Biomedical subjects

M-L McLaws

Publications and source records attributed to M-L McLaws.

4 recordsLinked to original sources

PubMed2006

Behavioural considerations for hand hygiene practices: the basic building blocks.

Hand hygiene is considered to be the most effective measure to prevent microbial pathogen cross-transmission and healthcare-associated infections. In October 2005, the World Health Organization (WHO) World Alliance for Patient Safety launched the first Global Patient Safety Challenge 2005-2006, 'Clean Care is Safer Care', to tackle healthcare-associated infection on a large scale. Within the Challenge framework, international infection control experts and consultative taskforces met to develop new WHO Guidelines on Hand Hygiene in Healthcare. The taskforce was asked to explore aspects underlying hand hygiene behaviour that may influence its promotion among healthcare workers. The dynamics of behavioural change are complex and multi-faceted, but are of vital importance when designing a strategy to improve hand hygiene compliance. A reflection on challenges to be met and areas for future research are also proposed.

Attitude of Health Personnel↗

PubMed2004

Handwashing in healthcare workers: accessibility of sink location does not improve compliance.

In spite of its importance, handwashing frequency in healthcare workers is generally low. The rebuilding and relocation of an 800-bed tertiary referral hospital on the same campus allowed assessment of the impact of easy accessibility to sinks on handwashing compliance. The new hospital design ensured that no clinical activity could occur more than 5 m (usually much less) from a sink. In the old hospital, clinical staff were often up to 30 m from a sink. Covert observation of nursing staff was undertaken in intensive care, infectious diseases, internal medicine and urology wards, over a total of 24 h during three consecutive days, two months before and one and 10 months after relocation to the new hospital. In all areas, handwashing compliance was greater before than after-patient contact. Initial increases (9-24%) in after-patient contact handwashing frequency following patient contact were demonstrated in units of both high and low clinical care activity one month after relocation. However, no sustained clinically significant improvement could be demonstrated nine months later. Glove use was shown to diminish compliance with handwashing protocols by as much as 25%. Improved accessibility to sinks does not lead to an improvement in healthcare workers' handwashing compliance.

Gloves, Protective↗

PubMed2003

The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot.

In 1998 the New South Wales (NSW) Health Department funded the development and implementation of the State's first standardized methodology for the surveillance of healthcare-associated infection for public hospitals. Fifteen pilot hospitals targeted inpatient groups considered to represent their core patient groups to act as sentinel measurements of patient safety. The aggregated rates of surgical site infection for coronary artery bypass graft (CABG) (chest & leg) surgery was 1.7% (95%CI: 1.1-2.5), CABG (chest only) 2.1% (95%CI: 1.0-3.7), vascular 7.1% (95%CI: 4.6-10.3), hip prosthesis 1.3% (95%CI: 0.5-2.7), knee prosthesis 6.1% (95%CI: 2.8-11.2) and colorectal 12.5% (95%CI: 9.5-16.1). The development of a bloodstream infection (BSI) associated with a central venous catheter (CVC) was not significantly (P=0.6) different when examined by duration of exposure with 3.7 BSI per 1000 line-days for CVC in situ six or more days compared with 4.0 BSI per 1000 line-days for CVC in situ for five or less days. A significantly (P<0.0001) greater proportion of patients whose CVC was in situ six or more days (6.8 per 100 patients, 95%CI: 4.2-10.2) developed a BSI compared with the proportion of patients whose CVC was in situ for five or fewer days (0.6 per 100 patients, 95%CI: 0.3-1.3). Significantly (P<0.0001) different rates of patients acquiring a new methicillin-resistant Staphylococcus aureus infection were found when hospital type was examined with rates ranging from 0.2 to 5.0 per 10000 occupied acute-care bed-days. The pilot highlighted that the collection of data for aggregation of some procedures and intravascular catheters may take many years before a reliable benchmark can be identified and many hospitals may not achieve reliable local rates annually. For surveillance to provide timely measures of patient safety we should consider surveillance methods for many small to medium sized hospitals that includes active surveillance only for infections with concurrent passive surveillance of the relevant denominators.

Catheterization↗

PubMed2002

Post-discharge surveillance: can patients reliably diagnose surgical wound infections?

Post-discharge surgical wound infection surveillance is an important part of many infection control programs. It is frequently undertaken by patient self-assessment, prompted either by a telephone or postal questionnaire. To assess the reliability of this method, 290 patients were followed for six weeks postoperatively. Their wounds were photographed and also covertly assessed for signs of infection by two experienced infection control nurses (ICNs). Patients also responded to a postal questionnaire seeking evidence of infection at both week four and week six post-surgery. Correlation between the patient's assessment of their wound and the ICNs diagnosis was poor (r = 0.37) with a low positive predictive value (28.7%), although negative predictive value was high (98.2%). Assessment of photos for signs of infection by two experienced clinicians also correlated poorly with the ICNs diagnosis of infection (r = 0.54). The patient's recall of prescription of an antibiotic by their general practitioner (GP) for wound infection during the postoperative period correlated best with the ICNs diagnosis (r = 0.76). This latter measure, particularly when confirmed by the GP in those patients reporting an infection, appears to provide the most valid and resource efficient marker of post-discharge surgical wound infection.

Aftercare↗