Patients In Health Care Settings Research Articles

Assessment of the knowledge and attitudes of nurses and social caregivers in relation to falls among elderly patients in healthcare settings in a Hungarian county

AbstractPurposeThe aim of this descriptive study was to evaluate the knowledge and attitudes of nurses and social caregivers in relation to falls among elderly patients.Materials/MethodsA total of 442 nurses and social caregivers working in acute or chronic care settings participated in our study. Data were gathered on the participants' general characteristics, the characteristics of their workplace, and their levels of knowledge in relation to risk factors and types of falls. Our questionnaire also included a survey of attitudes towards fall prevention. Data were analysed using IBM SPSS software.ResultsOur results showed a significant correlation between the participants' level of knowledge and age, level of professional education, workplace localisation, form and type of care, risk evaluation scale score, and the existence of a healthcare protocol at the workplace. Participants demonstrated a positive attitude towards fall prevention: the mean value for attitude was 48.03 out of 65 points. Participants who experienced a lower number of falls among elderly patients at their workplace demonstrated a significantly more positive attitude to prevention compared to those experiencing falls more frequently.ConclusionsIn our professional opinion, trainings focusing on fall prevention are required. In addition to knowledge transfer, these should emphasise the formation of attitudes, especially in the context of chronic healthcare, among professionals working in institutions in smaller towns.

Real-time dynamic polygenic prediction for streaming data.

Polygenic risk scores (PRSs) are promising tools for advancing precision medicine. However, existing PRS construction methods rely on static summary statistics derived from genome-wide association studies (GWASs), which are often updated at lengthy intervals. As genetic data and health outcomes are continuously being generated at an ever-increasing pace, the current PRS training and deployment paradigm is suboptimal in maximizing the prediction accuracy of PRSs for incoming patients in healthcare settings. Here, we introduce real-time PRS-CS (rtPRS-CS), which enables online, dynamic refinement and calibration of PRS as each new sample is collected, without the need to perform intermediate GWASs. Through extensive simulation studies, we evaluate the performance of rtPRS-CS across various genetic architectures and training sample sizes. Leveraging quantitative traits from the Mass General Brigham Biobank and UK Biobank, we show that rtPRS-CS can integrate massive streaming data to enhance PRS prediction over time. We further apply rtPRS-CS to 22 schizophrenia cohorts in 7 Asian regions, demonstrating the clinical utility of rtPRS-CS in dynamically predicting and stratifying disease risk across diverse genetic ancestries.

An Evaluation of the Changing Trends in Substance Use Behavior Among Patients in the Tertiary Care Setting After the Implementation of Liquor Prohibition in Bihar, India: A Cross-Sectional Study.

Background and objective Substance use disorders pose significant global public health challenges, with India being no exception. Bihar, one of India's most populous states, implemented alcohol prohibition in April 2016 to address the adverse effects of alcohol abuse. However, the impact of this policy on overall substance use behavior among patients in healthcare settings remains to be explored. This cross-sectional study aimed to evaluate the changing trends in substance use behavior among patients in the tertiary care setting following the prohibition of alcohol use in Bihar. Methods A total of 372 patients diagnosed with substance use disorders were recruited from tertiary care facilities in Bihar. Data on demographic characteristics, types of substances used, frequency and quantity of use, reasons for use, and awareness of prohibition laws were collected through structured interviews and reviews of medical records. Descriptive and inferential statistics were used for data analysis. Results The majority of the participants were male (n = 346, 93.01%), with a mean age of 38.5 years. While tobacco use remains stable, there are significant increases in opioid and cannabis consumption post-prohibition, highlighting unintended consequences (p-values - opioids: 0.008, cannabis: 0.021). Additionally, heightened daily and weekly substance use after prohibition is evident (p-values: daily: 0.008, weekly: 0.021), emphasizing the necessity for nuanced policy considerations. Reasons for substance use, including coping with stress and peer pressure, showed significant differences before and after the prohibition (p<0.05). Moreover, awareness of alcohol prohibition laws increased significantly after the implementation of the prohibition (p = 0.003). Conclusions Our findings suggest that while alcohol prohibition in Bihar did not significantly lead to any changes in terms of the types of substances used among patients in tertiary care settings, it did influence the frequency and quantity of tobacco and cannabis consumption. Increased awareness of prohibition laws underscores the importance of policy enforcement and public education initiatives in addressing substance use behavior.

A novel molecular assay conducted on the BD Max system to facilitate reflex testing for vanA and vanB in clinical isolates of enterococci

Infections caused by vancomycin-resistant enterococci (VRE) are common. Real-time PCR assays targeting vanA and vanB facilitate screening of patients in healthcare settings to limit the risk of dissemination, especially amongst those at high-risk of infection or with limited treatment options. Such assays are commonly performed as reflex testing procedures where they augment phenotypic techniques and shorten turnaround time to benefit timely clinical management. 'Random access' and 'sample-to-result' real-time PCR platforms are suited for this application as they are of low complexity and less technically demanding. Modelled on these attributes, we configured a real-time PCR assay (VRE BD) for detection of vanA/B in clinical isolates of enterococci, adapted for the BD Max System (Becton Dickinson). We applied an unconventional approach by testing suspensions of microorganisms in water to circumvent the traditional pre-analytical genomic extraction process. Our objective of this study was to assess the performance of this assay for detection of VRE in cultures by validating against a traditional real-time PCR assay based on the LightCycler 2.0 platform (Roche, VRE RO). A high level of analytical sensitivity and specificity (≥99.0%) for both genes was obtained when testing suspensions derived from blood agar. Results for suspensions obtained from chromID VRE (Edwards Group) showed a similar level of performance for vanA detection (100%), but not for the vanB target (≥90.9%) where a lesser number of isolates were available for testing. However, our results for VRE detection in isolates from these media were repeatable and reproducible, and equated to positive and negative predictive values of ≥95.2% and ≥97.8%, respectively. Furthermore, the VRE BD assay was also able to accurately detect VRE in clinical and spiked BacT/ALERT (bioMérieux) blood cultures. Thus, the technical simplicity, short turnaround time and robustness of this high performing assay for VRE is suitable for reflex testing. In addition, the format developed for the BD Max platform has potential application for reflex testing other molecular targets of clinical importance.

Emerging trends of invasive yeast infections and azole resistance in Beijing intensive care units

Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. A two-phase surveillance project was conducted in Beijing, China, involving 37 centers across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016–2017 exhibited a significant decline compared to the 2012–2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Insight into the Antibiotic Susceptibility Algorithm Procedures for Detecting Carbapenem-Resistant Enterobacter Cloacae

The sudden increase in the predominance and clinical impact of infection caused by carbapenem resistance Enterobacter cloacae (CR-ECL) is a global health concern. CR-ECL is notably problematic when identified in the clinical microbiology laboratory. Due to CR-ECL's intrinsic resistance to most cephalosporin and carbapenem and their ability to spread and colonize patients in healthcare settings, identifying and preventing the transmission of these organisms is a significant public health initiative, and coordinated international efforts are needed. Following established antibiotic susceptibility algorithms ensures a systematic and comprehensive assessment of bacterial resistance patterns. This approach helps identify potential resistance mechanisms and guide effective treatment strategies. The algorithm approach considers clinical factors such as patient history, site of infection, and local resistance patterns, enhancing the relevance and applicability of susceptibility testing results to individual patient management. Importantly, continuously monitoring CR-ECL antibiotic resistance patterns and surveillance of emerging resistance mechanisms is essential to adapting and refining antibiotic susceptibility algorithms to evolving clinical needs. This review highlights our current understanding of CR-ECL, emphasizing their epidemiology, detection, treatment, and control.

Unfinished nursing care in healthcare settings during the COVID-19 pandemic: a systematic review

BackgroundUnfinished nursing care is becoming increasingly more of a concern in worldwide healthcare settings. Given their negative outcomes, it is crucial to continuously assess those nursing interventions that are commonly postponed or missed, as well as the underlying reasons and consequences. The worldwide COVID-19 pandemic has made it difficult for health facilities to maintain their sustainability and continuity of care, which has also influenced the unfinished nursing care phenomenon. However, no summary of the studies conducted during the COVID-19 pandemic was produced up to now. The main aim of this study was to systematically review the occurrence of, reasons for, and consequences of unfinished nursing care among patients in healthcare settings during the COVID-19 pandemic.MethodsSystematic review registered in PROSPERO (CRD42023422871). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline and the Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies were used. MEDLINE-PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from March 2020 up to May 2023, using keywords established in the field as missed care, unfinished nursing care, or implicit rationing.ResultsTwenty-five studies conducted mainly in European and Asiatic countries were included and assessed as possessing good methodological quality. The following tools were used: the MISSCARE Survey (= 14); the Basel Extent of Rationing of Nursing Care (= 1), also in its revised form (= 2) and regarding nursing homes (= 2); the Perceived Implicit Rationing of Nursing Care (= 4); the Intensive Care Unit-Omitted Nursing Care (= 1); and the Unfinished Nursing Care Survey (= 1). The order of unfinished nursing care interventions that emerged across studies for some countries is substantially in line with pre-pandemic data (e.g., oral care, ambulation). However, some interesting variations emerged at the country and inter-country levels. Conversely, labour resources and reasons close to the emotional state and well-being of nurses were mentioned homogeneously as most affecting unfinished nursing care during the pandemic. None of the studies investigated the consequences of unfinished nursing care.ConclusionsTwo continents led the research in this field during the pandemic: Europe, where this research was already well established, and Asia, where this research is substantially new. While unfinished care occurrence seems to be based on pre-established patterns across Europe (e.g., regarding fundamentals needs), new patterns emerged across Asiatic countries. Among the reasons, homogeneity in the findings emerged all in line with those documented in the pre-pandemic era.

Quality of examination gloves in health facilities in Addis Ababa, Ethiopia

Background: Examination gloves are used in health facilities to protect health professionals and patients from the risk of infection and reduce opportunities for cross-transmission of infectious microorganisms. Poor-quality examination gloves can expose health professionals to infectious diseases such as Covid-19, Hepatitis, HIV/AIDS, and other contagious diseases. Hence, this study aimed to assess the quality of examination gloves in health facilities in Addis Ababa.&#x0D; Methods: A cross-sectional study design was employed. The examination gloves were collected from randomly selected health facilities in Addis Ababa. The gloves were examined following standard procedure in the Ethiopian Food and Drug Authority. Holes in the examination gloves were detected using the watertight (leakage test) and geometrical dimensions such as thickness, width, and length were measured.&#x0D; Results: A total of 2500 selected examination gloves were collected between Feb 10 and Feb 20, 2021. The gloves were sampled from health facilities in Addis Ababa. From the total samples collected, only 2280 examination gloves of five different brands were tested, which makes the response rate 91.2%. The proportion of gloves with holes detected ranged from 5.7% to 21.9%. Overall, only 0.17% and 3.2% of the gloves had width and length below standard, respectively. None of the gloves tested in this study had a thickness below the standard.&#x0D; Conclusions: All brands of examination gloves tested had a higher hole (leakage) rate than the acceptable quality limit. This implies there is a substantial risk of infectious disease transmission to health professionals and patients in healthcare settings. Hence, regulatory enforcements need to be strengthened across the life cycle of the product.

Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions.

This article explores how broad, contextual factors may be influential in the retention of direct care workers (DCWs; i.e., entry-level caregivers) who provide vital support to patients in healthcare settings. We reflect on lessons learned from an evaluation of a multisite intervention to improve retention among DCWs employed primarily in hospital settings at three health systems. We evaluated a multitiered program for entry-level caregivers that included a risk assessment, a 4-day curriculum, and follow-up sessions, as well as workforce coaching at the three health systems. As part of our evaluation, we collected data on roughly 3,000 DCWs from the three health systems; the information included hiring date, any transfer date, and any termination date for each new DCW, as well as demographic information, position characteristics, and termination status and reasons for any termination. In addition, we collected information about organizational characteristics, including staffing and number of employees. We also conducted interviews with 56 DCWs and 21 staff members who implemented a retention program across each of the three health systems and remotely conducted virtual observations of the curriculum sessions at each system. Although the program we evaluated focused on individual-level factors that may affect retention, our findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation, aspects of the job itself, and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic. As the direct care workforce continues to grow, interventions to improve retention should consider the interconnectedness of these multilevel factors rather than solely individual-level factors. In addition, further research is needed to rigorously evaluate any potential intervention and consider how such an approach can target DCWs in hospital-based settings who are most affected by the multilevel challenges identified. Finally, any intervention to improve retention must be also aligned to ensure equity, especially in this population of low-wage DCWs, many of whom are marginalized women and individuals of color.

Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings. Urinary tract infections have a significant health impact on HIV-infected patients. Nowadays, drug-resistant pathogens are widespread poses a serious clinical risk, and causes urinary tract infection. The common agents of bacteria and fungi that cause urinary tract infection are Escherichia coli followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida. albicans. This study aimed to investigate uro-pathogen, multidrug resistance pattern of bacteria, and associated factors of community-acquired urinary tract infection among HIV-positive patients attending antiretroviral therapy in Dessie comprehensive specialized hospital, Northeast Ethiopia from February 1, 2021, to March 30, 2021. An institutional-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital. Socio-demographic and clinical data were collected by using structured questionnaires from HIV patients suspected of community-acquired urinary tract infections. About 10 ml of clean-catch midstream urine was collected and inoculated into Blood agar, MacConkey, and Cysteine lactose electrolyte deficient media. Yeasts were identified by using Gram stain, germ tube test, carbohydrate fermentation, assimilation tests, and chromogenic medium. Gram stain and biochemical tests were performed to identify isolates and an antimicrobial susceptibility pattern was performed on disc diffusion techniques. Data were entered and analyzed using SPSS version 25. Both bivariate and multivariable logistic regression analysis was performed and a P value of < 0.05 with an adjusted odds ratio with their 95% confidence interval (CI) was used as statistically significant associations. From the total 346 study participants, 92 (26.6%) were culture positive 75 (81.52%) were bacterial and 17 (18.48%) were fungal pathogens. From a total of 75 bacteria isolates 51(68%) were Gram-negative bacteria and the most commonly isolated bacteria were E. coli 16 (21.33%) followed by K. pneumoniae 11(14.67%) and enterococcus species 10(10.87. Of the 17 fungal isolates of fungi, 8(47.1%) were represented by C. tropicalis. Of the isolated bacteria, 61(81.3%) were resistant to three and above classes of antibiotics (drug classes). About 13 (81.3%) of E. coli, 9(81.8%) of K. pneumoniae, 8(80%) of Enterococcus species, 7 (77.8%) of P. aeruginosa, and CoNs 7(87.5%) were the most frequently exhibited three and above classes of antibiotics (multi-drug resistance). Amikacin and gentamicin were effective against Gram-negative Uro-pathogens. Participants aged>44year, female, being daily labor, being farmer, unable to read and write, patients with CD4 count of ≤ 200 cells/mm3 and CD4 count of 201-350 cells/mm3, who had chronic diabetics, patients having a history of hospitalization and who had urgency of urinations were statistically significant association with significant urinary tract infections. The burden of community-acquired urinary tract infections among HIV patients is alarmingly increased. Therefore, behavior change communications might be considered for promoting the health status of HIV patients. Moreover, CD4 level monitoring and therapeutics selection based on microbiological culture are quite advisable for the management of urinary tract infections of HIV patients.

Barriers Contributing to Loss to Follow-up among HIV-patients in Limpopo Province, South Africa: Patients’ and Nurses’ Perspectives

Background: Antiretroviral therapy is a lifelong commitment that requires patients to adhere to their daily medication dose schedules and make frequent visits to health services for their care. People living with HIV can live healthy long lives when retained on antiretroviral therapy. Retention in care has been identified as the benchmark in the HIV Care Continuum, where most people living with HIV fail. Interventions are urgently needed to address this benchmark to achieve the worldwide 95-95-95 goals. Despite the South African government`s efforts to expand access to antiretroviral therapy services from urban centers to resource-constrained rural communities, there were 140,000 HIV- related deaths in 2014 and 85,796 HIV- related deaths in 2021. Patients have become lost to follow-up, putting their health and that of their communities at risk. Moreover, the loss of follow-up care among HIV-positive people who are on antiretroviral treatment continues to be a significant problem. The study determined barriers contributing to the Loss of follow-up rates among people living with HIV. Methods: A qualitative research study was conducted; Non-probability purposive sampling was used to select eight nurses from clinics with the highest and lowest loss-to-follow-up rates. The probability systematic sampling method was used to select patients from the selected clinics. Data were collected through semi-structured interviews, and content analysis was used to analyse the data. Results: Patients’ and nurses’ perspectives on barriers contributing to the loss of follow-up among people living with HIV included lack of confidentiality, lack of understanding of antiretroviral treatment, patients’ self-transfer, and feeling better physically. Conclusion: Understanding the reasons for the Loss of follow-up could inform the development of retention in care interventions for Limpopo province. The study can be most beneficial with HIV education, skills building, and outreach programme strategies; this will, in turn, increase the knowledge needed to better attract and retain HIV-positive patients in healthcare settings.

Core competencies in critical care for general medical practitioners in South Africa: A Delphi study.

Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. A final list of 153 core competencies in critical care was identified. The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.

Healthy Workplaces for Nurses: A Review of Lateral Violence and Evidence-Based Interventions

Most nurses in the United States have experienced workplace bullying, also referred to as lateral violence. Workplace bullying is serious within professional nursing practice. These behaviors are often associated with detrimental consequences for nurses, their patients, and the greater health care organization. We performed a literature review to summarize recent studies on this pervasive yet persistent problem as well as evidence-based solutions. In environments where managers, supervisors, and administrators are unable or unwilling to address lateral violence, a common pattern is that offenders continue to target new employees and cause turmoil for workers and patients in healthcare settings. This work environment also causes harm and endangers patients. Although workplace bullying cannot be fixed with just one solution, there are different initiatives healthcare settings and educational institutions can implement to help prevent and eliminate workplace bullying, such as improving leadership training and interprofessional communication. Once these initiatives are put into practice, healthcare practices can start saving money, increasing employee satisfaction, retaining workers, and providing better healthcare services for their patients.

Low Rate of Bacterial Coinfections and Antibiotic Overprescribing During COVID-19 Pandemic: A Retrospective Study from Oman.

The recommended treatment for COVID-19 includes antiviral drugs, corticosteroids, immunomodulatory drugs, low molecular weight heparin, as well as antibiotics. Although COVID-19 is a viral disease, many studies indicate that antibiotics are prescribed frequently, mainly to treat suspected bacterial coinfection. At the same time, the prevalence of bacterial coinfections during COVID-19 is rather low indicating the significant antibiotic overuse in these patients. It is well known that this can trigger antibiotic bacterial resistance, and once it emerges the reversal of resistance is a complex and long-lasting process. The aims of this study were to estimate the prevalence of bacterial coinfections during the COVID-19 and to analyze the antibiotic treatment justification during this pandemic in Oman. This retrospective analysis was conducted using the Royal Hospital COVID-19 Registry Database. The study analyzed demographic and clinical characteristics, as well as laboratory parameters and antibiotic treatment of hospitalized patients. During the study period, 584 patients were enrolled in the analysis. Coinfection was rare as it was confirmed in 0.9% of patients. Superinfections were present in 15.2% of patients. Gram-negative bacteria were isolated in 95 (69.9%) samples, gram-positive bacteria in 25 (18.4%) samples, while Candida spp. was found in 16 (11.8%) samples. On admission, empirical antibiotic treatment was started in 543 (93.0%) patients. During COVID-19, coinfections are rarely seen and the overuse of antibiotics is not justified. The incidence of superinfections is the same as in other patients in healthcare settings caused by the same resistant microorganisms, which implies the use of even more.

Evolución de las opiniones estudiantiles sobre el ciberaprendizaje en la carrera de obstetricia

IntroductionDuring the COVID-19 lockdown, educational institutions implemented online learning, revealing that some university teachers and students were not prepared for this transition. Additionally, students were unable to attend clinical preceptorship in healthcare settings. The objective of this study was to analyze the evolution of agreement-disagreement levels among obstetrics students with virtual learning and identify variables that can predict changes in opinion. MethodA predictive longitudinal study was conducted using a Likert-adapted and validated survey administered to students at the beginning and end of the lockdown. Bayesian statistical analysis was performed using ordinal regression model analogs due to their advantages over frequentist methods. ResultsOpinions evolved from disagreement at the beginning to neutral opinions in half of the survey items at the end. It can be predicted that students will disagree with online learning when they are in their final semesters. ConclusionsAgreement with teleeducation improved due to its association with multiple advantages and the computer skills acquired during this period, especially among students. However, students in their final semesters expressed disagreement with online learning, which can be attributed to the lack of clinical preceptorship with patients in healthcare settings. Digital competencies must be improved among students and teachers to take advantage of the benefits offered by online learning.

Professional Boundaries in The Relationship Between Nurses and Patients in Healthcare Settings: A Scoping Review

Professional Boundaries in The Relationship Between Nurses and Patients in Healthcare Settings: A Scoping Review

Decolonization of hospital patients may aid efforts to reduce transmission of carbapenem-resistant Enterobacterales

Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.Disclosures: None

Detection of multidrug-resistant pathogens as a risk for patients in healthcare settings

Purpose of review Healthcare-acquired Infections and antimicrobial resistance are major challenges for both healthcare management and patient safety. Every year, resistant microorganisms seem to outperform our ability to develop new interventions to counteract this escalation. This review, focusing mainly on bacteria, aims to provide an update on the recent advances in diagnostics and on the strategies to manage healthcare-acquired infections. Recent findings Both phenotypic and molecular methods are profitably growing in recent years. In addition to these classical techniques, new methodologies are continuously developed with more focus on other methods like the use of nanotechnologies, the implementation of computational analysis, and the machine-learning approach. An increasing effort is also given to developing alternatives to antibiotics such as phage therapy and the use of probiotics or other antagonizing microorganisms. Summary Unfortunately, even if new methods are developed each year, on the surveillance and infection prevention side of the problem, the main approach is still based on observational and descriptive studies. A shift in how we implement infection control measures by using modern diagnostic tools and novel typing approaches is essential in resolving the problem.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.

Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.