Behavior Of Healthcare Workers Research Articles

Research on Healthcare Worker Behavior To Increase Hand Hygiene Compliance in a Japanese Hospital

Research on Healthcare Worker Behavior To Increase Hand Hygiene Compliance in a Japanese Hospital

Prevention of central venous catheter-related infections: what works other than impregnated or coated catheters?

Catheter-related bloodstream infections (CRBSI) are a significant cause of morbidity and excess hospital cost. Data from prospective, randomized trials demonstrate that the risk of these infections can be minimized by simple interventions. Changing the behaviour of healthcare workers who insert and care for intravascular catheters is imperative. Creating a culture of patient safety and assuring easy access to the products necessary to maintain strict asepsis during catheter insertion, dressing changes, and when manipulating catheter hubs, will enhance adherence to optimal practice and will reduce the risk posed to the millions of patients in need of such devices.

Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infection

To assess the effect of a multifaceted hand hygiene culture-change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections. Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive "culture change" package) to five clinical areas of a large university teaching hospital that had high levels of MRSA. Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL-producing Escherichia coli and Klebsiella spp. In study wards, health care worker hand hygiene compliance improved from a pre-intervention mean of 21% (95% CI, 20.3%-22.9%) to 42% (95% CI, 40.2%-43.8%) 12 months post-intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed-days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty-six months post-intervention, there had been significant reductions in hospital-wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient-episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL-producing E. coli and Klebsiella spp (90% reduction; P < 0.001). Introduction of ACHRS and a detailed culture-change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high-level MRSA endemicity.

Monitoring of compliance with infection control practices at a 710-bed tertiary facility

ISSUE: Compliance with hand hygiene practices and expanded precautions are two means of reducing healthcare-associated infections (HAIs). Monitoring of these performance indicators can be challenging in a facility with over 7000 employees and 80–100 patients on expanded precautions daily. PROJECT: Observations of hand hygiene are completed by registered nurses (RNs) of the supplemental staffing (SST) and IV teams. The RN makes random observations of hand hygiene behaviors of healthcare workers (HCWs) while performing his/her job duties. To monitor isolation, the infection control practitioners (ICPs) make weekly rounds of the units to assess compliance with established protocols. The ICP documents commendations and errors and communicates directly with available staff members. The manager is responsible for following up with staff to correct noncompliance and documenting actions taken. The data from both forms of monitoring is compiled into a quarterly report that includes unit specific HAI methicillin-resistant Staphylococcus aureus infection/colonization rates. The report is disseminated to directors, managers, and staff to communicate unit compliance with infection control practices and identify areas for improvement. Focused education is conducted for specific identified issues, such as the education campaign directed at increasing physician hand hygiene compliance. RESULTS: A total of 1124 hand hygiene observations of individual HCWs were completed between January and December 2004. Observations indicate physician compliance is 32.0%, while total HCW compliance is 68.7%. Hand hygiene education focusing on physicians increased their compliance to 59.5%, which is a statistically significant improvement (p = 0.01). For isolation monitoring, 2095 commendations and 1302 errors have been documented. An increasing trend of the amount of commendations given each quarter can be noted since initiation of monitoring in October 2003. LESSONS LEARNED: Monitoring with feedback is an effective way of increasing compliance with infection control practices if done continuously. Utilizing SST and the IV Team in hand hygiene monitoring is an easy, time-efficient method of obtaining data. When attempting to monitor infection control practices at a large facility, the use of simple, standardized forms and uniform education of the monitoring process are key factors in the consistency of the data collected.

Protecting health care workers from SARS and other respiratory pathogens: Organizational and individual factors that affect adherence to infection control guidelines

BackgroundTraditional infection control policies have focused on engineering controls, specific protocols, and personal protective equipment (PPE). In light of the variable success in protecting health care workers (HCWs) from Severe Acute Respiratory Syndrome (SARS) in 2003, organizational and individual factors related to self-protective behavior in health care settings may also play an important role.MethodsA critical review of the literature was conducted, directed at understanding what organizational and individual factors are important in protecting HCWs from infectious diseases at work.ResultsOrganizational factors, such as a positive safety climate, have been associated with increased HCW adherence to universal precautions. There is some evidence that appropriate training of HCWs could be effective in changing HCW behavior if appropriate follow-up is applied. Very little research into these factors has been conducted with regard to preventing exposures to respiratory tract pathogens, but there was evidence from the SARS outbreaks that training programs and the availability of adequate PPE were associated with a decrease risk of infection.ConclusionVariations in organizational and individual factors can explain much of the variations in self-protective behavior in health care settings. It is likely that these factors were also important determinants during the SARS outbreaks, but they have not been extensively studied.

Perinatal care for women who are addicted: implications for empowerment.

This article explores societal responses to perinatal drug abuse, including stigmatic attitudes and behaviors of health care workers that are directed toward women who abuse drugs during pregnancy. Health care providers' stigmatic responses can deter women from receiving perinatal care and place women and their unborn children at risk. Because poor women and women of color face a greater probability of being prosecuted or losing custody of their children for using drugs while they are pregnant, the article emphasizes societal responses to these client populations. Empowering strategies are suggested by which social workers and clients can potentially redefine perinatal drug abuse as a health problem rather than a legal issue and improve the environment in which perinatal care is provided.

Vaccination against influenza: UK health care workers not on-message.

Vaccination of health care workers against influenza is considered to be important as a means of protecting patients from nosocomial infection. Vaccine uptake rates have been reported to be no more than 40% and often between 20 and 30%. An evaluation of the performance of UK National Health Service trusts, following a governmental directive to implement vaccination during the winter of 2000-2001, has shown a poor uptake of vaccine. Reasons for accepting or declining vaccine are discussed. There is a need for global leadership on this issue to promote the value of vaccination and to change the behaviour of health care workers.

Knowledge, practice, and behavior of health care workers confronted to AIDS and the occupational risk of HIV transmission in Morocco

Objectives – We wanted to evaluate the knowledge, attitude, and behavior of healthcare workers on AIDS. Method – Two hundred sixty six healthcare workers were surveyed in 2 hospitals, (Rabat and Casablanca). Working conditions presenting a risk of occupational HIV transmission were also analyzed, to develop appropriate prevention. A cross-sectional study was made, using a standardized questionnaire. Ninety one doctors (34.2%), 106 nurses (39.8%), 12 laboratory technicians (8.8%) and 47 support staff (17.6%) working in various departments were included. The mean age was 32.7 years, with 83% under 40 and more than half having worked in hospital for less than 10 years. Results – The personnel knew a great deal about HIV transmission but much less about possible occupational contamination. One person out of 2 was unaware of how to inactivate HIV in hospital environment (Chlorine water, 70% alcohol), and only 18.4% knew that HIV was heat sensitive. Fifty percent thought that a systematic exclusion of patients with HIV was essential and 66% suggested that every patient admitted to the hospital should undergo systematic HIV testing. Anxiety in these settings was expressed by 56% of doctors and 62% of paramedical workers, and 85% thought they were at high risk of contamination. The frequency of occupational injuries was high and such accidents rarely declared (7%). Conclusion – This shows that greater efforts should be made to educate and inform health care workers through the occupational medicine units recently set up for the benefit of the staff.

Protocol implementation in hospital infection control practice: an Italian experience of preoperative antibiotic prophylaxis

This study evaluates the effectiveness of a protocol implemented to induce behavioural modifications in healthcare workers (HCWs). A preoperative antibiotic prophylaxis protocol for surgical procedures in clean and clean-contaminated wounds was used. The study was conducted in a 300-bed Italian university hospital between 1998 and 1999. The protocol's impact was analysed by retrospective examination of the clinical records for selected common surgical procedures. The study also investigated the reasons for the low compliance with the protocol through a focus group methodology. We examined 723 surgical procedures and the overall compliance was 30.8% (56/182) before the implementation of the protocol and 45.2% (76/168) after 1 year (P< or = 0.01). During the same period compliance with the use of antibiotics increased when antibiotics were recommended by the protocol (5/115 vs. 19/109, P< or = 0.01) and use decreased when they were not (51/67 vs. 57/59, P< or = 0.01). As reported in the focus groups, reasons for low compliance included hospital policy weaknesses in protocol definition and implementation and the cultural behaviour of HCWs. Our results reinforce previous findings that monitoring the effectiveness of protocol implementation in the medical care setting is essential. Critical points that might increase the effectiveness of protocol implementation have also been identified.

Tuberculosis control in less developed countries: can culture explain the whole picture?

Healthcare practices, adherence to treatment, and organizational behaviour of healthcare workers are the main issues concerning tuberculosis (TB) control influenced by culture. A review of research findings published in the English language literature concerning these issues, and the way in which they are affected by cultural and structural factors is presented and discussed. These findings suggest that structural rather than cultural factors may be the main explanation for the questionable behaviour of healthcare workers and patients suffering from TB in less developed countries.

Recommendations for surgical therapy planning and interventions in patients with AIDS

No other disease has exhibited such a significant influence on the behaviour of health care workers (HCW) as the AIDS pandemic. Numerous epidemiological data, however, have proven that the overall risk of transmission of the human deficiency virus (HIV) during surgical interventions is low; it is 0.3% for all types of percutaneous exposures. Nevertheless, there still is a need for wider adoption of safer surgical techniques to reduce the chances of HIV transmission in the operation theatre, which additionally minimize the risk of transmission of other blood-borne pathogens. In the case of occupational exposure to HIV-contaminated blood or body secretions post-exposure prophylaxis should be recommended stratified by the type of exposure and source material.

Organizational socialization of hospital employees. A comparative view of occupational groups

As the delivery of high-quality medical care becomes increasingly dependent on the attitudes and behaviors of health care workers, more analysis of personnel programs designed for hospital employees is needed. This research examines the organizational socialization of hospital employees--the ways in which employees are attracted to, recruited by, and developed and trained within hospitals. Using interview and questionnaire data collected from one hundred eighteen hospital employees (nurses, nurse's aides, radiology technologists, tradesmen, and accounting clerks), the research first identifies three distinct stages of socialization and specifies the activities engaged in by employees at each stage. Secondly, the research identifies four variables as possible outcomes of the socialization process (general satisfaction, mutual influence, internal work motivation, and job involvement) and empirically links important aspects of the socialization process to those outcomes. Finally, some differences between the experiences of professional, paraprofessional, and nonprofessional workers are identified and explained, and implications for the conduct of hospital socialization programs are drawn.