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Privacy curtains found to be the source of multidrug-resistant bacteria

“Patient colonisation with MRSA and VRE were each associated with contamination of the bedside curtain”

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Privacy curtains contaminated with multidrug-resistant bacteria could be a source of disease transmission to patients.

Patient privacy curtains, used in most healthcare facilities in the world, are surfaces which are subjected to frequent touching but are only cleaned infrequently, and could potentially be a mode of transmission for multidrug-resistant bacteria.

A study by Dr Lona Mody, Kristen Gibson and colleagues at the University of Michigan Medical Center, University Hospital, Ann Arbor, USA, looked at the prevalence of curtain contamination with multidrug-resistant organisms.

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Researchers conducted a prospective cohort study across six facilities in southeast Michigan, obtaining bacterial culture samples from several sites on each patient’s body, as well as from high-touch surfaces in the patient’s room.

‘Curtains tested positive’.

Samples were taken upon admission, and again after 14 days, 30 days, then monthly up to 6 months where possible. A total of 1521 samples from 625 rooms were obtained from the edges of privacy curtains where they are touched most often, and the researchers were particularly interested in any links between bacteria found on patients, and MDRO contamination on their privacy curtain at the same visit. The team also wanted to discover whether this contamination occurred intermittently, or was persistent for those patients with 6 months of follow-up.

The study found that a total of 334 (22%) cultures taken from privacy curtains tested positive for MDROs, with contamination rates varying from 11.9% to 28.5% across the different facilities. Of these cultures, 210 (13.8%) were contaminated with vancomycin-resistant enterococci (VRE); 94 (6.2%) with resistant gram-negative bacilli (R-GNB); and 74 (4.9%) with methicillin-resistant Staphylococcus aureus (MRSA). The team discovered no statistically significant difference in contamination rates between private and shared rooms.

The authors found that in 15.7% (238/1518) of sampling visits, patients and their privacy curtain were concurrently colonised with the same MDRO.

‘Patients contaminated with the same organism’.

They say: “Patient colonisation with MRSA and VRE were each associated with contamination of the bedside curtain”. And of the 210 sampling visits which found VRE contamination on the curtain, 57.6% of patients were also contaminated with VRE. Conversely, VRE was not detected on the curtain in 73.3% of sampling visits where VRE was not present on the patient. Where 6-month follow-up data were available, the study found that curtain contamination was often intermittent.

The researchers say that their findings show contamination of privacy curtains with MDROs is a common problem, and that patients are frequently contaminated with the same MDRO as their privacy curtain.

They conclude: “We were surprised to see that MDROs, especially VRE, shed by patients routinely contaminate their privacy curtains. These pathogens on privacy curtains often survive and have the potential to transfer to other surfaces and patients. As privacy curtains are used all over the world, it’s a global issue. Further studies are needed to determine conclusively whether contaminated privacy curtains are a source of MDRO transmission to patients.”

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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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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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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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