Evaluation of the effect of hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center

Summary: Hand hygiene is a critical element of patient care, which needs to be learned and reinforced to become an autonomous behavior. Previous studies have explored aspects of hand hygiene behavior in the clinical workplace, but not in controlled learning environments with health professional students. Development of good hand hygiene behavior requires a multi-faceted approach, including education, reinforcement, feedback and audit. Our study aimed to identify the effect of unannounced hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center. Year 2 MBChB students received practical learning regarding hand hygiene in their clinical skills sessions. Baseline hand gel use was measured using before and after weighing of the bottles. An A5 sign was created to remind the students to hand cleanse and was used as an unannounced intervention. In semester 2 (2012), the student groups were randomly allocated as intervention (signs) or control (no signs). Hand gel use at all sessions was measured. Data were compared between groups and over time. In total, 237 students attended the skills sessions twice during the study. Hand gel use was not significantly different between the two study arms. Overall use was low, typically 1–2 hand gel pumps per student per session. In addition, hand gel use fell over time. A visual reminder to cleanse hands did not appear to have any effect on behavior. These findings may have implications for their value in a clinical setting. Low overall use of hand gel may be context-dependent. Students are in a simulated environment and examine ‘healthy’ peers or actors. There may have been inconsistent tutor role-modeling or problems with the educational approach to the skill. Analysis at the level of the group, and not the individual, may have also limited our study. Keywords: Hand hygiene, Human factors, Medical students, Evaluatio

Energetics and Dynamics of the Low-Lying Electronic States of Constrained Polyenes: Implications for Infinite Polyenes

Steady-state and ultrafast transient absorption spectra were obtained for a series of conformationally constrained, isomerically pure polyenes with 5–23 conjugated double bonds (N). These data and fluorescence spectra of the shorter polyenes reveal the N dependence of the energies of six [superscript 1]B[subscript u] [superscript +] and two [superscript 1]A[subscript g] [superscript –] excited states. The [superscript 1]B[subscript u] [superscript +] states converge to a common infinite polyene limit of 15 900 ± 100 cm [superscript –1]. The two excited [superscript 1]A[subscript g] [superscript –] states, however, exhibit a large (∼9000 cm–1) energy difference in the infinite polyene limit, in contrast to the common value previously predicted by theory. EOM-CCSD ab initio and MNDO-PSDCI semiempirical MO theories account for the experimental transition energies and intensities. The complex, multistep dynamics of the 1[superscript 1]B[subscript u] [superscript +] → 2 [superscript 1]A[subscript g] [superscript –] → 1 [superscript 1]A[subscript g] [superscript –] excited state decay pathways as a function of N are compared with kinetic data from several natural and synthetic carotenoids. Distinctive transient absorption signals in the visible region, previously identified with S* states in carotenoids, also are observed for the longer polyenes. Analysis of the lifetimes of the 2 [superscript 1]A[subscript g] [superscript –] states, using the energy gap law for nonradiative decay, reveals remarkable similarities in the N dependence of the 2 [superscript 1]A[subscript g] [superscript –] decay kinetics of the carotenoid and polyene systems. These findings are important for understanding the mechanisms by which carotenoids carry out their roles as light-harvesting molecules and photoprotective agents in biological systems.United States. Dept. of Energy (DE-FG02-86ER13564)National Science Foundation (U.S.) (Grant EMT-0829916)National Institutes of Health (U.S.) (Grant GM-34548