Bed Rails Research Articles

Cognitive Dissonance of Students Between Falls Prevention Evidence and Strategies

IntroductionHealth professional students may commonly encounter cognitive dissonance when they leave university and enter clinical placement. The primary aim was to understand if education and placement impact health professional student's knowledge of falls prevention evidence base. Theoretical FrameworkThe research design was a repeated-measure, pre-post workshop intervention, followed postplacement, intervention design. It was nested within a cluster, cross-over randomized controlled trial, and utilized data only from intervention group participants from the broader trial who were exposed to the education intervention. MethodsThis was a repeated measures design. Health professional students attended a simulation-based workshop about falls prevention strategies. Students were surveyed at three time points, pre- and postworkshop, and postplacement. Evidence supporting falls prevention strategies education was provided. Strategies were grouped into those strategies with evidence of them preventing falls, those with no evidence of preventing falls, or those that have not been tested rigorously therefore have inconclusive evidence in preventing falls. Data were analyzed with multilevel mixed-effects generalized linear model and logistic regression analyses. ResultsThere were 171 (82% female) students recruited. Following simulation-based education, students demonstrated a knowledge change (p < .05) for all strategies. Following placement, students demonstrated a knowledge shift, with more students reporting there being evidence for strategies having evidence supporting their use (i.e., Bed/chair alarms and low-low beds) (p = .003), and those strategies with an absence of evidence supporting use (i.e., Patient sitters or Bed rails) (p = .02). Students reported less support for strategies with no or an absence of evidence in prevention of falls (p < .05) following the workshop. However, students shifted their support of these strategies following placement, with more students supporting strategies with no evidence (p = .002). ConclusionsThis research highlights that students can be rapidly taught evidence supporting health care interventions. Placement can then influence and even change students’ beliefs, or perceptions of common health care interventions.

Effectiveness of barrier precautions for prevention of patient-to-patient transfer of a viral DNA surrogate marker.

Gloves and gowns are used during patient care to reduce contamination of personnel and prevent pathogen transmission. To determine whether the use of gowns adds a substantial benefit over gloves alone in preventing patient-to-patient transfer of a viral DNA surrogate marker. In total, 30 source patients had 1 cauliflower mosaic virus surrogate marker applied to their skin and clothing and a second to their bed rail and bedside table. Personnel caring for the source patients were randomized to wear gloves, gloves plus cover gowns, or no barrier. Interactions with up to 7 subsequent patients were observed, and the percentages of transfer of the DNA markers were compared among the 3 groups. In comparison to the no-barrier group (57.8% transfer of 1 or both markers), there were significant reductions in transfer of the DNA markers in the gloves group (31.1% transfer; odds ratio [OR], 0.16; 95% confidence interval [CI], 0.02-0.73) and the gloves-plus-gown group (25.9% transfer; OR, 0.11; 95% CI, 0.01-0.51). The addition of a cover gown to gloves during the interaction with the source patient did not significantly reduce the transfer of the DNA marker (P = .53). During subsequent patient interactions, transfer of the DNA markers was significantly reduced if gloves plus gowns were worn and if hand hygiene was performed (P < .05). Wearing gloves or gloves plus gowns reduced the frequency of patient-to-patient transfer of a viral DNA surrogate marker. The use of gloves plus gowns during interactions with the source patient did not reduce transfer in comparison to gloves alone.

Home Safety Evaluation Model for Older Adults With Recurrent Falls

Recurrent falls are a major threat in older adults. Home environment can be a hazard, but it is potentially modifiable/reversible. In Miami VA, occupational therapists conduct home safety evaluations (HSE) to ascertain the need for modifications to reduce falls risk. We reviewed the cohort of high-risk, recurrent falls patients evaluated at our Falls Prevention Clinic (FPC) between August 2017 to November 2019, to evaluate the impact of HSE. We identified 48 Veterans, age 76.5±6.9 years, of whom 15 (31.3%) reported 1-2 falls/year, 18 (37.5%) reported 3-4 falls/year, and 15 (31.3%) reported ≥5 falls/year. Twenty-eight (58.3%) were offered a HSE. Within these subjects, 74.2% reported falling at least once within their home, 43.8% had fear of falling, 5 (17.9%) had a history of substance or alcohol abuse. We observed that 29 (60.4%) would benefit from the addition of grab bars and 26 (54.2%) could benefit from toilet adjustments. Twelve (25.0%) were recommended to install bed rails. Only 15 (31.3%) Veterans agreed to all recommendations, 25 (52.1%) declined due to preference, and 8 (16.7%) declined for other reasons. Only 8 (16.7%) of these Veterans lived alone. Another factor is that 11 (22.9%) Veterans were renting and 32 (66.7%) owned their homes. Addressing and improving environmental hazards may ameliorate the risk for recurrent falls. Our next steps are to evaluate the extent of home modifications, and the long-term changes in falls/year. Further research needs to determine the long-term efficacy and cost-effectiveness of HSE, and how it can be more accessible to the community.

SARS-CoV-2 analysis on environmental surfaces collected in an intensive care unit: keeping Ernest Shackleton\u2019s spirit

SummaryBackgroundIntensive care unit workers are at high risk of acquiring COVID-19 infection, especially when performing invasive techniques and certain procedures that generate aerosols (< 5 μm). Therefore, one of the objectives of the health systems should implement safety practices to minimize the risk of contagion among these health professionals. Monitoring environmental contamination of SARS-CoV-2 may help to determine the potential of the environment as a transmission medium in an area highly exposed to SARS-CoV-2, such as an intensive care unit. The objective of the study was to analyze the environmental contamination by SARS-CoV-2 on surfaces collected in an intensive care unit, which is dedicated exclusively to the care of patients with COVID-19 and equipped with negative pressure of – 10 Pa and an air change rate of 20 cycles per hour. Furthermore, all ICU workers were tested for COVID-19 by quantitative RT-PCR and ELISA methods.ResultsA total of 102 samples (72 collected with pre-moistened swabs used for collection of nasopharyngeal exudates and 30 with moistened wipes used in the environmental microbiological control of the food industry) were obtained from ventilators, monitors, perfusion pumps, bed rails, lab benches, containers of personal protective equipment, computer keyboards and mice, telephones, workers’ shoes, floor, and other areas of close contact with COVID-19 patients and healthcare professionals who cared for them. The analysis by quantitative RT-PCR showed no detection of SARS-CoV-2 genome in environmental samples collected by any of the two methods described. Furthermore, none of the 237 ICU workers was infected by the virus.ConclusionsPresence of SARS-CoV-2 on the ICU surfaces could not be determined supporting that a strict cleaning protocol with sodium hypochlorite, a high air change rate, and a negative pressure in the ICU are effective in preventing environmental contamination. These facts together with the protection measures used could also explain the absence of contagion among staff inside ICUs.

Monitoring of the Environmental Contamination and Exposure Risk of COVID-19 in the Medical Staff of Coronavirus referral hospitals in Qom, Iran

COVID-19 is a new infection that first occurred in China and now is spreading worldwide. The disease is considered to be a serious respiratory disease in humans. This study has been designed to assess surface contamination of SARS-CoV-2and exposure risk of the disease in the medical staff of two coronavirus referral hospitals of Qom province, which were dedicated to the admission and treatment of COVID -19 patients.. This study was carried in two steps including analysis of environmental samples and exposure risk assessment of COVID-19. In this study 50 environmental samples were collected from different sites of the hospitals. After extracting RNA, RT-PCR was done for the detection of SARS-CoV-2. The results showed that 18% of environmental sites, including elevator buttons (8%), doorknobs (6%) and bed rails (4%) were positive. In the risk assessment process based on according to wear of personal protective equipment, exposed to high touch surfaces, performing hand hygiene, any accident with biological fluid/respiratory secretions, the results indicate that 60.4 %, 68.3%, 28.6% and 20.6% health care personal including medical doctors, nurses and assistant nurses have high risk, respectively. In general, implement a plan for monitoring health personnel exposed to confirmed COVID-19 cases for respiratory illness including environmental surveillance engineering controls and personal protective equipment recommended.

Characteristics of injuries among infants who fall from bed

IntroductionAccidental falls are the most common causes of injury among infants. Due to their limited ability to move independently, falling from bed or other types of furniture (such as sofas or armchairs) is considered the most common reason for such injury. However, little is known about the frequency and types of injury associated with this type of fall among infants. This study aimed to determine the incidence and characteristics of injury among infants presented at emergency departments (ED) after falling from bed or similar furniture. MethodsThe retrospective analysis of infants under one year old presenting at ED after falling from bed (or similar furniture) was performed over a four-year period (2016–2019). Patient demographics, incidence and patterns of injury, outcomes, and ED resources use were evaluated as part of the study. ResultsIn total, 1,439 infants were included in the study, of whom 782 (54.3%) were male and 657 (45.7%) female. The median age of the patients was 7 months (interquartile range [IQR]: 6–9 months). More than half the infants (n = 812, 56.4%) had minor injuries, such as abrasions, bruising, contusions, and lacerations. There were significant injuries for 135 (9.4%) infants. The most common fracture was skull fracture (n = 59, 4.1%), followed by proximal fracture of the upper extremities (n = 26, 1.8%). Six (0.4%) patients had radial head subluxation. Traumatic brain injury featured for 30 (2.1%) infants (intracranial hemorrhage/cerebral contusion). While the majority of patients (n = 1352, 94%) were discharged from ED, 86 (6%) infants were hospitalized, all due to head injuries. A neurosurgical intervention was performed with three (0.2% of all patients) of the hospitalized patients. ConclusionFalling from bed causes skull fractures, traumatic brain injury, and long bone fractures among infants. Therefore, campaigns should be organized to raise awareness of these risks among parents and caregivers of infants. In addition, the use of safety equipment (such as bed rails) and creating a safe environment can help prevent significant injuries.

A Continuously Active Antimicrobial Surface Coating Reduces Bioburden in a Healthcare Setting

Background: It is well known that contaminated surfaces contribute to the transmission of pathogens in healthcare settings, necessitating the need for antimicrobial strategies beyond routine cleaning with momentary disinfectants. A recent publication demonstrated that application of a novel, continuously active antimicrobial surface coating in ICUs resulted in the reduction of healthcare-associated infections. Objective: We determined the general microbial bioburden and incidence of relevant pathogens present in patient rooms at 2 metropolitan hospitals before and after application of a continuously active antimicrobial surface coating. Methods: A continuously active antimicrobial surface coating was applied to patient rooms in intensive care units (ICUs) twice over an 18-month period and in non-ICUs twice over a 6-month study period. The environmental bioburden was assessed 8–16 weeks after each treatment. A 100-cm2 area was swabbed from frequently touched areas in patient rooms: patient chair arm rest, bed rail, TV remote, and backsplash behind the sink. The total aerobic bacteria count was determined for each location by enumeration on tryptic soy agar (TSA); the geometric mean was used to compare bioburden before and after treatment. Each sample was also plated on selective agar for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile to determine whether pathogens were present. Pathogen incidence was calculated as the percentage of total sites positive for at least 1 of the 4 target organisms. Results: Before application of the antimicrobial coating, total aerobic bacteria counts in ICUs were &gt;1,500 CFU/100 cm2, and at least 30% of the sites were positive for a target pathogen (ie, CRE, VRE, MRSA or C. difficile). In non-ICUs, the bioburden before treatment was at least 500 CFU/100 cm2, with &gt;50% of sites being contaminated with a pathogen. After successive applications of the surface coating, total aerobic bacteria were reduced by &gt;80% in the ICUs and &gt;40% in the non-ICUs. Similarly, the incidence of pathogen-positive sites was reduced by at least 50% in both ICUs and non-ICUs. Conclusions: The use of a continuously active antimicrobial surface coating provides a significant (P &lt; .01) and sustained reduction in aerobic bacteria while also reducing the occurrence of epidemiologically important pathogens on frequently touched surfaces in patient rooms. These findings support the use of novel antimicrobial technologies as an additional layer of protection against the transmission of potentially harmful bacteria from contaminated surfaces to patients.Funding: Allied BioScience provided Funding: for this study.Disclosures: Valerie Beck reports salary from Allied BioScience.

Quantitative Characterization of High-Touch Surfaces in Emergency Departments and Hemodialysis Facilities

Background: The healthcare environment can serve as a reservoir for many microorganisms and, in the absence of appropriate cleaning and disinfection, can contribute to pathogen transmission. Identification of high-touch surfaces (HTS) in hospital patient rooms has allowed the recognition of surfaces that represent the greatest transmission risk and prioritization of cleaning and disinfection resources for infection prevention. HTS in other healthcare settings, including high-volume and high-risk settings such as emergency departments (EDs) and hemodialysis facilities (HDFs), have not been well studied or defined. Methods: Observations were conducted in 2 EDs and 3 HDFs using structured observation tools. All touch episodes, defined as hand-to-surface contact regardless of hand hygiene and/or glove use, were recorded. Touches by healthcare personnel, patients, and visitors were included. Surfaces were classified as being allocated to individual patients or shared among multiple patients. The number of touch episodes per hour was calculated for each surface to rank surfaces by frequency of touch. Results: In total, 28 hours of observation (14 hours each in EDs and HDFs) were conducted. 1,976 touch episodes were observed among 62 surfaces. On average, more touch episodes were observed per hour in HDFs than in EDs (89 vs 52, respectively). The most frequently touched surfaces in EDs included stretcher rails, privacy curtains, visitor chair arm rests and seats, and patient bedside tables, which together accounted for 68.8% of all touch episodes in EDs (Fig. 1). Frequently touched surfaces in HDFs included both shared and single-patient surfaces: 27.8% and 72.2% of HDF touch episodes, respectively. The most frequently touched surfaces in HDFs were supply cart drawers, dialysis machine control panels and keyboards, handwashing faucet handles, bedside work tables, and bed rail or dialysis chair armrests, which accounted for 68.4% of all touch-episodes recorded. Conclusions: To our knowledge, this is the first quantitative study to identify HTSs in EDs and HDFs. Our observations reveal that certain surfaces within these environments are subject to a substantially greater frequency of hand contact than others and that a relatively small number of surfaces account for most touch episodes. Notably, whereas HTSs in EDs were primarily single-patient surfaces, HTSs in HDFs included surfaces shared in the care of multiple patients, which may represent an even greater risk of patient-to-patient pathogen transmission than single-patient surfaces. The identification of HTSs in EDs and HDFs contributes to a better understanding of the risk of environment-related pathogen transmission in these settings and may allow prioritization and optimization of cleaning and disinfection resources within facilities.Funding: NoneDisclosures: None

Environmental contamination related to SARS-CoV-2 in ICU patients

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak is a primary global concern, and data are lacking concerning risk of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination.ObjectiveTo identify risk factors for SARS-CoV-2 environmental contamination in COVID-19 patients admitted to the intensive care unit (ICU).MethodsA prospective single centre 1-day study was carried out in an ICU. Four surfaces (the ventilator control screen, the control buttons of the syringe pump, the bed rails and the computer table located >1 m away from the patient) were systematically swabbed at least 8 h after any cleaning process. We analysed clinical, microbiological and radiological data to identify risk factors for SARS-CoV-2 environmental contamination.Results40% of ICU patients were found to contaminate their environment. No particular trend emerged regarding the type of surface contaminated. Modality of oxygen support (high-flow nasal cannula oxygenation, invasive mechanical ventilation, standard oxygen mask) was not associated with the risk of environmental contamination. Univariate analysis showed that lymphopenia <0.7×109·L−1 was associated with environmental contamination.ConclusionDespite small sample size, our study generated surprising results. Modality of oxygen support is not associated with risk of environmental contamination. Further studies are needed.

Analysis of the Virus Contamination and Disinfection Effect in Isolation Ward of Patients With COVID-19.

The recent outbreak of COVID-19 has infected a large number of patients, increasing the importance of adequate disinfection of the hospital environment. We conducted this study to explore environmental virus contamination and the effect of terminal disinfection in the isolation ward of patients with COVID-19. A swab kit was used to sample various surfaces in the isolation and observation wards using the smear method. The samples were immediately sent to the PCR department of the laboratory for nucleic acid detection of COVID-19. We analyzed 31 high-frequency contact sites in three isolation wards of actively sick patients, of which seven were positive (22.58%, 7/31). Positive sites included the transfer window, bed rail, buffer room door handle, toilet door handle, and toilet faucet. All 55 samples taken from the wards of cured patients and the wards after terminal disinfection were negative. Virus contamination in areas frequently touched by patients in the isolation ward was high, so the awareness of correct disinfection must be increased. Use of 1,000–2,000 mg/L chlorine-containing disinfectant in the isolation ward was effective.

Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

Bacteriological Assessment of Hospital Air and Selected Surfaces in Three Referral Hospitals in Makurdi Middle Belt Nigeria

Hospital environment needs more attention because of the influx of people into the environment for medical checkup and other services. This study unveils the incidence of bacteria isolated from air and selected surfaces in three referral hospitals (City hospital, Federal Medical Centre, Wadata and Saint Theresa Hospital) in Makurdi Middle Belt Nigeria. Fifty (50) bacteria were isolated; hospital air (26%), bed rails (16%), door knobs (2%), floor (4%), nurse table top (10%), operation table (4%), sink (18%), stretchers (2%) and toilet seat (12%). In City Hospital, the bacteria isolated include Escherichia coli (6%), Pseudomonas aeruginosa (2%), Staphylococcus aureus and Staphylococcus spp (2%), from Federal Medical Centre, bacteria isolated were Klebsiella spp (10%), Staphylococcus aureus (4%), Staphylococcus spp (8%), Pseudomonas aeruginosa (12%) and E. coli (6%). In STH, bacteria isolated include E. coli (8%), Pseudomonas aeruginosa (4%), Staphylococcus spp (8%) and Staphylococcus aureus (14%). The invitro antibiotics susceptibility pattern shows that Pseudomonas aeruginosa showed highest resistant to the antibiotics while Klebsiella spp was susceptible to majority of the antibiotics but resistant to cloxacillin and erythromycin. The study reveals Klebsiella spp, Escherichia coli, Pseudomonas aeruginosa, S. aureus and other Staphylococcus spp as bacteria commonly associated with hospital environment. This study affirms the presence of resistant bacteria strains and highlighted world-wide problem of hospital borne infections as it concerns the study area and population. This report will create awareness and be a good guide to health care workers, patients and the public about the likeliness of contracting nosocomial infection and how to treat such infection. Major recommendations offered suggests that, healthcare workers should be more careful in carrying out their duty to avoid chance of being infected in the course of their work. Also, the in-vitro antibiotics susceptibility testing on the bacterial pathogens in the study will assist the clinicians in making improvement on the management of nosocomial infections.

Microbial Assessment of Recontamination with Acinetobacter in Patient Room Environment in Burn Units

<h3>Background</h3> Acinetobacter is an important opportunistic pathogen causing healthcare-associated infections and outbreaks in burn patients. The healthcare environment can be persistently contaminated despite routine room cleaning/disinfection and recontaminated via healthcare personnel and patients. The aim of this study was to investigate the microbial burden on patient room environment in burn units and assess how much environmental sites become recontaminated with Acinetobacter over time after cleaning/disinfection. <h3>Methods</h3> This study was conducted in burn units of an academic hospital. A baseline of the amount of contamination were evaluated by sampling six environmental sites (i.e., chair, bed rail, overbed table, supply cart, stock cabinet, IV pump, and monitor) with Rodac plates in four rooms housing patients with Acinetobacter infection/colonization. After cleaning/disinfection, samples were taken from those sites at 1-hour intervals for ten hours. Two Rodac plates were collected at each site, and total colony forming units (CFU) and Acinetobacter counts were calculated. <h3>Results</h3> Mean aerobes and Acinetobacter CFU/RODAC in four rooms housing patients with Acinetobacter were determined. At baseline all environmental sites sampled except overbed table were contaminated with Acinetobacter. Immediately after cleaning/disinfection, Acinetobacter was only detected on the bed rail (1 CFU). First time to recontamination with Acinetobacter was as follows: chair, 3 hours; overbed table, 2 hours; stock cabinet, 3 hours; and IV pump, 2 hours. No recontamination were observed at the monitor. The level of Acinetobacter contamination on surfaces was occasionally high (e.g., when stock cabinet sampled at 5 hours, 75 of 96 CFU were Acinetobacter). The amount of recontamination with aerobes and Acinetobacter increased over time. <h3>Conclusions</h3> Our study demonstrated that recontamination with Acinetobacter occurred rapidly at environmental sites in burn units even after cleaning/disinfection and underscored the need for enhanced environmental cleaning, including continuous disinfection methods, to prevent transmission of healthcare-associated pathogens.

Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

BackgroundThe fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix.AimThe study aimed to determine the factors that influence patient falls.SettingA private hospital group in the Cape Metropole of the Western Cape.MethodsA quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS).ResultsIntrinsic factors contributing to patient falls includedthe patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment.ConclusionThe lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.

Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19).

The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)-laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports. Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients' clinical samples and environmental samples was analyzed. All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients' mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001). SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.

Evaluating bio-burden of frequently touched surfaces using Adenosine Triphosphate bioluminescence (ATP): Results from the Researching Effective Approaches to Cleaning in Hospitals (REACH) trial.

Environmental cleaning is an important approach to reducing healthcare-associated infection. The aim of this short research paper is to describe changes in the efficacy of post-discharge cleaning by examining the amount of bio-burden on frequent touch points (FTPs) in patient areas, using a validated Adenosine Triphosphate (ATP) bioluminescence sampling method. In so doing, we present findings from a secondary outcome of a recent trial, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study. The REACH study used a prospective, stepped-wedge randomised cluster design. Cross sectional ATP sampling was conducted at three of the 11 participating hospitals. At each hospital, during the control and intervention phase of the study, six Frequent Touch Points (FTPs) were sampled: toilet flush, bathroom tap, inside bathroom door handle, patient call button, over bed tray table, and bed rails. Across the three hospitals, 519 surfaces in 49 rooms (control phase) and 2856 surfaces in 251 rooms (intervention phase) were sampled. Bedroom FTP cleaning improved across all three hospitals. The cleaning of bathroom FTPs was generally high from the outset and remained consistent throughout the whole study period. Average cleaning outcomes for bathroom FTPs were consistently high during the control period however outcomes varied between individual FTP. Changes in cleaning performance over time reflected variation in intervention effectiveness at the hospital level. Findings confirm improvement in cleaning in the FTPs in bedrooms, demonstrating improvements in discharge cleaning aligned with the improvements seen when using fluorescent marking technology as a marker of performance.

From both sides of the bed rails

In the latest in the Patient Story series, Beth Greenaway recalls how her condition has impacted her life, from her career choices to her living situation.

Disinfection of Endoscopy and Reusability of Accessories

Corona viruses are a group of medium-sized positive-sense single-stranded RNA viruses with crown-like structure due to projections noted over the surface of the virus. The infection has been declared as a pandemic by the world health organization (WHO) in March 2020. Health care professionals in endoscopy are at high risk of infection by novel corona virus disease 2019 (COVID-19) from inhalation of droplets, conjunctival contact, feces, and touch contamination. Upper gastrointestinal (GI) endoscopy is considered to be a high-risk aerosol-generating procedures (AGPs) and the live virus has been found in patient stool. Flexible endoscopes when contaminated have been considered as the vector for transmission of infections. Infections related to the side viewing endoscopes and endoscopic ultrasound scopes are more frequent than upper GI scope and colonoscopes. Stratifying patients needing endoscopy and deferral of elective procedures will help to decrease the virus spread. Planning and revision of workflows is necessary for safety of patient and staff and to successfully provide infection prevention and control measures, for this a “three zones and two passages” concept should be followed. Manual cleaning followed by high-level disinfection (HLD), effectively eliminates nearly all microorganisms from endoscopes during reprocessing. Transmission of viral infections during endoscopy is quite rare and, it is usually the result of noncompliance from the essential steps of reprocessing. Reuse of any disposable GI endoscopic device is strongly discouraged. Environmental decontamination is essential to reduce the risk of fomite transmission. Noncritical environmental surfaces frequently touched by hands (e.g., bedside tables and bed rails) and endoscopy furniture and floor should be considered heavily contaminated in patients with intermediate or high risk of COVID-19 and should be thoroughly disinfected at the end of each procedure. If available, negative pressure rooms are preferred for endoscopy, as has been advised by Centers for Disease Control and Prevention (CDC). Staff involved in reprocessing and the cleaning of endoscopy rooms should utilize personal protective equipment (PPE) including N95 mask. Reprocessing staff should undergo necessary training and ongoing annual assessment of competency.

Mechanical Restraint in Nursing Homes in Brazil: a cross-sectional study.

to estimate the mechanical restraint prevalence in Nursing Homes in Brazil and the factors associated with its performance. this cross-sectional study was carried out in 14 institutions, with a final sample of 443 elderly people. Mechanical restraint was considered as a dependent variable. there was a 7.45% prevalence of mechanical restraint considering bed rails and 3.84% without considering bed rails. Main justification for restraint use was risk of falls (66.7%), and restraint duration was 24 hours (84.8%). The factors associated with the dependent variable were: wandering (p=0.000); MMSE, with cognitive loss (p=0.000); Katz Index, with dependence for Activities of Daily Living (p=0.000); and Alzheimer's comorbidity (p=0.001) Conclusion: prevalence was lower than international studies, but there was an association with worsening of wandering, dependence, cognitive worsening, and Alzheimer's Disease, showing the need for alternative interventions to mechanical restraint.

Covid-19 Infection

Covid-19 Infection