Can educational speech intervention improve visitors' hand hygiene compliance?

BACKGROUND: Hand hygiene, a simple and low-cost measure, remains the leading intervention for reducing the burden related to healthcare-associated infections (HAIs). While many interventions have been tested to improve staff hand hygiene compliance, hospital visitors continue to have low compliance rates, which increases the risk of HAIs and resistant organisms' transmission into hospitals and out to the community. AIM: To assess the effectiveness of educational speech intervention (ESI) for increasing hand hygiene compliance rate among hospital visitors. METHODS: This interventional study was conducted from March to June 2019 in an inpatient unit of a large academic hospital. Visitor hand hygiene compliance was observed before and after implementation of ESI. The purpose of providing ESI to the visitors in the intervention phase was to remind them about the importance of hand hygiene and the proper method for cleaning hands. Post-intervention data were collected using the survey questionnaires. Unpaired t-test compared the hand hygiene compliance rate before and after the intervention. FINDINGS: Baseline hand hygiene compliance rate was 9.73% while hand hygiene compliance rate post-intervention increased to 87.06% (P<0.001). Barriers to hand hygiene compliance included occupied hands, improper location of hand hygiene supplies, and past habit of not practising hand hygiene. Visitors preferred to be reminded about hand hygiene by verbal reminder (57%), followed by signage (38%), and wristband notices (5%). CONCLUSION: The ESI substantially increased visitors' hand hygiene compliance rate. Further studies are warranted to assess the sustainability of ESI and address other barriers to visitors' hand hygiene compliance.

The TNF-family cytokine TL1A drives IL-13-dependent small intestinal inflammation.

The tumor necrosis factor (TNF)-family cytokine TL1A (TNFSF15) costimulates T cells through its receptor DR3 (TNFRSF25) and is required for autoimmune pathology driven by diverse T-cell subsets. TL1A has been linked to human inflammatory bowel disease (IBD), but its pathogenic role is not known. We generated transgenic mice that constitutively express TL1A in T cells or dendritic cells. These mice spontaneously develop IL-13-dependent inflammatory small bowel pathology that strikingly resembles the intestinal response to nematode infections. These changes were dependent on the presence of a polyclonal T-cell receptor (TCR) repertoire, suggesting that they are driven by components in the intestinal flora. Forkhead box P3 (FoxP3)-positive regulatory T cells (Tregs) were present in increased numbers despite the fact that TL1A suppresses the generation of inducible Tregs. Finally, blocking TL1A-DR3 interactions abrogates 2,4,6 trinitrobenzenesulfonic acid (TNBS) colitis, indicating that these interactions influence other causes of intestinal inflammation as well. These results establish a novel link between TL1A and interleukin 13 (IL-13) responses that results in small intestinal inflammation, and also establish that TL1A-DR3 interactions are necessary and sufficient for T cell-dependent IBD.

Anti-ADDL antibodies differentially block oligomer binding to hippocampal neurons.

Abeta-derived diffusible ligands (ADDLs) are abundant in AD brain, bind to hippocampal neurons and induce deficits in rodent cognition. To further investigate ADDL binding to neurons and identify antibodies that block this association, a panel of anti-Abeta and anti-ADDL antibodies was characterized for their ability to immuno-detect neuronally bound ADDLs and attenuate the binding of ADDLs to neurons. The results showed that anti-Abeta and anti-ADDL antibodies were able to abate ADDLs binding to hippocampal neurons, but to different degrees. Quantitative assessment of binding showed that one antibody, ACU-954 was markedly more effective at blocking ADDL binding than other antibodies assessed. ACU-954 was also found to block ADDL binding to hippocampal slice cultures, attenuate the ADDL-induced loss of dendritic spines and detect "natural ADDLs" in human AD tissue. These results demonstrated that antibodies that bind to and block ADDL binding to neurons can be identified, although their efficacy is conformationally specific since it is not readily apparent or predictable based on the core linear epitope or affinity for monomeric Abeta.

Enhancement of recombinant hemoglobin production in Escherichia coli BL21(DE3) containing the Plesiomonas shigelloides heme transport system.

To produce recombinant hemoglobin in Escherichia coli, sufficient intracellular heme must be present, or the protein folds improperly and is degraded. In this study, coexpression of human hemoglobin genes and Plesiomonas shigelloides heme transport genes enhanced recombinant hemoglobin production in E. coli BL21(DE3) grown in medium containing heme.

'Side locked' migraine and trigeminal autonomic cephalgias: evidence for clinical overlap.

This paper will discuss evidence which supports a link between 'side locked' migraine (SLM) and the trigeminal autonomic cephalgias (TACs). Recent papers brought strictly unilateral primary headaches into focus, proposing new classification and discussing pathophysiological mechanisms. We reviewed those proposals and present evidence that SLM falls in between the well-defined TACs and side shifting migraine (SSM). It is difficult to differentiate SLM from the recently proposed headache subtype called hemicrania generis incerti (i.e. hemicrania continua unresponsive to indomethacin). We also present cases that may exemplify the considerations made in the paper.

Interventions among adolescents who were violently injured and those who attempted suicide.

To examine responses to the psychological needs of adolescent injury victims, the records of all adolescents hospitalized at an urban trauma center during a one-year period for injury by gunshots, stabbings, and physical assaults (N = 59) were compared with the records of adolescents admitted that year for attempting suicide (N = 28). Victims of intentional injuries received significantly lower levels of psychosocial interventions than suicide attempters, and access to such interventions appeared to be influenced by gender and race. Intentionally injured adolescents may not receive available interventions for the psychosocial consequences of their injuries.

Neurologic and ophthalmologic findings in children exposed to cocaine in utero.

We studied a cohort of 73 children exposed to cocaine in utero to characterize the spectrum of neurologic and ophthalmologic abnormalities; 36 children with no documented in utero drug exposure were selected as a control group. Most referrals of cocaine-exposed children to the child neurologist were made in the 1st year of life (81%). Reasons for referral were hypertonia (29%), seizures (22%), developmental delay (11%), tremulousness (11%), and hypotonia (4%). The most common abnormal finding in the cocaine-exposed children was hypertonia/hyperreflexia (63%), which was rarely seen in the control group. In addition, hypertonia/hyperreflexia was underdiagnosed by referring physicians. Similarly, hypotonia was seen on neurologic examination of cocaine-exposed children more frequently than documented by referral (16% versus 4%). Hypotonia was rarely seen in the control group. Twelve (43%) of 28 cocaine-exposed children seen by a pediatric ophthalmologist had structural ophthalmologic abnormalities. Neurologic and ophthalmologic findings suggesting structural lesions of the nervous system must be considered in cocaine-exposed children.

Posttraumatic chylous ascites in a child: recognition and management of an unusual condition.

Chylous ascites is an extremely rare and often unrecognized complication of abdominal trauma in children. The management of this condition has traditionally been nonsurgical, but the success rate with nonoperative treatment is not always satisfactory. A case of posttraumatic chylous ascites in an abused toddler is presented, with emphasis on the diagnosis and treatment of this rare disorder.

A comparative study of selected patient variables as risk factors in hospitalization for chronic headache.

Patients seeking relief for chronic headache at specialized headache treatment centers are offered a multidisciplinary approach to treating their disorder. Neurologists, who specialize in headache, offer both inhospital and outpatient treatment programs. Clinicians and researchers experienced in headache disorders have advocated inpatient treatment for certain patients. Hospital programs address such issues as elevated anxiety and depression levels, overuse of analgesics, and related factors. This study was undertaken to investigate those differences, long observed by clinicians, between patients assigned to inpatient or outpatient care or to both. In view of the ever-tightening purse strings of third-party payers, the results may aid in delineating some of the forthcoming practice guidelines for dealing with headache sufferers. This study suggests: (a) significant differences do exist between the groups, (b) hospitalized patients may indeed require more complex interventions than those managed with outpatient care, and (c) documenting some of the etiologic factors that predict hospitalization may help alert providers at the front end and preclude some of the current need for hospital care.

Telephone encounters in a university pediatric group practice. A 2-year analysis of after-hour calls.

The records of off-hours calls received by the University of Colorado Pediatric Group Practice from 4:30 p.m. throughout 8:00 a.m. weekdays and all day Saturday, Sunday, and holidays were audited. An answering service and pageboy system ensured 24-hour, 7-day-a-week accessibility through a single telephone number. The four practices received 2386 after-hours calls from November 1978 to October 1980. An average of 104 calls per month were received with approximately four calls per day on weekday evenings and six calls per day on Saturday, Sunday, and holidays. Five concerns accounted for 49 percent of all after hours calls: fever, vomiting and/or diarrhea, upper respiratory infection (URI), earache, and rash. While 75 percent of families made fewer than four calls per year, 4 percent made at least 12 calls per year, accounting for 18 percent of all calls. Families calling three or more times a month were defined as "frequent users" and accounted for 22 percent of a given month's calls. Most calls from the same families (55%) occurred within a 24-hour period and dealt chiefly with parental concerns about fever, vomiting and diarrhea, URIs, ear infection, accident, and rashes. The additional responsibility that residents assume in taking calls for the Pediatric Group Practice while on other off-hour assignments was not excessively demanding, and cost of the answering service was easily absorbed by group practice revenues.

Use of a seminar as an aid in helping interns care for dying children and their families.

An annual seminar held by the University of Colorado, Department of Pediatrics, is designed to assist interns to cope more effectively with the emotional strains of caring for dying patients and their families. In the seminar, interns are randomly divided into four small groups consisting of six interns, a chief resident, two pediatric faculty members, and a nurse or social worker from an intensive care unit. This paper reviews the resident evaluations of the seminar, as well as the results of a questionnaire which explored attitude formation toward death. Interns felt that the opportunity to discuss death and dying early in their training program helped them gain an understanding of their own feelings about death, which enabled them to cope better with the stress involved in caring for dying children. Additional benefits from the seminar included more effective interpersonal communication, the establishment of deeper and more meaningful friendships, and a stronger esprit de corps.

Gross hematuria associated with sickle cell trait and von Willebrand's disease.

A case of recurrent gross hematuria, sickle cell trait and von Willebrand's disease is reported. The gross hematuria abated promptly after the institution of cryoprecipitate therapy. The importance of considering von Willebrand's disease in the differential diagnosis in patients with sickle cell trait and hematuria is discussed.