Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization \u27five moments of hand hygiene (HH), and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback

Illicit Tactics as Substitutes: Election Fraud, Ballot Reform and Contested Congressional Elections in the United States, 1860- 1930

What is the relationship between ballot reforms and electoral malpractice? This article contributes to the growing comparative politics literature on the causes of election fraud in democratizing countries using the case of the 19th-century United States. We examine the adoption of the Australian ballot and disenfranchisement laws, and estimate their effects on multiple types of election fraud. Using a new measure of fraud in elections to the House of Representatives from 1860 to 1930, we find that the Australian ballot and disenfranchisement measures reduced vote-buying and voter intimidation. However, we further find that the Australian ballot had an “iatrogenic effect” of increasing registration and ballot fraud. Voting secrecy therefore led to substitution of one illicit electoral tactic for another