Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections

BACKGROUND: Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. METHODS AND FINDINGS: A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate. CONCLUSIONS: Implementation of a HHP reduces preventable HAIs and is cost effective

The impact of world Englishes on language assessment: rater attitude, rating behavior, and challenges

By centralizing the issue of test fairness in language proficiency assessments, this study responds to a call by researchers for developing greater social responsibility in the language testing agenda. As inquiries into language attitude and psychology indicate, there is an underlying uncertainty pertaining to the validity of test use and score interpretation based on listeners’ bias against for non-standard English and negative evaluation of such speakers. Of greater relevance in oral proficiency assessment is that listeners, that is, raters, transfer such attitudes to their scoring judgments. As an attempt to address this issue, this study investigates the scoring validity of the IELTS speaking test by examining its relationship in relation to a criterion designed to measure rater attitudes towards World Englishes. Validity arguments were formulated to guide two independent, yet related, studies based on mixed-methods approach and evaluate the claims and hypotheses set for the studies. In view of the lack of instruments measuring rater attitude towards global English in the language assessment context, the first study constructed the criterion measure, the Rater Attitude Instrument (RAI), involving 119 ESL teacher raters in the U.S. and India. As a result of the three-phase development, the RAI comprises 22 semantic differential scale items and 32 Likert scale items representing the three attitude dimensions of feeling, cognition, and behavior tendency used by psychologists. Confirmatory factor analysis supports the internal structure of the RAI with acceptable model fit indices (2 =20.052, p =.094 , RMSEA=0.076 , CFI =0.954 , TLI=0.926). Content validity is ensured through teacher raters and content experts perspectives that continuously shaped the substance of the RAI. As the RAI demonstrates, rater attitudes towards World Englishes were generally positive and tended to focus more on speech comprehensibility; nevertheless, the majority of raters were inclined towards a preference for standard English in their scoring judgments. In the second study, the RAI and the six IELTS descriptive tasks produced by Indian examinees were administered on-line to the 96 teacher raters and the data analyzed to evaluate the extent to which the claim that rater attitude is a biasing factor affecting their scoring judgment on IELTS descriptive tasks can be sustained. The RAI scores were analyzed by FACETS that classified the raters into positive, neutral, and negative attitude groups according to measurement logit. Next, MANOVA was performed which suggested that the ratings by the positive and negative attitude groups were significantly different, with the positive group consistently rating higher on all the four criteria of Fluency, Sentence Structure, Vocabulary, and Pronunciation. The neutral and negative attitude groups rated significantly differently on Sentence Structure and Vocabulary, with the former rating higher than the negative group. Moderate to strong correlations ranging from .272 to .569 were observed between the RAI and the IELTS descriptive task scores. Multiple regression analysis revealed that RAI scores accounted for a significant amount of variance on the IELTS descriptive tasks sub- and total-scores, ranging from 17.5% to 32.4%. Moreover, the Indian/non-Indian variable was the only rater background characteristic investigated that significantly related to the rater feeling scores that formed one of the triplet attitude constructs, though contributing to only 10% of the score variance. Lastly, the verbal protocol study provided insightful information suggesting that raters with positive attitudes generally took into account the expected performance of language learners while some negative-attitude raters used the native speaker model as the underlying criterion for judgment. The impact of the findings on validity argument, test fairness, and rater trainings are also discussed

Effect of Body Weight on Temperature Control and Energy Expenditure in Preterm Infants

The purpose of this study was to compare resting energy expenditure (REE) in premature infants of different body weights during weaning from the incubator. We hypothesized that premature infants would respond to weaning from an incubator with an increase in REE, and that the increment would be larger in infants with lower body weights than in those with higher body weights. Methods: Stable preterm infants with body weights between 1800–2200 g were enrolled. REE was measured using indirect calorimetry at 1 hour before weaning and 3 hours after turning off the incubator. REE measurements from infants with higher body weight (2000–2200 g, Group A) were compared to those of infants with lower body weight (1800–2000 g, Group B). Results: A total of 22 patients were studied (10 in Group A and 12 in Group B). REE increased significantly after weaning in both groups (Group A: from 62 ± 7 kcal/kg/day to 69 ± 8 kcal/kg/day, p = 0.045 and Group B: from 65 ± 5 kcal/kg/day to 70 ± 7 kcal/kg/day, p = 0.001). However, there was no significant difference in REE increments between the two groups. Conclusion: REE increased significantly in infants during weaning from an incubator. The increase in REE increment was similar in smaller (1800–2000 g) and larger (2000–2200 g) babies in this study. Weaning of preterm babies from an incubator may be safely started when their body weight reaches 1800 g

Limited Diagnostic Value of Routine Screening of Neonates with the Urinary Group B Streptococcal Antigen Tests

A urinary latex test for detection of antigens from group B Streptococcus (GBS) has been used for the diagnosis of invasive GBS disease. However, the value of routine screening of infants with this test has not been determined. Methods: All infants admitted to Linkou Chang-Gung Memorial Hospital (Taoyuan, Taiwan) from January 2005 to May 2013 were screened with a urinary GBS antigen test (Wellcogen Strep B). Medical records were retrospectively reviewed to determine the diagnostic value of this test. Results: A total of 14,277 infants were tested and 38 cases had confirmed diagnoses of invasive GBS disease (34 bacteremia, 18 meningitis, 14 both), corresponding to a prevalence of 0.27% among our admitted infants. A total of 106 infants had positive results, but only 26 had confirmed disease. Among infants with confirmed disease, 12 had negative antigen results. These data allowed calculation of the sensitivity (68.4%), specificity (99.4%), positive predictive value (24.5%), and negative predictive value (99.9%). Adjusting for prevalence, the disease probability of a positive test result was 23.6%, and the probability of a negative post-test result was 0.09%. The absolute risk reduction of a negative result was very small (0.18%). Analysis of demographic, clinical, and laboratory parameters indicated that late age of onset (≥7 days-old), presence of seizure, fever, respiratory distress, leukopenia, bandemia, thrombocytopenia, coagulopathy, metabolic acidosis, and elevated levels of C-reactive protein (CRP) were significantly related to the presence of a true positive test result. Conclusion: In our study population, the positive predictive value of the GBS antigen test was poor and the risk reduction of a negative result was weak. These results indicate that routine screening with this test has a limited diagnostic value. However, GBS antigen testing appears to be useful for early detection of disease in infants with certain demographic, clinical, and laboratory risk factors