Should automated electronic hand-hygiene monitoring systems be implemented in routine patient care? Systematic review and appraisal with Medical Research Council Framework for Complex Interventions.

Manual hand-hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand-hygiene monitoring systems (AHHMSs) offer advantages (generation of standardized data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. The objective of this review was to assess the current state of the literature for AHHMSs and offer recommendations for use in real-world settings. This was a systematic literature review, and publications included were from the time that PubMed commenced until 19th November 2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorized as intervention development studies. Thirty-nine were evaluations. Two described implementation in real-world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance in the short term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMS was in use. Health workers' opinions about AHHMSs were mixed. In conclusion, at present too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The Medical Research Council Framework could be used to categorize other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.

What techniques are recommended to undertake procedures that require asepsis? Content and cluster analysis of information supplied in international guidance.

BACKGROUND: Health professionals frequently conduct procedures requiring asepsis but there is no definitive evidence-based guidance on how aseptic technique should be undertaken. OBJECTIVE: To undertake content and cluster analysis to compare and contrast information relating to the conduct of aseptic technique in national and international guidance. METHODS: Content and hierarchical cluster analysis. RESULTS: We identified 16 sources of information from: organizations that generate infection prevention guidelines, provide advice about infection prevention in addition to other topics, generate guidance for procedures (e.g., wound care); practice manuals; MeSH and Wikipedia. Content related to: theory underpinning aseptic technique; terminology used; how and when it should be undertaken; and equipment. The nature and amount of information varied widely. Most frequently stated information related to: environment or equipment (N = 13), followed by the absolute nature of asepsis and the importance of hand hygiene (N = 10); general personal protective equipment, the significance of pathogens, and no-touch techniques (N = 8); that it is risk-based (N = 7); the existence of key parts or sites, and that there are different types of aseptic technique (N = 6). The most comprehensive sources were a wound care organization in the USA, and a British internationally used textbook. Least information was provided in some general infection prevention guidelines. CONCLUSION: Progress with research and practice in relation to aseptic technique suffers through lack of common goals and understanding. This study is one step towards establishing what constitutes aseptic technique, how and when it should be conducted, and the equipment necessary. This is required to support practice, policy and education, and may improve sustainability of healthcare resources.

Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses.

BACKGROUND: Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs), but report challenges and unwarranted variations in practice. OBJECTIVE: To explore nurses' experiences, perceived gaps in information and support needed to conduct PRAs. METHODS: Qualitative interviews were undertaken with 20 nurses in the UK National Health Service between September 2021 and January 2022 employing approaches to sampling and data collection adopted in grounded theory. RESULTS: Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised, but that much could still be done to contain the risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported, and informants were unclear whether asepsis was needed to perform routine procedures (e.g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development, and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. CONCLUSION: There is a need for detailed guidelines to inform PRAs, better access to clinical updating, and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognized methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.

Delivery of antimicrobial stewardship competencies in UK pre-registration nurse education programmes: a national cross-sectional survey.

BACKGROUND: Registered nurses perform numerous functions critical to the success of antimicrobial stewardship, but only 63% of pre-registration nursing programmes include any teaching about stewardship. Updated nursing standards indicate that nurses require antimicrobial stewardship knowledge and skills. AIM: To explore the delivery of key antimicrobial stewardship competencies within updated pre-registration nursing programmes. METHODS: This study had a cross-sectional survey design. Data were collected between March and June 2021. FINDINGS: Lecturers from 35 UK universities responsible for teaching antimicrobial stewardship participated in this study. The provision of antimicrobial stewardship teaching and learning was inconsistent across programmes, with competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice taking precedent over competencies pertaining to the use, management and monitoring of antimicrobials. Online learning and teaching surrounding hand hygiene, personal protective equipment and immunization theory was reported to have increased during the pandemic. Only a small number of respondents reported that students shared taught learning with other healthcare professional groups. CONCLUSION: There is a need to ensure consistency in antimicrobial stewardship across programmes, and greater knowledge pertaining to the use, management and monitoring of antimicrobials should be included. Programmes need to adopt teaching strategies and methods that allow nurses to develop interprofessional skills in order to practice collaboratively.

Exploring the associations between gambling cravings, self-efficacy, and gambling episodes: An Ecological Momentary Assessment study.

AIMS: To explore reciprocal relationships between real-time gambling cravings and self-efficacy with gambling behaviour, and the moderating role of gambling, mental health, and addiction-related variables. DESIGN: Secondary analysis of a 4-week Ecological Momentary Assessment (EMA) study conducted in Tasmania, Australia. SETTING: Data were collected via telephone interviews (pre-EMA) and smartphones (EMA). PARTICIPANTS: Ninety-seven regular gamblers (mean age: 45.90 years, 57.73% male) reported 5,113 observations. MEASUREMENTS: EMA measures included gambling cravings (occurrence, frequency, intensity), self-efficacy (craving-related, gambling-related), and gambling behaviour (episodes, expenditure, duration). Pre-EMA measures included gambling (severity; harms; motives; high-risk situations), mental health (depressive symptoms; anxiety symptoms) and addiction-related (alcohol use; smoking; substance use) moderator variables. FINDINGS: Mixed-effects binary logistic regression analyses revealed that gambling cravings predicted gambling episodes (OR = 2.23, 95% CI:1.61, 3.08), gambling self-efficacy and gambling duration were reciprocally related (OR = 4.65, 95% CI:1.08, 20.04; OR = 0.21, 95% CI:0.05, 0.93), and craving self-efficacy predicted gambling expenditure (OR = 0.30, 95% CI:0.10, 0.86). Moderation analyses revealed that: (1) craving self-efficacy exacerbated craving frequency with gambling expenditure; (2) coping motives exacerbated gambling self-efficacy with gambling expenditure; (3) high-risk positive reinforcement situations exacerbated craving intensity and gambling self-efficacy with gambling episodes, and gambling episode with craving occurrence; and (4) substance use exacerbated gambling self-efficacy with duration, and buffered gambling expenditure with craving intensity. CONCLUSIONS: These findings have implications for the development of real-time gambling interventions that aim to reduce gambling cravings and increase self-efficacy, which could be targeted to vulnerable individuals, including people who frequently gambled for coping purposes or positive reinforcement, and people with comorbid substance use.

Tuning conformation and properties of peptidomimetic backbones through dual N/Cα-substitution.

We demonstrate that changing the backbone between peptides, peptoids and the underexplored dual N/Cα-substituted peptoids analogues allows for control over the preferred conformation of the intrinsically disordered biomimetic oligomers. The conformation tunability is directly probed using electron paramagnetic resonance (EPR), and is shown to manifest itself in differences in the nanoparticle-oligomer hybridization propensity.

Catechol-based layer-by-layer assembly of composite coatings: a versatile platform to hierarchical nano-materials.

Inspired by the marine mussel's ability to adhere to surfaces underwater, an aqueous catechol-based dip coating platform was developed. Using a catechol-functionalized polyacrylamide binder in combination with inorganic nanoparticles enables the facile fabrication of robust composite coatings via a layer-by-layer process. This modular assembly of well-defined building blocks provides a versatile alternative to electrostatic driven approaches with layer thickness and refractive indices being readily tunable. The platform nature of this approach enables the fabrication of hierarchically ordered nano-materials such as Bragg stacks.

Determination of the electron escape depth for NEXAFS spectroscopy.

A novel method was developed to determine carbon atom density as a function of depth by analyzing the postedge signal in near-edge X-ray absorption fine structure (NEXAFS) spectra. We show that the common assumption in the analysis of NEXAFS data from polymer films, namely, that the carbon atom density is constant as a function of depth, is not valid. This analysis method is then used to calculate the electron escape depth (EED) for NEXAFS in a model bilayer system that contains a perfluorinated polyether (PFPE) on top of a highly oriented pyrolitic graphite (HOPG) sample. Because the carbon atom densitites of both layers are known, in addition to the PFPE surface layer thickness, the EED is determined to be 1.95 nm. This EED is then used to measure the thickness of the perfluorinated surface layer of poly(4-(1H,1H,2H,2H-perfluorodecyl)oxymethylstyrene) (PFPS).

Influence of molecular architecture on the dewetting of thin polystyrene films.

The control of dewetting for thin polymer films is a technical challenge and of significant academic interest. We have used polystyrene nanoparticles to inhibit dewetting of high molecular weight, linear polystyrene, demonstrating that molecular architecture has a unique effect on surface properties. Neutron reflectivity measurements were used to demonstrate that the nanoparticles were uniformly distributed in the thin (ca. 40 nm) film prior to high temperature annealing, yet after annealing, they were found to separate to the solid substrate, a silanized silicon wafer. Dewetting was eliminated when the nanoparticles separated to form a monolayer or above while below this surface coverage the dewetting dynamics was severely retarded. Blending linear polystyrene of similar molecular weight to the polystyrene nanoparticle with the high molecular weight polystyrene did not eliminate dewetting.

Self-encapsulation of poly-2,7-fluorenes in a dendrimer matrix.

The synthesis and characterization of complex dendritic, rigid rod poly-2,7-fluorene homopolymers and copolymers via a macromonomer approach is reported. Several 2,7-dibromofluorene monomers containing benzyl ether dendrons (generations 1, 2, and 3) in the 9,9'-position of the fluorene ring were prepared and employed in condensation polymerizations to yield both homopolymers and copolymers with diethylhexylfluorene. Fluorescence measurements of the materials reveal extensive conjugation along the polymer backbone. The determination of the solid-state PL spectra and quantum efficiencies showed that there is an apparent optimum size of the dendritic side groups with the [G-2]-derivatives showing high reactivity with associated site isolation of the conjugated chain. AFM analysis and DSC results confirmed that the hybrid polymers and copolymers did not show any sign of a microphase-separated morphology. First EL-results demonstrated that the homopolymers have higher turn-on voltages then the corresponding copolymers.

Development of standards for laboratory automation.

In clinical laboratories, the installation of total laboratory automation systems and/or modular systems has grown dramatically in the 1990s, particularly in the US, Japan, and Europe. As the number of installations and level of interest grew, several individuals and corporations active in the automation field recognized that the development of prospective standards might enable customers of such systems or equipment to purchase analyzers, automation systems or devices, and software from different vendors and retain interconnectivity of such equipment. These individuals also believed that the total market for automation systems and equipment would be significantly greater with standards than without standards, especially if customers were not forced to purchase everything from one vendor, and that there might be competitive pricing and new technology fostered via the standards. This early interest in standards development led to the initiation of a program by NCCLS in 1996 to develop prospective standards for laboratory automation. Part of the NCCLS effort has involved interaction and cooperation with other standards organizations in the US and other countries. This report describes the current status of the development of prospective standards for laboratory automation by NCCLS and the relationship of those standards to those of other standards organizations.

Adaptation of bulk constitutive equations to insoluble monolayer collapse at the air-water interface.

A constitutive equation based on stress-strain models of bulk solids was adapted to relate the surface pressure, compression rate, and temperature of an insoluble monolayer of monodendrons during collapse at the air-water interface. A power law relation between compression rate and surface pressure and an Arrhenius temperature dependence of the steady-state creep rate were observed in data from compression rate and creep experiments in the collapse region. These relations were combined into a single constitutive equation to calculate the temperature dependence of the collapse pressure with a maximum error of 5 percent for temperatures ranging from 10 degrees to 25 degrees C.

Transition in quality: from quality assurance to strategic quality management.

The 1990s and beyond present formidable challenges to health-care providers, including clinical laboratories and pathology departments. However, numerous opportunities lie within these challenges. Discovering these opportunities and exploiting them will be critical success factors for future survival. Quality assurance, continuous quality improvement, and strategic and financial planning are all activities used to a varying extent by clinical laboratories. The cumulative potential benefits to an organization in which these activities are integrated can far exceed their sum as individual components. Coordinating these interdependent processes is the basis for managing strategically. The experience of one organization's efforts to plan and develop such a strategy is presented and discussed.

Valproic acid, unlike other anticonvulsants, has no effect on methadone metabolism: two cases.

Two patients who were concomitantly undergoing methadone maintenance treatment and receiving phenytoin suffered continuing opioid withdrawal symptoms as a results of phenytoin's acceleration of methadone metabolism. When anticonvulsant therapy was discontinued, these patients had seizures. One patient was switched to carbamazepine as an alternative anticonvulsant, but this treatment resulted in a similar clinical problem. When both patients received valproic acid instead, the withdrawal symptoms disappeared and their conditions stabilized.

Alterations in calcium, phosphorus and C-terminal parathyroid hormone levels in equine acute renal disease.

The changes in serum and urinary levels of calcium and phosphorus and serum parathyroid hormone (PTH) were studied during controlled, chemically induced, acute renal disease in 4 ponies. There was an initial rise in daily urinary calcium and hydroxyproline excretion in 2 ponies which may have indicated increased bone resorption. Mild hypercalcemia, hypophosphatemia and elevated C-terminal PTH levels were associated with oliguria. Total daily urinary excretion of calcium and phosphorus decreased as oliguria developed. The levels of C-terminal PTH were increased in all four animals. This appears to have been related to their diminished renal function in that C-terminal fragments of intact PTH (which require functioning kidneys in order to be cleared) were probably being accumulated. Although there was no evidence with regard to an actual increase in PTH secretion, prolongation of intact PTH half-life due to renal tubular damage may have contributed to the development of hypercalcemia.