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Guidance on HCP Attire to Prevent Infections

Guidance on HCP Attire to Prevent Infections

Healthcare personnel (HCP) attire is an aspect of the medical profession steeped in culture and tradition, according to Gonzalo Bearman, MD, MPH. “Apparel and appearance of HCPs have been linked with significant symbolism and professionalism, but we’ve recently increased our awareness of the potential role of attire in the transmission of healthcare- associated infections (HAIs).” HCP apparel can be contaminated with potential pathogens, but the role of clothing in the transmission of these microorganisms to patients has not been established. This has made it challenging to create generalizable, evidence-based recommendations on attire for non-operating room HCP. The Society for Healthcare Epidemiology of America (SHEA) recently analyzed available data on this topic and issued a guidance paper with reasonable recommendations for HCP attire. “The SHEA recommendations should not be viewed as a consensus guideline or as a standard of care,” explains Dr. Bearman, who was lead author of the paper and is a member of SHEA’s guidelines committee. “Instead, it’s intended to help acute care hospitals develop or modify policies relating to HCP attire.” The SHEA article evaluated and summarized the literature around the perception of both patients and HCP regarding attire in relation to professionalism and the potential risk for transmitting microorganisms. It also assessed the evidence for contamination of HCP attire and the potential for it to contribute to the transmission of pathogenic microorganisms in hospitals. In addition, a survey of the SHEA membership and SHEA Research Network was conducted to learn more about the policies related to HCP attire that are currently in place in members’ institutions. “Bare Below the Elbow” & White Coats The concept of...

Hospitalists & the Intensivist Shortage

The growing intensivist shortage is challenging hospitals’ ability to care for critically ill patients. Despite numerous recommendations that intensivists manage critically ill adults, the majority of American hospitals cannot meet this standard. As a consequence, hospitalists have become de facto intensivists in many hospitals, with 75% reporting that they practice in the ICU. While legitimate concerns have been raised whether hospitalists are uniformly qualified to practice in the ICU, the issue has become moot at many hospitals where intensivists are either in short supply or entirely absent. Efforts are needed to ensure that hospitalists manage critically ill patients safely, effectively, and seamlessly. In the Journal of Hospital Medicine and Critical Care Medicine, the Society of Hospital Medicine and the Society of Critical Care Medicine co-published a position paper on training the hospitalist workforce to address the intensivist shortage. In this paper, we discussed the potential value of hospitalists in the ICU and the importance of enhancing hospitalists’ skills to provide critical care services. Adding Value & Enhancing Skills of Hospitalists Hospital medicine and critical care medicine share similar structures, competencies, and values, positioning hospitalists as a logical solution to the intensivist shortage. Many of the competencies needed for practicing critical care medicine are encompassed in internal medicine training as well as in core competencies in hospital medicine. The ideology and mechanics of high-performing hospitalist and intensivist programs are similar, yet despite these commonalities, hospitalists remain largely untapped as a potential source of new intensivists. Exploring Alternative Critical Care Models With no solution to the intensivist shortage in sight, alternative critical care delivery models are needed. We proposed a 1-year...

The Framework for Eliminating HAIs

Healthcare-associated infections (HAIs) are one of the leading causes of death in the United States and are becoming increasingly problematic for hospitals and healthcare facilities throughout the country. The World Health Organization has reported that approximately 1.4 million people have an HAI at any given time. Compounding the problem is that little is known about the burden of infections outside of hospitals, particularly in long-term care facilities, ambulatory surgical centers, and other outpatient settings. The emergence of HAIs caused by multidrug-resistant microorganisms is another increasing concern. As Americans continue to age and healthcare costs continue to rise, the elimination of HAIs is paramount for improving patient health and healthcare savings. “The number of people who become sick or die from HAIs is unacceptably high, and these infections cause a significant financial burden,” says Denise Cardo, MD. “As consumers are increasingly asking for transparency and accountability in healthcare, their expectations on how well these infections are managed will continue to increase. This is a unique and timely opportunity to move toward the elimination of these infections.” Inconsistent Implementation According to Dr. Cardo, tried and true preventive measures for HAIs are inconsistently implemented. “The success of prevention efforts has varied considerably from one setting to the next,” she says. “However, we have a growing body of knowledge that defines a full range of prevention interventions that can address specific HAIs when consistently applied across settings. HAIs can be eliminated by implementing a proven framework for prevention at all levels of healthcare delivery. For the infections that we know how to prevent, we must prevent them consistently and effectively. For the infections...

Helpful Guidelines on Hand Hygiene in Healthcare

Throughout the world, surveillance and prevention of healthcare-associated infections (HCAIs) have become a greater priority for institutions committed to making healthcare safer. These infections have been associated with prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, massive financial burdens, high costs for patients and their families, and excess deaths. One prominent reason for the spread of HCAIs has been poor hand hygiene. In an effort to address this issue, the World Health Organization (WHO) issued guidelines on hand hygiene in healthcare in May 2009. Available at www.who.int, the guidelines offer a thorough review of evidence as well as specific recommendations to improve hand hygiene practices and reduce transmission of pathogenic microorganisms to patients and healthcare workers (HCWs). “The new WHO guidelines are an extension to recommendations issued by the CDC in 2002,” explains Maryanne McGuckin, ScEd, MT, who was on the task force that created both the WHO and CDC guidelines. “They provide an extensive literature review and inform clinicians on strategies for improvement that have tested successfully.” The WHO guidelines are designed to be used in any setting in which healthcare is delivered. Individual adaptation of the recommendations is encouraged, based on local regulations, settings, needs, and resources. Assessing Practices & Adherence According to the WHO guidelines, understanding hand hygiene practices among HCWs is essential to planning interventions. Adherence by HCWs to recommended procedures has been reported with significant variation, reaching unacceptably poor levels in some cases. Risk factors for poor adherence to hand hygiene recommendations have been well-documented, and there appears to be an inverse relationship between intensity of patient care and adherence to...
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