Willpower Depletion and Hand Hygiene in Emergency Medicine

Psychology research suggests that willpower functions like a muscle and tires with use; as willpower is depleted, we have less available for other, unrelated tasks that also require willpower. Recent research has found that people demonstrate declines in performance in various areas as they work hard without breaks. To date, there is minimal research investigating evidence of willpower decline in a medical context. One candidate as a metric for finding evidence of willpower decline is hand hygiene. Performance of hand hygiene requires conscious mental effort on the part of the physician, suggesting it is subject to willpower depletion. Evidence suggests that the low hand hygiene rates in medicine are responsible for nosocomial infections. This paper consists of two distinct parts: a systematic review and an original manuscript describing plans for an observational research study. The systematic review assesses the current literature on hand hygiene to determine whether there is evidence of a willpower depletion effect by examining hand hygiene rates and performance in the beginning and end of a shift. This review found only three studies that met inclusion criteria. Although these studies did suggest some mild effect of willpower depletion, all three studies were subject to significant limitations related to measurement of time or hand hygiene. The original manuscript lays out a design for an observational study of hand hygiene, comparing hand hygiene rates in the beginning and end of a shift. It is to take place in an Emergency Department and will use criteria for of hand hygiene indications defined by the World Health Organization. If the study finds evidence of willpower depletion in hand hygiene, it suggests that other areas in medicine may be at risk of declining performance over the course of a shift and should be more thoroughly investigated.Master of Public Healt

Improvements to water purification and sanitation infrastructure may reduce the diarrheal burden in a marginalized and flood prone population in remote Nicaragua

<p>Abstract</p> <p>Background</p> <p>The isolated northern region of Nicaragua has one of the highest rates of diarrheal disease in Central America. Political and environmental hardships faced by inhabitants of this region are contributing factors to this health inequity. The aim of this study was to assess the relationship between water and latrine infrastructure and the prevalence of diarrhea in this region.</p> <p>Methods</p> <p>A population-based, cross-sectional survey of women of reproductive age was conducted in the Sahsa region of northern Nicaragua in July, 2009. Households were selected by two stage cluster sampling methodology. A questionnaire was administered in Spanish and Miskito with assessment of household and socioeconomic conditions, sanitation practices, and health care access. Diarrhea prevalence differences at the household level over a two week reporting period were estimated with a standardized instrument which included assessment of water treatment and latrine use and maintenance.</p> <p>Results</p> <p>There were 189 women enrolled in the current study. The use of water purification methods, such as chlorine and filters, and latrine ownership were not associated with reduced prevalence of household diarrhea in the two week reporting period. Latrine overflow, however, was associated with an increased prevalence of diarrhea during the same two week period [adjusted prevalence difference and 95% CI: 0.19 (0.03, 0.36)].</p> <p>Conclusions</p> <p>Simple, low cost interventions that improve water and latrine infrastructure may reduce the prevalence of diarrheal disease in the isolated regions of Nicaragua and Central America.</p