Anita Huis

Background Neonatal vascular access is essential for life-sustaining therapies but is associated with frequent device failure, repeated procedures, and patient harm. Although technical aspects have been widely studied, less is known about how organisational and behavioural factors influence decision-making. Methods We conducted a multicentre qualitative study across three tertiary neonatal intensive care units in the Netherlands. Semi-structured interviews were conducted with 12 neonatal nurses involved in vascular access and infusion therapy. Data were analysed using reflexive thematic analysis, with sample adequacy guided by information power. Results Four themes were identified. Participants described vascular access care as predominantly characterised by reactive decision-making, with escalation commonly occurring after complications rather than through anticipatory planning. Delayed escalation, repeated peripheral intravenous attempts, and inconsistent monitoring were reported across all centres. Participants described organisational pressures, variability in knowledge and implementation, and limited parental involvement as factors influencing these patterns. A persistent gap between risk awareness and clinical action emerged from the interviews. Conclusion Participants suggest that vascular access care is influenced by interacting organisational, behavioural, knowledge-related, and relational factors that may reinforce reactive practice. Promoting anticipatory vascular access care through structured, workflow-integrated approaches may improve consistency, reduce avoidable harm, and support safer vascular access care. Impact Identifies a predominantly reactive pattern of vascular access care within neonatal nurses’ accounts across three tertiary NICUs. Identifies organisational, behavioural, knowledge-related, and relational factors that may contribute to delayed escalation beyond technical considerations. Extends existing literature by providing insight into factors that may contribute to repeated peripheral catheter failure and delayed escalation in routine practice. Supports consideration of structured, anticipatory vascular access approaches integrated into clinical workflows to reduce avoidable harm and improve patient safety.

Aiming to investigate small island resilience in public health emergencies, we found existing classifications of Small Island Developing States (SIDS) failed to provide a homogeneous group suitable for comparative studies. While SIDS classifications highlight small states’ challenges globally, they include countries with vast differences in geography, population, economy and health systems, making them ineffective for studying public health emergency resilience. Islands classified as Overseas Countries and Territories (OCTs) face similar challenges to SIDS. Considering both in comparative research offers deeper insights into shared vulnerabilities and strengths, policy effectiveness and the variability in response strategies. As global health efforts focus on pandemic preparedness, a more precise classification system is essential to identify patterns across similar small island contexts. To improve comparability for public health research, we propose an alternative classification method that integrates SIDS and OCTs, using clear, data-driven criteria. We applied three criteria to identify islands with comparable characteristics relevant to public health emergency resilience: population size≤1.5 million, insularity and Gross Domestic Product per capita≤US$30 000. This data-driven approach identified 51 islands forming a more homogeneous group for comparative analysis. Despite limitations in data availability, indicator reliability and the application of not universally standardised thresholds, our method offers a pragmatic response to the lack of uniform classification and highlights the need for standardised, context-sensitive data collection. While acknowledging the need for ongoing refinement and broader multidimensional indicators, this approach allows for more accurate research on public health emergency resilience, enabling small islands to better advocate for tailored support.

Background Short peripheral catheter (SPC) use is widespread in neonatal care but is associated with serious complications like infiltration and extravasation. Early recognition and prompt management are essential for improving outcomes. Objective To examine the evidence on SPC infiltration and extravasation complications in neonates, focusing on incidence, risk factors, detection tools, research gaps, and opportunities for standardization. Methods Following the Joanna Briggs Institute (JBI) scoping review framework, we systematically searched five databases (PubMed, EMBASE, CINAHL, Cochrane, and Web of Science) for studies published between January 2000 and May 2024. The search was conducted over a 3-month period (March–May 2024). Studies were included if they focused on SPC-related infiltration or extravasation in neonates in hospital settings. Exclusion criteria included studies on central or arterial lines, non-primary research, or lacking separate neonatal data. Two reviewers independently screened all records using a standardized template. Results 2879 records were identified, after 820 duplicates and one retracted article were removed, 2058 were left for initial screening. Of these, 1904 were screened in full, and 30 studies met the inclusion criteria. The reported incidence of infiltration and extravasation ranged widely (up to 70%). Risk factors identified included catheter insertion site, technique, and dwell time, and patient characteristics such as low birth weight. Detection was predominantly by subjective visual and tactile assessment, although emerging technologies such as near-infrared spectroscopy and sensor-based tools were explored in some studies. Conclusions SPC-related infiltration and extravasation remain frequent in neonatal care. Despite increasing interest in objective detection tools, their clinical adoption is limited. Standardized definitions and validated early detection methods are essential for improving outcomes and guiding evidence-based practice. Impact Addressing a critical neonatal concern—peripheral infiltration/extravasation remains a serious concern in neonatal practice, though its definition and incidence vary widely. This review consolidates existing knowledge, emphasizing the lack of standardized definitions and the need for consensus in clinical assessment. Bridging evidence gaps in prevention—few substantive measures are clinically proven to reduce the incidence and severity of SPC-related complications. This review highlights the limitations of current strategies and the potential of emerging technologies, advocating for robust clinical validation. Guiding future research and practice—the findings call for standardized protocols, multicenter trials, and objective detection tools to improve neonatal vascular access management and patient safety.

DOEL: Steeds meer oudere cliënten met meervoudige, chronische en complexe aandoeningen hebben wijkverpleegkundige zorg nodig in hun thuisomgeving. Hierbij wordt ook gebruik gemaakt van invasieve procedures en hulpmiddelen. Infectiepreventie vormt dan ook een specifieke uitdaging voor verpleegkundige zorgverleners en cliënten. Dit artikel heeft als doel om de toepassing van infectiepreventiemaatregelen en gerelateerde gedragsfactoren bij zowel verpleegkundigen als cliënten te onderzoeken en om belemmerende en bevorderende factoren van infectiepreventiemaatregelen in de wijkverpleging te identificeren. METHODE: Een kwalitatief, explorerend onderzoek bij vier zorgorganisaties die wijkverpleging aanbieden in Nederland waarbij participerende observaties de belangrijkste bron van gegevensverzameling vormden, aangevuld met focusgroepdiscussies en semi-gestructureerde interviews. Zestien verpleegkundigen en drie verzorgenden werden tijdens hun werk bij 80 cliënten geobserveerd. Voor de interviews werden 11 cliënten geïncludeerd en voor de focusgroepdiscussies 15 verpleegkundigen en vier verzorgenden. RESULTATEN: In totaal werden 87 unieke zorgsituaties, gedurende 55 uur, geobserveerd. Daarnaast vonden drie focusgroepdiscussies plaats en 11 individuele semi-gestructureerde interviews met cliënten. Infectiepreventie stond onder druk door onder andere: 1. De specifieke zorgcontext, die meer autonoom, minder gestructureerd, gecontroleerd en voorspelbaar is dan andere zorgsettings; 2. De aanzienlijke variatie en suboptimale uitvoering van handhygiëne en het gebruik van persoonlijke beschermingsmiddelen zoals gezichtsmaskers, isolatieschorten en wegwerphandschoenen; 3. Het veelvuldig gebruik van mobiele communicatieapparatuur in de cliëntomgeving waardoor verpleegkundige handelingen regelmatig werden onderbroken en waarbij de apparatuur niet altijd goed werd schoongemaakt; 4. Versnippering, variatie en tegenstrijdige informatie in professionele richtlijnen en protocollen en de ontoereikende organisatorische ondersteuning bij de implementatie en evaluatie van het infectiepreventiebeleid. CONCLUSIE: Deze studie laat zien dat de toepassing van infectiepreventiemaatregelen in de wijkverpleegkundige zorg suboptimaal is. Bovendien laat deze studie een aanzienlijke variatie zien met betrekking tot de werkomgeving; de toepassing van handhygiëne; het juiste gebruik van persoonlijke beschermingsmiddelen; de omgang met communicatieapparatuur, en organisatorisch beleid, procedures en ondersteuning. Deze studie heeft daarnaast een aantal belangrijke belemmerende en bevorderende factoren geïdentificeerd die van invloed zijn op de toepassing van infectiepreventiemaatregelen, zoals de werkomgeving, factoren op het niveau van de individuele zorgverlener en het team, cliëntfactoren, en factoren op het niveau van de organisaties.

Background: Hand hygiene is an important measure to prevent healthcare-associated infections in long-term care facilities. Objectives: To evaluate compliance with hand hygiene recommendations by different nursing professionals in long-term care facilities and to investigate determinants potentially influencing hand hygiene and whether these differed between the different cadres of staff. Methods: We conducted two sub-studies: we measured hand hygiene compliance of 496 professionals in 14 long-term care facilities (23 wards) through direct observation using World Health Organisation’s ‘five moments of hand hygiene’ observation tool. In addition, we performed a survey to examine determinants that may influence hand hygiene and to determine differences between different cadres of staff. We used a principal component analysis approach with varimax rotation to explore the underlying factor structure of the determinants. Results: We found an overall mean hand hygiene compliance of 17%. There was considerable variation between wards (5–38%) and between specific World Health Organization hand hygiene moments. In addition, hand hygiene compliance varied widely within and between different cadres of staff. The determinant analysis was conducted on 177 questionnaires. For all nursing professionals, we found multiple determinants in four domains: ‘social context and leadership’, ‘resources’, ‘individual healthcare professional factors’ and ‘risk perception’. In two domains, several barriers were perceived differently by nursing assistants and nurses. In the domain ‘social context and leadership’, this included (1) how the manager addresses barriers to enable hand hygiene as recommended and (2) how the manager pays attention to correct adherence to the hand hygiene guidelines. In the ‘risk perception’ domain, this included a resident's risk of acquiring an infection as a result of the nursing professional’s failure to comply with the hand hygiene guidelines. Conclusion: Hand hygiene compliance was low and influenced by multiple factors, several of which varied among different cadres of staff. When designing interventions to improve hand hygiene performance in long-term care facilities, strategies should take into account these determinants and how they vary between different cadres of staff. We recommend exploring hand hygiene determinants at ward level and among different cadres of staff, for example by using our exploratory questionnaire. Trial registration: Registration number 50-53000-98-113, ‘Compliance with hand hygiene in nursing homes: go for a sustainable effect’ on ClinicalTrials.gov. Date of registration 28-6-2016.

We aimed to evaluate the use of an eHealth platform and a self-management outpatient clinic in patients with RA in a real-world setting. The effects on health-care utilization and disease activity were studied. Using hospital data of patients with RA between 2014 and 2019, the use of an eHealth platform and participation in a self-management outpatient clinic were studied. An interrupted time series analysis compared the period before and after the introduction of the eHealth platform. The change in trend (relative to the pre-interruption trend) for the number of outpatient clinic visits and the DAS for 28 joints (DAS28) were determined for several scenarios. After implementation of the platform in April 2017, the percentage of patients using it was stable at ∼37%. On average, the users of the platform were younger, more highly educated and had better health outcomes than the total RA population. After implementation of the platform, the mean number of quarterly outpatient clinic visits per patient decreased by 0.027 per quarter (95% CI: −0.045, −0.08, P = 0.007). This was accompanied by a significant decrease in DAS28 of 0.056 per quarter (95% CI: −0.086, −0025, P = 0.001). On average, this resulted in 0.955 fewer visits per patient per year and a reduction of 0.503 in the DAS28. The implementation of remote patient monitoring has a positive effect on health-care utilization, while maintaining low disease activity. This should encourage the use of this type of telemedicine in the management of RA, especially while many routine outpatient clinic visits are cancelled owing to COVID-19.

Background: The clinical landscape of prostate biopsy (PB) is evolving with changes in procedures and techniques. Moreover, antibiotic resistance is increasing and influences the efficacy of pre-biopsy prophylactic regimens. Therefore, increasing antibiotic resistance may impact on clinical care, which probably results in differences between hospitals. The objective of our study is to determine the (variability in) current practices of PB in the Netherlands and to gain insight into Dutch urologists’ perceptions of fluoroquinolone resistance and biopsy related infections.Methods: An online questionnaire was prepared using SurveyMonkey® platform and distributed to all 420 members of the Dutch Association of Urology, who work in 81 Dutch hospitals. Information about PB techniques and periprocedural antimicrobial prophylaxis was collected. Urologists’ perceptions regarding pre-biopsy antibiotic prophylaxis in an era of antibiotic resistance was assessed. Descriptive statistical analysis was performed.Results: One hundred sixty-one responses (38.3%) were analyzed representing 65 (80.3%) of all Dutch hospitals performing PB. Transrectal ultrasound guided prostate biopsy (TRUSPB) was performed in 64 (98.5%) hospitals. 43.1% of the hospitals (also) used other image-guided biopsy techniques. Twenty-three different empirical prophylactic regimens were reported among the hospitals. Ciprofloxacin was most commonly prescribed (84.4%). The duration ranged from one pre-biopsy dose (59.4%) to 5 days extended prophylaxis. 25.2% of the urologists experienced ciprofloxacin resistance as a current problem in the prevention of biopsy related infections and 73.6% as a future problem.Conclusions: There is a wide variation in practice patterns among Dutch urologists. TRUSPB is the most commonly used biopsy technique, but other image-guided biopsy techniques are increasingly used. Antimicrobial prophylaxis is not standardized and prolonged prophylaxis is common. The wide variation in practice patterns and lack of standardization underlines the need for evidence-based recommendations to guide urologists in choosing appropriate antimicrobial prophylaxis for PB in the context of increasing antibiotic resistance.

To re-evaluate the adherence to clinical practice guidelines recommended disease activity–based management of rheumatoid arthritis (RA) in daily clinical practice, among Dutch rheumatologists in the past decade. In 2007, disease activity was measured in only 16% of outpatient visits. All rheumatologists that participated in the 2007 study were invited to re-enter our study in 2016/2017. If necessary, data were supplemented with data from other rheumatologists. For all 26 rheumatologists who agreed to participate in our study, data were collected from 30 consecutive patients that visited the outpatient clinic. Per patient, data from four consecutive rheumatologist outpatient visits were collected. Since 2007, disease activity was measured more frequently in Dutch daily clinical practice, increasing from 16 to 79% of visits (2440/3081 visits). In addition, intensification of medication based on disease activity scores increased from 33 to 50% of visits (260/525 visits). DAS/DAS28 was the most frequently used disease activity measure (1596/2440 visits). There was a wide variation among rheumatologists in measuring disease activity and intensification of medication, 20–100% and 0–75% respectively. Over the past years, there has been a large improvement in disease activity assessment in daily clinical practice. Disease activity–based medication intensifications, also called tight control or treat to target, increased to a lesser extent. Large variation between different rheumatologists and clinics indicates that there is still room for improvement. Key Points • Following guideline dissemination disease activity is assessed more frequently (79%). • There is large variation between rheumatologists, indicating room for improvement. • Finding factors that explain variation is necessary to improve tight control in daily practice.

Objective: To examine the extent to which acute care hospitals in the Netherlands have adopted recommended practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). Methods: Between 18 July 2017 and 31 October 2017, we surveyed the infection prevention teams of all acute care hospitals in the Netherlands. The survey instrument was based on the ‘Translating Healthcare-Associated Infection Prevention Research into Practice’ (TRIP) questionnaire and adapted to the Dutch context. Descriptive statistics were used to examine the reported regular use of CAUTI, CLABSI, VAP, and CDI prevention practices as well as the hospital characteristics. Results: Out of 72 eligible hospitals, 47 (65.3%) responded. Surveillance systems for monitoring CAUTI, CLABSI, VAP, and CDI were present in 17.8, 95.4, 26.2, and 77.3% of hospitals, respectively. Antimicrobial stewardship programs have been established in 91.5% of participating hospitals. For CAUTI, the majority of hospitals regularly used aseptic technique during catheter insertion (95%) and portable bladder ultrasound scanners (86.1%). Intermittent catheterization and catheter stop-orders were regularly used by 65.8 and 62.2% of hospitals. For CLABSI, all hospitals regularly used maximum sterile barrier precautions and chlorhexidine gluconate for insertion site antisepsis. Avoidance of the femoral site for central line insertions was regularly used by 65.9% of hospitals. Urinary catheters and central-lines impregnated with antibiotics or antiseptics were rarely used (≤ 5%). Selective decontamination strategies for preventing VAP were used in 84% of hospitals. With the exception of disposable thermometers (31.8%), all prevention practices to prevent CDI were regularly used by more than 80% of hospitals. Conclusions: Most Dutch hospitals report regular use of recommended practices for preventing CLABSI and CDI. Several specific practices to prevent CAUTI and VAP were less frequently used, however, providing an opportunity for improvement.