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Posts Tagged ‘Study 3’

ips 2013So I am back ready to work on my thesis today, but I have to admit that half my screen in taken up with Twitter feed…. Usually I am much more disciplined, trying to ensure that I “schedule” Twitter sessions in to my day – but I am making allowances for today/tomorrow so I can keep up with the exciting proceedings still going on at Infection Prevention 2013 (#IP2013).

Impressions of #IP2013

I was, again, overwhelmed by the amazing blend of scale and intimacy of this event, which first struck me last year in Liverpool.  At #IP2012 I was experiencing everything for the first time, including the whole concept of a “full conference”.  My only previous conference experience was the HPA conference, which was held at my own research institution (University of Warwick), therefore had not given me the same immersion opportunity as #IP2012.  So I wasn’t sure how this year’s event would feel – would it have lost some of its charm? Also, this year I had been accepted for oral presentation, giving me another new experience, but also an additional layer of nerves…

Happily #IP2013 more than fulfilled my expectations – from the moment I arrived I found I was rapidly taking notes, excitedly making links to my own work and seeing parallels I could draw between other people’s experiences and my future plans.

ConferenceI love that about conference. The sudden immersion into an environment where everyone shares a common sense of purpose, can understand experiences, and can debate ideas.  As I have – from an academic point of view – been working alone for the past four years, such opportunities are very welcome. 

It was also hugely exciting and a source of great pride to see how many of the key concepts highlighted by the experts in the morning session (more of which later) were reflected in work already been carried out by my IPC heroes.  They really are superstars, and it’s wonderful to know they’re getting to share some of that work at #IP2013 too.

Personal Highlights

As well as sharing my work on Study 3, which explored behavioural drivers to hand hygiene, I also had the opportunity to meet and hear from some leading experts in Infection Prevention.  Here are just a few highlights…

Professor Dale Fisher – offered really useful information about experience in successfully achieving organisational “buy-in”.  Very closely linked to my work and subsequent thoughts on “Meaningful Data”, and thought it was particularly useful to connect with the work of Human Factors (Ergonomics).  Definitely areas to follow up…

Dr Michael Gardam – presented the concept of Front Line Ownership (FLO) as part of a complexity science approach, with the message that solutions to problems may be very context specific. What works for one unit/team/setting may not work for another…  I’m interested in linking this to “Domain Knowledge”, which is a key theme throughout my thesis, so really pleased to see that evidence of successful practice using the FLO approach.

Professor Hugo Sax – provided a clear, logical background for why hand hygiene is vital, with particular emphasis on the role of endogenous infection, something I have discussed, but would like to look at in more depth.  I was particularly interested in the human factors approach, and thought the examples of innovations where error had seemingly been “designed in” through a failure to realise what was intuitive, were very persuasive.  Within hand hygiene I agree that understanding what is intuitive and what requires explicit learning would be of great benefit when designing interventions.

Martin Kiernan – delivering the EM Cottrell Lecture was a clear highlight, not just for me but for the audience as a whole.  Entertaining yet highly informative, “The life and times of the urinary catheter” was a talk spanning 2,000 years, examining (scant!) evidence, demanding action and research, and ending with a self-penned poem.  I don’t think you can ask any more of a speaker can you…except maybe a dance?  Roll on #IP2014…

Finally I also got to meet Pat Cattini and Jon Otter, both of whom made my day possible, and also helped ease my presentation nerves by being wonderfully welcoming, supportive and friendly.  I’m not sure I could have made it to the podium without their reassuring presence in the front row, and it was a fantastic example of the inclusive environment I appreciate from IPS.  Needless to say Jon then gave a flawless and superb talk on targeted MRSA screening – a presentation master class thrown in for free!  I also found out that Pat has an MSc which explored hand hygiene auditing, that she’s familiar with the key papers I’ve based Study 3 on, and that she’s involved in hand hygiene technology trials. In other words, she is my new superhero.

Now, back to the thesis………..the first step on my journey into Infection Prevention!

writing

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whirlwindThe 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!

ips 2013

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ReturnedSo it’s been almost 2 months since my last blog post….

I seem to start a lot of my posts with a comment on how long it has been since I last wrote, but apparently, when you’re writing up a thesis (or doing any kind of intensive project) it is expected that the odd MIA will occur, and I have been reassured that apologies are not necessary….  Still, I have to admit that I have felt rather frustrated at myself for lack of blogging – having had rather a lot to blog about!

That’s where Twitter is such a great tool, those 140 characters have helped me feel in sight of the loop, if not entirely in it over the course of the summer.

Well, what have I been up to?

The Summer List

Resorting to a list seems to be the only sensible course of action here, for everyone:Thesis

  • Working on the thesis – a given, but happily progress has been rapid (give or take a few moments of horror) and I am well on course to submit by Christmas.

 

  • I’ve been accepted to present my work on Study 3 at IPS 2013, the annual conference of the Infection Prevention Society.  I’m really excited about this, as the work on Inherent and Elective hand hygiene has proven really interesting to discuss with those from the field of infection prevention. The study represents the first (as I am aware) work of its kind within the NHS, so will be great to get some feedback now that the results are in. Just waiting on funding news before I can make final plans…

 

  • WHO 5 Moments Spent a great day with the wonderfully bubbly team over at UHCW who hosted hand hygiene heroes Julie Storr and Claire Kilpatrick for a day focussing on the WHO 5 Moments, looking at system and behavioural change.  Absolutely fascinating topics covered, and great to see the involvement of lots of healthcare professionals from a range of clinical settings, engaging in discussions and scenarios designed to help translate the 5 Moments into real-life Patient care. I certainly left the day with a greater level of clarity regarding the concept, and I am sure I wasn’t the only one.

 

  • Outside hand hygiene I’ve also been spending time with the lovely Women in Science committee as we prepare for our symposium on the 26th September.  The event is entitled “WIS A Day With” and follows on from the successful event earlier this year, “WIS An Evening With”, which saw two highly regarded speakers share their experiences of a career in the field of science.  WIS A Day With features 4 speakers who will also share their career stories, along with sessions run by complimentary organisations looking to support career development. And, of course, there will be the popular wine and cheese event to finish.

Migraine

  • And as it’s Migraine Awareness Week it’s fair to say I’ve been doing a bit of that (right) too. I’ve posted about this once before, but I thought I’d mention it again briefly in this post after reading and discussing the condition a lot this week. Key words I noticed featuring heavily in discussions were ‘debilitating’, ‘underestimated’, ‘impact’ and, naturally, ‘pain’.  I’d also throw ‘unpredicatable’ and ‘exhausting’ into the mix, not to mention the effect on those around you.

 

  • But on a brighter note, and what could be better – the Bake Off is back…!  That should take me nicely through until submission. Great timing from The Berry.

 

To celebrate the work with Women In Science, and just because it is rather special in itself, I shall finish this update with this rather glorious picture from Lego:

First female scientist figure by Lego

First female scientist figure by Lego

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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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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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clockTime has flown by over the past few weeks, so to briefly update you…..

Study 3

I have been spending rather a lot of time loitering on the Ward carrying out my in-situ observations for Study 3, looking at Hand Hygiene and Behaviour. Trying (and failing!) not to get in the way/be mistaken for a Doctor/freak the staff out has been rather entertaining, but mainly I have been collecting some great data for my study, and all being well I should complete this final phase early next week, then move onto the analysis straight away.  Really looking forward to seeing whether the data matches my original hypothesis….will keep you posted on that one!

twitterTwitter

Had a great surprise this week when my IPCT heroes launched their Twitter account, to coincide with a big Valentine’s Day activity they had planned to mark their #GetStoolSmart campaign. So great to be able to keep in touch with the work they are doing, and from the photos they posted during the day it looks like they spread a lot of smiles as well as vital information during their rounds…you can check them out here.

Thesis

Have been filling my non-observation time with writing up my thesis (submission date races ever closer…) and have now officially got 1 Chapter draft reviewed (we’re ok, mainly positive!), and have swapped it for half of another Chapter. I have to try to get the other half-finished by 6th March now, so it’s very much head down and write as much as I can…this week it’s been all about Methods for Measuring Hand Hygiene Compliance.  I jump around a lot (in writing, not physically, that’d be somewhat self-defeating to the deadline target…) though, so it’s hard to try to concentrate on one topic – as concurrently I am reviewing some Hand Hygiene technologies for a later section/paper…however need to just concentrate on getting one thing finished, rather than constantly having too many unfinished bits on the go. So self-discipline is the watchword for next week…

Conferences

Also on the approach for next week is my abstract draft for ICPIC 2013. Really hope to make it to Geneva in June, fingers crossed I can pull it all together – have 2 main topics to decide between, so that’s in the diary for next week. Oh, and then writing the abstract!

Off for more observations this afternoon, then a weekend of (hopefully) sunshine, another short run as I continue my uphill return from injury, and some epic baking. Because there is always a good reason for cake….

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This week has been a true representation of how varied a PhD experience can be, especially one like mine which has a number of different threads  being (carefully…) woven together.  The brief overview of my schedule below should give some insight into how all the topics within my research are currently being explored in parallel, turning me into something akin to a plate-spinner….plates

Monday: (Snow Day) Chapter writing for Thesis on the topic of Hand Hygiene Compliance; Factors Affecting Compliance (especially Intensity  of Patient Care, Ward Context and Patient Type) and Issues of Measurement of Hand Hygiene Compliance (which links with the work for my Study 1, which explores how Hand Hygiene is Audited at an NHS Acute Trust).

Tuesday: (Rescheduled from in-situ study day), instead Paper writing on the topic of Electronic Monitoring Technologies and Hand Hygiene, discussing  their Fit-For-Purpose rating according to established guidelines. This links in with the work for my Study 2, which explores the potential for Technology within the Audit Process at an NHS Acute Trust. Also had good Twitterchat and received support (and Thesis!) from great source of knowledge in Infection Prevention – Microbiology expert Jon Otter.

Wednesday: Very interesting meeting with Engineering company to hear all about Hand Hygiene system which can provide data to Healthcare Professionals about their Hand Hygiene compliance against scientifically sound ‘benchmarks’ (expected compliance rates) based on WHO 5 Moments. So much potential to explore….  Also an opportunity for exciting, motivating and woefully short catch-up with Claire Kilpatrick,  already working on outputs from that session!

Thursday: (Today) Back to collecting data in-situ for Study 3, looking at the effect of Human Behaviour on Hand Hygiene, and then back to writing the Thesis Chapter draft…

Tomorrow I shall be collecting more data, and then next week I am attending a networking event at my University, aiming to bring together Health Research from all departments and schools. Health @ Warwick3should be an interesting and vibrant day, and I am looking forward to sharing my “Why Do You Wash You Hands” poster from IFIC, to give a flavour of the work I have been doing over the past 3 or so years.  I’ll probably Tweet from the day, so if you’re there/interested, make sure you keep an eye out for @CHD05!

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So it snowed…..!!

Yes, a few days into my Observational Study investigating the effect of Human Behaviour on Hand Hygiene (see here for more details) and it snowed.

And not just a dusting – for those of you out of the Country and thus perhaps oblivious to the recent wall-to-wall media coverage of the weather (including an impromptu BBC News Special on Friday…), there was more than enough snow this time to cause the usual mixture of traffic chaos, school closures, snowball frenzies and high-speed sledging. Plus the annual addition of ‘treacherous’ into every headline.

For me, this snow resulted in 2 key things. 

Firstly, the weekend was thus filled with some epic outdoor activities, with the snow on both Friday and Sunday making everywhere very still and beautiful, especially for a warming walk along the local canal on Sunday morning….

Photo1154

Secondly, after more snow overnight, it meant that today (Monday) I had to ‘pause’ collecting data until later in the week – as the cars here….they were going nowhere!  An optimistic first attempt at movement early this morning was abandoned, which was probably for the best bearing in mind reports overnight of blocked roads surrounding our area – however not to be defeated a pre-lunchtime walk to the shop has resulted in the purchase of a Snow Shovel….   Granted the snow has had one last bite back, and the handle is now snapped in half…but the cars can now be seen properly, and later today the test of the snow/ice/slope/traction will commence.  Research will always occur, despite of the conditions….

Car

Help digging my car out….

Car 2

White car in snow….

 

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Yesterday, 10th January, I passed a big landmark in my research, when I finished the final stage of the interview transcriptions for Study 1 and 2.  It feels great!

This process has involved a number of stages, initial recordings of the first wave of interviews, which were then transcribed verbatim to form a Coding Schedule, and then further cycles of new interviews being recorded and transcribed, new themes being discovered, further interviews, further transcriptions, and then revisiting the earlier scripts to re-code based on new emergent themes.  Yesterday I added the final 2 interviews to the ‘pool’, and so can now begin the final full sweep of analysis, using both the initial Deductive and then emergent Inductive Coding Schedules which have been developed as the research has evolved – and I have to say it is very exciting… 

Having personally conducted and transcribed all 18 Interview sessions (including 3 group interview sessions), I feel like I ‘know’ the data well, however it will be good to see it as a whole, to see which themes emerge as ‘strong’ across more Participants, and which appear to come from individuals, and of course, to see if there is a difference based on which area the Participants come from.

I start Study 3 next week, which is partially based on the existing major themes to have emerged from the earlier analysis of this data, so it will be very useful to have it so fresh in my mind when I am back on the wards come Tuesday….

Will keep you posted – and full results will be available by June 2013 – submission time!!!

Getting there...!

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page

So this is 2013.  The year I will submit my PhD.

7 words that are rather easy to write. It’s the other 70,000 that make up the dissertation that pose the tricky bit….   Over Christmas and New Year, in between the standard giving, receiving, eating and being merry, and not-so-standard but absolute top quality use of NHS services, I had the big old think about what to do next as discussed previously – and came down hard on the side of carrying the research forward.  Always the decision in my heart, it was just the head that needed the additional encouragement, knowing how hard it can be to get research funding and positions, however well-intentioned, planned and necessary future research may be.  Yet despite all this, I decided that I want to try. I have to try. I need to try.  I have had so much interest and encouragement in this topic, from both those working in the field, and those who experience Healthcare from the ‘other side’, that it seems a waste not to try to take it forwards, to see just what we could do next.

So I emailed (a very, very long email….) my champion Claire (Kilpatrick) – Infection Prevention and Hand Hygiene Legend – on Christmas Eve, as you do, and received the most wonderful and encouraging email back within days, which has swept me through the first dark week of January, and literally dragged me out of bed and back to the computer. I have so many future plans, but need the discipline to write-up this work before I can go any further, and that is where the encouragement of others comes in. And it’s brilliant!  Hopefully I will be able to meet up with Claire soon and chat over some ideas, but before that I have promised (to myself) that I will commit another few thousand words to draft, and produce the article abstract which has been haunting me for about a month now. PLAN!

I also had a great email of encouragement from NursingTimes, after contacting them re: writing an article for them about the work we’ve been doing at my Case Study Site. I think it would be great to share this with the Nursing Community, and they’ve been really supportive, and also added that Hand Hygiene will be a topic they want to look at a lot this year – which is great for everyone. Another nod of encouragement!  I must also add a note to a great IPC Healthcare Professional@Mimsiebel at this point who always gives me lots of motivation for my work via Twitter, and has added her voice to the encouragement for an NT article – thank you!

Finally I also have a meeting with the Chief Nurse at the Case Study site later this month to update him on my research, and explore potential areas for future work. As a fellow academic as well as clinical expert I am very much looking forward to gaining insight from both ‘sides’ of his expertise, and am really excited to hear his views on ideas for ways in which we could translate this research into practical, measurable, and Patient Safety conscious practice.

The plan, therefore, is now to write this week – and then start the practical aspect of Study 3 on-site next week – which I will blog about once it is up and running. Got an email through about IFIC applications at the back-end of last week too, and that has given me a massive boost of encouragement….definitely, definitely want to be presenting my work in Buenos Aires in October!

IFIC

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