Staff Contact Research Articles

Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital

Compliance with hand hygiene (HH) standards is a critical component to reducing the prevalence of Health Care Acquired Infections (HAIs). The use of HH technologies is increasing and studies examining the success of these technologies on HH compliance and HAIs are important to inform standards of care. COVID-19 has emphasized compliance HH standards. This study evaluated HH compliance and Clostridium difficile (C difficile) rates following implementation of an HH technology at a long-term acute care hospital. The HH technology required nursing and other staff with direct patient contact to wear a "badge" that measured alcohol concentration on a health care worker's hands or time washing hands at designated sinks upon exit/entry of patient rooms. No changes were made to environmental cleaning or antibiotic stewardship standards. Compliance and infection rates were compared 12 months pre-post implementation during 2017-2019. There was an increase in HH compliance (89.82%-97.10%, P< .001)) and a reduction in the incidence of C. difficile (9.541-3.720, P= .0032). The HH technology significantly and quickly increased HH compliance and reduced rates of C difficile. The technology provided ancillary benefits, including data tracing of all patient and staff contacts and cross-contamination events.

Ensuring Access to Crisis Services During COVID-19

This article discusses the access to crisis services during COVID-19 Behavioral health crisis services provide an effective alternative to emergency departments (EDs), hospitals, and jails for patients with mental health and substance use emergencies This alternative is especially important during a pandemic, when EDs are overwhelmed Connections Health Solutions operates crisis centers in Arizona and is recognized as a national model Many patients arrive via law enforcement Common presentations include danger to self or other, psychosis, agitation, and intoxication or withdrawal Patients who might otherwise be arrested or board in EDs are instead stabilized in the 23-hour observation units With rapid assessment, early intervention, and proactive discharge planning, most patients return to the community without hospitalization The crisis setting poses unique challenges not addressed by existing COVID-19 guidelines The observation units are open spaces that facilitate line-of-sight visualization and social interactions rather than isolation and quarantine Impaired patients have difficulty adhering to masking and social distancing protocols Contact tracing suggests staff-to-staff or community transmission Staff infection rates have been similar to those in the general population in Arizona This approach identifies infected asymptomatic staff who would not otherwise be isolated and provides peace of mind to symptomatic staff or staff exposed to the virus who turned out to be uninfected (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Practice-Based Research Networks and Massage Therapy: a Scoping Review

Background: Practice-based research networks (PBRNs) are means to connect practitioners with researchers and increase the body of rigorous research. PBRNs have been used in medicine for decades, but efforts to create PBRNs in massage therapy (MT) are limited.&#x0D; Purpose: Examine and describe the amount of and nature of MT-related publications derived from PBRN-supported endeavors.&#x0D; Publication Selection: Databases: Scopus, CINAHL, PubMed, ClinicalKey, EMBASE, Google Scholar. Keywords: massage, massage therapy, practice-based research network, PBRN. Key items: publication year, operating PBRN, article type, study design, general theme, massage therapist involvement/MT application. Inclusion Criteria: studies conducted through a PBRN using MT/massage therapists as an investigated factor; articles/editorials focused on PBRN-related MT research.&#x0D; Results: Initial database search resulted in 444 records; 40 articles included in analysis from database search, PBRN website access, and PBRN staff contacts. Publication dates ranged from 2005 to 2019, with nearly all published since 2013. Nine PBRNs published 29 articles based on 20 studies and sub-studies as research papers (n=21) or poster/oral presentation abstracts (n=8), and articles discussing the need for PBRNs in MT (n=8). Most research studies were conducted as surveys (n=21), examining practice characteristics (n=9) and patient perspectives/utilization (n=7). Three articles discussing PBRNs in MT were not connected to any specific PBRN.&#x0D; Conclusion: The PBRN model holds promise to further the field of MT, but implementation needs significant development. Promoting the creation and growth of massage-specific PBRNs should be a focus of professional associations and research institutions to expand the body of scientific evidence supporting MT. While the United States has had the most PBRN-related research efforts, a sustainable implementation model is not evident as highlighted by inactivity from US-based PBRNs after initial productivity. An Australian PBRN may serve as a needed sustainability model for massage-related PBRNs in the US if their productivity trajectory continues.

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

BackgroundMedical student mental health and wellbeing is highly topical and the subject of much research. While theoretically informed definitions of wellbeing abound, how do medical students themselves understand and perceive wellbeing? What aspects of the curriculum do they regard as affecting their wellbeing and mental health? This study explored these questions, and aimed to identify factors associated with student acceptability of wellbeing programs and interventions.MethodsAll students at an Australian undergraduate medical school (n = 619) were invited to complete a qualitative online questionnaire between 2017 and 2018 following the introduction of several wellbeing initiatives, including “Wellbeing Days” (WBD). WBD allow students to take single absence days for self-care. Open-ended questions were asked about perceptions and experience of mental health and wellbeing, and views on interventions to improve wellbeing such as WBD. Thematic analysis was conducted across all responses. Three authors developed preliminary themes, which were then refined and confirmed by all researchers. Thematic saturation was achieved within data from the 68 respondents, which included participants from all cohorts.ResultsParticipants described wellbeing as positively experienced work/life balance, impacted by four factors; contact hours, peer relationships, staff relationships, and trust in how wellbeing initiatives were used. Long contact hours were deemed incompatible with self-care activities, maintaining employment, and seeking professional medical/psychological help. Peers could promote wellbeing by offering social and academic support, but also undermine wellbeing by being competitors. Degree of trust, engagement and communication with staff influenced acceptability of interventions. Participants viewed initiatives such as WBD favourably, but distrust of peers, and of staff, led to perceptions that WBD could be prone to misuse, or used for surveillance rather than support.ConclusionOur findings suggest that wellbeing days which allow self-care, reduction in contact hours, and peer support may promote student wellbeing, but the acceptability of any interventions is influenced by relationships between staff and students, and in particular, trust in these relationships. We suggest strategies to strengthen trust and further research to investigate the relationship between trust and perceptions of wellbeing in self and peers.

Knocking sovereign customers off their pedestals? When contact staff educate, amateurize, and penalize deviant customers

Promoted by marketing discourses, customer sovereignty is characterized by the cult of the customer and the belief that contact staff have to serve the customer. However, research shows that customers adopt improper conduct, such as fraudulent or aggressive behaviors. While largely tolerated, these behaviors prove damaging for contact staff and could eventually lead them to react. How do frontline actors react to such behaviors, which prevent them from developing customer relations in accordance with the mythical discourse? This is the question our article explores. To do so, we use Becker’s interactionism approach to deviance, and investigate how frontline actors in five organizations deal with customer complaints they consider as ‘deviant’. Our results show that when faced with behaviors that they no longer wish to tolerate, contact staff educate, amateurize, or penalize the customer. This research contributes by conceptualizing three alternative forms of relations to customer sovereignty, which contact staff attempt to legitimize through internal and external resources.

Liver Transplantation in the Time of COVID19: Barriers and Ethical Considerations for Management and Next Steps.

The recent outbreak of the novel virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes the corona virus disease of 2019 (COVID19), has spread globally and affects millions of people. This pandemic has taxed our health care system and disrupted normal operations, even life-saving procedures, such as liver transplants. During these unprecedented times, providers and patients are imperiled and resources for diagnosis and care may be limited. Continuing to perform resource-intense advanced procedures is challenging, as is caring for patients with end-stage liver disease or patients with urgent needs for liver tumor control. Liver transplantation, in particular, requires critical resources, like blood products and critical care beds, which are fairly limited in the COVID19 pandemic. The potential of COVID19 infections in posttransplant recipients on immunosuppression and staff contacts further adds to the complexity. Therefore, transplant programs must reevaluate the ethicality, feasibility, and safety of performing liver transplants during this pandemic. Herein, we discuss the clinical and ethical challenges posed by performing liver transplants and offer guidance for managing patients with end-stage liver disease during the COVID19 pandemic.

Electroencephalography during SARS-CoV-2 outbreak: practical recommendations from the task force of the Italian Society of Neurophysiology (SINC), the Italian League Against Epilepsy (LICE), and the Italian Association of Neurophysiology Technologists (AITN).

BackgroundDuring COVID-19 lockdown, non-urgent medical procedures were suspended. Grade of urgency of electroencephalography (EEG) may vary according to the clinical indication, setting, and status of infection of SARS-CoV-2 virus. “Italian Society of Clinical Neurophysiology” (SINC), “Italian League Against Epilepsy” (LICE), and the “Italian Association of Neurophysiology Technologists” (AITN) aimed to provide clinical and technical recommendation for EEG indications and recording standards in this pandemic era.MethodsPresidents of SINC, LICE, and AITN endorsed three members per each society to formulate recommendations: classification of the degree of urgency of EEG clinical indications, management and behavior of physicians and neurophysiology technologists, hygiene and personal protection standards, and use of technical equipment.ResultsScientific societies endorsed a paper conveying the recommendation for EEG execution in accordance with clinical urgency, setting (inpatients/outpatients), status of SARS-CoV-2 virus infection (positive, negative and uncertain), and phase of governmental restrictions (phase 1 and 2). Briefly, in phase 1, EEG was recommended only for those acute/subacute neurological symptoms where EEG is necessary for diagnosis, prognosis, or therapy. Outpatient examinations should be avoided in phase 1, while they should be recommended in urgent cases in phase 2 when they could prevent an emergency room access. Reduction of staff contacts must be encouraged through rescheduling job shifts. The use of disposable electrodes and dedicated EEG devices for COVID-19-positive patients are recommended.ConclusionsDuring the different phases of COVID-19 pandemic, the EEG should be reserved for patients really benefiting from its execution in terms of diagnosis, treatment, prognosis, and avoidance of emergency room access.

Establishment of a Palliative Care Consultation Service (PCCS) in an Acute Hospital Setting.

Background and study aims: Acute health service requires focused palliative care (PC). This study was performed to provide guidance for the establishment of a palliative care consultation service (PCCS). Patients and methods: This study was conceived as a retrospective single-center study for observing, analyzing and evaluating the initial setup of a PCCS from 1 May 2015 to 31 May 2018. Patients from Muenster University Hospital with advanced life-limiting diseases, identified to require PC, were included. Results: PCCS was requested from various departments, for between 20 and 80 patients per month, corresponding to a total of 2359 for the study period. Requests were highest in internal medicine (27.3%), gynecology (18.1%) and radiotherapy (17.6%). Time to referral was significantly shorter in departments with special PCCS ward rounds (6 ± 9 vs. 12 ± 22 days, p < 0.001). The most frequently reported symptoms were fatigue, pain and loss of appetite. Pain was frequently localized in the stomach (20.4%), back (17.1%), or in the head and neck area (14.9%). After the first PCCS consultation, 254 patients (90%) reported sufficient pain relief after 48 h. An introduction/modification of painkiller medication, which was recommended for 142 inpatients, was implemented in 57.0% of cases by the respective departments. Overall, the direct realization of PCCS recommendations reached only 50% on average. Conclusions: Besides an analysis of the ability to address the symptoms of the referred patients by the PCCS, this study highlights the importance of the interaction between PCCS and other departments. It further elucidates the role and possibilities of this service both in regular ward rounds and individual staff contacts.

Safe extubation during the COVID-19 pandemic.

Extubation of patients with Coronavirus Disease 2019 (COVID-19) is a high risk procedure for both patients and staff. Shortages in personal protective equipment (PPE) and the high volume of contact staff have with COVID-19 patients has generated an interest in ways to reduce exposure that might be feasible especially during pandemic times and in resource limited healthcare settings. The development of portable barrier hood devices (or intubation/extubation boxes) is an area of interest for many clinicians due to the theoretical reduction in aerosolization of SARS-CoV-2, the causative virus for COVID-19.We present a review of the current literature along with recommendations concerning safe extubation during the COVID-19 pandemic. In addition, a focused summary on the use of portable barrier hood devices, during the recent surge of COVID-19 is highlighted.

Interventional radiology and COVID-19: evidence-based measures to limit transmission.

As we face an explosion of COVID-19 cases and deal with an unprecedented set of circumstances all over the world, healthcare personnel are at the forefront, dealing with this emerging scenario. Certain subspecialties like interventional radiology entails a greater risk of acquiring and transmitting infection due to the close patient contact and invasive patient care the service provides. This makes it imperative to develop and set guidelines in place to limit transmission and utilize resources in an optimal fashion. A multi-tiered approach needs to be devised and monitored at the administrative level, taking into account the various staff and patient contact points. Based on these factors, work site and health force rearrangements need to be in place while enforcing segregation and disinfection parameters. We are putting forth an all-encompassing review of infection control measures that cover the dynamics of patient care and staff protocols that such a situation demands of an interventional department.

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission.

Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.

Engaging with Indigenous Australian communities for a human papilloma virus and oropharyngeal cancer project; use of the CONSIDER statement

BackgroundThe prevalence of oral HPV infection and HPV-related oropharyngeal squamous cell carcinoma (OPSCC) among Indigenous Australians is unknown. This paper outlines the engagement, consultation and recruitment strategies for a study involving investigation of HPV and OPSCC among Indigenous South Australians, based on the consolidated criteria for strengthening the reporting of health research involving Indigenous Peoples (CONSIDER) statement.MethodsInitial consultations with all interested Aboriginal Community Controlled Health Organisations (ACCHOs) were done throughout 2014 and 2015. This resulted in a funding application submitted that reflected Indigenous community views and inputs in study design and methodology, and which included nine Indigenous investigators. Once funding was received, community consultation was again undertaken, with six ACCHOs providing structures, strategies and recommendations for how recruitment for participants taking part in the study should be undertaken. Staff were hired (n = 6), with non-Indigenous staff (n = 3) undertaking extensive cultural competency training. An Indigenous Reference Group was established to provide oversight and cultural guidance. Recruitment of Indigenous participants by trained field officers occurred between Feb 2018 and Dec 2018, with n = 1011 recruited. Qualitative records summarising research staff contact with ACCHOs and participants were documented. These records, together with field trip notes, key ACCHO stakeholder reflections and research staff comments, were reviewed to summarise the culturally sensitive strategies that appeared to work most successfully to facilitate ACCHO and participant buy-in.ResultsFindings were documented against the CONSIDER statement’s research reporting framework of governance: relationships, prioritization, methodologies, participation, capacity, analysis and findings, and dissemination. The apparent success of the community engagement processes were then conceptualised into five domains: (1) engaging with ACCHOs as equal partners very early in the research process; (2) having an Indigenous Reference Group; (3) ACCHOs actively promoting the study; (4) having a flexible agenda responsive to broader environment demands and; (5) including Indigenous capacity building.ConclusionsConsultation and engagement with all sectors of the Indigenous community are essential in any research, especially a project involving HPV and OPSCC. Enabling local Indigenous staff to provide cultural guidance throughout the research process is helpful. Research that is culturally respectful and in partnership with Indigenous groups can be embraced when the research is collaborative and has clear translational benefits. The CONSIDER statement is a useful checklist against which to assess Indigenous health research processes. In future, the findings may be useful to yield important Aboriginal population estimates for both oral HPV infection and OPSCC. This may serve to convince funding bodies to provide health promotion personnel in the field of oral health, specifically OPSCC, in ACCHOs.

Risk factors for Staphylococcus capitis pulsotype NRCS-A colonisation among premature neonates in the neonatal intensive care unit of a tertiary-care hospital: a retrospective case-control study

SummaryBackgroundA S. capitis strain called NRCS-A (S. capitis NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide.AimTo identify risk factors for S. capitis NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015.MethodsWeekly axillary swabs categorised eligible neonates as a case or a control. A case was defined as a week ending with a neonate's first positive swab for S. capitis NRCS-A and a control as a week in which a neonate remained negative. Weekly exposures were abstracted from hospital medical records. Analyses were performed using conditional logistic regression.FindingsThe median (range) gestational age at birth of participants was 32.7 (23.1–41.3) weeks. Participants contributed 26 weeks of case data and 177 weeks of control data. On adjusted analysis compared with matched controls, cases had higher odds of requiring invasive mechanical ventilation (OR 3.6, 95% CI: 1.1–11.6, p=0.035) and of a patent ductus arteriosus (PDA) (OR 3.0, 95% CI: 1.0–9.0, p=0.044). Cases had lower odds of being part of a multiple birth (OR 0.24, 95% CI 0.08–0.73, p=0.001), having an area of inflamed skin (OR 0.31, 95% CI: 0.13–0.75, p=0.009), and specifically an area of inflamed axillary skin (OR 0.08, 95% CI: 0.01–0.50, p=0.006).ConclusionsWe found that premature neonates with invasive mechanical ventilation and PDA had greater odds for S. capitis NRCS-A colonisation. Transmission may be mediated by increased staff contact, but prospective research is needed to confirm this.

Peer Connect Service for people with pulmonary fibrosis in Australia: Participants' experiences and process evaluation.

People living with pulmonary fibrosis (PF) report unmet needs for information and support. Lung Foundation Australia (LFA) have developed the Peer Connect Service to facilitate telephone support for people with PF across Australia. This project documented the experiences of participants and the resources required to support the service. Consenting participants took part in semi-structured interviews by telephone. Primary peers (peers who agreed to initiate contact) and secondary peers (eligible patients who sought a peer match) were interviewed. Thematic analysis was undertaken by two independent researchers. Data were collected on the number of matches and contacts required to establish each match. Interviews were conducted with 32 participants (16 primary peers, 15 secondary peers and 1 who was both), aged from 53 to 89 years with 56% being male. Major themes included the value of shared experiences, providing mutual support and the importance of shared personal characteristics (e.g. gender and hobbies) in allowing information and emotional support needs to be met. Participants saw face-to-face contact with peers as highly desirable whilst acknowledging the practical difficulties. Primary peers were cognizant that their role was not to provide medical advice but to listen and share experiences. In the 12-month period, 60 peer matches were made, each match requiring a minimum of seven staff contacts. The Peer Connect Service provides a unique opportunity for people with PF to share experiences and offer mutual support. This telephone matching model may be useful in providing peer support for individuals with rare diseases who are geographically dispersed.

The Design of A Digital Timing Automatic Feeder With Adjustable Temperature and Humidity

Abstract An automatic feeder for poultry farm with digital display, adjustable temperature and humidity and timing function. It is mainly composed of feeding mechanism, feeding mechanism, travel mechanism, temperature humidity and electrical control box with digital display, can display 24 hours, and with time setting function, in the case of a single intervention to perform automatic feeding work, reduces the labor cost, not only can reduce the time of staff contact with poultry, reduce the spread of disease. With a temperature humidity sensor at the same time, the real-time monitoring and display of breeding field numerical, temperature and humidity can be set to allow upper and lower limits of temperature and humidity fluctuations, and according to the set point control spraying water pump, fan, or heating equipment synchronization work, simplifies the operation of separation equipment, precise control of the feeding environment of temperature and humidity value, achieve the goal of the poultry feeding scientifically.

PCN78 CHANGES IN HEALTH STATE COSTS IN HEPATOCELLULAR CARCINOMA (HCC)

There is a paucity of UK-specific resource use data in unresectable HCC. Cost-effectiveness analyses have been based on surveys performed in 2007 and 2015, however clinicians have reported changes in resource utilisation, which could affect HCC-related health state (HS) costs. This study aimed to assess these changes for patients receiving selective internal radiation therapy (SIRT) and systemic therapy. Resource use was elicited via a questionnaire from experienced medical professionals involved in care. The questionnaire (including background information, medical staff contacts, monitoring, hospitalisations and social care) was developed based on previous examples, guidelines and was validated by a medical oncologist. Face-to-face or telephone interviews were conducted. Unit costs were obtained from publicly available databases. Mean 2018/19 HS costs were compared to 2007 and 2015 results. Five interviews were conducted (two oncologists, one hepatologist, two specialist nurses). Pre-progression HS costs for SIRT and systemic therapy were £245.74 and £287.19/month respectively. One-off cost at progression was £207.79, and post-progression palliative care £499.37/month. Post-progression HS cost when on systemic therapy was same as pre-progression. Monthly costs were lower than in previous studies (by 55% and 80% pre- and post-progression respectively), mainly due to reduced hospitalisations and reduced use of funded social care. The main cost drivers pre- and post-progression were diagnostic procedures (53%) and medical staff contacts (45%) in the current study, and hospitalisations (41%) and social care (42%) in the 2007/2015 costs. Current results suggest important changes in clinical practice in HCC care since 2007, especially post-progression, due to increased familiarity with treatments and a shift from palliative care towards informal care. HS costs were also more dependent on patients receiving chemo-, radiation or palliative therapy, than on progression status, with costs doubling for palliative treatments. Further research would be beneficial using patient level information from large databases, registries.

Learning disabilities: Interventions and clinical issues

Learning disabilities: Interventions and clinical issues

Indigenous traumatic brain injury research: responding to recruitment challenges in the hospital environment

BackgroundHospitals are common recruitment sites for injury and disability studies. However, the clinical and rehabilitation environment can create unique challenges for researchers to recruit participant populations. While there is growing injury and disability focused research involving Indigenous people to understand the types of services and supports required by this population to enhance their recovery experiences, there is limited knowledge of researchers’ experiences implementing recruitment processes in the tertiary hospital environment. This paper reflects on the specific challenges of recruiting Indigenous patients following a traumatic brain injury from two tertiary hospitals in Northern Australia.MethodsBetween July 2016 and April 2018, research staff recruited eligible patients from one hospital in Queensland and one hospital in the Northern Territory. Qualitative records summarising research staff contact with patients, family members and clinical hospital staff were documented. These qualitative records, in addition to field trip notes and researcher reflections were reviewed to summarise the main challenges in gaining access to patients who fit the eligibility criteria.ResultsDuring the recruitment process, there were five main challenges encountered: (1) Patients discharging against medical advice from hospital; (2) Discharge prior to formal emergence from Post Traumatic Amnesia as per the Westmead Post Trauma Amnesia Scale; (3) Patients under adult guardianship orders; (4) Narrow participant eligibility criteria and (5) Coordinating around patient commitments and treatment. Details of how the recruitment processes were modified throughout the recruitment phase of the study to ensure greater access to patients that met the criteria are described.ConclusionBased on our recruitment experiences, several recommendations are proposed for future TBI studies with Indigenous Australians. In addition to treatment, Indigenous TBI patients have wide range of needs that must be addressed while in hospital. Patient engagement and data collection processes should be flexible to respond to patient needs and the hospital environment. Employment of a centralized recruiter at each hospital site may help to minimise the challenges researchers need to navigate in the hospital environment. To improve recruitment processes in hospitals, it is essential for researchers examining other health or injury outcomes to describe their recruitment experiences.

Staff experiences working in community‐based services for people with learning disabilities who show behaviour described as challenging: The role of management support

Accessible summary We looked at staff working with people with a learning disability and challenging behaviour. We tried to find out if managers' help their staff to work better. We looked at how often staff saw their manager and if their manager tried to help their staff to work better or spent more time doing office work. We found out that when managers helped staff to work better, staff feel better about their work. Even when staff did not see their manager very often, other staff were helping them to do their work better. Organisations need to decide who will help staff to work better, and this will also help staff to feel better about their work. AbstractIntroductionResearch has shown a positive relationship between practice leadership (frontline management focused upon supporting staff to work better) and better staff experiences of working with people with learning disabilities who may show challenging behaviours. However, little is known regarding the impact of frequency and accessibility of frontline managerial support upon staff experiences, or upon the provision of practice leadership. Current policy and practice in England may lead to frontline managers being responsible for more fragmented services, thus influencing the accessibility of managerial support and practice leadership for staff. The current study investigated the impact on staff experiences of frequency of contact with service manager and of practice leadership.MethodsA single point in time survey of 144 staff measured: characteristics of service users, frequency of contact with manager, practice leadership and staff experiences, for example burnout, teamwork and job satisfaction.ResultsPractice leadership was positively associated with more frequent contact with the manager. Better staff experiences were associated with more frequent contact with the manager and practice leadership and negatively with challenging behaviours.ConclusionThe associations between practice leadership, manager contact and better staff experiences suggest further research, and organisational action is needed to provide management support for staff.

An outbreak of meticillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit: use of a case–control study to investigate and control it and lessons learnt

To describe the investigation and management of a meticillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal intensive care unit (NICU) and the lessons learnt. This was an outbreak report and case-control study conducted in a 40-cot NICU in a tertiary referral hospital and included all infants colonized/infected with gentamicin-resistant MRSA. Standard infection-control measures including segregation of infants, barrier precautions, enhanced cleaning, assessment of staff practice including hand hygiene, and increased MRSA screening of infants were implemented. Continued MRSA acquisitions led to screening of all NICU staff. A case-control study was performed to assess staff contact with colonized babies and inform the management of the outbreak. Eight infants were colonized with MRSA (spa type t2068), one of whom subsequently developed an MRSA bacteraemia. MRSA colonization was significantly associated with lower gestational age; lower birthweight and with being a twin. Three nurses were MRSA colonized but only one nurse (45) was colonized with MRSA spa type t2068. Multivariable logistic regression analysis identified being cared for by nurse 45 as an independent risk factor for MRSA colonization. Lack of accurate recording of which nurses looked after which infants (and when) made identification of the risk posed by being cared for by particular nurses difficult. If this had been clearer, it may have enabled earlier identification of the colonized nurse, avoiding subsequent cases. This study highlights the benefit of using a case-control study, which showed that most nurses had no association with colonized infants.