Browsing by Author "Henderson, Elizabeth Ann"

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    Building Educational Practice and Culture in Infection Prevention and Control: A Design-Based Research Study
    (2017) Meyers, Gwyneth Louise; Jacobsen, Michele DM; Henderson, Elizabeth Ann; Friesen, Sharon L.; Lock, Jennifer Vivian; Seneviratne, Cydnee Christine; Reeves, Thomas Charles
    Emerging antibiotic resistant organisms and diseases such as Ebola pose significant public health threats. Infection Prevention and Control (IPAC) programs are charged with educating healthcare workers (HCWs) to prevent the spread of such microorganisms and infections. Despite ongoing education by Infection Control Professionals (ICPs), HCWs’ adherence to IPAC practice remains low. While education is an expected core competency for ICPs, they are not prepared for this educator role and opportunities for educational professional development are limited. This gap leads to a narrow conceptualization of education, limited application of theory, and research challenges. Relying on conventional teaching methods, ICPs are frustrated with the poor results and are disengaged from their educational efforts. Using Design-based research as an interventional change methodology, the purpose of this research was to begin addressing these problems by designing, developing and implementing an innovative professional development experience in education for a group of ICPs in the Alberta Health Services IPAC program. This professional development experience was situated in the context of a community of learning (CoL) located in the ICPs’ workplace practice. Learning in the CoL was mediated through use of collaborative teaching and learning activities over a one year timeframe. The core interventionist strategy was to have the ICPs create a flipped learning experience the ICPs could use to teach HCWs. Drawing on contemporary constructivist concepts and principles from the Learning Sciences, this research resulted in the creation of an innovative design framework for the educational professional development of ICPs that successfully changed ICPs educational understanding and practice by building their pedagogical expertise and developing their identity as educators through the acquisition of knowledge, language and experience with which to reflect on and explore their teaching and learning practices. This study demonstrated the value of using DBR to explore teaching and learning in the context of a healthcare workplace setting where the focus is on the production and delivery of activities other than teaching and learning. The application of DBR to IPAC practice, whose focus is often to create change, suggests that DBR has potential use beyond the design and improvement of teaching and learning environments.
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    A Cost-Effectiveness Analysis of a Decolonization Protocol for Staphylococcus aureus Prior to Hip and Knee Arthroplasty in Alberta, Canada
    (2019-04-30) Rennert-May, Elissa; Manns, Braden J.; Conly, John M.; Smith, Stephanie Wrenn; Puloski, Shannon K. T.; Henderson, Elizabeth Ann; Loeb, Mark
    There are over 100,000 knee/hip replacements yearly in Canada. While these procedures improve mobility and quality of life, approximately 1% develop complex surgical site infections (SSIs) after surgery. Detailed costing analysis of these infections, particularly in Canada, is lacking. We assessed incidence and cost of complex SSIs following primary hip/knee arthroplasty in patients across Alberta. We then evaluated the cost-effectiveness of an evidence-based decolonization protocol in patients prior to hip/knee arthroplasty in Alberta, compared with standard care (no decolonization) using decision analysis. Among 24,667 operations, 1.04% developed a complex SSI. The most common causative pathogen was Staphylococcus aureus (38%). Mean first-year costs for the infected and non-infected cohort were CAN $95,321 (IQR49,623 – 120,636) and $19,893 (IQR12,610 – 19,723), respectively. The decolonization protocol was associated with lower risk of complex SSI and cost savings of $153/person. A decolonization protocol should be considered for implementation in Alberta to reduce infections and save costs.
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    The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services
    (2019-04-30) Leal, Jenine Rocha; Manns, Braden; Henderson, Elizabeth Ann; Conly, John M.; Ronksley, Paul Everett; Loeb, Mark; Noseworthy, Tom W.
    The clinical and economic burden of hospital-acquired Clostridioides difficile infection (HA-CDI) is significant, however there is uncertainty in the cost-effectiveness of implementing probiotics for the primary prevention of HA-CDI among hospitalized patients prescribed antibiotics. In this thesis we examined the predictors of mortality and length of stay among this patient population in Alberta. We determined the attributable cost of HA-CDI and applied these estimates in a cost-effectiveness analysis of probiotics for the primary prevention of HA-CDI in Alberta from the perspective of a publicly-funded healthcare system. We conducted three studies: a population-based, retrospective cohort study using clinical surveillance, administrative and laboratory databases to determine the predictors of 30-day all-cause and attributable mortality and length of stay; a propensity score-matched study to compare patients with HA-CDI to patients without CDI to determine the attributable cost of HA-CDI in Alberta; and a cost-effectiveness analysis using decision analytic modelling to evaluate the costs and consequences related to probiotic use for the primary prevention of CDI. We found that the incidence and mortality rates of HA-CDI are declining, though the latter was not statistically significant. Advancing age was associated with all outcomes after adjusting for a number of baseline factors. Increased baseline white blood cell counts were associated with a lower risk of mortality. Hospital-acquired CDI total adjusted costs were 27% higher and length of stay was 13% higher than non-cases of CDI. Oral probiotics as a preventive strategy for CDI resulted in a lower risk of CDI and cost-savings. Previous studies on the burden of HA-CDI have been limited in their size and scope. Our first study was the largest population-based cohort study evaluating predictors of mortality; while our second study was the first to use propensity score-matching and a micro-costing approach for the estimation of costs associated with HA-CDI. We were the first to conduct an economic evaluation of probiotics for the primary prevention of CDI. This work will be presented to Alberta Health Services to support the evaluation of probiotics as a preventive strategy against CDI and whether to scale up probiotics to all provincial hospitals.
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    Nosocomial infections amongst patients delivered by Cesarian section
    (1989) Henderson, Elizabeth Ann; Love, Edgar J.
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    To Investigate the Validity and Reliability of a Radio Frequency ID/Electronic Exciter System in Detection of Hand Washing Events; and to Investigate Nurses’ Hand Hygiene Practices and Explore the Social and Behavioral Factors which Influence these Practices
    (2013-05-27) Kaunda, Joseph Josaphat; Henderson, Elizabeth Ann
    Background: HH is the most important strategy to prevent spread of hospital-acquired infections. HCWs’ HH compliance is typically 30-50%. Human monitoring of HH is inconvenient and labor-intensive. Purpose: Objectives. Sub-study 1: Investigate validity and reliability of an RFID system in detection of handwashing events. Sub-study 2: Investigate changes in HH compliance and duration with perceived level of infectious risk (PRF). Sub-study 3: Explore social/behavioral factors which influence HH practice. Design: Observational. Results: RFID system Sensitivity =0.175[0.057, 0.293]; PPV =0.778[0.649, 0.907]; Reliability =0.266[0.109, 0.520]. HH compliance was higher for higher PRFs, χ-square =67.36, p<0.0001. Handwashing duration was longer for higher PRFs, χ-square =18.25, p<0.0001. Meaning of Hand Hygiene is central to nurses’ HH practice. Conclusion: RFID system has poor reliability but reasonable validity when used for detecting handwashing. HH compliance is higher and handwashing duration longer after exposure to higher PRFs. Meaning of HH is central to HH practice.