#IP2013 eve…!

The last week has been a complete whirlwind, culminating in an early start tomorrow so I can share my work on Inherent and Elective hand hygiene (Study 3).

Having had my abstract for Infection Prevention 2013 accepted back in July, my planned funding was then delayed which meant I was left with no choice but to sadly pull out of the programme with only a few weeks to go. This was such a disappointment, as I had been really looking forward to Infection Prevention, having got so much out of the conference in Liverpool last year.  However, due to some amazing help from IPS (especially Claire Kilpatrick, Jon Otter and Pat Cattini) within hours of letting them know the news last Monday, I was offered funding support meaning I can join the event tomorrow (30th September). 

Really looking forward to sharing my work, and giving experts in the field the opportunity to comment/get in touch with regard to my plans for future developments!! 

Also have a HUGE sense of excitement building about the chance to hear from Hugo Sax again tomorrow. I was totally blown away by hearing him speak at ICPIC2013, so I’m sure tomorrow’s session will be worth the anticipation.  The programme is bursting with other gems, and I’m particularly looking forward to the EM Cottrell Lecture, given by Martin Kiernan.  Based on previous experience I’m sure this will be entertaining as well as informative…

Will be tweeting as much as possible, but with only one day at the conference, a huge exhibition, lots of posters I want to see, public transport to master, not to mention some #PoshMuffinsonTour to track down, I can’t be sure how much will be done…  Expect a blog in the next few days to wrap up thoughts!

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‘Potentially’ interesting

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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Stuck for Stats….

Since my last post two things have happened.

Firstly, I am feeling lots better, so quarantine is being lifted and the plan to go to IPS 2012 is still on – Happy Times!

Secondly, my further readings and discussions surrounding the use of the Cochran Q test proved it was unsuitable for what I wanted to do. This is most definitely not good….  All is not lost, and I can still go forward with Study 3, but can only confidently investigate my first Hypothesis regarding Inherent and Elective Trigger activities – what I cannot plan to do is look into the effect of these triggers over time. In other words, how variable people’s Hand Hygiene behaviour is when reacting to these triggers when measured at different opportunities – do the same people always react to the same Inherent Triggers the same way?  Try as we might we cannot find a statistical analysis model that will allow for binary data using a within-subjects design over some element of ‘longitudinal’ measurement.

Off to Liverpool…!
If only my number puzzles were still this simple….

 

So, what I am really hoping will happen now is that I can head to IPS 2012, and find inspiration amongst all the promising talk and poster presenters; who knows what kind of study designers may be Liverpool-bound, just desperate for a new study-puzzle to pour over….?

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Study Design – Deciding what is possible….

Currently I am practicing good Infection Control and am in quarantine – which has thrown a spanner in the works with regard to my active research at UHCW, but on the positive has given me time to work on planning my next phase of work.

Following the emerging themes produced from Study 1 and 2 (including interviews with Healthcare Professionals) the design for Study 3 has had to change.  It is no longer feasible to carry out the Inherent/Elective categorisation task as originally planned, as there is too much ‘noise’ around the concepts of Hand Hygiene triggers such as “Patient Contact” and “Contaminated Items”.  Therefore, instead of using existing audit data for a retrospective analysis, the new design involves an in-situ observational study collecting fresh Hand Hygiene data relating to specific activities deemed “Inherent” or “Elective” by current Healthcare Professionals.

From a conceptual point of view, this seems simple.  Indeed, when discussing the idea with others the idea – to see whether people perform Hand Hygiene more at certain points than others, and then whether this behaviour is stable – seems both clear and interesting; however when delving slightly deeper, the actual quantitative analysis required to investigate this theory appears much more complex.  Issues such as the use of binary (dichotomous) data, and a within-subjects design, makes the study actually quite abnormal.   However, after much design/re-design and discussions with some great sources of help, I think we may be getting close to a solution.  Today I thus have to just confirm that  the McNemar and Cochran Q are potentially solutions, and then I can firm up the design…

Whilst statistics are difficult in such cases, as has been said to me recently, the good part is once you have found the correct design, the actual carrying out is relatively simple. I cannot say how much I am looking forward to that part…!  The redesign of Study 3 has really shown how hard it can be to decide what is possible in research – having to compromise what you find interesting with what is possible to quantify or work into a design.  Patience, logic and the understanding that future work is always an option.  Lessons learnt…!

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