Ward Environment Research Articles

168 A quality improvement initiative to enhance dementia inclusivity within the physical environment of an older persons’ acute hospital ward

Abstract Background There are currently over 64,000 people living with dementia in Ireland, this number is expected to double by 2045. Direct observation from multiple disciplines highlighted a large cohort of people living with dementia experiencing disorientation, wandering, and falls at ward level. National Guidelines and Strategies state that physical ward environments should be a key consideration for dementia care. Research shows that physical ward environments can be adapted to reduce confusion and agitation and improve wayfinding for those living with dementia. Methods An environmental ward audit was conducted through direct observation, using the environmental checklist from the Irish National Audit of Dementia (INAD-2). The results of the audit were compared with national standards which showed reduced compliance. Adaptations and/or modifications including the installation of orientation clocks, orientation whiteboards and increasing signage and labels to the physical ward were implemented to increase compliance. The ward was re-audited to assess change. Results The results highlighted increased compliance with national standards. Direct observations from the multidisciplinary team identified increased wayfinding and orientation for patients living with dementia on the ward. Multidisciplinary education on dementia inclusivity is essential in fostering a person centred approach to dementia care in the acute ward environment. Conclusion Multidisciplinary collaboration and commitment to dementia inclusive care may enhance the experience of those living with dementia in the acute hospital setting. Barriers such as infection control measures emphasised the need for a collaborative approach to overcome challenges and facilitate change.

O.2.2-6 ‘Let’s Ask the Service Users and Staff!’ - Barriers and Facilitators to Increasing Physical Activity in Medium Secure Psychiatric Services in the UK?

Abstract Purpose As part of a four-phase project, ‘Increasing Physical Activity in a Medium Service: The Development and Feasibility of a Physical ACTivity Intervention (IMPACT)’, the barriers and facilitators to increasing physical activity (PA) in medium secure psychiatric services, in the UK, were explored. Previous reviews have called for additional exploration into barriers and facilitators, as evidence has suggested a positive association between PA and the improvement in physical and psychological health for people with serious mental illnesses (SMI) and low activity levels. Methods A mixed-method approach was adopted. Questionnaires, co-developed with service users, were completed across two NHS study sites in England, UK (n = 68), collecting qualitative and quantitative data from service users in medium secure services. Two focus groups were also conducted to collect qualitative data (n = 24) from hospital staff and key stakeholders. Framework Analysis and the COM-B Model of Behaviour Change (C for Capability, O for Opportunity, M for Motivation and B for Behaviour) were used to analyse the data. For this paper, the qualitative data from both the questionnaires and the focus groups will be discussed. Results Similar themes were identified by the service users, hospital staff and key stakeholders. One main barrier discussed was environmental factors in secure services such as sedentary ward environments and the lack of autonomy in secure services. Main facilitators discussed were increasing the knowledge of benefits to PA and having structural guidance for personal development. Conclusion The barriers and facilitators identified will inform the remaining phases of the IMPACT project, including a co-produced PA intervention, based on overcoming the barriers and supporting the facilitators identified. A feasibility study will then test the PA Intervention. This feature of co-producing a PA intervention in medium secure services, based on barriers and facilitators, adds to the limited literature in this area. The aim of the IMPACT project is to inform future a pilot study and policies. Support/Source National Institute for Health and Care Research (NIHR) - Research for Patient Benefit Programme (IRAS ID 297420).

Can a simulated window improve the ward environment? A survey of patient, carer and staff perspectives

Background/Aims Simulated windows displaying images of the outside world can help to reduce emotional stress. This study investigated the effect of a simulated window on perceptions of the environment in a hospital ward among patients, family members, nurses and doctors. Methods A total of 48 participants (12 patients, 12 family members, 12 doctors and 12 nurses) were recruited from a four-bed patient room in a neurological ward in Japan. A 12-item questionnaire was administered, with participants rating their agreement with 11 statements about the room's simulated window on a 5-point Likert scale. The final item was a free-text question. Data were analysed using descriptive statistics. Results The majority of questionnaire items had average scores of 3–4, indicating neutral to moderately positive views of the simulated window. The majority of participants agreed that the window provided visual stimulation, but many did not see the benefits for communication or stress reduction. Qualitative feedback noted that they would prefer a simulated window that allowed patients to choose the image. Conclusions The simulated window was generally viewed positively or neutrally across participant groups, with feedback noting improvements to the technology that would lead to a better experience.

Hong Kong general ward nurses' experiences of transitional care for patients discharged from the intensive care unit: An inductive thematic analysis

Hong Kong general ward nurses' experiences of transitional care for patients discharged from the intensive care unit: An inductive thematic analysis

Delivery of virtual acute cardiac care- a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background The increasing incidence of chronic conditions, along with the SARS CoV-2 pandemic, put unprecedented capacity restraints on hospital bed access. New models of care are required to meet the increasing clinical demand for hospital services. Digital health technologies to support virtual hospital in the home services may address this need by offering patient-centered, safe and efficient models of care that are not reliant on physical hospital infrastructure. Specific cardiac conditions are well suited to a virtual model of care. Purpose To describe and evaluate a novel virtual model of care for cardiac patients that delivers early supported discharge from the acute inpatient ward to home. Model of Care The cardiac hospital in the home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. This 48-hour model of care utilized wearable technology to monitor cardiac rhythm and vital signs in conjunction with daily virtual ward rounds to manage recognised post operative/ procedural complications. Escalation pathways for clinical deterioration were designed to support patient safety. Transitional care to discharge was a key element of this model. Quality, safety, efficiency and patient experience were evaluated. Key Results From March-November 2022, 260 patients were referred to cHITH with 191 (74%) patients accepted according to the risk-stratification criteria. This cohort included post cardiac surgery (CSUR) patients (54%); post interventional procedures (31%), post device implant (6%) and other (9%). The cHITH length of stay (LOS) was 1.9 ± 0.1 days reflecting 20% of the episode of acute care delivered in the virtual environment. Re-admission rates were 9.4% at 30-days, with 0% mortality. Patient satisfaction was >90% (net promoter score). The CSUR cohort (n=103) had a mean age of 62 ± 4 years; male 82%; isolated CABG 62%; 30-day re-admission rate 7.8%. Total post-operative LOS was 7.1 ± 2.4 days with 35% of post-operative care delivered in the virtual cHITH environment. A total of 258 bed days were realized. Conclusion This pilot virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.

Introducing a group-based psychoeducation intervention for older people in an inpatient mental healthcare setting.

This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.

Postoperative pain assessment and management among nurses in selected hospitals in Benin City, Edo State, Nigeria

ABSTRACTObjective:This study was designed to determine the nurse assessment of postoperative pain and its management in selected hospitals, Benin City, Edo State, Nigeria.Materials and Methods:A descriptive cross-sectional survey was adopted. The target population consist of 222 purposely nurses who are in the cadre of nursing officer II to chief nursing officer who works in the various surgical wards/units of the selected health facilities. The data were collected from the participants using the pretested structured questionnaire developed by the researcher.Results:Results showed that 66.2% of nurses had a poor level of knowledge on postoperative pain assessment. The McGill Pain Questionnaire was the most used pain assessment tool with a mean score of 2.84 whereas the Dallas Pain Questionnaire was the least used with a mean score of 1.90. “Providing clean, calm, and well-ventilated ward environment” (3.69 ± 0.61) was the most used nonpharmacological method for postoperative pain management, followed by “distraction, relaxation, and guided imagery” (3.52 ± 0.50), “dressing, bandage, splint, and reinforce wound sites postoperatively” (3.39 ± 0.54), and “early ambulation/exercise” (3.20 ± 0.62). The most used pharmacological interventions were “acetaminophen” (3.63 ± 0.55), “topical anesthetic” (2.92 ± 0.62), “nonselective nonsteroidal anti-inflammatory drugs” (2.87 ± 0.43), and “mixed opioid agonist–antagonist” (2.56 ± 0.56).Conclusion:There is a poor level of knowledge on postoperative pain assessment among nurses in this study setting. It is, therefore, pertinent for hospitals to organize continuous in-service training for postoperative pain assessment and management, especially on nonpharmacological approaches among nurses.

The educational value of ward rounds as a learning and teaching opportunity for house officers, medical officers, and registrars in Sudanese hospitals: a multi-center cross-sectional study

BackgroundWard rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors’ perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals.MethodA cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors’ perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions.ResultsA total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week.Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment.ConclusionWard rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Influence of the birthing room design on midwives' job satisfaction – A cross-sectional online survey embedded in the ‘Be-Up’ study

BackgroundJob satisfaction is an important factor influencing work performance, personal well-being, commitment and retention. The working environment influences job satisfaction. The design of the birthing room could influence the practice of midwives and their satisfaction. This study investigates whether the alternative design of the birthing room implemented in the randomized controlled trial ‘Be-Up’ (Birth environment-Upright position) has an impact on job satisfaction of midwives. MethodA cross-sectional survey using an online questionnaire with 50 items addressing job satisfaction and birth room design was performed. The sample (n = 312) consists of midwives whose obstetric units participated in the Be-Up study and, as comparison group, midwives working in non-study obstetric units. These two independent groups were compared using t-tests; correlations and impacts were examined. ResultsThe results of the T-tests revealed statistically significant higher global job satisfaction and higher satisfaction with team support of midwives in the Be-Up room. However, midwives working in customary birthing rooms were more satisfied with the design of the room. The most important predictors of job satisfaction were team factors and understaffing in both groups. ConclusionReasons for diminished satisfaction with the working environment in the Be-Up study may be assumed in uncertainties about emergency management in a new and unfamiliar environment. Furthermore the impact of a single redesigned room within a customary obstetric unit on job satisfaction seems small, as the room is embedded in the ward and hospital environment. More comprehensive concepts on the potential of the work environment influencing midwives’ job satisfaction are needed.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives.

The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.

Evaluation of Environmental Contamination with Salmonella spp. in a Large Animal Ward at a Veterinary Hospital in Malaysia

Veterinary hospitals are important locations for various sick and immunocompromised animal patients. These centers may act as reservoirs for nosocomial diseases such as Salmonella infection, one of the most common causes of healthcare-associated infections in veterinary hospitals. The study was performed at the Large Animal Ward (LAW), University Veterinary Hospital, Universiti Putra Malaysia, to assess the environment’s degree of Salmonella spp. contamination. Environmental samples were obtained from various floor and surface areas in the LAW using sterile, moistened gauze. Salmonella spp. was determined using conventional bacteriological culture on all samples. Positive Salmonella isolates were subject to antimicrobial sensitivity testing. A total of 6 out of 135 (4.4%) samples were found to be positive for Salmonella spp., with 5/116 (4.3%) samples obtained from the ward environment and 1/19 (5.3%) obtained from reusable equipment. Antimicrobial sensitivity testing revealed three resistance profiles: all isolates were resistant to penicillin and enrofloxacin, one isolate was resistant to streptomycin, and one was resistant to gentamicin. The results indicate that animal treatment areas within the LAW can become contaminated with Salmonella spp. This study highlights the importance of improving biosecurity programs to prevent nosocomial diseases in patients and the hospital environment.

THE PERSPECTIVE OF NURSING STAFF- FACTORS AFFECTING MEDICATION ERROR

One of the most frequent mistakes is medication administration error, which happens when the medication given to the patient differs from the medication that was prescribed and administered by the staff nurses. The goal of this study was to evaluate the variables that affect medication error. In this study, the factors associated with medication error were described using a crosssectional descriptive study methodology. The study was carried out in a chosen hospital in Coimbatore. The 150 staff nurses working in private hospitals in Coimbatore were the study's target population. The participants were chosen using a practical sampling technique. 123 nurses who work in the chosen hospitals made up the sample. The questionnaire used for the study had two sections. Section B includes nurse-related factors, ward environments, management-related factors, and patient-related factors using a scale of Strongly Disagree=1 to Strongly Agree=5. Section A contains demographic data (Age, Gender, Income, Working experience, Educational level, and Working area). Data was gathered using a Google form and provided to the staff nurse by the nursing in-charge individual. According to the results, the management and patient-related component had the greatest Grand Mean Value (3.87), followed by the ward-related factor (3.81), and the nurse-related factor (3.57). These drug mistakes endangered the patient's health and put them at risk. To prevent medication errors, management should take action to address the issue and maintain an appropriate nurse-to-patient ratio. This guarantees the patient's safety when seeking medical attention.

The illness severity of ward remaining patients reviewed by the medical emergency team: A retrospective cohort study.

Although progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety. This study sought to quantify the illness severity of ward patients after medical emergency team review. This retrospective cohort study examined the clinical records of 1500 randomly sampled adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies. No direct patient contact was made during the data collection and analysis phases of the study. Patients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse-to-patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities. Patients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements. Profiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment.

Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments

Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70–10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5–4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.

Sociopetal design in psychiatric therapuetic settings

AbstractSociopetal design methods can offer interesting means to support therapeutic concepts within ward environments. They can help to forge group identities through offering patients, staff and visitors opportunities to identify with the spaces they inhabit. “Sociopetal space” has been defined as “spaces which help bring people together"; but how does this actually work and what role can these types of spaces play in a hospital ward setting?Some of these elements operate at a detail level and can be rather simple to deploy. Normalising the environment by making “regular” design decisions such as by using real rather then simulated materials (ie., actual wood rather then “wood patterned” furniture); or through offering a mix of lighting (ie., artificial and natural sources in variation) can create more homely spaces for patients and staff alike. Ultimately, design decisions at the detail scale can create phenomenal elements which can play a large role towards generating a favorable atmospheric experience on the ward.It is also possible to explore how specific moments or places within a psychiatric ward might be designed to support patient agency, even on a closed ward. Sociopetal elements such as well-sited sitting spaces can offer moments of safety or retreat, leading to a greater sense of control. This can help patients feel more open to positive interactions with their colleagues and staff because they can safely observe or choose less committed ways of participation in daily or group activities.Zooming out from these details, we will also look at the layout of a psychiatric ward (ie. accommodations) to help identify where opportunities such as those listed can be found. Simple gestures such as a slight widening of the corridor leading to important shared areas or better access to light or views of nature have been shown to improve outcomes for patients. What other design elements can be placed on or within wards to further this approach? Recent and ongoing projects within our practice will be shared to help workshop participants gather literacy in case they may be involved in future design projects.Disclosure of InterestNone Declared

Investigating the impact of music therapy on two in-patient psychiatric wards for people living with dementia: retrospective observational study.

Music therapy can lift mood and reduce agitation for people living with dementia (PwD) in community and residential care settings, potentially reducing the prevalence of distress behaviours. However, less is known about the impact of music therapy on in-patient psychiatric wards for PwD. To investigate the impact of music therapy on two in-patient psychiatric wards for PwD. A mixed-methods design was used. Statistical analysis was conducted on incidents involving behaviours reported as 'disruptive and aggressive' in 2020, when music therapy delivery varied because of the COVID-19 pandemic. Semi-structured interviews conducted online with three music therapists and eight ward-based staff were analysed using reflexive thematic analysis. Quantitative findings showed a significant reduction in the frequency of behaviours reported as disruptive and aggressive on days with in-person music therapy (every 14 days) than on the same weekday with no or online music therapy (every 3.3 or 3.1 days, respectively). Qualitative findings support this, with music therapy reported by music therapists and staff members to be accessible and meaningful, lifting mood and reducing agitation, with benefits potentially lasting throughout the day and affecting the ward environment. We identified a significant reduction in the occurrence of distress behaviours on days with in-person music therapy when compared with no music therapy. Music therapy was reported to be a valuable intervention, supporting patient mood and reducing agitation. Interventional studies are needed to investigate the impact of music therapy and its optimum mode of delivery.

Identification and Resistance Testing of Bacteria Causing Nosocomial Infections in Surgery Inpatient Rooms

Background: Nosocomial infections are the most common infections that occur when patients are under medical care in hospitals. The most common pathogenic bacteria that cause nosocomial infections are Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp, and Klebsiella pneumonia. One of the factors causing a nosocomial infection is the environment. The spread of nosocomial infections in dr. Doris Sylvanus can occur in the surgical ward environment. Therefore, it is necessary to study and know the identification of bacteria and knowing the pattern of antibiotic resistance of bacteria that cause nosocomial infections in the surgical inpatient ward of dr. Doris Sylvanus Hospital. Methods: This type of research used an observational method with a descriptive approach. The research at dr Doris Sylvanus Hospital. The population is dahlia room which consisted of floors, sheets, patient beds, tables, and door handles. Results: Bacterial identification was Staphylococcus aureus at 13.4% and Staphylococcus non-coagulase at 10%, also found Gram-negative bacteria suspected Salmonella sp. 3.3% and other bacteria at 73.3% The results of the Trimethoprim-sulfamethoxazole antibiotic resistance test on S. aureus bacteria had a sensitivity of 50% and Oxacillin had a sensitivity of 75%, while the Trimethoprim-sulfamethoxazole resistance test results on S. non-coagulase bacteria had a sensitivity of 66.7% and Oxacillin had a sensitivity of 100%. Conclusion: The Trimethoprim-sulfamethoxazole antibiotic resistance test on S. aureus bacteria has moderate sensitivity and the Oxacillin antibiotic has a fairly high sensitivity while on S. non-coagulase bacteria have a fairly high sensitivity and oxacillin antibiotics have high sensitivity.

SG-APSIC1164: Cost-effectiveness of temporary isolation rooms in acute-care settings in Asia

Objectives: We estimated the change to health-service costs and health benefits resulting from a decision to adopt temporary isolation rooms, which are effective at isolating the patient within a general ward environment. We assessed the cost-effectiveness of the decision to adopt temporary isolation rooms in a Singapore hospital. Methods: Existing data were used to update a model of the impact of adopting temporary isolation rooms on healthcare-associated infections. We predicted the expected change to health service costs and health benefits, measured in life years gained. Uncertainty was addressed using probabilistic sensitivity analysis, and the findings were tested with plausible scenarios to determine the effectiveness of the intervention. Results: We predicted 478 fewer HAIs per 100,000 occupied bed days resulting from a decision to adopt temporary isolation rooms. This decreased would result in cost savings of SGD$329,432 (US $247,302) and 1,754 life years gained. When the effectiveness of the intervention was set at 1% of cases of HAI prevented, the incremental cost per life year saved was SGD$16,519 (US $12,400), indicating that this would be a cost-effective measure in Singapore. Conclusions: We have provided evidence that adoption of a temporary isolation room would be cost-effective for Singapore acute-care hospitals. Using temporary isolation rooms may be a positive decision for other countries in the region with fewer resources for infection prevention and control.

Clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection.

To analyze the clinical effect of standardized nursing for lymphoma patients and the influencing factors of nosocomial infection, a total of 360 diffuse large B-cell lymphoma patients with disease recurrence or progression after first-line treatment were retrospectively selected from our hospital from January 2021 to July 2022. After standardized nursing, the overall infection rate of lymphoma patients was 2.50% (9/360), which was significantly lower than the overall infection rate of our hospital in 2021 (7.44%, 844/11342) (P < .05). The proportion of 3 kinds of pathogenic bacteria detected were G+ bacteria (33.5%), G- bacteria (53.3%), and fungi (13.2%). The pathogenic bacteria genus with the most G+ bacteria is Enterococcus, the pathogenic bacteria genus with the most G+ bacteria is Enterobacteriaceae, and the pathogenic bacteria with the most fungi is Candida albicans. Female infection rate was significantly higher than male (P < .05). There was no significant difference in nosocomial infection among different marital status/fertility status (P > .05). The nosocomial infection of patients with different hospitalization times was statistically significant (P < .05). The duration of hospitalization in the infected group was significantly higher than that in the non-infected group (P < .05). The clinical effect of standardized nursing for lymphoma patients is significant, and the influencing factors of nosocomial infection include patient gender, hospitalization frequency, and hospitalization duration.

Improving the Sensory Environments of Mental Health in-patient Facilities for Autistic Children and Young People

ABSTRACT Poor mental health—compared to that of the neurotypical child population—is a serious concern for many autistic children and young people around the world. In the UK, we have an increasing number of autistic young people receiving care in NHS funded in-patient mental health facilities. While sensory processing differences have now been added to international diagnostic criteria for autism, recent autistic-led and co-produced, practice-based research commissioned by the Children and Young People’s Mental Health Taskforce and delivered by National Development Team for Inclusion has identified that knowledge of autistic sensory differences and needs is institutionally absent. In particular, the sensory environments of NHS England-funded in-patient facilities were found to present sometimes extreme challenges for autistic young people that at best hinder wellbeing and at worst exacerbate existing mental health problems: instigating a cycle of progressing upwards through increasingly restrictive settings for some. This paper shares some of this learning, gained from the consultation with young autistic people who have experience of inpatient services and autistic Experts by Experience working on novel sensory ward environment reviews. We first introduce the framing of autism as primarily shaped by sensory and social processing differences and outline the significance of this perspective for the in-patient care of autistic young people and children. We then provide an overview of the current sensory challenges that exist in inpatient mental health facilities for autistic children and young people. Finally, we conclude with some suggestions for areas of future research around the impact of adapting ward environments, that have promise for broader and international settings.