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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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Putting pen to paper, finger to key....

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

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….

ICPIC

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

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The past few weeks since finishing data collection have been spent going back over my thesis outline, working out what can be “written up without delay”, what “needs more work”, and what I would ideally like to put in a big box called “never look at again”….

Image from dreamstime.com

Safety deposit box for Dissertation Issues….(Image from dreamstime.com)

Naturally it is that third category that contains rather a lot of the “meat” of the dissertation at the moment, and it takes a lot of self-discipline to ensure that each of the “issues” are logged, so that I can plan to tackle them as I write-up, even if it is not something I can do all at once.  Fortunately I have been able to call on some great sources of assistance so far to help me with each “issue” I have plucked from the box, and therefore I am hoping that over the next few months the balance of what can be “written up without delay and what I’d like to “never look at again” will swing…but one thing is for sure, the whole thesis “needs a lot more work”.

What I have found really useful though, is the use of copious “pictures” to help me translate both my ideas and actions into formats that are easier to communicate – I am now forever drawing process flow diagrams of some kind, showing how my thoughts are flowing, what actions I carried out, and why certain processes were carried out in particular orders.  Whilst these started out as being tools to help me avoid “head-pop“, I have now found that they may well be jolly useful to include in the finished written dissertation, to help the examiner avoid the same fate, and to save the legendary 1,000 words

Learning - Risky Times (Image from ninapaley.com)

Learning – Risky Times (Image from ninapaley.com)

The “head-pop” issue has actually been a serious one this past week, as I’ve succumbed to 2 migraines – which as previously noted are not the best news.  Having to cancel hard to arrange meetings is never a good thing, nor is the time lost to feeling like you’ve just run a marathon. And that’s an analogy I can just about work with these days – except with a migraine you miss out on the shiny medal and cake rewards.  Still, fingers crossed it has just been a blip, and happily I managed to proceed with a re-arranged meeting, during which I learnt some fascinating new information which will help underpin a major theme in my discussion section, and plans for future Post-Doc work.  Well worth the snowy walk up to Warwick Medical School!

I also had a fantastic discussion re: my plans for Post-Doc work, which has really helped clarify the direction I want my research to go in, as well as help motivate me to keep up the pressure to get a thesis draft produced sooner rather than later.  More details on this further down the line, suffice to say Hand Hygiene remains close to my heart!

Icing on the Cake - going literal...

Icing on the Cake – going literal…

Outside the thesis write-up the past few weeks have seen me once again having some great help and advice from Claire Kilpatrick who gave some really useful feedback and encouragement on my ICPIC abstract draft.  ICPIC promises to be an amazing event, with some of the leading experts in the Infection Prevention field coming together, and I am keeping everything crossed that I will be able to attend; being able to take contribute my research in some capacity would only be the icing on the cake.

 

 

And finally, exciting times tomorrow on the Hand Hygiene and Technology front….will post soon…..

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hurdlesSo last week I managed to finish collecting the in-situ data for Study 3 which explores the link between Human Behaviour and Hand Hygiene – and has been a great opportunity to learn more about the day-to-day reality of life on an NHS Acute ward, which really brings context to the other elements of my work, about auditing, technology and Hand Hygiene compliance.

I now have no more data to formally collect, which is a strange feeling, as there are actually so many more questions to ask – however I am at the stage of the PhD process where discipline has to step in, and the doors have to close on further investigation in the interests of ensuring the thesis is written, conclusions are drawn, and a line is drawn in the sand. BUT THEN….then the future research can be planned! 

And that is where March comes in – as I have a number of exciting meetings set up then, to help guide the potential future threads which are starting to spin out of my thesis already and into the wider Infection Prevention community.  Will be great to talk about what has happened so far, to hear what other people have been up to, and to discuss what could happen next. There is so much still left to do in this field, but continued collaboration is of paramount importance to ensure we build on what has gone before, and prevent re-inventing the wheel. Things look bright…

For now, I have my thesis writing motivation plan – the day it is handed in, I am getting an entire cake to eat. Oh yes. You heard right. Because deep down, we all want to be Mary Berry when we grow up don’t we?

cakes

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Today pages of notes swirl in my head like autumn leaves

 

Just a quick post whilst I let my head work out what to do with the pages of notes I’ve amassed whilst working on the structure of my PhD Dissertation ‘Background’ chapter….  I decided thinking about something else may allow it time to settle before I start adding in the next layer…

One of the key themes of my research is the potential for technology within the field of Healthcare Hand Hygiene, primarily to aid accurate monitoring, measurement and feedback – but through researching for such examples, all kinds of innovations have surfaced.  My interest lies in how these technologies are perceived by the Healthcare Professionals themselves, from a ‘fit for purpose’ aspect, and also how they may inspire different types of innovations or interventions themselves.  Thus, for a start, whilst examples shown to some participants in my research were judged not to be ‘fit for purpose’ they did inspire great discussion about how Hand Hygiene could be improved through better education, using a combination of technology and training.  The technology itself was seen as a tool for something entirely different from it was being marketed, yet the end goal – improving Hand Hygiene – may be the same.  A great example of the importance of the context, and allowing a wide range of thinking prior to implementing innovations.  sometimes, perhaps, it may be better to ignore what it says on the tin….

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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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  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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