Clinical Research Directory

Integrated Clinical Decision Support for Empiric Antibiotic Selection in Sepsis

As antibiotic resistance increases globally, it becomes more difficult to select empiric antibiotic therapy, particularly in patients with sepsis who stand to benefit from early adequate treatment. In particular it is difficult for clinicians to balance antibiotic stewardship principles (the need to avoid unnecessary prescribing of antibiotics that have an excessively broad spectrum of activity that favour resistance development) and under treatment. The integration of multiple risk variables for resistance are hard for clinicians to translate into clinical action, and is seemingly at odds with the natural inclination to provide heuristic/emotion-based antibiotic selection. The inappropriate treatment of sepsis is not uniformly too broad, or too narrow, and there is a need to optimize and tailor selection of antibiotic therapy to each patient, such that those that are at risk for resistant organisms receive broad therapy, and those that are not at risk, receive narrower antibiotic agents. Clinicians need support picking the right antibiotic for each patient, and from this they can potentially drive reduction of unnecessarily broad antibiotic prescribing while preserving adequacy of treatment. Individualized clinical prediction models and decision support interventions are promising approaches that meet these needs by improving the classification of patient risk for antibiotic resistant or susceptible infections in sepsis. Unfortunately, few have been validated in the clinical setting and larger rigorous studies are needed to provide the evidence to support broader clinical adoption. The investigators will perform a cluster randomized cross-over trial of an individualized antibiotic prescribing decision support intervention for providers treating hospitalized patients with suspected sepsis. The aim of this trial is to determine whether a stewardship led clinical decision support intervention can improve antibiotic de-escalation in patients with sepsis while maintaining or improving adequacy of antibiotic coverage. This decision support intervention will be based on a combination of proven decision heuristics (for Gram-positive organisms) and modelled predicted susceptibilities (for Gram-negative organisms) that are individualized to the patient. The primary outcome will be the proportion of patients de-escalated from their initial empiric regimen at 48 hours.

Development of Hand Hygiene Training Virtual Reality Simulation and Evaluation of Its Effectiveness

Healthcare-associated infections (HAI), which have become a major problem in all countries, prolong hospital stay and increase treatment and care costs. In health care institutions, HAIs that occur directly or indirectly related to health services are among the most common causes of mortality and morbidity. A high level of hand hygiene compliance, which is the most basic step of infection control and precautions, is the first and most important step to prevent HAIs. However, it has been determined in the literature that the compliance rates of healthcare professionals with hand hygiene are low and that nurses' attitudes and behaviors regarding hand hygiene are not at the desired level. Well-structured training programs need to be developed to maintain and increase nurses' hand hygiene compliance rates. Different training methods and tools are needed to increase hand hygiene compliance, awareness and awareness. It is recommended that innovative training approaches such as virtual simulation be developed and evaluated to further internalize and encourage nurses' most effective hand hygiene practice behaviors. In recent years, the use of simulation methods in the training of healthcare professionals has been increasing as they facilitate the transfer of theoretical knowledge into clinical practice. One of these simulation methods is virtual reality (VR). The use of gamification in the virtual environment supports different learning styles, enabling learners to participate more intensively in education and increase their internal motivation. In this context, with VR support, entertainment and learning processes can be used to support each other. Considering the features of VR usage such as integrating knowledge and skills, creating a learning environment for the learner by doing, giving the opportunity to repeat until the correct application is made, reducing incorrect interventions in clinical practice and increasing patient safety, it is recommended that virtual simulation systems be used in nursing education. VR provides different opportunities to learners by enriching and diversifying learning environments. In these virtual environments, learners can have new experiences and these experiences remain permanent for the learners. As stated in the WHO Hand Hygiene Theme, it is important to develop innovative training programs, learning materials and measurement and evaluation tools regarding hand hygiene within the scope of infection control and prevention studies. VR simulation can be used to attract nurses' attention and awareness by increasing intrinsic motivation to perform hand hygiene, and can be used to support nurses in developing positive attitudes towards hand hygiene. Hand hygiene simulation scenarios created with virtual reality can contribute to greater awareness about the problems caused by microorganism transmission by increasing hand hygiene awareness. Thus, increasing attitudes and awareness regarding hand hygiene can have a positive effect on reducing the HAI rate by supporting the transformation of hand hygiene awareness into behavior. In the study, it was planned to develop, implement and evaluate a virtual reality hand hygiene simulation. It is thought that this virtual reality simulation will pave the way for the development of psychomotor skills for hand hygiene, increase the level of knowledge, and increase hand hygiene compliance by providing internal motivation to perform hand hygiene. In our country, no studies have been found on the development of virtual reality simulation in hand hygiene practice. The aim of this study is to develop and implement virtual reality hand hygiene simulation in teaching hand hygiene behaviors in nurses and to evaluate its effect on hand hygiene compliance.