Hands of health care personnel frequently serve as vectors for the transmission of organisms betw... more Hands of health care personnel frequently serve as vectors for the transmission of organisms between patients and are also a major reservoir for pathogens with antimicrobial resistance. Hand hygiene is one effective strategy to reduce health care associated infections. The purposes of this study were to (a) compare the costs of hand hygiene in hospitals with high and low hand hygiene compliance as well as high and low frequency of alcohol hand rub use; and (b) examine associations between hospital characteristics and hand hygiene compliance as well as frequency of alcohol hand rub use. Nursing and health care policy leaders should look for ways to promote sustained adherence to hand hygiene recommendations.
The global impact of antibiotic resistance is potentially devastating, threatening to set back pr... more The global impact of antibiotic resistance is potentially devastating, threatening to set back progress against certain infectious diseases to the preantibiotic era. Although most antibiotic-resistant bacteria originally emerged in hospitals, drug-resistant strains are becoming more common in the community. Factors that facilitate the development of resistance within the community can be categorized as behavioral or environmental/policy. Behavioral factors include inappropriate use of antibiotics and ineffective infection control and hygiene practices. Environmental/policy factors include the continued use of antibiotics in agriculture and the lack of new drug development. A multifaceted approach that includes behavioral strategies in the community and the political will to make difficult regulatory decisions will help to minimize the problem of antimicrobial resistance globally.
Although interdisciplinary research is becoming the dominant model for understanding complex heal... more Although interdisciplinary research is becoming the dominant model for understanding complex health issues, little is known about the competencies required for successful interdisciplinary collaboration. Published research has discussed attitudes about interdisciplinary work and organizational resources but not the needed competencies. This report describes the method and results of the competency specification process for health research. Based on an established definition of interdisciplinary research, a preliminary set of competencies was developed from expert opinion of key informants and a review of the interdisciplinary research literature. A Delphi panel of interdisciplinary researchers then reached consensus on 17 competencies necessary for interdisciplinary research.
Bioluminescence ATP monitoring as a surrogate marker for microbial load on hands and surfaces in ... more Bioluminescence ATP monitoring as a surrogate marker for microbial load on hands and surfaces in the home
Objectives—To assess attitudes of ICU staff members toward practice guidelines in general and tow... more Objectives—To assess attitudes of ICU staff members toward practice guidelines in general and toward a specific guideline, CDC's Guideline for Hand Hygiene in Healthcare Settings; to correlate these attitudes with staff and hospital characteristics; and to examine the impact of staff attitudes toward the Hand Hygiene Guideline on self reported implementation of the Guideline. Methods—A cross-sectional survey of staff in 70 ICUs in 39 U.S. hospitals, members of The National Nosocomial Infection Surveillance (NNIS) System. A survey, “Attitudes Regarding Practice Guidelines”, was administered anonymously to all willing staff during a site visit at each hospital; 1,359 ICU personnel: 1,003 nurses (74%), 228 physicians (17%), and 128 others (10%) responded. Results—Significantly more positive attitudes toward practice guidelines were found among staff in pediatric as compared with adult ICUs (p<0.001). Nurses and other staff when compared with physicians had more positive attitud...
Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene pract... more Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P=.04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P=.004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P=.02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.
There were significant quantitative differences in the composition and density of microflora in d... more There were significant quantitative differences in the composition and density of microflora in different areas of the hands of 26 adult volunteers. The subungual spaces had an average log10 CFU of 5.39, compared with a range from 2.55 to 3.53 for other hand sites. In quantitative cultures from five subungual spaces in 26 subjects, coagulase-negative staphylococci were the dominant organisms, with Staphylococcus epidermidis, S. haemolyticus and S. hominis being the most frequently isolated species. Other bacteria recovered from subungual spaces included gram-negative bacilli in 42.3% of subjects, with Pseudomonas species composing 31.3% of this group, and coryneforms in 42.3% of subjects, with multiply resistant JK group coryneforms making up 12.5%. Yeasts were isolated from 69.0% of subjects sampled, with 51.3% of the yeasts identified as Candida parapsilosis. The subungual coagulase-negative staphylococci were susceptible to most antibiotics, with resistance to penicillin, ampicil...
Multiple drug resistant organisms (MDRO), predominantly bacteria that are resistant to one or mor... more Multiple drug resistant organisms (MDRO), predominantly bacteria that are resistant to one or more classes of antimicrobial agents, have spread in hospitals with increasing frequency (Center for Disease Control and Prevention, 2013a; Spellberg et al., 2008). The Centers for Disease Control and Prevention (CDC) has noted this alarming trend and issued a ‘threat’ warning (http://www.cdc.gov/drugresistance/threatreport-2013/pdf/ar-threats-2013-508.pdf) for hospitals and beyond. The reasons for hospital spread are multi-factorial but the primary strategy to prevent transmission is use of hand hygiene and barriers as part of contact precautions, previously called contact isolation (Siegel et al., 2007). Virtually all MDRO are spread by contact (Sandora and Goldman, 2012). Contact can be direct, e.g. by actual touching, or indirect, by contact with objects or the environment. Contact precautions include use of single room (when possible), hand hygiene, use of dedicated equipment and supplies, and wearing personal protective equipment (PPE) (gowns and gloves) for all interactions that may involve contact with the patient or potentially contaminated areas of the environment (Sandora and Goldman, 2012). The aim of this paper is to suggest that contact precautions are failing, suggest why they are failing, and recommend changes to improve their effectiveness, because failure to stop the epidemic of MDRO will affect every aspect of clinical medicine, including inpatients and outpatients. Many experts recommend contact precautions for patients infected or colonised with MDRO (Muto et al., 2003; Siegel et al., 2006). Thus, active surveillance – screening of asymptomatic patients to determine colonisation – is often recommended (Huskins and O’Grady, 2011) to identify undetected reservoirs of MDRO. Colonised (or infected) patients are then placed in contact precautions, usually until screening is negative (Shenoy et al., 2013). However, use of screening and contact precautions has been shown to be ineffective for preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) in ICU in a large cluster-randomised trial (Huskins et al., 2011). Even universal glove and gown use in ICU did not prevent acquisition of MRSA and VRE (Harris et al., 2013), even though gloves, gowns, and hand hygiene are the backbone of contact precautions (Siegel et al., 2007). Much like for MRSA and VRE, asymptomatic carriers of Clostridium difficile account for nearly as much crosstransmission as those who are clinically infected, suggesting that surveillance screening may have a role in preventing transmission (Curry et al., 2013). Use of surveillance screening for other MDRO clearly identifies more patients that require contact precautions than does relying only on clinical cultures (Muto et al., 2003) and therefore is likely to increase the use of contact precautions. However, not only is the evidence of effectiveness minimal, as currently practiced, contact precautions have also been associated with a number of adverse events (Stelfox et al., 2003). Given the cost of such active surveillance, the lack of proven efficacy, and the potential for adverse events, its use should be re-evaluated at least for MRSA and VRE for which active surveillance has been studied and failed (Edmond and Wenzel, 2013). Universal decolonization for MRSA with chlorhexidine bathing has proven more effective than targeted MRSA surveillance and contact precautions in the ICU (Huang et al., 2013). These studies suggest that alternative strategies to contact precautions may prevent transmission and be preferable for some MDRO, being both more effective and more acceptable (Huang et al., 2013; Milstone et al., 2013). Many studies have shown reduction of transmission of MDRO with enhanced and enforced contact precautions during epidemics. Such studies usually also include a number of Multiple drug resistant organisms in healthcare: the failure of contact precautions
Journal of clinical and translational science, 2017
We aimed to improve the research consenting process by developing and evaluating simplified conse... more We aimed to improve the research consenting process by developing and evaluating simplified consent forms. Four templates written at the eighth-tenth grade reading level were developed and trialed by a group of experts in clinical research, health literacy, national regulatory requirements, and end users. Researchers from protocols which had received expedited review were surveyed at 2 time points regarding their use and assessment of the templates. At baseline 18/86 (20.9%) responding researchers had heard of the templates and 5 (5.8%) reported that they had used them; 2 years later, 54.2% (32/59) had heard of the templates and 87.5% (28/32) had used them (<0.001). Consent form templates may be one mechanism to improve patient comprehension of research protocols as well as efficiency of the review process, but require considerable time for development and implementation, and one key to their success is involvement and support from the IRB and technical staff.
Hands of health care personnel frequently serve as vectors for the transmission of organisms betw... more Hands of health care personnel frequently serve as vectors for the transmission of organisms between patients and are also a major reservoir for pathogens with antimicrobial resistance. Hand hygiene is one effective strategy to reduce health care associated infections. The purposes of this study were to (a) compare the costs of hand hygiene in hospitals with high and low hand hygiene compliance as well as high and low frequency of alcohol hand rub use; and (b) examine associations between hospital characteristics and hand hygiene compliance as well as frequency of alcohol hand rub use. Nursing and health care policy leaders should look for ways to promote sustained adherence to hand hygiene recommendations.
The global impact of antibiotic resistance is potentially devastating, threatening to set back pr... more The global impact of antibiotic resistance is potentially devastating, threatening to set back progress against certain infectious diseases to the preantibiotic era. Although most antibiotic-resistant bacteria originally emerged in hospitals, drug-resistant strains are becoming more common in the community. Factors that facilitate the development of resistance within the community can be categorized as behavioral or environmental/policy. Behavioral factors include inappropriate use of antibiotics and ineffective infection control and hygiene practices. Environmental/policy factors include the continued use of antibiotics in agriculture and the lack of new drug development. A multifaceted approach that includes behavioral strategies in the community and the political will to make difficult regulatory decisions will help to minimize the problem of antimicrobial resistance globally.
Although interdisciplinary research is becoming the dominant model for understanding complex heal... more Although interdisciplinary research is becoming the dominant model for understanding complex health issues, little is known about the competencies required for successful interdisciplinary collaboration. Published research has discussed attitudes about interdisciplinary work and organizational resources but not the needed competencies. This report describes the method and results of the competency specification process for health research. Based on an established definition of interdisciplinary research, a preliminary set of competencies was developed from expert opinion of key informants and a review of the interdisciplinary research literature. A Delphi panel of interdisciplinary researchers then reached consensus on 17 competencies necessary for interdisciplinary research.
Bioluminescence ATP monitoring as a surrogate marker for microbial load on hands and surfaces in ... more Bioluminescence ATP monitoring as a surrogate marker for microbial load on hands and surfaces in the home
Objectives—To assess attitudes of ICU staff members toward practice guidelines in general and tow... more Objectives—To assess attitudes of ICU staff members toward practice guidelines in general and toward a specific guideline, CDC's Guideline for Hand Hygiene in Healthcare Settings; to correlate these attitudes with staff and hospital characteristics; and to examine the impact of staff attitudes toward the Hand Hygiene Guideline on self reported implementation of the Guideline. Methods—A cross-sectional survey of staff in 70 ICUs in 39 U.S. hospitals, members of The National Nosocomial Infection Surveillance (NNIS) System. A survey, “Attitudes Regarding Practice Guidelines”, was administered anonymously to all willing staff during a site visit at each hospital; 1,359 ICU personnel: 1,003 nurses (74%), 228 physicians (17%), and 128 others (10%) responded. Results—Significantly more positive attitudes toward practice guidelines were found among staff in pediatric as compared with adult ICUs (p<0.001). Nurses and other staff when compared with physicians had more positive attitud...
Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene pract... more Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P=.04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P=.004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P=.02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.
There were significant quantitative differences in the composition and density of microflora in d... more There were significant quantitative differences in the composition and density of microflora in different areas of the hands of 26 adult volunteers. The subungual spaces had an average log10 CFU of 5.39, compared with a range from 2.55 to 3.53 for other hand sites. In quantitative cultures from five subungual spaces in 26 subjects, coagulase-negative staphylococci were the dominant organisms, with Staphylococcus epidermidis, S. haemolyticus and S. hominis being the most frequently isolated species. Other bacteria recovered from subungual spaces included gram-negative bacilli in 42.3% of subjects, with Pseudomonas species composing 31.3% of this group, and coryneforms in 42.3% of subjects, with multiply resistant JK group coryneforms making up 12.5%. Yeasts were isolated from 69.0% of subjects sampled, with 51.3% of the yeasts identified as Candida parapsilosis. The subungual coagulase-negative staphylococci were susceptible to most antibiotics, with resistance to penicillin, ampicil...
Multiple drug resistant organisms (MDRO), predominantly bacteria that are resistant to one or mor... more Multiple drug resistant organisms (MDRO), predominantly bacteria that are resistant to one or more classes of antimicrobial agents, have spread in hospitals with increasing frequency (Center for Disease Control and Prevention, 2013a; Spellberg et al., 2008). The Centers for Disease Control and Prevention (CDC) has noted this alarming trend and issued a ‘threat’ warning (http://www.cdc.gov/drugresistance/threatreport-2013/pdf/ar-threats-2013-508.pdf) for hospitals and beyond. The reasons for hospital spread are multi-factorial but the primary strategy to prevent transmission is use of hand hygiene and barriers as part of contact precautions, previously called contact isolation (Siegel et al., 2007). Virtually all MDRO are spread by contact (Sandora and Goldman, 2012). Contact can be direct, e.g. by actual touching, or indirect, by contact with objects or the environment. Contact precautions include use of single room (when possible), hand hygiene, use of dedicated equipment and supplies, and wearing personal protective equipment (PPE) (gowns and gloves) for all interactions that may involve contact with the patient or potentially contaminated areas of the environment (Sandora and Goldman, 2012). The aim of this paper is to suggest that contact precautions are failing, suggest why they are failing, and recommend changes to improve their effectiveness, because failure to stop the epidemic of MDRO will affect every aspect of clinical medicine, including inpatients and outpatients. Many experts recommend contact precautions for patients infected or colonised with MDRO (Muto et al., 2003; Siegel et al., 2006). Thus, active surveillance – screening of asymptomatic patients to determine colonisation – is often recommended (Huskins and O’Grady, 2011) to identify undetected reservoirs of MDRO. Colonised (or infected) patients are then placed in contact precautions, usually until screening is negative (Shenoy et al., 2013). However, use of screening and contact precautions has been shown to be ineffective for preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) in ICU in a large cluster-randomised trial (Huskins et al., 2011). Even universal glove and gown use in ICU did not prevent acquisition of MRSA and VRE (Harris et al., 2013), even though gloves, gowns, and hand hygiene are the backbone of contact precautions (Siegel et al., 2007). Much like for MRSA and VRE, asymptomatic carriers of Clostridium difficile account for nearly as much crosstransmission as those who are clinically infected, suggesting that surveillance screening may have a role in preventing transmission (Curry et al., 2013). Use of surveillance screening for other MDRO clearly identifies more patients that require contact precautions than does relying only on clinical cultures (Muto et al., 2003) and therefore is likely to increase the use of contact precautions. However, not only is the evidence of effectiveness minimal, as currently practiced, contact precautions have also been associated with a number of adverse events (Stelfox et al., 2003). Given the cost of such active surveillance, the lack of proven efficacy, and the potential for adverse events, its use should be re-evaluated at least for MRSA and VRE for which active surveillance has been studied and failed (Edmond and Wenzel, 2013). Universal decolonization for MRSA with chlorhexidine bathing has proven more effective than targeted MRSA surveillance and contact precautions in the ICU (Huang et al., 2013). These studies suggest that alternative strategies to contact precautions may prevent transmission and be preferable for some MDRO, being both more effective and more acceptable (Huang et al., 2013; Milstone et al., 2013). Many studies have shown reduction of transmission of MDRO with enhanced and enforced contact precautions during epidemics. Such studies usually also include a number of Multiple drug resistant organisms in healthcare: the failure of contact precautions
Journal of clinical and translational science, 2017
We aimed to improve the research consenting process by developing and evaluating simplified conse... more We aimed to improve the research consenting process by developing and evaluating simplified consent forms. Four templates written at the eighth-tenth grade reading level were developed and trialed by a group of experts in clinical research, health literacy, national regulatory requirements, and end users. Researchers from protocols which had received expedited review were surveyed at 2 time points regarding their use and assessment of the templates. At baseline 18/86 (20.9%) responding researchers had heard of the templates and 5 (5.8%) reported that they had used them; 2 years later, 54.2% (32/59) had heard of the templates and 87.5% (28/32) had used them (<0.001). Consent form templates may be one mechanism to improve patient comprehension of research protocols as well as efficiency of the review process, but require considerable time for development and implementation, and one key to their success is involvement and support from the IRB and technical staff.
Uploads