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Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

ABSTRACT: BACKGROUND:Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers' (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and may lead to more targeted and effective control strategies in the hospital setting. METHODS:Staff at 3 urban university-based tertiary care hospitals in Canada completed a detailed questionnaire on demographics, interpersonal contacts, in-hospital movement, and infection prevention and control practices. Staff were divided into categories of administrative/support, nurses, physicians, and "Other HCWs" - a fourth distinct category, which excludes physicians and nurses. Using quantitative network modeling tools, we constructed the resulting HCW "co-location network" to illustrate contacts among different occupations and with locations in hospital settings. RESULTS:Among 3048 respondents (response rate 38%) an average of 3.79, 3.69 and 3.88 floors were visited by each HCW each week in the 3 hospitals, with a standard deviation of 2.63, 1.74 and 2.08, respectively. Physicians reported the highest rate of direct patient contacts (>?20 patients/day) but the lowest rate of contacts with other HCWs; nurses had the most extended (>?20 min) periods of direct patient contact. "Other HCWs" had the most direct daily contact with all other HCWs. Physicians also reported significantly more locations visited per week than nurses, other HCW, or administrators; nurses visited the fewest. Public spaces such as the cafeteria had the most staff visits per week, but the least mean hours spent per visit. Inpatient settings had significantly more HCW interactions per week than outpatient settings. CONCLUSIONS:HCW contact patterns and spatial movement demonstrate significant heterogeneity by occupation. Control strategies that address this diversity among health care workers may be more effective than "one-strategy-fits-all" HAI prevention and control programs.

SUBMITTER: English KM

PROVIDER: S-EPMC5905140 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

English Krista M KM Langley Joanne M JM McGeer Allison A Hupert Nathaniel N Tellier Raymond R Henry Bonnie B Halperin Scott A SA Johnston Lynn L Pourbohloul Babak B

BMC infectious diseases 20180417 1

<h4>Background</h4>Nosocomial, or healthcare-associated infections (HAI), exact a high medical and financial toll on patients, healthcare workers, caretakers, and the health system. Interpersonal contact patterns play a large role in infectious disease spread, but little is known about the relationship between health care workers' (HCW) movements and contact patterns within a heath care facility and HAI. Quantitatively capturing these patterns will aid in understanding the dynamics of HAI and ma ...[more]

PMID: 29665775

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Project description:BackgroundHand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.MethodsSpatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors' contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes.ResultsNurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm - 7 am) and weekends as compared to weekdays (7 am - 5 pm).ConclusionSpatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies.

Project description:BACKGROUND:Organizational justice is the first virtue in social institutions (J Manage 16:399-432, 1990). It is one of the most determinant factors for an effective utilization of human resources and an essential predictor of organizational success (J Manag Dev 28:457-477, 2009). Employees who perceive fairness are more likely happy with their job and less likely leave their organization (Int J Bus Manage 4:145-154, 2009). Perceived injustice, on the other hand, diminishes motivation of workers to accomplish their duties (Int J Bus Manage 4:145-154, 2009; J Educ Sci Univ Tabriz 2:27-34, 2009). Ethiopia has given emphasis to the expansion of health institutions and increasing the number of health professionals. Despite this, little emphasis has been given the human resource aspect of the health sector. Therefore, this study aims to investigate organizational justice perceptions and turnover intentions among healthcare workers in Amhara region. METHODS:One hundred ninety seven healthcare workers participated in the study. Data were collected through self- report questionnaire and semi-structured interview. The quantitative data were analyzed through MANOVA, multiple regression, and independent samples t-test. The qualitative data were analyzed through thematic analysis. RESULTS:The results of this study revealed that healthcare workers in the public hospitals held low perceived distributive, procedural, interpersonal and informational justice. Similarly, private hospitals healthcare workers had low perceptions on distributive and procedural justice. On the contrary, healthcare workers in private hospitals reported high perception of fairness on interpersonal and informational justice aspects. Both public and private hospital healthcare workers had high turnover intention. The result revealed significant difference in organizational justice perceptions between private and public hospital healthcare workers (F (4, 182)?=?9.17; p?<?.05; partial ?2 =. 168). Organizational justice dimensions (distributive, procedural, interpersonal and informational justice) significantly contributed an additional 9.9% variation in turnover intention (R 2 change?=?.099, F (4,170)?=?4.86, p?<?.05). Distributive justice was the most important predictor of turnover intention (??=?-.23, p <?.05). CONCLUSION:Organizational justice perceptions of healthcare workers significantly predicted turnover intention. Hence, organizational justice should be given due emphasis in designing and implementing policies and strategies of human resource management.

Dataset Information

Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

Publications

Contact among healthcare workers in the hospital setting: developing the evidence base for innovative approaches to infection control.

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