Aim To investigate the collaborative networks among expert clinical nurse and midwifery researchers in eastern and southern Africa. Methods Thirty-eight clinical nurse and midwifery researchers completed an online survey to analyse collaboration between respondents. Data were analysed using social network analysis, generating a network map and associated measurements. Results Regional collaboration was poor. Those links that did exist centred on geographic proximity and participation in regional and international organizations. Conclusion These results help us to understand better ways to strengthen and support nursing and midwifery clinical research in eastern and southern Africa. Implications for nursing policy Clinical nursing and midwifery research capacity building efforts should focus on supporting collaboration networks among individuals and institutions in the region.

INTRODUCTION:National efforts to curtail healthcare-associated infections (HAI) proliferated recently, though data detailing progress over time are limited. This retrospective cohort study aims to describe changes in incidence and antimicrobial susceptibility of HAI in four New York City hospitals over seven years.METHODS:Electronic data were collected retrospectively for all patients discharged from 2006 through 2012. Previously validated computerized algorithms based on National Healthcare Safety Network criteria detected bloodstream infections, pneumonia, surgical site infections, and urinary tract infections with Enterococcus spp., Staphylococcus aureus, Streptococcus pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. Antimicrobial susceptibilities were obtained from electronic laboratory records. Logistic regression was used to assess changes in odds of acquiring an HAI and odds of antimicrobial resistance over time, controlling for age, gender, severity of illness, previous hospitalizations, and admission source.RESULTS:In total, 19,052 HAI were identified among 761,426 discharges. HAI rates fell for all organisms, all infection types, and within all hospitals. Odds of acquiring an HAI decreased significantly over time for all organisms. Resistance levels were stable for Enterococcus spp., S. aureus, A. baumannii, and S. pneumoniae. Multidrug resistance increased for P. aeruginosa and decreased for K. pneumoniae, though imipenem resistance among K. pneumoniae climbed sharply in 2011.CONCLUSIONS:This study suggests that HAI incidence rates are falling, possibly due to increased federal, state and local attention to healthcare quality and patient safety. Though we found no substantial reductions in resistance, recent national attention towards antimicrobial stewardship may precipitate a change in coming years.

Background: Published data regarding temporal trends in vancomycin-resistant enterococci (VRE) prevalence within specific regions or healthcare systems are scarce.Aim: To characterize temporal trends and risk factors for healthcare-associated infections caused by VRE.Methods: The study included all adult discharges occurring from 2006 to 2014 with an enterococcal infection from three hospitals in a large academic healthcare system. Bivariate analyses were used to identify statistically significant factors associated with vancomycin-susceptible or-resistant infection. Statistically significant variables were included in a final logistic regression model. Trends assessed whether the proportion of enterococcal infections resistant to vancomycin changed over time.Findings: The sample included 10,186 adults with first-time healthcare-associated enterococcal infection. Significant risk factors (P <= 0.05) for VRE in the final logistic regression model included: tertiary 1 hospital, intensive care unit length of stay, higher Charlson Comorbidity Index, previous immunosuppressive or chemotherapeutic medications, previous hospitalization, renal failure, malignancy, longer length of stay prior to infection, taking an antibiotic prior to infection, being female, and having an infection in winter or spring. Between 2006 and 2014, the rate of resistance varied from 37.1 to 42.9% but there were no significant differences in the proportion resistant to vancomycin over time (P=0.36).Conclusion: Research targeted at risk factors is important to decrease the amount of VRE infections. (C) 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

AIM:This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade.BACKGROUND:The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research ('grey literature'), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence-based care.INTRODUCTION:This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research.METHODS:Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi-square tests were performed to compare differences between indexed and non-indexed literature.RESULTS:We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed.DISCUSSION:Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric-related research were less often published.CONCLUSIONS AND IMPLICATIONS FOR NURSING AND HEALTH POLICY:Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing science in southern and eastern African countries will help nurses and midwives to understand gaps in clinical research knowledge, potentially direct their research to more critical topics, and inform funding bodies and policy-makers of the situation of nursing science in southern and eastern African countries.

SummaryObjective: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool.Methods: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool.Results: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%).Discussion: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved.Conclusion: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.Citation: Hum RS, Cato K, Sheehan B, Patel S, Duchon J, DeLaMora P, Ferng YH, Graham P, Vawdrey DK, Perlman J, Larson E, Saiman L. Developing clinical decision support within a commercial electronic health record system to improve antimicrobial prescribing in the neonatal ICU. Appl Clin Inf 2014; 5: 368–387 http://dx.doi.org/10.4338/ACI-2013-09-RA-0069

To develop a tool for self-assessment of HH resources, practice and promotion in healthcare facilities (HCF), based on the key components of the WHO Multimodal Hand Hygiene (HH) Improvement Strategy (MHHIS).

The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.

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.

Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.

ISSUE: Although it has been four years since the publication of the new CDC Hand Hygiene Guideline for Healthcare Settings, to date no study has assessed the attitudes of staff toward recommendations in the new Guideline. PROJECT: “Attitudes Regarding Practice Guidelines” questionnaire was administered to a sample of ICU staff members in 38 U.S. hospitals. The tool has a 6-point Likert scale and two sections: Section 1 includes attitudinal statements about practice guideline in general (18 statements) and Section 2 includes 18 parallel statements specifically regarding the Hand Hygiene Guideline. Possible scores range from 0-180, with higher scores indicating more positive attitudes. Additionally, the instrument asks the respondent to name the most important factors that would either facilitate or prevent the use of the Guideline, and asks them to self-report the proportion of time when they use an alcohol hand degermer. RESULTS: 1,974 surveys were distributed, 1,346 were returned (68.2%). The respondents included of 996 nurses (74%), 222 physicians (16%), and 128 others (10%). 80% of the respondents agreed there was sufficient administrative support and resources in their setting to allow the implementation of the Guideline. 861/ 1282 (67%) reported using alcohol ‘almost always’ in their practice. Those with higher scores on the survey reported using alcohol hand hygiene significantly more frequently than those with lower scores (ANOVA, p < 0.001). 63% reported that following the Guideline would increase their risk of skin damage; they also reported frequent use of alcohol significantly less often than those who did not report that use of the Guideline would increase skin damage (65.3% and 73.0% respectively, p < 0.001). Staff named six barriers to hand hygiene, with the most frequent (92.9%) being lack of time or equipment and negative effects on skin. LESSONS LEARNED: Recommendations in the Guideline seem to be widely implemented, and a more positive attitude toward practice guidelines was associated with increased use of alcohol hand hygiene products. Nevertheless, reported barriers to hand hygiene do not seem to have changed since publication of the Guideline. ISSUE: Although it has been four years since the publication of the new CDC Hand Hygiene Guideline for Healthcare Settings, to date no study has assessed the attitudes of staff toward recommendations in the new Guideline. PROJECT: “Attitudes Regarding Practice Guidelines” questionnaire was administered to a sample of ICU staff members in 38 U.S. hospitals. The tool has a 6-point Likert scale and two sections: Section 1 includes attitudinal statements about practice guideline in general (18 statements) and Section 2 includes 18 parallel statements specifically regarding the Hand Hygiene Guideline. Possible scores range from 0-180, with higher scores indicating more positive attitudes. Additionally, the instrument asks the respondent to name the most important factors that would either facilitate or prevent the use of the Guideline, and asks them to self-report the proportion of time when they use an alcohol hand degermer. RESULTS: 1,974 surveys were distributed, 1,346 were returned (68.2%). The respondents included of 996 nurses (74%), 222 physicians (16%), and 128 others (10%). 80% of the respondents agreed there was sufficient administrative support and resources in their setting to allow the implementation of the Guideline. 861/ 1282 (67%) reported using alcohol ‘almost always’ in their practice. Those with higher scores on the survey reported using alcohol hand hygiene significantly more frequently than those with lower scores (ANOVA, p < 0.001). 63% reported that following the Guideline would increase their risk of skin damage; they also reported frequent use of alcohol significantly less often than those who did not report that use of the Guideline would increase skin damage (65.3% and 73.0% respectively, p < 0.001). Staff named six barriers to hand hygiene, with the most frequent (92.9%) being lack of time or equipment and negative effects on skin. LESSONS LEARNED: Recommendations in the Guideline seem to be widely implemented, and a more positive attitude toward practice guidelines was associated with increased use of alcohol hand hygiene products. Nevertheless, reported barriers to hand hygiene do not seem to have changed since publication of the Guideline.

This open-label study evaluated the effects on body fat of the use of a low-dose oral contraceptive (gestodene75/EE20) in a group of 61 women (OC-U group) as compared to a nonuser group (OC-N group) of 51 women who did not receive an oral contraceptive. Weight, body mass index (BMI), waist-over-hip ratio and body composition data, obtained by bioelectrical impedance [percentages of body fat (%FAT), water (%TBW) and lean mass (%FFM)], were assessed before and after six treatment cycles. Baseline OC-U group weight, BMI, %FAT, %TBW and %FFM did not differ from the OC-N group, either at baseline or at the end of the study, and did not significantly change within each group during the study. Also, there was no modification of fat distribution in either group. Among women in the OC-U group, there was a slight increase in total cholesterol levels and a trend towards higher triglycerides levels. No changes were detected in blood pressure. In conclusion, this low-dose oral contraceptive did not affect weight or body composition. Thus, our data suggest that gestodene75/EE20 represents an appropriate OC choice and may enhance compliance of women who mistakenly believe that the use of oral contraceptives always leads to weight gain.

Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation's clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present--public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a view to improving the overall performance of the US clinical research enterprise.

The infrastructure and organization of hospitals are changing rapidly as a result of major transitions in health care. Downsizing in hospitals has caused employees to have to take on new tasks and, often, multiple tasks with a decrease in available resources and an increase in job complexity. Naturally, such organizational changes have a profound effect on the nature and duration of patient hospitalization and on the job responsibilities and roles of inpatient staff. In many hospitals, there is a perception of chaos, sometimes resulting in frustration among the nursing personnel. The purpose of this study was to describe the relationship between nurses' job satisfaction and organizational climate.

In February 1999, the Columbia University School of Nursing and the Columbia Presbyterian Medical Center hosted an international invitational symposium, “Perspectives on Home Hygiene: Building A Rational Approach,” to examine the science behind home hygiene practices to prevent the spread of infections among household members. This supplement includes the consensus statement summarizing the findings of that meeting and the papers presented.

The purpose of this article is to review research indicating a link between hand hygiene and nosocomial infections and the effects of hand care practices on skin integrity and to make recommendations for potential changes in clinical practice and for further research regarding hand hygiene practices. Despite some methodological flaws and data gaps, evidence for a causal relationship between hand hygiene and reduced transmission of infections is convincing, but frequent handwashing causes skin damage, with resultant changes in microbial flora, increased skin shedding, and risk of transmission of microorganisms, suggesting that some traditional hand hygiene practices warrant reexamination. Some recommended changes in practice include use of waterless alcohol-based products rather than detergent-based antiseptics, modifications in lengthy surgical scrub protocols, and incorporation of moisturizers into skin care regimens of health care professionals.

The perceptions of physicians and nurses vary in a number of respects, including the extent to which collaboration and joint decision making are valued, the definition of what constitutes adequate and appropriate interprofessional communication, the quality of nurse-physician interactions, and the understanding of respective areas of responsibility as well as patient goals. Reasons for these differences have been attributed to gender, historical origins of the two professions, and disparities between physicians and nurses with regard to socioeconomic status, education, and socialization. Failure of physicians and nurses to interact in a coordinated and positive fashion results in unhealthy work environments and poor patient outcomes. Both professions must examine their will to improve interprofessional interactions.