RESUMEN

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.

Asunto(s)

RESUMEN

All successful strategies for preventing healthcare-associated infections require a multifaceted evidence-based approach that includes providing practitioners with the best evidence for clinically effective practice and then supporting them to understand and use this evidence to minimise infection risks and increase patient safety. This paper describes how national evidence-based guidelines from the Department of Health and the National Institute for Health and Clinical Excellence in England form the foundations for ensuring the availability of best evidence to practitioners, and how the development of an associated e-learning/blended learning programme is now supporting all NHS staff to effectively use this evidence to protect patients from the risk of preventable infections during care.

Asunto(s)

RESUMEN

A systematic search and quality assessment of published literature was conducted to establish current knowledge on the role of healthcare workers uniforms' as vehicles for the transfer of healthcare-associated infections. This review comprised a systematic search of national and international guidance, published literature and data on recent advances in laundry technology and processes. We found only a small number of relevant studies that provided limited evidence directly related to the decontamination of uniforms. Studies concerning domestic laundry processes are small scale and largely observational. Current practice and guidance for laundering uniforms is extrapolated from studies of industrial hospital linen processing. Healthcare workers' uniforms, including white coats, become progressively contaminated in use with bacteria of low pathogenicity from the wearer and of mixed pathogenicity from the clinical environment and patients. The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence. All components of the laundering process contribute to the removal or killing of micro-organisms on fabric. There is no robust evidence of a difference in efficacy of decontamination of uniforms/clothing between industrial and domestic laundry processes, or that the home laundering of uniforms provides inadequate decontamination.

Asunto(s)

RESUMEN

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.

Asunto(s)

RESUMEN

A systematic review was undertaken of the evidence published between 1996 and 2004 on the effectiveness, and associated economic costs, of a range of interventions to prevent and control the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in hospital settings. The review questions focused on screening, patient isolation, use of decolonization strategies, feedback of surveillance data, and environmental hygiene interventions. The reviewers assessed evidence from four recent systematic reviews, 24 non-experimental descriptive studies, five economic evaluations and one recently revised international guideline. The methodological quality of studies retrieved was such that there is currently insufficient high-quality evidence for infection prevention and control interventions in the fields identified for this review. However, evidence from clinically based, non-experimental studies does provide support for the continued use of a range and combination of interventions that contribute to the prevention and control of MRSA within acute hospitals and long-term-care settings. Well-conducted economic evaluations reporting the economic benefits arising from infection prevention and control interventions are lacking.

Asunto(s)

Asunto(s)

RESUMEN

PURPOSE: This study investigated the factors that may affect adherence to antiretroviral therapy in people with HIV infection and compared the use of three self-report tools to determine client adherence. METHOD: A descriptive, cross-sectional study of 260 HIV-infected clients attending nine HIV outpatient centers in England was conducted using researcher-administered instruments. Self-reports of adherence were assessed using the Morisky Medication Adherence Scale (MMAS), Reported Adherence to Medication Scale (RAM), and the Patient Adjustment to Medication Scale (PAM). RESULTS: Univariate analysis of clients' self-reports indicated a number of associations with adherence. Significant associations with less adherent behavior identified by two or more self-report tools were the reported use of recreational drugs, p =.001; living alone, p =.041; feeling depressed, p =.02; being influenced by the media, p =.037; and lack of a close confidant, p =.037. Greater adherence was associated with clients reporting a positive mental attitude to HIV infection, p =.038. Principal component analysis (PCA) of each self-report tool identified two well-recognized constructs: intentional nonadherence and unintentional nonadherence. In addition, a third construct of following instructions was identified from PAM, a scale developed by the authors. Subsequent regression analysis failed to confirm the associations with adherence suggested by the univariate analysis. CONCLUSION: This study suggests that the design and use of self-report tools to identify client's adherence to complex antiretroviral regimens may need to measure individual constructs of adherence to accurately assess adherence behavior.

Asunto(s)

RESUMEN

As the national epidemic of human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS) epidemic rapidly unfolds in India, nurses have to acquire new competencies in order to provide appropriate care to an increasing number of affected persons. In response, an Indo-British action research collaboration was initiated to build clinical confidence and facilitate relevant changes in nursing practice. During a 10-day educational programme, a change intervention was applied, culminating in the development of individual and partnership action plans focused on bringing about changes in nursing practice within well-defined fields of action. Following implementation of their action plans, participants were reassembled 12 months later for a follow-up workshop to discuss their progress and describe those factors that either helped or hindered them in achieving their objectives. They then developed new action plans for the next 12-month period. This article reports on the results from six cohorts (n = 160) in India who participated in this project between 1995 and 1999. Action plans were frequently focused on infection control, primary prevention, curriculum development in preregistration nursing programmes and in-service nursing education. The majority of participants reported significant achievements in realizing their action-plan objectives. Data analysis revealed that the change intervention itself, together with multidisciplinary support from colleagues, the senior status of the participant, and anticipating and attending the follow-up workshop, were all positively correlated with achievement. The lack of personal authority and resistance from managers were the two major factors negatively correlated with achievement. This method for facilitating changes in nursing practice has been successfully adapted and replicated by our group in other countries.

Asunto(s)

RESUMEN

In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling ureteral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site http://www.epic.tvu.ac.uk. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Tropical disease may not figure highly in the differential diagnosis of a facial swelling in the United Kingdom but should be considered in those who have been in a tropical area. This case history documents details of the presentation and investigation of a case of leishmaniasis that appeared as a facial swelling in a 4-year-old boy who had recently returned from the Middle East.

Asunto(s)

Asunto(s)

RESUMEN

In 1983, the aetiological agent of AIDS was discovered by French scientists and was termed the 'lym- phadenopathy-associated virus' (LAV) [ 1 ]. A year later, American researchers also described this retrovirus and termed it the 'Human T-cell leukemia virus, type III' (HTLV-III) [ 2 ], Both LAV and HTLV-III were the same retrovirus and in 1986, it was agreed that the viruses which can cause AIDS be termed the 'human immunodeficiency viruses' (HIV).

Asunto(s)

Asunto(s)