Archive for July, 2013


In addition to my recent discussion of Hand Hygiene posters on display at ICPIC 2013 Jon Otter has provded a great blog overview here

Due to the hectic schedule poor Jon didn’t get to visit a single poster…so for him, and for anyone else who didn’t get a chance to visit either the Poster exhibit or ICPIC 2013 – here is my poster, discussing “Technologies to measure hand hygiene: examining the incorporation of the World Health Organisation (WHO) 5 moments“.   A link to the abstract can be found here, courtesy of an Antimicrobial Resistance and Infection Control supplement.

The poster provides an overview of Studies 1 and 2 which explored the current state of measuring Hand Hygiene within an NHS acute setting, and then the potential of technologies as an alternative or complementary method for providing measurment. Whilst Study 1 found limitations in the current process led to perceptions of “Meaningless Data”, Study 2 found current technologies failed a purpose designed “fit-for-purpose” assessment, yet may offer a facility to provide “Meaningful Data”.

ICPIC 2013 provided an interesting opportunity to share these studies with researchers, practioners and experts in the IPCT field, and the incoporation of the global WHO 5 Moments guidelines allowed a common starting point for discussion.  I was particualrly enthused to hear of the findings of the WHO’s systematic review on Electronic Surveillance, presented by Benedetta Allegranzi, which agreed that current systems do not yet have the capabilities to monitor all WHO 5 Moments, and whilst they offer benefits further research is required before a such innovations are adopted as standard.

Indulgent "Holiday Snap"!

Indulgent “Holiday Snap”!

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Ribeiro et al P118

Ribeiro et al P118

   The second theme discussed in ICPIC 2013 posters that I enjoyed pondering was that of Hand Hygiene compliance rates split by each of the WHO 5 Moments

A clear example of this can be seen in the figure from Ribero et al’s poster (P118 – left), where compliance levels in the ICU at each of the moments were measured pre- and post the study intervention.  Compliance After Patient Contact was found to have the highest rate of compliance (both pre and post intervention), followed by Before Patient Contact, then After Body Fluids Exposure Risk.  After Contact with  Patient Surrounding and Before an Aseptic Procedure had the lowest levels of compliance respectively.

These were surprising findings for me, especially the fact that Moment 5 (After Contact with Patient Surroundings) did not show the lowest levels of compliance; as I had found this Moment the one to be perceived most likely to be considered able to be “dropped” if workload/other factors also occurred, and the Moment most Healthcare Professionals in my Study (2) felt likely to be “missed”.  Also, other literature supports Moment 5 as the one with lowest levels of compliance – for example Rossini et al. (2013, in press) found M5 compliance = 22.5% compared with M1 =36.5%, M2 =54.5%, M3 =25.2% and M4 = 25.4%.  

Grayson et al (2011)

Grayson et al (2011)



Finally the figure (right) provided by Grayson et al (2011) – who also spoke at ICPIC 2013 – from the Australian National Hand Hygiene Initiative  shows Moment 5 having the lowest rate of Hand Hygiene, and a different spread of compliance over the Moments than that presented by Ribeiro et al at ICPIC.  

Ikeda et al P119

Ikeda et al P119


A further poster at ICPIC 2013, that of Ikeda et al (P119 left) caused additional confusion, with another variation of spread being seen across the 5 Moments. Here, Moment 3 was found to have the highest level of compliance, followed by Moment 4, Moment 5, Moment 2 and Moment 1.


As this is a blog post rather than a paper I’ll leave the discussion brief; but naturally variables such as context, method and sample size need to be considered when comparing findings across studies. However, for me the lack of consistency drives me forward with my next level of research, which hypothesises that there is a difference between the likelihood of Hand Hygiene dependent on the activity being performed (based on Study 3 – see preliminary results here).  My future work aims to investigate whether the 5 Moments can be “split” in a similar way, dependent on the activities each may represent, and therefore could be treated differently in terms of education and measurement opportunities. 

Based on my work to date I would have expected more consistency across emerging results employing the 5 Moments….but it is still early days. I need to wait for papers to develop based on the posters shown at ICPIC 2013, and carefully consider additional contextual factors.  It’s definitely thought provoking…I’ll give it that…

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 ICPICThere were over 400 posters on display at ICPIC 2013, and it took me almost 2 days to visit them all, spread as they were over all the floors of the CICG.

The next few blog posts will briefly review a few of these posters, the ones which struck a chord with me in terms of how they related to my current work (dissertation), and perhaps how they may offer direction/influence my future plans. As such they are predominantly on the topic of Hand Hygiene (no surprise!), with the first two looking at education  – to be followed next by a discussion of the WHO 5 Moments for Hand Hygiene.


Kaur et al – Poster 143; Poster 145

Kaur et al #1

Kaur et al P143

– Key findings of interest –

Their finding ties in with an emergent theme in my own work, and one which I am hoping to develop further in my future work.

I call it the “Buckaroo Hypothesis”, which in brief suggests that the topic of Hand Hygiene education needs further review to avoid Healthcare Professionals rejecting it as a concept that needs teaching. Responses from interviews from my research included classic phrases such as “…of course I’d wash my hands when I’ve got blood on them and stuff”.  The idea that education or prompting may be required was not always perceived positively.

My work involves the investigation of behavioural aspects of Hand Hygiene – Inherent and Elective components – which appear to affect the likelihood of Hand Hygiene occurring.  Understanding that some Hand Hygiene maybe more “automatic” than others may prove a gateway to discussing Hand Hygiene in a way that is more engaging to both medical students and other Healthcare Professionals.  Inherent and Elective Hand Hygiene is the basis of my 3rd Study, and you can find out more information here.

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So now I’m back….

Back, unpacked, photos uploaded, a huge stack of papers, notes and handouts sitting next to me – where do I start?!

My aim today is to try to sift through all the scrawled and typed ‘notes-to-self’ that I made during the conference and decide if I agree with my initial views on what would be relevant for my current work (dissertation), what would be good for my current planned future work, and what needs further investigation before I can make any decision. 

Tweeting was a great was to make ‘notes-to-self’ (thanks Jon Otter for that gem), and where that failed the trusty pen-and-paper helped – you cannot (yet!) draw a diagram on Twitter! 

I plan to blog later on some of my key thoughts re: ICPIC, with some photos – for now I have to strike whilst the tea is hot – otherwise this paper pile may swamp me before I get anywhere….

Post-Conference Paperwork

Post-Conference Paperwork

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