Archive for October, 2012

Haven’t written a post for a while, as it has been somewhat difficult to think of what to write….half of me is very excited about the direction my research is potentially taking, whilst the other half is so hung up on the ‘potentially’ aspect, that I find myself getting tied up in knots and fighting waves of panic…..  And no one wants to read a blog post about that (but they might want to look at a picture….)

SO, a brief update as to all things research, to help me clear the mind, and reassure those who are asking that work is still continuing.

  • Study 3 – the revised version – is currently in the recruitment stage.  This will be investigating Inherent and Elective Hand Hygiene in an NHS setting, and will be on a pilot scale, hopefully giving me the grounds for future Post-Doc development, exploring themes of training and technology/process development all centred around the WHO 5 Moments.
  • Studies 1 and 2 – the data collected from these studies are being analysed, using thematic coding (for interviews) with a mixture of both inductive and deductive analysis.  A process map, based on how Auditing works within the Case Study site has been produced, showing areas of perceived ‘confusion’, and it is here that analysis is being concentrated – is there a potential role for technology to help reduce this confusion?
  • I am now looking forwards to the time after my PhD (only 8 months left) and have had some great conversations about the potential to extend the PhD work, to develop the emergent themes. A number of NHS sites have potentially shown an interest in collaborating, which is excellent, and I believe we have in place some excellent (relatively short-term) study designs that could help us explore issues surrounding the understanding and use of the WHO 5 Moments further.  My main decisions to make are how to fund (applying for an independent Fellowship…?) and where to base myself (Academic Institution…?).  These are big decisions to make, and always harder at a time when trying to finish a PhD. A recognised and shared worry I’m sure.

What else is happening?

  • I had an amazing conversation with Claire Kilpatrick and Jules Storr at IFIC 2012.  I cannot say too much about it (because I’ll sound far too over-excited), but suffice to say their encouragement and support about my work was immeasurable. Well timed and simply perfect.  As a researcher working without a ‘team’ (I am the only member of my department working on Infection Prevention) it is often a disappointment not to be able to become passionate about the work with other people; this conversation certainly gave me a strong shot of that passion!  Cannot thank them enough.
  • Have also been asked to share my work at my host NHS site’s ICT study day (November 14th), which I’m really looking forward to.  I’ve been given free range to talk on anything related to the work we’ve been doing, and I’m really eager to share what we’ve been upto – especially as the ICT often (it seems) get a bit of a ‘bad press’ within hospital circles, by nature having to appear mainly at times of crises, and often being seen to be ‘telling people off’. Will be great to share the story of how the work on Hand Hygiene is preventative, looking to stop these crises happening, and how the new work (Study 3) is trying to explore an angle the audience may not have heard about before.  We can but see….
  • In off topic news, I’ve also been testing out the NHS as a Patient, as I’m sporting a knee injury post-marathon. This has left me unable to run, and may be in someway linked to my ‘PhD blues’ state.  Fingers crossed I will be able to get some more answers tomorrow at the next check.  The only good thing is I get to play one of my favourtie games, where I see the Doctor’s face when I tell them what I do for a living……cue instant fear, and sudden Hand washing….!

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What are you doing? What can you learn? What have you discovered?

A whole week dedicated to Infection Prevention – find out more here: http://iipw.site.apic.org/



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Feet up day!

Completed Run Liverpool yesterday – my first Marathon (not yet committed to saying my ‘only’ Marathon…..), to complete an amazing 3 weeks of firsts; first ‘away’ conference (IPS 2012) and first International conference (IFIC 2012).  Throw in first solo journey on a plane, first visit to London Heathrow and first flight at all since 2003, and it’s fair to say it has been quite a monumental time for me…!

So now, I am having a quiet day, nursing a few sore patches from yesterday, and following up a whole host of leads and notes from my time away.  First was to update my Twitter to include new people to follow based on people I met, people I have been made aware of – and now it is time to send out copies of my Poster to people who have emailed requests, as even though I took folders full of hand-outs, they still ran out. Good times!

Later I’ll upload the poster here, and upload some photos from Zagreb – but as that involves moving to get some cables, I think I’ll have to wait a little while.  An ice pack is currently delicately balanced……

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Today was my first day attending sessions at IFIC 2012 – yesterday being spent registering, having a tour of Zagreb, and attending the Opening Ceremony and welcome reception.

There is far too much to cover right now (and my scrawl may take a while to decipher) but it is immediately clear that attending this Conference has been hugely important for my research – both in terms of content, and also in terms of the potential sources of support, inspiration and future direction.  I have written lots of ‘notes for home’, which will help me remember all the thoughts buzzing through my mind, and hopefully help me turn them into actions over the next few months.

Today I concentrated on Hand Hygiene ( surprise!), but through a wider lens than I perhaps would usually focus – thus the sessions covered work on an international scene, in environments outside the acute setting, and often in settings with dramatically fewer resources than I am used to interacting with.  However, a strong theme of the importance of Hand Hygiene was never far from the surface, alongside a continual mention/nod towards the WHO 5 Moments – an ever-increasing integral part of my thesis.

I will cover more on the sessions when I get back to the UK; just to note that I had a great moment of excitement this afternoon when I got to attend a session featuring two highly prominent figures in the field – Benedetta Allegranzi and Sally Bloomfield.  There is a moment when you (I….?!) have to fight hard not to revert to an awe-struck teenager….  Tomorrow I’m going to have to do the same; as it’s the turn of the UK IPS representatives to present, and as their work is about Audit and Surveillance, they are something of a big deal for me…!

Today was also the day of attending my Poster; a great opportunity to speak with people interested/intrigued by the Poster presented, a chance to elaborate, debate and defend the ideas I’m working on.  I thoroughly enjoyed it, there was much more discussion than I expected, and I was overwhelmed by the amount of positive and interested comments I received, and it was especially interesting to hear stories and experiences from all around the World; some very familiar, and some so very different. Lovely to see that the WHO 5 Moments were recognised by everyone though, regardless of background.

Now I need to continue to look towards the future though; this experience is definitely helping me formulate further the research I want to carry out, but I still need the guidance and support of those in the field to clarify, mould, direct and confirm that the plans are in the right vein; it is essential that we build upon the foundation already established, thus I want to make sure that any research I go on to do in a Post-Doc capacity is what is needed, wanted and welcomed…..

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Very quick post, to happily announce that I have safely made it to Zagreb for the IFIC12 Conference, where I will be attending my Poster Why do you wash your hands? Does the solution to hand hygiene compliance lie in understanding different types of hand hygiene behaviour – inherent and elective?’  

If you are attending this years Congress please feel free to view my Poster throughout the event, and pop by and say hello during the attended session on Thursday lunchtime.

Attached to this post is a copy of the Poster from IPS2012, which I have finally got round to uploading.  I shall do the same with the IFIC12 one when I return to the UK. And have run a Marathon. But more on that later in the week….

IPS Poster: Exploring Human Behaviour and Technology in NHS Hand Hygiene Auditing    (or as I see it, a whistle-stop tour of my PhD to date….).

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  So, now I have had time to let my thoughts settle/ferment since I returned from IPS 2012 I can write a little update about how I got on, and try and give a flavour of just how inspiring the whole event was. 

Yes, inspiring. Having thought long and hard, I think that is the best word to use as an overall theme.  Having been through a difficult few months with the PhD with various set-backs, not to mention the episode of quarantine immediately prior to the conference, it is fair to say I was a somewhat jaded character on the train north to Liverpool. Not so on the train home! I was brimming with new ideas, running thoughts over in my head, and with a bag full of notebooks, hand-outs and, naturally, hand-gel samples….

So what inspired me?  The answer is probably best split into 2 categories – my fellow delegates and the information presented.  

Fellow Delegates

The former was a great comfort, and a timely reminder that Infection Control is an area where people are hugely motivated towards moving forwards, and that to do so they understand that team work, multi-disciplinary collaboration and mutual support are crucial elements for success.  Having travelled to the conference alone it was a joy to meet with new people, to share stories, receive feedback on my work, and generally feel welcome in a room full of strangers. I was particularly made to feel welcome by some wonderful ladies from Bournemouth NHS Trust, Plymouth NHS Trust, St John’s Ambulance Head Office, and a Private healthcare provider in Sussex. It was also a perfect co-incidence to bump into one of my host ICT attending a fellow delegate – I was proud to see them there, knowing how hard they work helped me really relate the formal presentations to real-life, and it was great to debrief after a few of these sessions; relating them directly to ‘our’ NHS Acute trust.  A perfect balance of theory, experience and practice.

Information Presented

The formal presentations then, to sum up, were varied yet all thought-provoking.  Because of my focus on Hand Hygiene and Research I tended to attend sessions focused around these – although the session aimed at those new to Infection Control was a lovely way to start the Conference experience, really helped me feel less alienated as a ‘solo’ attendee.  It felt like there was a great emphasis in all of the sessions (I attended) to encourage empowerment in the delegates, to encourage the belief that change was possible, and that it could come from anyone, regardless of position, background or experience. I found that inspiring, as often it can feel like only ‘top’ people can make a difference – both in the academic and medical sectors; I’ve heard this a lot from those I’ve met during my studies, as well as from within my academic circle.  Great examples from Professor Judith Tanner helped illustrate how crucial research has often been born from the ideas of those on the ‘front-line’, continually perplexed or frustrated by a problem, and who took the step beyond fire-fighting to look for a more long-term solution.

Fire-fighting vs. long-term solutions

This was such a key theme in my decision to undertake a PhD; I felt it deserved a quick mention. Having worked in the private sector for 6 years, I had a great team there which was focused on this very topic, looking for, and implementing, long-term solutions rather than continually reverting to emergency work-arounds to get through a deadline; and repeating this again and again.  Doing a PhD allows an in-depth review of a particular issue or problem (for me, Hand Hygiene Auditing), using rigorous methodology, to produce a ‘unique contribution to knowledge’.  In this way it is hoped that the field moves forwards, and that others can benefit from another building block; rather than continually being stuck in a loop of emergency ‘make-do’s’.  

What the IPS Conference did was remind me of this initial excitement, the fact that so many people are stuck doing ‘work arounds’, and yet through rigorous research there is the potential to improve the situation in Infection Control; and for me, Hand Hygiene Auditing.

 Ending on a high

This idea, of being able to make a long-term difference, was firmly cemented during my final session at IPS – “Set me free – letting go of hand hygiene” presented by Julie Storr, (the new IPS President, WHO Consultant, Imperial College London) and Claire Kilpatrick (Consultant, World Health Oganisation Patient Safety).

An amazing presentation (you always know it’s going to a bit different, when the lights go down and Coldplay fills the speakers….), featuring an interview style debate on the future of Hand Hygiene.  Too much to jot down here (and I’m sure there would be some rules about plagiarism….), but the 5 ‘things to take away’, as outlined by Claire, were summarised a bit like this:

 Key points:

  1. Hand Hygiene should be part of the natural workflow, embedded in daily tasks
  2. Hand Hygiene interventions should be multipronged
  3. We should all look for ‘one key step for tomorrow’ to improve Hand Hygiene where we are
  4. Hand Hygiene is not that simple (but is should be….?)
  5. We need to understand the complexities (to get back to the simple side….)

An interesting point mentioned was that we may be living under an illusion of a ‘Perception of Success’; infection rates have gone down, we have been used to hearing about Hand Hygiene campaigns, we have seen an increase in AHR use, and AHR dispensers seem abundant – but have we really moved forwards in helping people understand why Hand Hygiene is important? Do we believe it is too simple?  Jules had a great slide, demonstrating the journey from simple, through complex, back to simple – using a myriad of disciplines to navigate the complex stage; including psychology, neuroscience and ergonomics.  Thus, we need to move away from the belief that “It’s easy, everyone can wash their hands’, through to understanding why and how we can enable Hand Hygiene at the right moments, to a point where it really is easy for people to act appropriately and perform Hand Hygiene correctly.  Seriously, the slide explains this so much better….!

Finally, and of real interest to me, someone asked a question about the relevance of ‘Electronic Monitoring’ – a key theme of my research.  A stand in the exhibition (see image, right) was causing great interest; having a badge system that had the ability to track (some) Healthcare worker Hand Hygiene compliance within a set zone – still in a prototype stage, but worthy of investigation.  Issues such as price were definitely high on the agenda for delegates, and for me, issue relating to accuracy of data and, critically the relevance to the 5 Moments….  I was delighted to hear this was something that WHO was already taking active steps towards ensuring.

What I’ve taken away, and what next….

 Now my thoughts have settled, and I have almost finished deciphering my handwritten scrawl, I think my main output from the Conference is twofold.

Firstly, I am confident that the work I have been doing is worthwhile, that Hand Hygiene is still a crucial nut yet to be ‘cracked’ fully, and that the methods to complete this process is still hotly debated.

Secondly, though, I am confused, verging on worried. Where do I go from here?  I was really intrigued by the presentation by Julie and Claire, the concept of Simple/Complex/Simple, the involvement of Neuroscience, Psychology and Ergonomics (to name but a few elements), and the emerging field of electronic monitoring – but I feel I need further guidance as to where to apply my energies next.  My PhD is very ‘open’ at the moment, I feel it could still go in a number of directions, which is exciting, yet I need to start pulling it down, ready to write up into one cohesive ‘story’.  But I do not want it to be the only story. It doesn’t end at submission…!  So, I am now off to IFIC 2012 (Twelfth Congress of the International Federation of Infection Control) and what I’d really like to come away with is a clearer idea of how I could plan my Post-Doc future…..  Time will tell…..

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Have just got back from IPS 2012 – and finally have a stable wireless connection…!

Tomorrow I’ll write-up properly re: my thoughts on the conference; I’ve taken so many notes, I feel I need to go through them before I add any real conclusions to my time away.  Suffice to say it was a packed programme, inspiring, enlightening, challenging, exhausting, and at times almost overwhelming, but overall the thing I’m taking away with me was how welcoming everyone was. Both in the conference, and in the Liverpool area as a whole. Could not have been better!

Now I’m off to unpack my bags, have a cup of tea, and then tomorrow it’s time to start following up all the exciting leads from the past few days…..

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IPS 2012 – Day 2


A quick break in proceedings has found me back at the suite (11.15); charging the phone (lots of Twitter time!) and trying to download my head onto paper….  A lack of internet means I cannot check emails or the like, which is probably a good thing – it helps keep me in the ‘Conference Bubble’ just that bit longer.  Not quite sure when I’ll be able to post this however, but hopefully a random wireless signal can be snared later in the day…

So, this morning saw an early start with a great ‘Meet the Experts’ session – Professor Judith Tanner and Dr David Jenkins encouraging the audience to see their ‘little projects’ as so much more – to see them for what they really are; research projects to help benefit Patients.  They explained how, with the help and guidance of the relevant experts, often key research can be developed right from the clinical level where it is experienced, involving if not indeed initiated by those working in that environment.  Great examples of Nurse-led research helped inspire the audience, with clear advice regarding R&D processes, how to handle statistics (see an expert….!) and the Ethics process all being addressed in an informative yet unintimidating manner. Top notch.

The nest two sessions I attended were led by Claire Kilpatrick and Dr David Jenkins (again) – the former giving an overview of the past 10 years of HCAI progress in Scotland, and the latter asking the question ‘How can we prove that infection prevention works?’. 

Both talks were highly relevant to me, and the speakers were excellent. It was a joy to see how far Health Protection Scotland (HPS) has come in their journey, especially seeing the slide relating to the impact of their Hand Hygiene campaign – and also to hear from Claire; a key figure in the WHO’s Clean Care is Safer Care programme, and something of an idol of mine…!    David’s talk was acutely relevant at the moment, what with my current stats-limbo, and need to plan for future work – and it was great to see that there is a need, and understanding, for high quality research in the area of Infection Control.  Glad to hear discussion of why it is hard to use the ‘Gold Standard’ of Randomised Control Trials (RCTs) in this domain, and very interested in the trend towards the interrupted time series design – particularly useful for case study design I think, to see local level results, and thus perfect for engaging those involved in a particular site, at all levels.

Off back for more sessions this afternoon – firstly an intriguing presentation about the over-use of gloves; a theme emerging from my work and one I am leaning towards following up in future works….  Also, presenting my poster at 14.30, so very much looking forward to chatting to more people about my project. Already spoken to lots of people about it; some great comments – very astute people here at IPS 2012, giving wonderful feedback, hints for future work, and potential links for areas to involve. Expect a flurry of emails and activity over the next few weeks….!!!

Back to the ACC now……………….

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IPS 2012 – Day 1

Popped back to my suite for a quick breather, before heading back for a reception this evening being held by Ecolab at the Albert Docks, focussed especially on Hand Hygiene Compliance Education.  Should be an interesting event, and another great way of meeting other Hand Hygiene enthusiasts….will add a brief blog post later.

So far the conference has exceeded expectations, both in terms of presentations and the Exhibition – the latter of which I managed to get lost in. Twice.  Professor Judith Tanner delivered the EM Cottrell Lecture ‘Think, Plan, Do’, with enthusiasm, humour and passion, and her aim to motivate the audience on their journey towards improving Patient Care was surely a resounding success.

A brilliant session designed especially for those new to Infection Control and Prevention included an ‘ice-breaker’, a phrase which usually strikes fear right to my heart, but which proved to be an excellent way to meet lots of other individuals ‘new’ to the field – and discuss a range of topics that we all may face going forwards.  I met with people from industry and NHS trusts, and from international companies, all of which helped me feel less of an ‘imposter’ in my ‘PhD Student’ status.  Everyone was incredibly warm and positive towards my work, and I’ve been exchanging details left, right and centre. IPS encourages networking as a form of support for all its members, and it was wonderful that this session helped lay the foundations for many potential developments going forwards; not just for me, but right around the room you could hear people finding others who were sharing the same problems, and then swapping ideas for solutions. Excellent.

I’ve spent quite a lot of time going round the exhibition, trying to visit all the stands relating to Hand Hygiene – not sure I’ve achieved that goal yet, but fortunately there is still tomorrow.  I have a bag full of brochures, business cards and hand gel now…and some stickers for my young consultant.  He may be too young for conferences, but he must always be considered part of the research team.

Some key Hand Hygiene technology stands I’ve visited today include an innovative ‘gel-in-the-door-handle’ system, two auditing systems based on the 5 Moments – 1 which monitors gel usage and the other which allows context to be added to direct observation – and an electronic badge system which gives direct feedback via visual lights.  I’ll add more about these when I’ve more time – but it has been great to talk to people about their innovations, to discuss their views on what is important, and how they see the future in light of acknowledged limitations.  It’s fair to say no-one is yet claiming to have a silver bullet (or at least, they haven’t claimed it in earshot of me….) to the problem of Hand Hygiene Auditing, but I’ve definitely got a lot to think about this afternoon, and no doubt this evening will give me even more…..

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