Interventions to improve hand hygiene compliance in patient care

Background Health care‐associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. Objectives To assess the short‐ and long‐term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care‐associated infection. Search methods We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. Selection criteria We included randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol‐based hand rub (ABHR), or both. Data collection and analysis Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta‐analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. Main results This review includes 26 studies: 14 randomised trials, two non‐randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long‐term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention. Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes. Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low. Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence). Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence. Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence. Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence. Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. Authors' conclusions With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context

Prostaglandin effects in the neuroendocrine mammalian brain

Publishers' versionThe original publication is available at http://www.samj.org.zaVarious prostaglandins (PGs) have been found in several areas of the brain. PGs of the E series have been found in the pituitary and pineal glands and the median eminence, and they have been shown to influence hypothalamic endocrine-release characteristics and release of melatonin from the pineal gland. It has been suggested that they may act, along with membrane phospholipids, as a link between neuronal depolarization, calcium uptake and neurotransmitter release. They may also influence postsynaptic effects of neurotransmitters. These latter effects may be due to interaction with membrane phospholipid- and cyclic nucleotide-induced changes of specific protein kinases. The PGs may act as intracellular mediators of neuro-endocrine control.Publishers' versio

Sample size determination for external pilot cluster randomised trials with binary feasibility outcomes:a tutorial

Abstract Justifying sample size for a pilot trial is a reporting requirement, but few pilot trials report a clear rationale for their chosen sample size. Unlike full-scale trials, pilot trials should not be designed to test effectiveness, and so, conventional sample size justification approaches do not apply. Rather, pilot trials typically specify a range of primary and secondary feasibility objectives. Often, these objectives relate to estimation of parameters that inform the sample size justification for the full-scale trial, many of which are binary. These binary outcomes are referred to as “feasibility outcomes” and include expected prevalence of the primary trial outcome, primary outcome availability, or recruitment or retention proportions. For pilot cluster trials, sample size calculations depend on the number of clusters, the cluster sizes, the anticipated intra-cluster correlation coefficient for the feasibility outcome and the anticipated proportion for that outcome. Of key importance is the intra-cluster correlation coefficient for the feasibility outcome. It has been suggested that correlations for feasibility outcomes are larger than for clinical outcomes measuring effectiveness. Yet, there is a dearth of information on realised values for these correlations. In this tutorial, we demonstrate how to justify sample size in external pilot cluster trials where the objective is to estimate a binary feasibility outcome. We provide sample size calculation formulae for a variety of scenarios, make available an R Shiny app for implementation, and compile a report of intra-cluster correlations for feasibility outcomes from a convenience sample. We demonstrate that unless correlations are very low, external pilot cluster trials can be made more efficient by including more clusters and fewer observations per cluster

LP (a) levels and apo (a) phenotypes in urban black South African men

CITATION: Carstens, M. E., Burgess, L. J. & Taljaard, J. J. F. 1998. LP (a) levels and apo (a) phenotypes in urban black South African men. South African Medical Journal, 88:139-142.The original publication is available at http://www.samj.org.zaObjective. To investigate the lipoprotein (a) (Lp (a)) levels and apolipoprotein (a) (apo (a)) phenotypes in a group of urban black South African men. Design. Cross-sectional design. Setting. Lead acid battery plant, East London, Eastern Cape. Participants. Blood samples from a study on the association between lead and renal failure were kindly donated for the present study and 111 of the donors participated (K Steyn - personal communication). Outcome measures. Lp (a) levels and apo (a) phenotypes. Results. Three groups were identified: those with normal ( 700 U/l) plasma Lp (a) concentrations. Nine apo (a) phenotypes and 26 combinations thereof could be discerned. Apart from the single- and double-band phenotypes described before, triple-band phenotypes were also present. As the Lp (a) values increased, the relative frequency of the single-band phenotype decreased, whereas the relative frequency of the double-band phenotype increased. The relative frequency of the triple-band phenotype was highest in the group with high Lp (a) concentrations. No correlation was evident between the size of the apo (a) isoforms and the Lp (a) concentrations. Conclusions. Raised plasma Lp (a) levels have been associated with coronary heart disease (CHD). In addition, it has been proposed that the apo (a) gene determined plasma Lp (a) concentrations. These studies were performed using plasma from white subjects. CHD is uncommon in black South Africans. The reason may be that, given the lack of relationship between the size of the apo (a) isoforms and the Lp (a) concentrations observed in the present study, factors other than the isoform size may determine the Lp (a) levels in this particular ethnic group.Publisher’s versio

LP (a) levels and apo (a) phenotypes in urban black South African men

Objective. To investigate the lipoprotein (a) (Lp (a)) levels and apolipoprotein (a) (apo (a)) phenotypes in a group of urban black South African men.Design. Cross-sectional design.Setting. Lead acid battery plant, East London, Eastern Cape.Participants. Blood samples from a study on the association between lead and renal failure were kindly donated for the present study and 111 of the donors participated (K Steyn - personal communication).Outcome measures. Lp (a) levels and apo (a) phenotypes.Results. Three groups were identified: those with normal (<300 U/I), intermediate (300 - 700 U/I) and high (> 700 U/I) plasma Lp (a) concentrations. Nine apo (a) phenotypes and 26 combinations thereof could be discerned. Apart from the single- and double-band phenotypes described before, triple-band phenotypes were also present. As the Lp (a) values increased, the relative frequency of the single-band phenotype decreased, whereas the relative frequency of the double-band phenotype increased. The relative frequency of the triple-band phenotype was highest in the group with high Lp (a) concentrations. No correlation was evident between the size of the apo (a) isoforms and the Lp (a) concentrations.Conclusions. Raised plasma Lp (a) levels have been associated with coronary heart disease (CHD). In addition, it has been proposed that the apo (a) gene determined plasma Lp (a) concentrations. These studies were performed using plasma from white subjects. CHD is uncommon in black South Africans. The reason may be that, given the lack of relationship between the size of the apo (a) isoforms and the Lp (a) concentrations observed in the present study, factors other than the isoform size may determine the Lp (a) levels in this particular ethnic group

Impact of CONSORT extension for cluster randomised trials on quality of reporting and study methodology : review of random sample of 300 trials, 2000-8

Peer reviewedPublisher PD

Accommodating quality and service improvement research within existing ethical principles

Funds were provided by a Canadian Institute of Health Research grant (Nominated PI: Monica Taljaard, PJT – 153045). Funds were also generously provided by Charles Weijer, who is funded by a Tier 1 Canadian Research Chair.Peer reviewedPublisher PD