#ICPIC2013 – #HandHygiene and #Technology

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”!

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#ICPIC2013 Posters – What did they say about #HandHygiene? (Part 2)

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)

 

 

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

 

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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#ICPIC2013 Posters – What did they say about #HandHygiene? (Part 1)

 There 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 P143

– Key findings of interest –

• Medical students do not see Hand Hygiene as an important topic, seeing it as a boring topic to learn, and feeling it condescending to be told if they are not doing it correctly.

• Medical educational experts believe students would benefit from more Hand Hygiene training but are unsure whether it should be taught in hospitals during clinical training, and believe students rate such training lower than other core medical concepts.

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 3^rd Study, and you can find out more information here.

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And so we’re off! #ICPIC2013

ICPIC2013 i-Spy is on!!

Just back from the Opening Ceremony of ICPIC2013 and already I feel I’ve got my “money’s worth” – Pittet, Voss, Seto, Kilpatrick, Kiernan…my ICPIC2013 “i-spy” book is off to a great start, and to be honest, I wasn’t even trying today..!!

There were some great talks this evening, covering topics including SARS and Patient Safety, and the feel in the room was one of anticipation mixed with excitement, I am sure I am not the only one who is looking forward to some great sessions and discussions over the next few days…and the packed programme promises to deliver just that. 

A few of the figures bounced around earlier in the session demonstrated the scope of this event; over 900 delegates, 89 nations represented, 97 oral presentations and 427 posters to compliment…  

I will start my ICPIC2013 experience fully tomorrow, and what better way than with a Hand Hygiene session, chaired by none other than Claire Kilpatrick.  I know.  Amazing.  Hope to Tweet, unlike this evening when I think there may have been a location-based-technical issue…will try a “closer-to-the-edge” strategy tomorrow!!

 

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ICPIC 2013 – Ready to go!

Almost ready to go to Geneva to take part in ICPIC 2013, and am very excited; both to have to opportunity to take my research to such an event, and because the programme is absolutely packed with Hand Hygiene related topics (amongst many other IPC issues!).

Abstracts were released last week – and make perfect reading to prime the appetite – my poster is P155…and I’ll add a copy here post-conference….

Hope to blog from Switzerland…and plan to Tweet lots!

 

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Exciting Times are here – Case Study Results in, and ICPIC 2013!

Putting pen to paper, finger to key….

The past month has been all about the writing…although that includes a lot of reading, re-reading, editing, re-writing and, perhaps oddly, drawing too.  However, progress is undoubtedly being made, and I now have some really thick stacks of paper which have a very strong resemblance to ‘chapters’; you don’t even need to look at them in too much of a funny way or anything!

I have been concentrating on writing up my empirical studies which formed the mixed methods case study I am using as the basis for my PhD research.  This case study has been carried out at a large NHS hospital, with great support from Healthcare Professionals participating in and facilitating the research.  Participants from all identified areas of the audit process were included in interviews and observations, to explore the research question:

What is the importance of Domain Knowledge and Human Behaviour for successful Quality Audit Processes and (associated) Technology Development?

Study Summaries

Research Question and 3 studies

• Study 1 addressed the current state of measurement for Hand Hygiene within the case study site, producing a map of the process helping to identify key burdens from the perceptions of those involved in generating and receiving the data. Feedback was highlighted as a key factor requiring further attention, current weaknesses leading to the conclusion from participants that audit output was seen as “meaningless data“.
• Study 2 investigated the potential of current technologies developed/promoted to aid Hand Hygiene auditing, questioning their ‘Fit-For-Purpose’ using the WHO 5 Moments as benchmark, and discussing examples of such innovations with current Healthcare Professionals.  Whilst some technologies were found to be able to detect Hand Hygiene activity at WHO Moments 1, 4 and 5, no technologies could detect such activity at Moments 2 and 3.  This fact, alongside issues of anonymity, feelings of “Big Brother” and accuracy led to concerns for the Healthcare Professionals as to the usability of technologies – however they were interested in their potential to provide meaningful data about their performance, especially at Moments 1, 4 and 5, which they recognised from their training.
• Study 3 applied an existing Hand Hygiene behavioural theory – Inherent and Elective Hand Hygiene – to a NHS setting, piloting a new method for both identifying activities classified as “Inherent” or “Elective”, then comparing whether Hand Hygiene in either classification was greater.  This led on from Study 2, where Healthcare Professionals noted that they felt technology to ‘prompt’ Hand Hygiene at activities related to Moments 2 and 3 (e.g. taking a blood sample, removing a urinary catheter) would be unnecessary as they would “always wash their hands if there were bodily fluids involved”.  The study found that, at the setting studied, Hand hygiene was indeed significantly more likely at Inherent activities than Elective activities.

Now I get the very exciting opportunity to take the details of two of these studies (1 and 2) and share them with some of the leading experts within the field of Infection Prevention, as I have been fortunate enough to get a place at ICPIC 2013 in Geneva.  I hope to Tweet as much as possible, and if time allows I will write a quick blog whilst I am out there; if not then I am sure I will have plenty to say about it all once I am back. Even reading (and highlighting!!) the conference programme this afternoon has caused my excitement levels to rise dramatically….

(NB: Will be back to the dissertation writing July 2nd….promise!)

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Checking In….

When I last blogged, way back in mid-April I was in need of a holiday, and was experiencing a mixed bag of events, although on the whole things were turning more positive, with enjoyable times being had with both Women In Science (#WISAnEveningWith) and the #GetStoolSmart campaign at UHCW.

So what has happened since?

Well, I managed to get away on the eagerly anticipated holiday! As with all such things, it seems a very long time ago now, but it was a wonderful break, and a great opportunity to spend some time outdoors (in all elements…!).  This isn’t a “Postcard From…” blog, but honourable mentions must go to (Dyfi Osprey Project, Welsh Cakes, MOMA Wales, Cadair Idris, and A Nets Catch).  Whilst I cannot say that I switched off from work completely (probably never possible for anyone), it was certainly much more pleasurable to be going through my presentations (Doctoral/IPS)  in my head whilst faced with scenery like this…

Doctoral Work – Getting it “Out There”

I hit the ground running when I got back from holiday, with the WMG Doctoral Conference (Healthcare) on the 29^th April, a positive chance to not only share my PhD progress with peers and WMG, but also to catch up with what other Doctoral students have been up to in the last 12 months. A PhD can be an isolating experience, especially when (like me) you are researching something “different” so spend most of your time working independently – so events like this are a welcome chance to gain feedback both professionally and personally. Fortunately the presentation seemed to be well received, and discussions over lunch were all positive, with great use of the word ‘rigour’…always a good thing to hear about your work when you’ve reached the ‘only writing up now’ stage I think…!

The 9^th May saw a second opportunity to share my work, this time as an Invited Speaker at the IPS Ambulance Forum and Audit and Surveillance Forum Conference (“Every Bug Counts!)” in Birmingham.  This was my first IPS meeting (outside of presenting my Poster at IPS 2012 last year), and I was absolutely blown away by the welcoming, supportive and truly friendly atmosphere; could not have been a more positive experience. Speaking after the ‘event’ that is Martin Kiernan, and with IPS President (not to mention Hand Hygiene legend!) Julie Storr mere meters away I think the word nervous barely covers it, but the excitement of being able to talk about my work, and knowing I was (in a way) representing the brilliant participants at my case study site helped me focus. And I think I got away with it…

Finally, I also found out I’ve been accepted to present my Poster summarising Studies 1 and 2 at ICPIC 2013 in Geneva at the end of June. Excited?  I believe I may have jumped a bit when I read the email. Fortunately I wasn’t in public…  Anyhow, bearing in mind the sheer scale of ICPIC 2013 with the speaker list looking like it has been copied right from my thesis reference section, I think a small amount of bouncing is allowed.

Hand Hygiene – Impressive NHS Activity

Some amazing ideas!

Also since I last blogged I also had a wonderful invite from the team at UHCW to come and judge their exciting Hand Hygiene poster competition, which involved both local primary school children and in-patients, all tasked with getting the vital “Hand Hygiene” message over.  These posters were displayed in the main entrance area of the hospital for over a week, generating much interest from Public and Staff alike, showing the worth of such apparently simple innovations.  Even some of the parents of the children came to see the handiwork of their offspring, and you could see the pride clearly – and also, interestingly, comments like “Oh yes, they’ve been on and on about when we should be washing our hands at home now…”. 

Baked Goodness for all!

Not just your standard poster competition then…!The judging panel found picking winners in each of the age categories nearly impossible, because each child seemed to have managed to put their own unique spin on the challenge, some going with the ‘Big and Bold’ strategy, others using ‘Devil in the Detail’, whilst others were just amazingly beautiful and colourful.  Naturally, we needed cake to help us with our discussions, and fortunately the IPCT office is a haven for such baked goodness….

In the end the winners reflect a real mixture, and the overall winner will be on display at UHCW soon – contact UHCW IPCT for more information.

Global Hand Hygiene Day – My Challenge

In preparation for May 5^th – Global Hand Hygiene Day – Professor Didier Pittet Tweeted a call asking what everyone would personally be doing to mark the event…which made me think about what I could do, specifically, on that date.  I decided, as my main activity in the sphere on Hand Hygiene at the moment is research, to set myself the target of trying to submit my first academic paper to a journal for review on May 5^th.  I chose the Journal of Infection Prevention (JIP), as it is the Journal of the Infection Prevention Society (IPS) who I have found an invaluable source of inspiration, information and support, and I felt that my research may be best suited to their audience at this stage.  Having contacted the Editor (the wonderful Dr Neil Wigglesworth, who I’d met briefly at IFIC 2012) and received a virtually immediate response to confirm that the topic would be fitting for JIP, I knuckled down and (with my co-author!!) managed to get this paper to a format suitable for submission…thus it found itself winging its way off to the reviewers on the 5^th May precisely.   Time will tell as to what feedback is returned, but we’re just looking forward to hearing what ‘outside eyes’ think of the topic, so we can take it from there. Don’t worry, I’ll keep you posted…

General PhD Progress

From a writing-up point of view progress is still being made; albeit a ‘non-linear, backwards/forwards, apparently quite normal’ PhD type way. I think it is best illustrated by the medium of cakes consumed recently, each representing either a breakthrough or breakdown in writing progress….

Fuel for IPS Talk run through…

The PG Hub turned 1!

Celebrating breakthrough in Study 1 writing

Dark times…not always bad…

Part of the PG Hub “Dissertation Station” season

Cake selection for Happy Monday!

And the eagle-eyed amongst you, if you haven’t been distracted by all that cake, may have spotted actual pages of thesis hidden in amongst those snap shots. Proof that amongst all those sugar hits, words are emerging….there’s even talk of “sense” and “logic”… But let’s not get too carried away yet…

Back to writing for today now – revisiting my Literature Review section at the moment to add-in a section on Effective Hand Hygiene, covering Soap and Water, ABHR, Technique and, of course, the 5 Moments…

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