Investigating the use of an electronic hand hygiene monitoring and prompt device: influence and acceptability

Introduction: Hand hygiene (HH) prevents the transmission of healthcare-associated infections. Electronic HH monitoring and prompt devices have been developed to overcome problems with monitoring HH and to improve compliance. Devices monitor room entry and exit and soap use through communication between ceiling sensors and badges worn by practitioners and the badges sense alcohol rub. Objectives: To investigate (1) the impact of devices on HH compliance, (2) how devices influence behaviour and (3) the experience and opinions of practitioners on the use devices. Methods: HH compliance was monitored (before, during and after system installation) by observations and alcohol rub usage. Compliance during installation was also monitored by the device. Healthcare practitioner interviews (n = 12) explored how the device influenced behaviour and experiences and opinions of wearing the device. Results: HH compliance improved during the period the device was installed. Practitioners reported the device increased their awareness, enhancing their empathy for patients and encouraged patients and colleagues to prompt when HH was needed. Practitioners’ reported better HH, gaming the system and feelings of irritation. Conclusion: HH prompt and monitoring systems seem to improve compliance but improvements may be undermined by practitioner irritation and system gaming

Survey to explore understanding of the principles of aseptic technique: Qualitative content analysis with descriptive analysis of confidence and training

BACKGROUND: In many countries, aseptic procedures are undertaken by nurses in the general ward setting, but variation in practice has been reported, and evidence indicates that the principles underpinning aseptic technique are not well understood. METHODS: A survey was conducted, employing a brief, purpose-designed, self-reported questionnaire. RESULTS: The response rate was 72%. Of those responding, 65% of nurses described aseptic technique in terms of the procedure used to undertake it, and 46% understood the principles of asepsis. The related concepts of cleanliness and sterilization were frequently confused with one another. Additionally, 72% reported that they not had received training for at least 5 years; 92% were confident of their ability to apply aseptic technique; and 90% reported that they had not been reassessed since their initial training. Qualitative analysis confirmed a lack of clarity about the meaning of aseptic technique. CONCLUSION: Nurses' understanding of aseptic technique and the concepts of sterility and cleanliness is inadequate, a finding in line with results of previous studies. This knowledge gap potentially places patients at risk. Nurses' understanding of the principles of asepsis could be improved. Further studies should establish the generalizability of the study findings. Possible improvements include renewed emphasis during initial nurse education, greater opportunity for updating knowledge and skills post-qualification, and audit of practice

Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study

Background: Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system. Objectives: Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK. Methods: Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system. Results: Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care. Conclusion: Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths

Master of Science

thesisHand hygiene frequency in hospitals is unacceptably low. To date, this problem has been approached from a technical standpoint, with intervention designs that lack a theoretical foundation in human behavior. Almost all interventions have failed to significantly increase hand hygiene frequency. The hypothesis of this work is that identifying hand hygiene interventions guided by psychological theory and principles will lead to more effective interventions. The goal of this study was to develop a lab-based paradigm to explore how principles of adherence engineering, specifically the minimization of cognitive and physical effort, affect the frequency of performing hand hygiene. The paradigm was used to explore the principles of physical and cognitive effort. Participants were asked to paint a series of circles in different colors, but were only given a single paint brush. After painting each circle they could choose if they wanted to wash the brush. In the first experiment, participants painted at varying distances from the washing station to explore the impact of physical effort on washing frequency. In the second experiment, participants were asked to memorize a varying number of digits while painting each circle to explore the impact of cognitive effort on washing frequency. Performance and observational data were collected. Physical distance from the washing station had a significant impact on brush washing frequency. When no cognitive load was present, the perception of risk of contamination accounted for the largest proportion of variation in brush washing frequency. The presence of a cognitive load was associated with an increase in washing frequency, with contamination risk having little effect on washing behavior. Physical distance to a hand washing station will have an effect on hand washing behavior. When the cognitive load of health care workers is increased, it is possible that they will revert to a default behavior because they do not have the mental resources necessary to develop a situation-specific washing strategy. In current hospital environments, the default behavior seems to be omitting hand hygiene. Future interventions should aim at reversing this default behavior in order to improve hand hygiene

IMPACT OF PODCASTING ON LEARNING OUTCOMES IN ASSOCIATE DEGREE NURSING STUDENTS

The dawn of the Information Age has provided rapid advances in technology that have improved lives and produced better tools for caring for each other. Nursing has begun to employ many of these new technologies and nurses are at the forefront of deciding how these innovations might best help patients. New technologies have made their way into schools of nursing and students are benefitting from improved learning experiences. Nursing faculty are leading the way in providing new learning opportunities to students through a multitude of technological advances. One of these advances is podcasting. Podcasting provides students the ability to listen, watch, download and manipulate content in ways that best serve their learning needs. The purpose of this program of study was to examine how technology impacts nursing practice and education. A state-of-the-science paper explored the use of wearable technology as well as provided guidance into how nurses can develop more of these devices. This data ignited a desire to learn about how technology, specifically podcasting, is used in nursing education through the experiences of faculty as well as students. Results from this analysis led to a quasi-experimental research study delving into the use of podcasting for Associate Degree Nursing students. While the results did not reveal a statistically significant improvement in outcomes, a close analysis of the data suggests that further research is warranted to determine if the use of podcasting as a learning supplement may benefit future generations of nursing students

Video-Based Electronic Surveillance for Hand Hygiene Auditing: An Exploratory and Evaluative Study

Hand hygiene (HH) is recognised as the most important thing a healthcare worker (HCW) can do to prevent healthcare associated infection. Practice is audited according to the WHO 5 Moments for HH and while direct human observation is considered the gold standard method, questions regarding utility have arisen. Various electronic systems have been suggested, however most use proxy measures. Video-based systems (VMS) offer possibilities in that compliance can be ascertained according to the WHO 5 Moments framework. However, this has yet to be explored via systematic, sustained research. This thesis explored the utility of VMS as a method of HH auditing via pragmatic, mixed-methods research across 3 interconnected studies. Study 1 explored the technical and methodological specifications that might be required of a VMS. Study 2 examined the feasibility and time efficiency of VMS approaches via a trial. Study 3 unearthed the acceptability of VMS methods for HH auditing to HCWs and patients. This study reveals the utility of VMS for auditing according to the WHO 5 Moments. It offers technical and methodological specifications for effective and efficient data collection and demonstrates VMS auditing is more time efficient. The literature suggested acceptability for HCWs and patients could be a potential barrier to the use within the patient zone, however, this thesis has demonstrated that this was not the case provided certain technical and methodological features and protections are in place. HCWs could see the advantages of the approach in relation to time efficiency, but expressed fears in terms of negative feedback or punitive consequences. A variety of legislative issues relating to privacy, consent, legal status of footage, retention and deletion and open disclosure would need to be taken into consideration. Future research should undertake in vivo experimentation of the technology and methodology