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Infection prevention & control challenges with the management of a suspected case of Ebola Virus Disease
Abstracts 2
Centre for Research Excellence in Reducing Healthcare Associated Infections, Kelvin Grove, Australia 3 Australian Centre for Health Services Innovation, Kelvin Grove, Australia Introduction: Translation of evidence into practice can be challenging. The PITCH study combined an environmental cleaning bundle with an implementation science framework called the Promoting Action on Research Implementation in Health Services (PARIHS) framework to maximize uptake of new practices. The PARIHS framework suggests that successful implementation is a product of the evidence and perceived value of the change, the local context and culture in which the change takes place, and the process by which the change is facilitated. Methods: The bundle was implemented in a before and after study into a 400 bed metropolitan hospital for 6months. The PARIHS framework was used in a prospectively to assess the evidence and include local knowledge into the development of the bundle. Context mapping then assessed the hospital’s systems, culture, and barriers and enablers for environmental services staff. Information gained in these steps was synthesized to develop targeted training and project resources, and local implementation plan. Results: Results demonstrated significant improvements to both the knowledge around cleaning practices and overall job satisfaction. Further, this led to significant improvements in cleaning performance, from 61% to 95% clean across the eight research wards. The PARIHS framework provided an easy to use, comprehensive process to support implementation of the bundle which led to strong practice change. Conclusion: By combining infection prevention and implementation science, this evidence based environmental cleaning bundle improved patient care and will ultimately reduce the risk of HAIs.
INACTIVATION OF SEXUALLY TRANSMITTED PATHOGENS USING AN AUTOMATED HYDROGEN PEROXIDE HIGH LEVEL DISINFECTION DEVICE FOR ULTRASOUND PROBES Lia Moshkanbaryans, Dr Nanosonics Ltd, Lane Cove West, Australia Surface and intracavity ultrasound probe bodies and handles have been shown to be a reservoir for a range of nosocomial pathogens. Recent studies have shown that probes can be contaminated with human papillomavirus (HPV), the causative agent of 99.7% of all cervical cancers and that aldehyde based high-level disinfectants seem to be ineffective against these viruses. A recent study showed that an automated ultrasound probe high level disinfection device (trophonâ EPR) completely inactivates HPV making this the only proven high level disinfection system to kill native HPV16 and HPV18 virions. We sought to test the efficacy of the automated device against other clinically relevant sexually transmitted pathogens including Chlamydia trachomatis, HBV, HCV, HIV and Neisseria gonorrhoeae. We demonstrated that the automated device eradicated these microorganisms when tested under normal use, manufacturer recommended conditions. While high-level disinfectants are assumed to inactivate all pathogens except spores, specific testing should be conducted to prove efficacy against clinically relevant organisms, especially those with atypical resistance profiles such as HPV.
INFECTION CONTROL EDUCATION e DOES ONE SIZE FIT ALL OR SHOULD IT BE MADE TO MEASURE? Joanne Baigent Counties Manukau Health, Otahuhu, New Zealand Introduction: Additional to positive attitude and behaviour, successful Infection Prevention and Control (IP and C) practice requires knowledge and skills. In a healthcare setting dependent on electronic records and computers, literature indicates that healthcare workers prefer online learning opportunities as opposed to traditional teaching-learning methods (Karaman, 2011). The aim of this study was to explore possible areas for improvement in our current I P and C education programme. Method: The IP and C team developed an online survey that focused on the perceived education needs of staff and their preferred learning methods. Survey Monkey was used to design a survey which was emailed to nurse managers, specialists, coordinators and educators across hospital services. The survey commenced on 15th April 2016 and ran for 3 weeks. Two email
131 reminders were sent to the target participants resulting in a total of 116 responses e a 23% response rate. Results: The results showed equal preference for the following topics: standard precautions, transmission-based precautions, cleaning and disinfection, MRO management, infection control policies and review of the infection control champion role (p >.05). Ward-based one-on-one training (mentoring) was the most preferred learning method, followed by lectures and workshops. Online tutorials and online resources were least preferred (p>.05) Conclusion: The provision of IP and C education should include the full range of topics, ensuring that ward-based one-on-one training is included as one of the delivery methods. However, it may well be that some services may also require education made to measure specific to their service requirements.
INFECTION PREVENTION & CONTROL CHALLENGES WITH THE MANAGEMENT OF A SUSPECTED CASE OF EBOLA VIRUS DISEASE Ruth Barratt Christchurch Hospital, Christchurch, New Zealand Introduction: In August 2014, The World Health Organisation declared that the Ebola Virus Disease outbreak in West Africa met the conditions for a Public Health Emergency of International Concern. Christchurch Hospital, New Zealand, was designated by the Ministry of Health as one of the four New Zealand centres to receive and care for a suspected or confirmed case of Ebola Virus Disease (EVD) and had been preparing for such an event since September 2014. In February 2015 Christchurch Hospital admitted a case of suspected EVD. Methods: The infection prevention & control (IPC) challenges of caring for the first suspected EVD case admitted to a New Zealand Hospital are presented. These include urgent training front line staff in the use of additional PPE, the defects of less than optimal PPE, disposing of large amounts of clinical waste and communicating with a variety of staff groups amidst an air of fear and unknown. Results: Although our hospital had planned and prepared well, the real life situation presented practice issues that required immediate resolution. An experienced infection prevention and control team was able to work through the challenges and provide support to staff who would be involved in the direct care of the patient. Conclusion: The admission of a ’real’ case of EVD identified significant challenges that the IPC team was able to address, using their own experience and working along side front line staff.
INFECTION PREVENTION AND CONTROL LEARNING AND PRACTICE IN PRE-REGISTRATION UNDERGRADUATE NURSING: THE SOCIOLOGICAL INFLUENCES OF THE CLINICAL ENVIRONMENT Peta-Anne Zimmerman, Dr1,2,3, Julia Gilbert 1, Lynne Brown 1, Ramon Z. Shaban, Professor1,2,3 1 School of Nursing and Midwifery, Griffith University, Southport, Australia 2 Gold Coast Hospital and Health Service, Gold Coast, Australia 3 Menzies Health Institute Queensland, Australia Introduction: This study explores factors influencing the infection prevention and control practice of pre-registration nursing students to identify methods to support their clinical experience. Methods: This cross-sectional study employed: 1) a previously validated questionnaire examining variables that influence students’ infection prevention and control practice in the clinical environment, and 2) focus groups/interviews exploring survey findings. A non-probability sample of nursing students enrolled in a pre-registration undergraduate nursing degree at an Australian university and employed clinical facilitators were invited to participate. Survey data were analysed using descriptive and inferential statistics. Focus group/interview data was subjected to thematic analysis. Results: The infection control practices of the majority of students sampled were positively influenced primarily by their university education and the good practice of their clinical mentors. 52% (102/195) reported they would ignore poor practice in the clinical environment and perform hand hygiene as they had been instructed at university. Meanwhile 41.5% (81/195) indicated they would attempt to correct poor practice in others. A small percentage (7.7%, 4/52) of senior students indicated that they would comply with poor practice, where none of the junior group indicated this. Clinical
Centre for Research Excellence in Reducing Healthcare Associated Infections, Kelvin Grove, Australia 3 Australian Centre for Health Services Innovation, Kelvin Grove, Australia Introduction: Translation of evidence into practice can be challenging. The PITCH study combined an environmental cleaning bundle with an implementation science framework called the Promoting Action on Research Implementation in Health Services (PARIHS) framework to maximize uptake of new practices. The PARIHS framework suggests that successful implementation is a product of the evidence and perceived value of the change, the local context and culture in which the change takes place, and the process by which the change is facilitated. Methods: The bundle was implemented in a before and after study into a 400 bed metropolitan hospital for 6months. The PARIHS framework was used in a prospectively to assess the evidence and include local knowledge into the development of the bundle. Context mapping then assessed the hospital’s systems, culture, and barriers and enablers for environmental services staff. Information gained in these steps was synthesized to develop targeted training and project resources, and local implementation plan. Results: Results demonstrated significant improvements to both the knowledge around cleaning practices and overall job satisfaction. Further, this led to significant improvements in cleaning performance, from 61% to 95% clean across the eight research wards. The PARIHS framework provided an easy to use, comprehensive process to support implementation of the bundle which led to strong practice change. Conclusion: By combining infection prevention and implementation science, this evidence based environmental cleaning bundle improved patient care and will ultimately reduce the risk of HAIs.
INACTIVATION OF SEXUALLY TRANSMITTED PATHOGENS USING AN AUTOMATED HYDROGEN PEROXIDE HIGH LEVEL DISINFECTION DEVICE FOR ULTRASOUND PROBES Lia Moshkanbaryans, Dr Nanosonics Ltd, Lane Cove West, Australia Surface and intracavity ultrasound probe bodies and handles have been shown to be a reservoir for a range of nosocomial pathogens. Recent studies have shown that probes can be contaminated with human papillomavirus (HPV), the causative agent of 99.7% of all cervical cancers and that aldehyde based high-level disinfectants seem to be ineffective against these viruses. A recent study showed that an automated ultrasound probe high level disinfection device (trophonâ EPR) completely inactivates HPV making this the only proven high level disinfection system to kill native HPV16 and HPV18 virions. We sought to test the efficacy of the automated device against other clinically relevant sexually transmitted pathogens including Chlamydia trachomatis, HBV, HCV, HIV and Neisseria gonorrhoeae. We demonstrated that the automated device eradicated these microorganisms when tested under normal use, manufacturer recommended conditions. While high-level disinfectants are assumed to inactivate all pathogens except spores, specific testing should be conducted to prove efficacy against clinically relevant organisms, especially those with atypical resistance profiles such as HPV.
INFECTION CONTROL EDUCATION e DOES ONE SIZE FIT ALL OR SHOULD IT BE MADE TO MEASURE? Joanne Baigent Counties Manukau Health, Otahuhu, New Zealand Introduction: Additional to positive attitude and behaviour, successful Infection Prevention and Control (IP and C) practice requires knowledge and skills. In a healthcare setting dependent on electronic records and computers, literature indicates that healthcare workers prefer online learning opportunities as opposed to traditional teaching-learning methods (Karaman, 2011). The aim of this study was to explore possible areas for improvement in our current I P and C education programme. Method: The IP and C team developed an online survey that focused on the perceived education needs of staff and their preferred learning methods. Survey Monkey was used to design a survey which was emailed to nurse managers, specialists, coordinators and educators across hospital services. The survey commenced on 15th April 2016 and ran for 3 weeks. Two email
131 reminders were sent to the target participants resulting in a total of 116 responses e a 23% response rate. Results: The results showed equal preference for the following topics: standard precautions, transmission-based precautions, cleaning and disinfection, MRO management, infection control policies and review of the infection control champion role (p >.05). Ward-based one-on-one training (mentoring) was the most preferred learning method, followed by lectures and workshops. Online tutorials and online resources were least preferred (p>.05) Conclusion: The provision of IP and C education should include the full range of topics, ensuring that ward-based one-on-one training is included as one of the delivery methods. However, it may well be that some services may also require education made to measure specific to their service requirements.
INFECTION PREVENTION & CONTROL CHALLENGES WITH THE MANAGEMENT OF A SUSPECTED CASE OF EBOLA VIRUS DISEASE Ruth Barratt Christchurch Hospital, Christchurch, New Zealand Introduction: In August 2014, The World Health Organisation declared that the Ebola Virus Disease outbreak in West Africa met the conditions for a Public Health Emergency of International Concern. Christchurch Hospital, New Zealand, was designated by the Ministry of Health as one of the four New Zealand centres to receive and care for a suspected or confirmed case of Ebola Virus Disease (EVD) and had been preparing for such an event since September 2014. In February 2015 Christchurch Hospital admitted a case of suspected EVD. Methods: The infection prevention & control (IPC) challenges of caring for the first suspected EVD case admitted to a New Zealand Hospital are presented. These include urgent training front line staff in the use of additional PPE, the defects of less than optimal PPE, disposing of large amounts of clinical waste and communicating with a variety of staff groups amidst an air of fear and unknown. Results: Although our hospital had planned and prepared well, the real life situation presented practice issues that required immediate resolution. An experienced infection prevention and control team was able to work through the challenges and provide support to staff who would be involved in the direct care of the patient. Conclusion: The admission of a ’real’ case of EVD identified significant challenges that the IPC team was able to address, using their own experience and working along side front line staff.
INFECTION PREVENTION AND CONTROL LEARNING AND PRACTICE IN PRE-REGISTRATION UNDERGRADUATE NURSING: THE SOCIOLOGICAL INFLUENCES OF THE CLINICAL ENVIRONMENT Peta-Anne Zimmerman, Dr1,2,3, Julia Gilbert 1, Lynne Brown 1, Ramon Z. Shaban, Professor1,2,3 1 School of Nursing and Midwifery, Griffith University, Southport, Australia 2 Gold Coast Hospital and Health Service, Gold Coast, Australia 3 Menzies Health Institute Queensland, Australia Introduction: This study explores factors influencing the infection prevention and control practice of pre-registration nursing students to identify methods to support their clinical experience. Methods: This cross-sectional study employed: 1) a previously validated questionnaire examining variables that influence students’ infection prevention and control practice in the clinical environment, and 2) focus groups/interviews exploring survey findings. A non-probability sample of nursing students enrolled in a pre-registration undergraduate nursing degree at an Australian university and employed clinical facilitators were invited to participate. Survey data were analysed using descriptive and inferential statistics. Focus group/interview data was subjected to thematic analysis. Results: The infection control practices of the majority of students sampled were positively influenced primarily by their university education and the good practice of their clinical mentors. 52% (102/195) reported they would ignore poor practice in the clinical environment and perform hand hygiene as they had been instructed at university. Meanwhile 41.5% (81/195) indicated they would attempt to correct poor practice in others. A small percentage (7.7%, 4/52) of senior students indicated that they would comply with poor practice, where none of the junior group indicated this. Clinical