particle dispersion versus education alone, two studies compared education with additional infection control support versus no intervention, one study compared peer evaluation versus no intervention, and one study evaluated use of a checklist and coloured cues. We considered all studies to be at high risk of bias with different risks. All eight studies used different measures to assess healthcare workers’ adherence to Standard Precautions. Three studies also assessed healthcare workers’ knowledge, and one measured rates of colonisation with methicillin-resistant Staphylococcus aureus (MRSA) among residents and staff of long-term care facilities. Because of heterogeneity in interventions and outcome measures, we did not conduct a meta-analysis.Education may slightly improve both healthcare workers’ adherence to Standard Precautions (three studies; four centres) and their level of knowledge (two studies; three centres; low certainty of evidence for both outcomes).Education with visualisation of respiratory particle dispersion probably improves healthcare workers’ use of facial protection but probably leads to little or no difference in knowledge (one study; 20 nurses; moderate certainty of evidence for both outcomes).Education with additional infection control support may slightly improve healthcare workers’ adherence to Standard Precautions (two studies; 44 long-term care facilities; low certainty of evidence) but probably leads to little or no difference in rates of health care-associated colonisation with MRSA (one study; 32 long-term care facilities; moderate certainty of evidence).Peer evaluation probably improves healthcare workers’ adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence).Checklists and coloured cues probably improve healthcare workers’ adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence).

Read the full systematic review at the Cochrane Library 

The Safety Net for Older People Living at Home is Failing and in Urgent Need of Repair

Age UK | September 2018 | The Safety Net for Older People Living at Home is Failing and in Urgent Need of Repair

A new interim report from Age UK warns that that the safety net we expect to be there for us as we age, if we are living at home, has become dangerously weak, with older people living alone in declining health, with no family and friends to support them, at particularly high risk

human-189282_1920.jpg

The report argues that while we may all assume that health and care professionals will keep a gentle eye on the wellbeing of older people who live at home and whose health is of concern or in decline, this can no longer be guaranteed, because of deficits within our over-stretched health and care services, plus fragmentation between them.

It explains that these problems are now often so great that a loved one needs to ‘hold the ring’ for an older person in this position, to chase progress and join up services for them. This job often falls to an adult child, or an ageing partner, placing a very considerable burden on families and often causing them considerable anxiety and distress. (Source: Age UK).

Read the full release at Age UK

Interim report here 

Ethnicity pay gap amongst consultants

BMJ| September 2018 | Ethnic pay gap among NHS doctors

A new data briefing from the BMJ looks at the discrepancy in pay between white and BME consultants; it uses basic salary data extracted from the NHS Electronic Staff Record (ESR) for December 2017 for doctors in England directly employed by the NHS, coupled with doctors’ self identified ethnicity category.

railway-1758208_1920.jpg

Tthe BMJ notes the lack of a significant pay gap for most doctor grades is encouraging, a larger gap exists among consultants: the median basic pay for white consultants is 4.9% higher than for BME consultants. This is equivalent to additional basic pay in December 2017 of £387 (€430; $490)—or, scaled up, around £4644 a year—for white consultants (Source: BMJ).

Full details at the BMJ 

In the media:

BBC News Ethnic minority consultants ‘paid less’ than white colleagues

The Guardian NHS accused of racial discrimination on pay for senior doctors

Healthy places: the link between your health and where you live [podcast]

The King’s Fund | September 2018 | Healthy places: the link between your health and where you live

The latest podcast from The King’s Fund considers the link between your health and where you live. It questionsHow do we make places healthier? Helen McKenna talks with Kate Ardern, Director of Public Health at Wigan Council, André Pinto, Public Health Manager from Public Health England and Chris Naylor, Senior Fellow from The King’s Fund.

microphone-2170049_640.jpg

Listen to it on Apple, Stitcher, Spotify and Acast or at The King’s Fund website 

Care home journey

Royal College of Nursing | September 2018 | Care home journey

A new online resource from the Royal College of Nursing has been designed to support nursing care in older peoples care homes. 

rcn.org.uk
Image source: rcn.org.uk

Care Home Journey comprises:

  • Pre-admission
  • Admission
  • Ongoing assessment / Care planning / Risk assessment
  • Short stay
  • Discharge
  • Fundamentals/ Essential care
  • Acute admission
  • Other transfer
  • End of life care

Access Care Home Journey from the RCN 

 

Superbug discovery renews hope for antibiotic treatment

University of Edinburgh| September 2018| Superbug discovery renews hope for antibiotic treatment

New research indicates that Listeria, previously thought to be resistant to antibiotics, may respond to  an antibiotic even though the bacteria carry genes that should make it highly resistant.The scientists behind the discovery argue that the antibiotic –  fosfomycin – should be reconsidered as a treatment for life-threatening Listeria infections.

drug-bottle-1674888_1280.png

Although early tests in the laboratory had indicated that it would not treat listeria infections, the findings of this new study show  fosfomycin could prove to be a useful treatment for life-threatening Listeria cases despite these bacteria testing resistant based on laboratory tests (via University of Edinburgh).

Read the full story from the University of Edinburgh

The full article is available from PLOS Genetics 

Full reference: Scortti, M., et al. | 2018| |Epistatic control of intrinsic resistance by virulence genes in Listeria| 2018| PLOS Genetics |Published: September 4, 2018| https://doi.org/10.1371/journal.pgen.1007525