"The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.

BACKGROUND Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. METHODOLOGY/PRINCIPAL FINDINGS Pre-post intervention study of HH performance at baseline (October 2007-December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: "3/3 strategy"); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2-80.7) vs 84.6% (95% CI:83.8-85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time ("positive": 90.1% as highest HH compliance coinciding with the "World hygiene day"; and "negative":73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). CONCLUSIONS/SIGNIFICANCE CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers.

Prescripción enfermera en el entorno de las urgencias y emergencias. Marco conceptual vs entorno legislado en España

The prescription, widely discussed and defined conceptually in recent years in an environment of widening the spectrum of responsibilities nurse, has capacity for integration and definition in the area of accident and emergency care and carried out over the patient urgently, about emergencies and life-long commitment. Be necessary to frame throughout the legal framework, following the amendment of the Twelfth Additional Provision of Law 29/2006 of guarantees and rational use of drugs and medical devices, can be waived and implementation required, provided under model and through the nursing process and method and as an exponent and endorsementn of science and advanced clinical practice, to join the idea of interdisciplinary professional consensus that the law posed by the preparation and implementation of standardized protocols, algorithms and / or clinical practice guidelines in the context of what has come to be called "collaborative standard prescription": Prescription to the nurse in certain clinical situations in terms of a performance protocol, agreed with multidisciplinary team care health of the population (Group Protocols), which can be considered an intermediate step in the evolution towards independent nurse prescribing, providing nurses experience of a prescription under these protocols and demonstrating their capabilities.

International trends in health science librarianship: part 4--four Southern European countries.

This is the fourth in a series of articles exploring international trends in health science librarianship in four Southern European countries in the first decade of the 21st century. The invited authors are from Greece, Italy, Spain and Portugal. Future issues will track trends in Latin America and Central Europe.

Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses.

Introduction.The new demands of a fast changing world necessitate expanding the traditional concepts of nursing, extending the classical aspects to cover new areas. Purpose. Based on their professional duties, the nursing team in the pharmacy of a second level hospital aimed to establish a theoretical and situational framework for nurses working in the central services. Material and Methods. Application of the nursing process to nursing work in an area with no direct contact with patients. Results and Discussion. The application of the NANDA diagnoses to professional practice enabled the establishment of a nursing diagnosis with the implementation of measures designed to overcome a stressful situation with a risk of becoming unmotivated. Main Conclusion. The capacity to adapt the nursing profession to undertake new roles in the field of healthcare and the power of nursing own methodological resources permit the indirect care of “faceless” patients to be complemented with the inclusion of nurses from other services as clients, forming the focus of care, who can thus be helped with their daily care work.