Electronic hand hygiene monitoring: accuracy, impact on the Hawthorne effect and efficiency

Objectives: To evaluate a type five electronic monitoring system (EMS) for hand hygiene (HH) adherence with respect to accuracy and ability to avoid the Hawthorne effect. Design: HH events were observed manually and electronically. The agreement between the two observation methods was evaluated. Continuous electronic measurement was made throughout the study. Setting: An acute 31-bed medical ward in a National Health Service trust in London, United Kingdom. Participants: Staff working or attached to the ward. Intervention: A newly developed type five EMS that can measure disinfectant dispenser usage as well as continuous movements of health workers throughout the ward with arm-length precision and analyse HH adherence was installed at the ward. Results: A total of 294 HH events were observed in five sessions by an observer previously unknown to the ward. There was concordance between HH adherence assessed by manual observer and the EMS on 84% (79.1%–89.9%) of the occasions. During the five observation sessions, the observed HH adherence increased from 24% to 76% while the EMS measurements immediately before the arrival of the observer remained constant for all sessions. Conclusion: The 84% agreement between the EMS and the manual observation suggest a high level of precision for the evaluated system. The Hawthorne effect (higher rate of HH performance) was clearly seen in the increase by a factor of three in the manually observed adherence from session to session as the health workers became more aware of them being observed. The EMS was able to avoid the Hawthorne effect when the observer was not present

Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study

Background: Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system. Objectives: Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK. Methods: Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system. Results: Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care. Conclusion: Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths

Common and Distinct Roles of Juvenile Hormone Signaling Genes in Metamorphosis of Holometabolous and Hemimetabolous Insects

Insect larvae metamorphose to winged and reproductive adults either directly (hemimetaboly) or through an intermediary pupal stage (holometaboly). In either case juvenile hormone (JH) prevents metamorphosis until a larva has attained an appropriate phase of development. In holometabolous insects, JH acts through its putative receptor Methoprene-tolerant (Met) to regulate Krüppel-homolog 1 (Kr-h1) and Broad-Complex (BR-C) genes. While Met and Kr-h1 prevent precocious metamorphosis in pre-final larval instars, BR-C specifies the pupal stage. How JH signaling operates in hemimetabolous insects is poorly understood. Here, we compare the function of Met, Kr-h1 and BR-C genes in the two types of insects. Using systemic RNAi in the hemimetabolous true bug, Pyrrhocoris apterus, we show that Met conveys the JH signal to prevent premature metamorphosis by maintaining high expression of Kr-h1. Knockdown of either Met or Kr-h1 (but not of BR-C) in penultimate-instar Pyrrhocoris larvae causes precocious development of adult color pattern, wings and genitalia. A natural fall of Kr-h1 expression in the last larval instar normally permits adult development, and treatment with an exogenous JH mimic methoprene at this time requires both Met and Kr-h1 to block the adult program and induce an extra larval instar. Met and Kr-h1 therefore serve as JH-dependent repressors of deleterious precocious metamorphic changes in both hemimetabolous and holometabolous juveniles, whereas BR-C has been recruited for a new role in specifying the holometabolous pupa. These results show that despite considerable evolutionary distance, insects with diverse developmental strategies employ a common-core JH signaling pathway to commit to adult morphogenesis

The clinical presentation of preterm cerebellar haemorrhage

The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n=3), folial (n=1), lobar (n=9, of which 4 bilateral), giant lobar (n=1, including vermis) and contusional (n=1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum

Immune Responses Accelerate Ageing: Proof-of-Principle in an Insect Model

The pathology of many of the world's most important infectious diseases is caused by the immune response. Additionally age-related disease is often attributed to inflammatory responses. Consequently a reduction in infections and hence inflammation early in life has been hypothesized to explain the rise in lifespan in industrialized societies. Here we demonstrate experimentally for the first time that eliciting an immune response early in life accelerates ageing. We use the beetle Tenebrio molitor as an inflammation model. We provide a proof of principle for the effects of early infection on morbidity late in life and demonstrate a long-lasting cost of immunopathology. Along with presenting a proof-of-principle study, we discuss a mechanism for the apparently counter-adaptive persistence of immunopathology in natural populations. If immunopathology from early immune response only becomes costly later in life, natural selection on reducing self-harm would be relaxed, which could explain the presence of immune self-harm in nature

Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

Background: Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings. Methodology/Principal Findings: A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and$10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and$36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and$232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively. Conclusions/ Significance: Admission screening costs$4,100-$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving

Photochromism and Electrochemistry of a Dithienylcyclopentene Electroactive Polymer

A bifunctional substituted dithienylcyclopentene photochromic switch bearing electropolymerisable methoxystyryl units, which enable immobilization of the photochromic unit on conducting substrates, is reported. The spectroscopic, electrochemical, and photochemical properties of a monomer in solution are compared with those of the polymer formed through oxidative electropolymerization. The electroactive polymer films prepared on gold, platinum, glassy carbon, and indium titanium oxide (ITO) electrodes were characterized by cyclic voltammetry, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM). The thickness of the films formed is found to be limited to several monolayer equivalents. The photochromic properties and stability of the polymer films have been investigated by UV/vis spectroscopy, electrochemistry, and XPS. Although the films are electrochemically and photochemically stable, their mechanical stability with respect to adhesion to the electrode was found to be sensitive to both the solvent and the electrode material employed, with more apolar solvents, glassy carbon, and ITO electrodes providing good adhesion of the polymer film. The polymer film is formed consistently as a thin film and can be switched both optically and electrochemically between the open and closed state of the photochromic dithienylethene moiety.