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Hand hygiene for patients and visitors is as important as it is for staff

Fourteen per cent of patients were found to carrying MRSA, VRE or resistant Gram-negative bacteria.

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Multi-drug resistant organisms were found on both patients and their environment.

For decades, hospitals have worked to get doctors, nurses and others to wash their hands but improving the hand hygiene amongst patients could be the key to prevent the spread of antibiotic-resistant bacteria, researchers claim.

A study by researchers at the University of Michigan found that almost a third of objects commonly used by patients – such as call buttons and bedside tables – were contaminated with multi-drug resistant organisms.

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Researchers visited the rooms of nearly 400 inpatients at two hospitals in Michigan in the United States to obtain samples.

In addition to MRSA, short for methicillin-resistant Staphylococcus aureus, the study examined the samples for ‘superbugs’ called VRE (vancomycin-resistant enterococcus) and a group called RGNB, for resistant Gram-negative bacteria.

The samples taken revealed that fourteen per cent of the patients tested had antibiotic-resistant bacteria on their hands or nostrils – even in the first few days of their admission.

‘Germs are on our hands’.

Using genetic testing researchers discovered that, in nearly all cases, the bacteria found on patients’ hands was the same as the bacteria found in their rooms – suggesting activate transfer was occurring.

Lona Mody, the Lead Researcher at the University of Michigan, said; “Hand hygiene narrative has largely focused on physicians, nurses and other front-line staff, and all the policies and performance measurements have centred on them, and rightfully so”

“But our findings make an argument for addressing transmission of multi-drug resistant organisms in a way that also involves patients.”

Katherine Reyes, a Specialist Doctor in Infectious Diseases, added; “This study highlights the importance of handwashing and environmental cleaning, especially within a healthcare setting where patients’ immune systems are compromised,”

“This step is crucial not only for healthcare providers, but also for patients and their families. Germs are on our hands; you do not need to see to believe it. And they travel. When these germs are not washed off, they pass easily from person to person and objects to person and make people sick.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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