Effectiveness of a structured, framework-based approach to implementation: the Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial.

BACKGROUND:Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning. DESIGN/METHODS:The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure). RESULTS:We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully. CONCLUSION:Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change. TRIAL REGISTRATION:Australia New Zealand Clinical Trial Registry ACTRN12615000325505, registered on 4 September 2015

Double cation formation from the Photo-Fragmentation of the closo-Carboranes

Time-of-flight mass analysis with multi-stop coincidence detection has been used to study the multi-cation ionic fragmentation via fission of three isomeric carborane icosahedral cage compounds closo-1,2-orthocarborane, closo-1,7-metacarborane, closo-1,12-paracarborane (C2B10H12) following inner-shell excitation at or above the B is regime. Photoelectron-photoion-photoion coincidence (PEPIPICO) spectroscopy was used to study the dominant fission routes in the core level excitation regime. Series of ion pairs are identified, where asymmetric fission dominates, leading to ion pairs of different mass. The fragmentation yields and charge separation mass spectra of all three isomers are generally quite similar in that the ion pairs (H+, Y+), Y-11(+)), and (Y-3(+), Y-9(+)) dominate, where denotes the mass region from B+ to CH. Slight differences are observed at the B 1s-threshold, where the H+ and BH2+/CH+ ion pairs dominate for ortho-and metacarborane, while (Y+, Y-11(+)) ion pairs dominate the multi-photofragment ion yield of paracarborane. These similarities and distinct differences in charge separation are discussed by considering the energetics of these three major species of ion pairs, as well as charge distributions in closo-carboranes and charge distributions in the carborane cage. It is shown that product formation via charge separation is driven by electronic relaxation, so that the lowest energy products are not necessarily formed