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

Using psychological theory to develop and test a tool for the implementation of evidence based practice : the case of hand hygiene practice

Background: The example of evidence based practice used for this research was hand hygiene. The aim of this research was: to develop and test a theory-based diagnostic instrument to accurately and prospectively assess the barriers and levers to hand hygiene practice to inform subsequent tailoring of implementation strategies. Study One: A qualitative study was carried out with health care practitioners (n=70) and recent hospital patients (n=25) to identify barriers and levers to hand hygiene in secondary care. A thematic analysis resulted in a list of 100 barriers and levers to hand hygiene. Study Two: A two round modified Delphi survey was administered to assess the fit of barriers and levers to hand hygiene to domains of the British Psychological Society theoretical framework. Expert participants were recruited from the fields of Infection Prevention and Control (n=l1) and Health Psychology (n=10). Consensus was achieved on the fit of 99 of 100 barriers and levers to the framework. Study Three: Studies one and two informed the construction of a questionnaire-style diagnostic instrument designed to identify barriers and levers to hand hygiene. Health care practitioners (a total of 470) from four NHS hospital trusts completed questionnaires in three rounds which allowed the instrument to be refined using psychometric testing principles. The result was a 35 item instrument demonstrating good levels of reliability and validity. Study Four: The instrument was used to carry out a feasibility study to assess whether theoretically based interventions could be tailored according to assessed barriers and levers to hand hygiene and to establish the potential effectiveness of such an approach. Barriers and levers to hand hygiene were assessed with 19 junior doctors in an NHS hospital trust. It was identified that such an approach was feasible and hand hygiene audits indicated the potential effectiveness of such an approach. Conclusion: The literature suggests that implementation strategies need to be theoretically based and tailored to assessed barriers and levers to hand hygiene. This study took a step forward in addressing these findings using the example of hand hygiene

Barriers to hand hygiene practices among healthcare workers in Sub-Saharan African countries: a narrative review

Review question:What are the barriers to hand hygiene practices among healthcare workers in Sub-Sahara African countries

The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: “There are so many barriers the barriers are limitless.”

Background: Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. Methods: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. Results: There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. Conclusions: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed

A systematic review examining reducing unplanned hospital admissions in adults with cancer

Review question:1.What interventions have been tested and have successfully reduced unplanned hospital admissions in adults with cancer?2.What are the factors associated with unplanned hospital admissions in adults with cancer

Do early warning track and trigger tools improve patient outcomes? A systematic synthesis without meta-analysis

Abstract Aim: To determine the effect of Early Warning Track and Trigger Tools on patient outcomes. Design: A systematic review: synthesis without meta-analysis. Data sources: Electronic databases were searched from 1 January 2013–1 August 2018 and 221 papers identified. Review methods: A systematic review and narrative synthesis supported the identification of synthesized findings named and reported according to outcome measure. RESULTS: Five international papers representing over 74,000 patients were included in the analysis. Seven key findings were identified, the impact of NEWS on: (a) cardiopulmonary arrest; (b) mortality; (c) serious adverse events; (d) length of hospital stay; (e) hospital admissions; (f) observation frequency; and (g) Intensive/High dependency Unit admission. Papers identified statistically significant improvements in mortality, serious adverse events, hospital admissions, observation frequency, and intensive care unit/high dependency unit admission when an Early Warning Track and Trigger protocol is in use. There were conflicting results regarding length of stay and cardiopulmonary arrest data. Conclusion: Early Warning Track and Trigger Tools can aid recognition of deteriorating patients. Further research is required in relation to hospital length of stay and cardiopulmonary arrests. Impact: Early warning track and trigger tools have been implemented nationally and to a lesser degree internationally. There is evidence to suggest improved clinical outcomes following their use. Further research needs to combine the use of the National Early Warning Score with an agreed set of measured outcomes, and then subsequent study data could be combined to provide much stronger levels of evidence

What are the patterns of compliance with Early Warning Track and Trigger Tools: A narrative review

© 2018 Elsevier Inc. Background: Early Warning Scores were introduced into acute hospitals in 2000. 99% of acute hospitals employ a EWS to monitor deteriorating patients with 97.9% of these linked to a referral protocol. Despite this high level of adoption, there has been little improvement in the recognition and response to deteriorating patients over the last decade. Objective: To explore the patterns of compliance with Early Warning Track and Trigger Tools. Design: A narrative review. Data sources: Electronic databases (Medline, CIHAHL, EmBase, the Cochrane library, the Centre for Reviews and Dissemination (CRD) and PROSPERO) were searched from 1 January 2000 to 5 July 2018. Titles, abstracts and full text papers were screened (two independent reviewers) against inclusion criteria and seven papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer using a bespoke data collection sheet. Review methods: All papers were quantitative in design but demonstrated clinical and methodological heterogeneity therefore a meta-analysis was not possible. A qualitative approach was undertaken to synthesise findings using a framework analysis and narrative synthesis. Themes were identified, named, defined and reported according to outcome measure. Results: 7/27 papers representing over 3000 patients and 963,000 data points were included in the analysis. Reported studies were conducted in the United Kingdom (n = 4), Denmark (n = 2) and Amsterdam (n = 1). Three key themes were identified, early warning score calculation accuracy, monitoring frequency and clinical response. This review identifies poor compliance with the Early Warning Score (EWS) protocol in all three themes. There is significant scoring inaccuracy with omitted EWS, missing elements of the EWS and incorrectly calculated EWS. Adherence to monitoring frequency is poor with a higher EWS being associated with reduced compliance with the escalation protocol. There is inadequate compliance with the escalation element of the EWS protocol with concerning extended delays to clinical review. There is evidence of worsening clinical response with increasing EWS. Although significant improvement is demonstrated in clinical response with the use of electronic EWS protocols, non-compliance still occurs at all EWS stages. Conclusion: Compliance with EWS is poor but the cause is unidentified. Outcomes can only improve if staff complete the EWS fully, calculate the score accurately, monitor according to protocol and escalate according to clinical response. Social, environmental and professional behaviours that affect effective use of track and trigger tools should be explored to improve our understanding of suboptimal management of the deteriorating patient

Facilitated group work for people with long-term conditions: a systematic review of benefits from studies of group-work interventions

Background About 15.4 million people in the UK live with a long-term condition. Of the health and social care spend, 70% is invested in caring for this population. Evidence suggests that group-work interventions offer patient support, improved outcomes, and reduce the costs of care. Aim To review the current evidence base examining the effectiveness of group work in long-term physical disease where such groups are facilitated by healthcare professionals. Design and setting Systematic review and narrative synthesis of studies of group-work interventions led by health professionals for adults with specified long-term illnesses. Method MEDLINE, EMBASE, PsycINFO, and Cochrane databases were systematically searched using terms relating to group work and long-term conditions. Studies were included if they were randomised controlled trials (RCTs) with a control group that did not include group work. Results The 14 included studies demonstrated a high degree of heterogeneity in terms of participant characteristics, interventions, and outcome measures and were of varying quality. The studies demonstrated some statistically significant improvements in pain, psychological outcomes, self-efficacy, self-care, and quality of life resulting from intervention. Conclusion This review demonstrates significant benefits resulting from group participation, in adults with long-term disease. Results were mixed and some benefits were short-lived. Nevertheless, these results suggest that group work should be more widely used in the management and support of adults with long-term illness. There is a need for larger and better-quality studies to explore this potentially important area further

Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community