Applying thematic synthesis to interpretation and commentary in epidemiological studies: identifying what contributes to successful interventions to promote hand hygiene in patient care

Objectives: Hand hygiene is considered the most important preventive measure for healthcare associated infections, but adherence is suboptimal. We previously undertook a Cochrane Review which demonstrated that interventions to improve adherence are moderately effective. Impact varied between organisations and sites with the same intervention and implementation approaches. This study seeks to explore these differences. Methods: A thematic synthesis was applied to the original authors’ interpretation and commentary that offered explanations of how hand hygiene interventions exerted their effects and suggested reasons why success varied. The synthesis used a published Cochrane Review followed by three-stage synthesis. Results: Twenty-one papers were reviewed: eleven randomised, one non-randomised and nine interrupted time series studies. Thirteen descriptive themes were identified. They reflected a range of factors perceived to influence effectiveness. Descriptive themes were synthesised into three analytical themes: Methodological Explanations for failure or success (e.g. Hawthorne Effect); and two related themes that address issues with implementing hand hygiene interventions: Successful implementation needs leadership and cooperation throughout the organisation (e.g. visible managerial support); and Understanding the context and aligning the intervention with it drives implementation (e.g. embedding the intervention into wider patient safety initiatives). Conclusions: The analytical themes help to explain the original authors’ perceptions of the degree to which interventions were effective and suggested new directions for research: exploring ways to avoid the Hawthorne effect; exploring the impact of components of multimodal interventions; the use of theoretical frameworks for behaviour change; potential to embed interventions into wider patient safety initiatives; adaptations to demonstrate sustainability; and the development of systematic approaches to implementation. Our findings corroborate studies exploring the success or failure of other clinical interventions: context and leadership are important

WASH coalition building guidelines

The Water Supply and Sanitation Collaborative Council (WSSCC) is an international membership organisation that has worked, since 1990, to achieve sustainable water supply and sanitation for all people, through enhancing collaboration among sector agencies and professionals. As part of its activities within two of its programme areas – Networking & Knowledge Management, and Advocacy & Communications – WSSCC encourages the development of national water supply, sanitation and hygiene (WASH) Coalitions. The role of WASH Coalitions ranges from information sharing to the advocacy of specific policy changes, but they universally address a felt need for improved systematic communication, collaboration and joint action among the sector players in a certain country. As a vehicle for awareness raising and advocacy, most national WASH Coalitions have developed national WASH Campaigns. A special role is given to the National Coordinators, who are expected to maintain the links with the WSSCC Secretariat, exercise quality control and practise a degree of coordination and facilitation of the coalition. However, coalitions, like partnerships, are complicated organisms and some of the existing WASH Coalitions have had only limited impact and varying degrees of success. This is partly due to the complexity of building a successful coalition that responds to the specific needs of the country in which it is created, and partly due to the undefined or open mandate of the WASH Coalitions, resulting in a lack of clarity about what they are intended to do

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective:(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings

Private Standards, Handling and Hygiene in Fruit Export Supply Chains: A Preliminary Evaluation of the Economic Impact of Parallel Standards

With the emergence of private food safety and quality standards in developed countries fruit exporting countries in the developing world face increasing constraints to access markets in the rich industrialised countries in the North. Producers in the South have no alternative as to make the necessary investments on farms and in pack houses to comply with the requirements of these food quality and safety standards. The export of fresh fruit is an important component of South African agricultural exports, with citrus fruit exported to markets such as Europe being of particular importance. This paper reports selected results from a large research project into the impact of private standard compliance on the quality of the fruit and the returns to farmers. The research process involved a multi-disciplinary analysis of Agricultural Economics and Microbiology / Plant pathology as we analysed the dynamics of the citrus export supply chain from the farms in South Africa to the end consumer in Europe. Sampled fruit containers were followed through the whole supply chain which allowed us to provide an exposé of the behaviour of the different actors in the citrus supply chain and obtain some evidence of poor handling and hygiene standards by means of a comparison of the experimental observations with various relevant components of the EurepGAP control points and compliance criteria for fruit and vegetables. Observations suggest that these standards are adequately applied to the production and handling of fruit at the farm and pack house levels while on the other hand the subsequent stages (mainly after the importing harbour in Europe) of the fruit supply chain are seemingly not subjected to the same strict requirements laid out for producers, leading to fruit quality deterioration and financial losses for producers. This constitutes clear parallel standards in terms of fruit safety and quality standards between upstream and downstream sections of the supply chain and questions thus the purpose of the standards and the financial return for producers making large investments to comply with these privately introduced standards.International Relations/Trade,

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions

Efficacious, effective, and embedded interventions: Implementation research in infectious disease control

Background: Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions. Results: We highlight the fundamental differences between the research paradigms associated with the development of technologies and interventions for disease control on the one hand and the research paradigms required for enhancing the sustainable uptake of those very same interventions within the communities on the other. We provide a definition for implementation research in an attempt to underscore its critical role and explore the multidisciplinary science needed to address the challenges in disease control. Conclusion: The greatest value for money in health research lies in the sustainable and effective implementation of already proven, efficacious solutions. The development of implementation research that can help provide some solutions on how this can be achieved is sorely needed

Program Learning Event on Violence against Children in and around Schools in East Africa

Sponsored by the Elevate Children Funders Group (ECFG), a three-day Program Learning Event (PLE) on Violence against Children in and around Schools (VACiS) held in Kampala, Uganda from 14-16 July 2015, attracted 77 practitioners, donors, advocates, researchers and government representatives in the field of violence against children from Uganda, Tanzania, Kenya, South Africa, Germany, the United Kingdom and United States of America. The theme of the event was developing a common learning agenda on preventing and responding to VACiS

The OneTogether collaborative approach to reduce the risk of surgical site infection: identifying the challenges to assuring best practice

Background: Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient’s surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments. Methods: A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses/operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners. Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review. Results: Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training. Conclusions: This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI

Design for safety: theoretical framework of the safety aspect of BIM system to determine the safety index

Despite the safety improvement drive that has been implemented in the construction industry in Singapore for many years, the industry continues to report the highest number of workplace fatalities, compared to other industries. The purpose of this paper is to discuss the theoretical framework of the safety aspect of a proposed BIM System to determine a Safety Index. An online questionnaire survey was conducted to ascertain the current workplace safety and health situation in the construction industry and explore how BIM can be used to improve safety performance in the industry. A safety hazard library was developed based on the main contributors to fatal accidents in the construction industry, determined from the formal records and existing literature, and a series of discussions with representatives from the Workplace Safety and Health Institute (WSH Institute) in Singapore. The results from the survey suggested that the majority of the firms have implemented the necessary policies, programmes and procedures on Workplace Safety and Health (WSH) practices. However, BIM is still not widely applied or explored beyond the mandatory requirement that building plans should be submitted to the authorities for approval in BIM format. This paper presents a discussion of the safety aspect of the Intelligent Productivity and Safety System (IPASS) developed in the study. IPASS is an intelligent system incorporating the buildable design concept, theory on the detection, prevention and control of hazards, and the Construction Safety Audit Scoring System (ConSASS). The system is based on the premise that safety should be considered at the design stage, and BIM can be an effective tool to facilitate the efforts to enhance safety performance. IPASS allows users to analyse and monitor key aspects of the safety performance of the project before the project starts and as the project progresses