Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design.

Background: Meaningful research creates evidence for Infection Prevention and Control (IPC) practice. Aim: To establish Infection Prevention Society (IPS) members' research priorities to support future research projects. Methods: A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022-2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach. Findings/Results: 132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety (n = 84, 16.1%); IPC Training and Education (n = 77, 14.8%); and IPC Evidence-based Guidelines (n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes 'Patient Centred Care', 'Training and Education', 'IPC Role and Identity', 'IPC Leadership', 'IPC is Everyone's Responsibility', and 'Research Activity'. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas. Discussion: This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.

Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis.

BACKGROUND: Direct observation of hand hygiene compliance is the gold standard despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance among physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM: To explore differences in compliance between physicians and nurses further, and to determine whether compliance estimates differed when observations were covert rather than overt. METHODS: A systematic search of databases PubMed, Embase, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS: The weighted pooled compliance rate for nurses was 52% (95% CI: 47-57) and for doctors was 45% (95% CI: 40-49%). Heterogeneity was considerable (I2 = 99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%; 95% CI for the difference: 0.8-13.5; P = 0.027) and covert (difference of 7%; 95% CI: 3-11; P = 0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION: Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.

Attitudes and practices of Irish hospital-based physicians towards hand hygiene and hand rubbing using alcohol-based hand rub: a comparison between 2007 and 2015.

BACKGROUND: Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance. AIM: To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. METHODS: In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey. FINDINGS: Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they 'almost always' used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products. CONCLUSION: Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009.

Hand hygiene-related clinical trials reported since 2010: a systematic review.

Considerable emphasis is currently placed on reducing healthcare-associated infection through improving hand hygiene compliance among healthcare professionals. There is also increasing discussion in the lay media of perceived poor hand hygiene compliance among healthcare staff. Our aim was to report the outcomes of a systematic search for peer-reviewed, published studies - especially clinical trials - that focused on hand hygiene compliance among healthcare professionals. Literature published between December 2009, after publication of the World Health Organization (WHO) hand hygiene guidelines, and February 2014, which was indexed in PubMed and CINAHL on the topic of hand hygiene compliance, was searched. Following examination of relevance and methodology of the 57 publications initially retrieved, 16 clinical trials were finally included in the review. The majority of studies were conducted in the USA and Europe. The intensive care unit emerged as the predominant focus of studies followed by facilities for care of the elderly. The category of healthcare worker most often the focus of the research was the nurse, followed by the healthcare assistant and the doctor. The unit of analysis reported for hand hygiene compliance was 'hand hygiene opportunity'; four studies adopted the 'my five moments for hand hygiene' framework, as set out in the WHO guidelines, whereas other papers focused on unique multimodal strategies of varying design. We concluded that adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or by another tested multimodal framework, results in moderate improvements in hand hygiene compliance.

Potent blockers of the monocarboxylate transporter MCT1: novel immunomodulatory compounds.

A novel series of potent blockers of the monocarboxylate transporter, MCT1, is disclosed. From very potent but lipophilic lead compounds, systematic changes to all parts of the molecule, targeting reduction in log D, afforded compounds with significantly improved overall properties. These compounds show potent immunomodulatory activity.

Complications in pediatric tracheostomies.

OBJECTIVE: To examine complications of pediatric tracheostomy. STUDY DESIGN: Retrospective. METHODS: Chart review of children undergoing tracheotomy or laryngeal diversion between 1990 and 1999. RESULTS: Charts of 142 children were examined. Average age was 2.64 years (standard deviation [SD], 4.73 y) at surgery. Duration of tracheostomy was 2.08 years (SD, 1.72 y) for those decannulated, 3.12 years (SD, 2.5 y) for those still with a stoma, and length of follow-up for the whole group was 4.14 years (SD, 8.69 y). At last follow-up, 56% had a tracheostomy, 29% had none, and 15% had died; one death was tracheostomy-related. Three percent had intraoperative complications, 11% had complications before the first tracheostomy tube change, and 63% had complications after the first tube change. Thirty-four percent had a trial of decannulation; 85% of these were successful. Fifty-four percent of those decannulated had complications. Number of complications was not related to duration of follow-up. In-hospital mortality was congruent to mortality predicted by PRISM (Pediatric Rate of Mortality) scores. CONCLUSIONS: Forty-three percent had serious complications involving loss of the tracheostomy airway (tube occlusion or accidental decannulation) or requiring a separate surgical procedure. Deaths directly attributable to tracheostomy complications occurred in 0.7%.

Common topics in pediatric otolaryngology.

This article outlines the perioperative and long-term management of children undergoing tonsillectomy, adenoidectomy, tympanostomy with tube insertion, and sinus surgery. Indications for complications of each of the procedures is reviewed in this article. The authors also cover the management of children with tracheostomies. Several questions frequently asked by parents of children with a tracheostomy are addressed.

Development and assessment of a home care tracheotomy manual.

As home care tracheotomy has become a viable option for children with long-term canulation, medical personnel are challenged to provide as safe an environment as possible out of the hospital for these children. The tools used in the training of the families and other caregivers have received little attention in the literature. This study describes the development of a home-care tracheotomy manual for parents. The use of appropriate content presented in an organized, informative and pleasing fashion at the appropriate reading level is stressed. The evaluation of the manual by parents with children who have a child with a tracheotomy is also described.

Primary care for women. Comprehensive assessment of the head and neck.

This article reviews the pertinent anatomy of each body system involved in the assessment of the head and neck (including the eyes, ears, nose, and throat) and describes the basic elements of the comprehensive health assessment. Frequently encountered chief complaints are discussed. Aspects of the health assessment that will assist the primary care provider in making a differential diagnosis and determining the need for referral are presented. This article is the first of two articles on this topic; the subsequent article will address primary care management of common conditions of the head and neck.

The development of patterns of stable, transient, and school-age onset aggressive behavior in young children.

OBJECTIVE: To examine the development of patterns of aggressive behavior in children from the age of 2 to 8 years. METHOD: Children with early histories of aggressive behavior were selected from a community sample of 2,400 infants participating in a longitudinal study. The sample was divided into four groups: children with stable aggressive behavior, those with transient aggression, those with aggression only after age 5 years (late onset), and a comparison group of nonaggressive children. RESULTS: Children with stable aggressive behavior were characterized by a difficult temperament, hostile sibling interactions, maternal perception of the child as difficult, and harsher child-rearing practices. Children whose early aggression decreased over time and those who became aggressive only after entering school could not be reliably classified with the selected family variables. Teacher ratings of temperament factors of task orientation and reactivity and ability ratings correctly classified 74% of children whose aggression began at school-age. CONCLUSIONS: Children with persistent aggressive behavior differed from those who improved, predominantly in terms of symptom severity. Problems with aggression can be identified early in development, and a significant proportion of aggressive children are at risk for continuing social and scholastic difficulties. Knowledge of associated factors may play an important role in prevention.

[Malaria infection during childbirth and in newborns in Bécédi (Ivory Coast)]. / Infection palustre a l'accouchement et issue de la grossesse a Bécédi (Côte-d'Ivoire).

Authors studied the parasitological and serological status of 108 new-born children from 102 deliveries during the 2nd term of 1987 at the Bécédi Maternity Hospital in Ivory Coast. The parasitism frequency of different studied bloods (mother, cord, delivery) is varying from 8 to 14%, antibodies have been found in 81 to 83% cases. The parity has an effect on the placental lesions frequency but not on the parasitism frequency. Children born with a pathogenic placenta have a lower birth weight. The retrospective study of 11,070 deliveries from last years shows that birth weight are lower while the two first pregnancies.

The pattern of metal deposition to a woodland ecosystem as revealed by bryophyte analysis.

The concentrations and enrichment factor data for 7 metals has been investigated in samples of Hypnum cupressiforme obtained from various parts of a woodland located to the south east of London and immediately adjacent to the M 25 motorway. Despite the rural location of the woodland, metal level and enrichment factor data suggest a moderate degree of contamination. Application of analysis of variance to the data indicates individual metal levels at woodland edges are significantly different from adjacent internal sites, suggesting enhanced deposition at these edges. The fact that this significance pattern is not repeated at all edges indicates a directional influence on levels. Correlation coefficient data indicates metal/metal associations and allows some speculation about the major pathways by which metals are atmospherically transported to and deposited in the woodland.