bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a Human Factors Framework to Assess Clinician Perceptions of and Barriers to High Reliability in Hand Hygiene
Authors: Vaughan Ana Maria , Sandora Thomas J. 
Published: November 2020

Background: Hand hygiene is essential to prevent healthcare-associated infections, but adherence among clinicians remains low. Objective: We used a human factors framework to understand clinician perceptions of and barriers to achieving high reliability in hand hygiene. Methods: The Systems Engineering Initiative for Patient Safety 2.0 model was used to develop a 24-item electronic survey. Perceived barriers to hand hygiene were classified into several domains: technology and tools, person, organization, tasks, environment, and care processes. After pilot testing, the survey was distributed to a stratified random sample of attending physicians, nurse practitioners, and physician assistants in medical specialties and surgery-anesthesia at a quaternary-care pediatric hospital. Frequencies, percentages, and descriptive statistics were used to summarize responses. Results: Of 200 clinicians, 61 (31%) responded to the survey: 74% were attending physicians, 18% were nurse practitioners, and 7% were physician assistants. Moreover, 51% of respondents represented medical specialties, and 49% came from surgical disciplines or anesthesia. Respondents had served a median 12 years (IQR, 5–19 years) in their current role. Overall, 70% perceived hand hygiene to be “essential” among patient safety issues at the institution, and 84% agreed that leadership openly promotes hand hygiene. Additionally, 97% believed personal hand hygiene efforts were effective in preventing healthcare-associated infections. The availability of alcohol-based hand rub and being a good example for colleagues were perceived as “very effective” in permanently improving hand hygiene reliability by most respondents (87% and 67%, respectively). Furthermore, 77% of clinicians reported alcohol-based hand rub dispensers to be “sometimes” or “often” empty; 52% cited distractions in the workplace as hindrances to hand hygiene; and 21% reported that peers do not openly promote hand hygiene. One-quarter of the respondents indicated that the layout of patient care areas was not conducive to performing hand hygiene. Staffing shortages and the pace and demands of work precluded hand hygiene for 15% and 11% of respondents, respectively. Conclusions: Most clinicians view hand hygiene as essential to patient safety, but aspects of organizational culture, environment, tasks, and tools were identified as barriers to high performance reliability. These data can inform efforts to use human factors engineering principles to optimize systems and organizations to more effectively promote hand hygiene.Funding: NoneDisclosures: None
Using Basic Principles of an Outbreak Investigation to Investigate Fractured Central Venous Catheter Hubs
Authors: Honeycutt Michele , Wisdom Christy , Barron Sharon , Capouya Jared 
Published: November 2020

Background: Central venous catheters (CVCs) are used to provide necessary vascular access. Mechanical issues with the catheters, such as fractures, result in a break in the sterility of the line, increasing the patient’s risk for infection or other adverse events. During a 5-month period in 2018, 15 CVCs (involving 13 patients) were noted to have cracked hubs. Methods: An outbreak should be suspected when a number of adverse events occur above the expected rate. We used a standardized process, Association for Professionals in Infection Control and Epidemiology (APIC) Basic Principles of an Outbreak Investigation, to conduct the epidemiological investigation of the outbreak.Results: All 15 CVCs required replacement, and 1 case of bacteremia was recorded. We suspect that the underlying cause was related to changes in the manufacturing process of hubs along with the product used to prepare the hubs prior to access (Table 1). Conclusions: Following an outbreak investigation process to investigate a noninfectious related outbreak can ensure that a thorough and comprehensive investigation is being completed. Early recognition of an outbreak is essential to recognition of the outbreak and the implementation of mitigation strategies. Inconsistent reporting of adverse events related to mechanical issues with the catheters may have contributed to a delay in recognition.Funding: NoneDisclosures: None
Application of a Continuously Active Antimicrobial Surface Coating in Two Professional Sports Training Facilities
Authors: Grossman Gavriel , Beck Valerie , Watson Dan , Toklu Ece , El-Sayed Maha 
Published: November 2020

Background: The role of surface contamination in infections is of interest in healthcare as well as other industries, especially where infections incur high cost. One such industry is professional sports, where infections pose significant risks to players and the organizations that employ them. Sports training facilities experience highly variable occupancy rates due to differing seasonal activities, presenting a measurement challenge because the relationship between occupancy and surface contamination is not well described. In a recent publication, a continuously active antimicrobial (CAA) surface coating demonstrated a reduction in bacterial bioburden in ICUs alongside a reduction in healthcare-associated infections (HAIs). Objective: We investigated the impact of a CAA surface coating on bioburden in 2 professional sports training facilities, despite changes in occupancy. Methods: A CAA surface coating was applied using an electrostatic sprayer to all surfaces in both facilities during a period of high-occupancy at facility A and during low occupancy at facility B. Surface cultures were taken using 3M Sponge-Sticks from lockers, gym equipment, and physiotherapy surfaces before treatment, 4–13 weeks after treatment at facility A and 4–23 weeks after treatment at facility B. Total aerobic bacteria counts were obtained by plating on tryptic soy agar, and geometric means of aerobic plate counts (APCs) were used to compare bioburden before and after treatment at both facilities and for an out-of-efficacy period at facility B (17–23 weeks). Occupancy rates were monitored as person days per week (pd/w) over the course of the study. Results: APC counts at facility A decreased 61% (585 CFU/100 cm2 to 226 CFU/100 cm2) from baseline to posttreatment, and occupancy remained constant (165 pd/w to 171 pd/w). At facility B, there was no significant change in APC (76 CFU/100 cm2 to 80 CFU/100 cm2), although occupancy increased >13,000% during the treatment period (3 pd/w to 386 pd/w). During the out-of-efficacy period at facility B, total bacteria increased 170% (217 CFU/100 cm2) compared to the treatment period, and the occupancy remained relatively constant (344 pd/w). Conclusions: Levels of bioburden were significantly influenced by the application of the CAA surface coating, especially considering the variation in occupancy in both facilities before, during, and after the efficacy period. Facility A saw a significant reduction in bioburden during the treatment period (P < .0001), and a significant increase was observed at facility B during the out-of-efficacy period (P < .0001) despite constant occupancy rates, demonstrating the ability of the surface coating to reduce bioburden levels despite large changes in occupancy.Funding: Allied BioScience, Inc, provided Funding: for this study.Disclosures: Gavri Grossman, Valerie Beck, and Daniel S Watson report salary from Allied BioScience.
One Health: Farmworker Perceptions of Antibiotic Resistance and Personal Protective Practices on Wisconsin Dairy Farms
Authors: Konkel Ali , Kates Ashley , Knobloch Mary Jo , Safdar Nasia , Byrs Nicole , Steinberger Andrew , Young Amanda , Shutske John , Ruegg Pamela , Sethi Ajay , Goldberg Tony , de Campos Juliana Leite , Suen Garret 
Published: November 2020

Background:
Antimicrobials are used on dairy farms for preventing disease and treating common infections such as mastitis. Objective: We aimed to understand farmworker practices that potentially contribute to transmission of antimicrobial resistance bacteria and their genes (ARG) among animals and farm workers, and to identify human behavioral interventions to reduce risk. Methods: Focus groups with farm workers were held at 8 dairy farms across Wisconsin selected to represent a range of antibiotic use in cattle. We explored the nature of potentially high-risk practices and farm-worker knowledge and experiences with antibiotic use and resistance. Farm workers were asked to describe common tasks, including hand hygiene and eating practices, and the policies guiding these practices. Focus groups were conducted in English and Spanish guided by the Systems Engineering in Patient Safety (SEIPS) framework, adapted for an agricultural context. Discussions were recorded, transcribed, and translated. A content analysis was conducted to identify themes. Dedoose version 8.0.35 software was used to organize the data. Results: In total, 10 focus groups were conducted on 8 farms. Knowledge of when to use antibiotics for human health varied; upset stomach, headache, and flu symptoms were suggested as appropriate uses. Few workers had personal experience with antibiotic resistance at home or on the farm. Some displayed knowledge of the role of antibiotic stewardship in preventing the spread of ARG (“I guess all dairy farmers have a responsibility not to overdo it”). Others associated the risk of spread with the consumption of raw milk or meat from cows receiving antibiotics. Knowledge of personal protective equipment was stronger among workers who commonly reported glove use. Some perceived glove use to be mandatory, and others chose to wear gloves in the perceived absence of written rules. Some workers reported changing gloves numerous times throughout the day, and others did so less frequently or “only when they rip.” In general, hand hygiene practices are guided by individual knowledge of established rules, beliefs about risk, and personal discretion. Conclusions: Knowledge about mechanisms of spread of ARGs varies among workers on Wisconsin dairy farms and reflects a combination of farm-level rules, experience, individual knowledge, and beliefs. Applying knowledge from the healthcare setting to reduce ARG spread into agriculture is crucial to the tenets of One Health. Programs to reduce ARG spread on dairy farms should focus on proper hand hygiene and PPE use at the level of knowledge, beliefs, and practices.Funding: Funding: was provided by the USDA-NIFA Food Safety Challenge (grant no. 2017-68003-26500).Disclosures: None
Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda
Authors: Lamorde Mohammed , Lozier Matthew , Kesande Maureen , Akers Patricia , Tumuhairwe Olive , Watsisi Martin , Omuut Winifred , Person Margaret , Murphy Jen , Quick Rob , Berendes David 
Published: November 2020

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan
Changes in Nursing Team Composition and Risk of Device Associated Infection in Intensive Care Units
Authors: Shah Hirsh , Knowlson Shelley A , Roberson Audrey , Godbout Emily , Stevens Michael , Bearman Gonzalo , Doll Michelle Elizabeth 
Published: November 2020

Background: The relationship between nursing staffing and healthcare-associated infections (HAIs) has been explored previously, with conflicting results. Intensive care units increasingly struggle to maintain trained staff. In May 2019, clinical coordinator (CC) roles changed to include 50% of time in direct patient care rather than supportive roles. In this study, we used shift records to explore the impact of staffing on HAI risk. Methods: Daily staffing records from December 2018 August 2019 for the medical-respiratory unit (MRICU) and the cardiac surgery unit (CSICU) were reviewed. Both units staff a fixed 2:1 patient:nurse ratio (1:1 for specific cardiac surgeries). Staff deficiency was defined as assignments filled by nurses pulled from other units/supplemental/or CC roles. Staff support comprised nursing assistants and unit secretaries. Census, admissions, and complexity score for number of devices were used to estimate care acuity. In CSICU, additional points were added for continuous renal replacement therapy, extracorporeal membrane oxygenation, ventricular assist devices, transplant, operative cases. NHSN definitions were used for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). The Spearman correlation coefficient was used to determine relationship between staffing, acuity, and risk window for HAI (days 1–10 preinfection). Linear regression was used to determine whether staffing deficiencies and/or support associate with the risk window prior to HAI. The final model included census and complexity score as control variables. The statistical analysis was performed using SAS version 9.4 software (Cary, NC). Results: Overall, 8 HAIs occurred in the study period: medical-respiratory intensive care unit (MRICU: 3 CAUTIs and 1 CLABSI) and cardiac surgery intensive care unit (CSICU: 1 CAUTI and 3 CLABSIs). Staffing and census fluctuated daily (Table 1). Total number of nurses correlated with complexity scores (r = 0.35; P < .0001) and daily census (r = 0.31; P < .0001) in the CSICU, and the census (r = 0.12; P = .04) in the MRICU. Nursing deficiencies correlated with days 1–10 before infection (r = 0.20; P = .0013) in the CSICU. In the regression model for the CSICU, nursing deficiencies increased in the time prior to HAI (P = .004), and support staff decreased in the time prior to HAI (P = .034) while controlling for census and complexity. These relationships were not significant in the MRICU. Conclusion: The lack of core nurses to support the staffing structure in CSICU correlated with periods prior to CLABSI or CAUTI in this small, unit-based study. Failure to recruit and retain highly skilled core staff may produce HAI risks, particularly for CLABSI in specialized units.Funding: NoneDisclosures: Michelle Doll, Research Grant from Molnlycke Healthcare
From Outbreak to Compliance and Beyond: UAB Medicine’s Successful Implementation of a Water Safety Program
Authors: Salah Shatha , Lee Rachael A. , Camins Bernard , Sidari Frank 
Published: November 2020

Background:
Pre-emptive management of the water supply can reduce hospital-onset legionellosis associated with building water systems. In 2014, an outbreak of Legionella pneumonia occurred in a 1,150-bed academic medical center (with ∼0.557 km2 or ∼6 million ft2 of space) among hematology-oncology patients. A comprehensive water safety and management program was implemented after the outbreak was controlled. We describe our experience implementing this prevention program. Methods: After the Legionella outbreak was controlled, an air and water safety committee (AWSC) was established and cochaired by the healthcare epidemiologist and the chief facilities officer. The AWSC established protocols for proactive environmental testing and the development of the an infection control risk assessment (ICRA) dedicated to water safety known as the water system construction and renovation risk assessment (WSCRRA).The water system management plan (WSMP) was developed (prior to the publication of ASHRAE 188) to direct the risk assessments and mitigation of any risks throughout the campus. Results: The WSMP identifies critical control measures, points, and limits that need to be maintained to control and monitor Legionella growth in the water systems. A control point is any step in a process at which biological, chemical, or physical factors can be controlled. The UAB Medicine WSMP includes 7 control points that are monitored on a daily basis. Examples of these control steps include monitoring of the hot water temperatures at the water heaters and distal outlets, managing the levels of mono-chloramines and chlorines in the water system, and managing water system components. To validate the efficacy of the WSMP, >610 water samples are collected from 19 hospital buildings over a year to be tested for Legionella. The results of water testing have shown significant decrease in distal site positivity due to managing and controlling these control points. This WSMP also evaluated the efficacy of 2 different methods for disinfecting water systems on campus as a corrective measure to Legionella growth. These methods are hyperchlorination and temporary copper silver ionization; based on the culture results of the water samples collected post disinfection, WSMP data show that the copper silver ionization method was more effective than hyperchlorination in controlling Legionella growth and decreasing the distal site positivity. Conclusions: The WSMP has provided ongoing management of building water systems and proactive actions around construction and renovation projects that involve water systems to prevent healthcare-acquired legionellosis. We strongly recommend other healthcare facilities to implement a similar program to avoid outbreaks.Funding: NoneDisclosures: Rachael Anne Lee reports speaker honoraria from Prime Education, LLC.
Point of Care Stations: A Novel Way to Improve Stethoscope Hygiene
Authors: Gibbens Kimberly , Hota Susy , Seidelin Peter , Rebelo Carly , Ross Kathleen , Vaisman Alon 
Published: November 2020

Background: Stethoscopes are known to be highly contaminated by a multitude of bacteria and therefore carry the potential to transmit pathogens within hospitals. North American infection prevention groups recommend low-level disinfection of stethoscopes for bioburden reduction between patients; however, adherence remains low in inpatient settings. Given that the lack of access to disinfection materials is the most commonly reported barrier to stethoscope hygiene, we studied an intervention using a point-of-care approach to increase stethoscope hygiene compliance among healthcare workers in critical care units. Methods: This quality improvement study was conducted in 2 critical-care units of a quaternary-care, academic, health sciences center in Toronto, Canada. We designed novel stethoscope hygiene stations consisting of a wall-mounted board with alcohol wipes, hooks for drying, and hand sanitizer dispensers to combine stethoscope and hand hygiene. Observations of stethoscope disinfection events per opportunity were collected by trained human auditors before and after the multimodal intervention, which consisted of the installation of 14 stations at the entrances of single-patient ICU rooms, accompanied by educational lectures and infographic dissemination. Anonymous feedback forms were used to gather information on healthcare workers’ stethoscope hygiene knowledge and behavior before and after the intervention. Results: In total, 124 observations were collected using convenience sampling between February and July 2019. Overall stethoscope hygiene compliance increased significantly from a baseline of 38% to 62% (P = .0316) (Fig. 1). Physician adherence to stethoscope disinfection increased by 22%. During the study period, hand hygiene compliance remained unchanged at 75%. Also, 74 healthcare providers completed feedback forms; they revealed an increase in awareness of stethoscope hygiene policies and/or recommendations (9% to 41%) and self reports of stethoscope hygiene compliance (28% to 44%). Conclusions: The implementation of stethoscope hygiene stations, coupled with an educational initiative, lead to a significant increase in overall stethoscope hygiene compliance among healthcare workers. Future quality improvement initiatives can adapt this strategy to promote disinfection and reduce pathogen burden of other personal and multiuse medical equipment.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.